Injury Incidence in Youth, High School, and NCAA Men's Lacrosse.

BACKGROUND: We compared injury incidence and mechanisms among youth, high school (HS), and National Collegiate Athletic Association (NCAA) boys' and men's lacrosse athletes for the 2014-2015 to 2016-2017 lacrosse seasons. METHODS: Multiple injury surveillance systems were used to capture 21 youth boys', 22 HS boys', and 20 NCAA men's lacrosse team-seasons of data during the 2014-2015 to 2016-2017 seasons. Athletic trainers reported game and practice injuries and athlete exposures (AEs). Injuries included those occurring during a game and/or practice and requiring evaluation from an athletic trainer and/or physician. Injury counts, rates per 1000 AEs, and injury rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated. RESULTS: The injury rate in youth was higher than those reported in HS (10.3 vs 5.3 per 1000 AEs; IRR = 2.0; 95% CI: 1.6-2.4) and the NCAA (10.3 vs 4.7 per 1000 AEs; IRR = 2.2; 95% CI: 1.9-2.5). When considering time loss injuries only (restricted participation of ≥24 hours), the injury rate in youth was lower than those reported in HS (2.0 vs 2.9 per 1000 AEs; IRR = 0.7; 95% CI: 0.5-0.95) and the NCAA (2.0 vs 3.3 per 1000 AEs; IRR = 0.6; 95% CI: 0.4-0.8). The concussion rate in youth was higher than those in HS (0.7 vs 0.3 per 1000 AEs; IRR = 2.4, 95% CI: 1.1-5.2) and the NCAA (0.7 vs 0.3 per 1000 AEs; IRR = 2.1, 95% CI: 1.2-3.7). Injuries at the youth, HS, and NCAA levels were most commonly associated with stick contact, inflammatory conditions (including bursitis, tendonitis, and other unspecified inflammation), and noncontact mechanisms, respectively. CONCLUSIONS: Although the time loss injury rate was lowest in youth boys' lacrosse, the concussion rate was the highest. Injury prevention approaches should be specific to the mechanisms associated with each level of play (eg, equipment skill development in youth).

Epidemiology of Youth Boys' and Girls' Lacrosse Injuries in the 2015 to 2016 Seasons.

PURPOSE: Examinations of injury among younger populations of lacrosse players that are beginning their development is limited. This study describes the epidemiology of youth boys' and girls' lacrosse injuries during the 2015 to 2016 seasons. METHODS: Surveillance data originated from a convenience sample of 10 leagues in five states with 1090 boy lacrosse players and 408 girl lacrosse players from the U9-U15 divisions. Athletic trainers reported injury and exposure data at games and practices. Time loss (TL) injuries were defined as resulting in ≥24 h of participation restriction time. Injury counts and rates per 1000 athlete games/practices were calculated. Injury rate ratios (IRR) with 95% confidence intervals (CI) compared rates by sex and age division. RESULTS: Overall, 241 and 59 injuries were reported in boys' and girls' youth lacrosse, respectively, of which 17.0% and 18.6% were TL. Compared with girls, boys had a higher overall injury rate (12.7 vs 8.7/1000 athlete games/practices; IRR, 1.5; 95% CI, 1.1-1.9). U13/U15 boys had a higher TL injury rate than U9/U11 boys (2.6 vs 1.0/1000 athlete game/practices; IRR, 2.6; 95% CI, 1.1-6.1). Most injuries were diagnosed as contusions (boys, 53.7%; girls, 47.2%) and resulted from stick contact (boys, 34.1%; girls, 30.6%) and ball contact (boys, 17.1%; girls, 25.0%). Among girls, ball contact contributed to 75.0% (n = 9) of all head/face injuries. Among the 14 concussions reported in boys, player contact was the most common injury mechanism (50.0%, n = 7), followed by stick contact (35.7%, n = 5). CONCLUSIONS: Boys' lacrosse has a higher injury incidence than girls' lacrosse, reflecting the contact nature of the boys' game. The high incidence of stick- and ball-related injuries suggests the need for youth-specific rules to better protect youth players.

Injury Rates in Age-Only Versus Age-and-Weight Playing Standard Conditions in American Youth Football.

BACKGROUND: American youth football leagues are typically structured using either age-only (AO) or age-and-weight (AW) playing standard conditions. These playing standard conditions group players by age in the former condition and by a combination of age and weight in the latter condition. However, no study has systematically compared injury risk between these 2 playing standards. PURPOSE: To compare injury rates between youth tackle football players in the AO and AW playing standard conditions. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Athletic trainers evaluated and recorded injuries at each practice and game during the 2012 and 2013 football seasons. Players (age, 5-14 years) were drawn from 13 recreational leagues across 6 states. The sample included 4092 athlete-seasons (AW, 2065; AO, 2027) from 210 teams (AW, 106; O, 104). Injury rate ratios (RRs) with 95% CIs were used to compare the playing standard conditions. Multivariate Poisson regression was used to estimate RRs adjusted for residual effects of age and clustering by team and league. There were 4 endpoints of interest: (1) any injury, (2) non-time loss (NTL) injuries only, (3) time loss (TL) injuries only, and (4) concussions only. RESULTS: Over 2 seasons, the cohort accumulated 1475 injuries and 142,536 athlete-exposures (AEs). The most common injuries were contusions (34.4%), ligament sprains (16.3%), concussions (9.6%), and muscle strains (7.8%). The overall injury rate for both playing standard conditions combined was 10.3 per 1000 AEs (95% CI, 9.8-10.9). The TL injury, NTL injury, and concussion rates in both playing standard conditions combined were 3.1, 7.2, and 1.0 per 1000 AEs, respectively. In multivariate Poisson regression models controlling for age, team, and league, no differences were found between playing standard conditions in the overall injury rate (RRoverall, 1.1; 95% CI, 0.4-2.6). Rates for the other 3 endpoints were also similar (RRNTL, 1.1 [95% CI, 0.4-3.0]; RRTL, 0.9 [95% CI, 0.4-1.9]; RRconcussion, 0.6 [95% CI, 0.3-1.4]). CONCLUSION: For the injury endpoints examined in this study, the injury rates were similar in the AO and AW playing standards. Future research should examine other policies, rules, and behavioral factors that may affect injury risk within youth football.

Comprehensive Coach Education and Practice Contact Restriction Guidelines Result in Lower Injury Rates in Youth American Football.

BACKGROUND: Research evaluating the effect of comprehensive coach education and practice contact restriction in youth football injury rates is sparse. In 2012, USA Football released their Heads Up Football coaching education program (HUF), and Pop Warner Football (PW) instituted guidelines to restrict contact during practice. PURPOSE: To compare injury rates among youth football players aged 5 to 15 years by whether their leagues implemented HUF and/or were PW-affiliated. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Athletic trainers (ATs) evaluated and tracked injuries at each practice and game during the 2014 youth football season. Players were drawn from 10 leagues across 4 states. The non-Heads Up Football (NHUF) group consisted of 704 players (none of whom were PW-affiliated) from 29 teams within 4 leagues. The HUF+PW group consisted of 741 players from 27 teams within 2 leagues. The HUF-only group consisted of 663 players from 44 teams within 4 leagues. Injury rates and injury rate ratios (IRRs) were reported with 95% CIs. RESULTS: A total of 370 injuries were reported during 71,262 athlete-exposures (AEs) (rate, 5.19/1000 AEs). Compared with the NHUF group (7.32/1000 AEs), the practice injury rates were lower for the HUF+PW group (0.97/1000 AEs; IRR, 0.13; 95% CI, 0.08-0.21) and the HUF-only group (2.73/1000 AEs; IRR, 0.37; 95% CI, 0.26-0.53). Compared with the NHUF group (13.42/1000 AEs), the game injury rate was lower for the HUF+PW group (3.42/1000 AEs; IRR, 0.25; 95% CI, 0.15-0.44) but not for the HUF-only group (13.76/1000 AEs; IRR, 1.02; 95% CI, 0.73-1.43). Also, the HUF+PW game injury rate was lower than that of HUF-only (IRR, 0.20; 95% CI, 0.12-0.36). Higher injury rates were typically found in those aged 11 to 15 years compared with those aged 5 to 10 years. However, stronger effects related to HUF implementation and PW affiliation were seen among 11- to 15-year-olds. When restricted to concussions only, the sole difference was found between the practice concussion rates among 11- to 15-year-olds in the HUF+PW (0.14/1000 AEs) and NHUF groups (0.79/1000 AEs) (IRR, 0.18; 95% CI, 0.04-0.85). CONCLUSION: These findings support comprehensive coach education and practice contact restrictions as effective methods of injury mitigation. Future research should continue evaluating similar programming within other levels of competition and sports.