Running head: CONCUSSIONS IN THE SPORT OF LACROSSE NEEDS

ASSESSMENT Gravel 1

Concussions in the Sport of Lacrosse Needs Assessment

AJ Gravel
University of Idaho

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Step 1-Big Picture-Purpose and Scope

Concussions in the sport of lacrosse are a mounting issue. It is often an overlooked consequence,
or is simply accepted as part of the game. The Center for Disease Control (CDC) terms this issue
as a traumatic brain injury. A concussion is a type of traumatic brain injury and occurs after a
bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of
the brain (CDC). They differ in severity and people can experience different symptoms, which
make detecting them difficult because they can be a subjective experience. Concussions have
recently been researched to quite the extent and have been uncovered as a threat to current and
future cognitive function and deterioration. This research however has mainly pertained to
football. A concern in the lacrosse community is that concussions may not be viewed in such a
negative light as they are if sustained through football. A Healthy People 2020 objective is to
lower the number of deaths caused by traumatic brain injuries to 15.7 annually. The Healthy
People 2020 target for mental health and mental disorders states to improve mental health
through prevention and by ensuring access to appropriate, quality mental health services. This
pertains to the proper recognition, diagnosis, and treatment of concussions sustained through
playing lacrosse.
Step 2- Quality of Life and Social Assessments
Demographic Data
Median Age
Language other than English spoken at
home
High school graduation
Bachelors degree
Median household income
Persons below poverty
Middle/Jr. High school enrollment
High school enrollment
Healthcare and Social Assistance

Ada
County
35.5
23,878

Idaho

28.6%
24.4%
$55,805
12.8%
24,670
22,368
1,387

33.6%
6.5%
$47,334
15.6%
95,403
92,891
4,865

35.2
95,635

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Professional, Scientific, and Technical
Services
All information retrieved from American Fact Finder.

3
1,634

4,198

The quality of life in Ada County according to American Fact Finder, in comparison to the whole
state of Idaho is good. The median household income is greater than the state average, persons in
poverty is lower, and the amount of people with a bachelors degree level of education is much
greater compared to the rest of the state (American Fact Finder). Residents of Ada County also
have access to healthcare and social assistance as well as to professional, scientific, and technical
services. This means that they have a quality level of access to these facilities that can help to
diagnose, treat, and study concussions.
Step 3- Epidemiological Assessment
According to the Idaho Vital Statistics set forth by the Department of Health and Welfare, the
number of deaths in Idaho in 2013 was 12,426 and was 2,543,579 in the United States. The ageadjusted rate for deaths in Idaho related to Alzheimers, which has been linked to concussions,
was 21.0 per an adjusted rate of 100,000 populations (Idaho vital stats). Also according to the
vital statistics report of Idaho, the risks for dying of Alzheimers at a national level are higher, at
an age-adjusted rate of 23.8. Furthermore, Healthy People 2020 has identified that17.4 deaths per
100,000 age adjusted to population, were caused by traumatic brain injuries in the year 2007.

From 2008 to 2010 an extensive study was carried out and the results of the study were
published in an article titled, Epidemiology of Concussions Among United States High School
Athletes in 20 Sports. In the sport of lacrosse, concussions were found to occur nine times more
often during competition than in practice and that they were due to player-to-player contact by

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body checking 76.1% of the time (Marar, Mcllvain, Fields, & Comstock, 2012). The other
incidences can be accounted to player-equipment contact, ground, or ball contact.

Some disparities certainly exist, especially when it comes to education, access, and diagnostic
care. It may be difficult to relate health disparities in lacrosse due to ethnicity or socioeconomic
status, but certainly, they do exist at an institutional level. Lacrosse is widely not sanctioned
across Idaho, meaning, the teams dont receive direct funding from their schools. This also
means that their access to having an athletic trainer on site during practice and games may be
difficult. Trainers can be vital in helping to diagnose a concussion, carrying our baseline tests,
and helping on the road to recovery. The responsibility of self-diagnosis and recognizing when to
sit out is often left to the players. This plays along with the disparity in education. If no trainer is
present, the responsibility is on the coaches and players, sometimes with very little experience in
recognizing the signs and symptoms. Poverty is also a disparity. Teams or schools may not have
funding to educate the coaches, players, and parents or may not have access to trainers or
baseline test equipment.
Step 4- Health Behavior Data
As stated above, concussions were found to occur nine times more often during competition than
in practice and that they were due to player-to-player contact by body checking 76.1% of the
time (Marar, Mcllvain. Et. al. 2012) This indicates that most concussions occur during game time
and when going up against an opponent. It is common to be aggressive and to be more inclined
to lay a big hit on someone if they are not a teammate. During a game, players are encouraged to
slide early and hard, meaning that the defensive player should use their body to move towards an
attacking offensive player in order to limit their ability to score or pass the ball, and to be

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relentless when going for a groundballs (balls that are not in either teams possession, not
controlled within a players stick, and are loose on the field of play). Lacrosse contact is also
initiated with the players sticks during slap checks, poke checks, takeaway checks (all defensive
maneuvers aimed at gaining possession of the ball) and follow through on a shot, or accidentally.
Slashing (hitting a part of the body rather than the stick) is not allowed but does occur and
sometimes the stick gets deflected into a players head during a ground ball scrum or when an
offensive player is dodging against a defensive player. Offensive players need to dodge to free
their hands up in order to pass the ball or to shoot to score. For shorter individuals, they often
find that when they lean into an opponent during a dodge, they get hit a little higher. The
defending players hands and stick, rather than meeting at a players waist or chest, meet the
shorter players shoulders and get deflected into their heads. Getting knocked down and hitting
the ground can also illicit a hard hit to the head or whiplash.
It is a very fast paced game with a lot of up and down the field action. Practice time is not
excluded from having its fair share of contact. There are numerous drills and exercises to work
on that do not include contact, but a majority of them include it to some extent. I have found that
when a player, or athlete, is injured, the last thing that they want to do is admit to that injury and
risk not playing. If they do sit out, sometimes the other players can be judgmental as to why, and
with no training staff present often, a lot of responsibility for recognizing when it is appropriate
to sit out or modify an exercise is left to the player or coaches word. As lacrosse players, it is
expected of us to play through some amount of pain and discomfort. This lifestyle aspect of the
game could be contributing to the sustainment of concussions. The main behavioral functions of
change are expectations and expectancies as well as self-control.

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Step 5- Environmental Data

The environment and culture needs to see a shift in change in order to better address this issue.
Already we are seeing this happen with US Lacrosse, the governing body of lacrosse, partner
with the CDC and the Heads Up program (US Lacrosse). The Heads Up program is a good
educational resource for coaches, players, and parents. Game day environment is high tempo,
high energy, and is coupled with big hits and adrenaline. It is a fun and exciting environment, but
player safety should not be jeopardized. Regardless of rules or helmet safety codes, concussions
will happen; its just a matter of limiting them and recognizing them in order to decrease the long

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term physical, emotional, cognitive, memory, and sensational impairment (CDC). Even though
we are beginning to see this cultural shift in the education of players, coaches and parents, one
study found that even when aware of the dangers of continuing to play with a concussion,
players thought it was okay to play through the injury and agreed that they would play through it
to win a game (National Research Council). The culture of the game has negatively affected the
players judgment to self-report the signs or symptoms of a concussion and adherence or
negligence of the return to play guidelines (National Research Council).
Step 6- Identifying Program Purpose
An adolescents brain undergoes dynamic changes throughout development and into the mid
twenties, constantly refining and reshaping information and creating new synapses and
neurological responses to stimuli (National Research Council). The changing adolescents brain
has been found to react differently to a concussion that to a mature brain and to affect the
integrity of the white and grey matter, which are core components to the central nervous system,
thus disrupting cognitive function and communication systems (National Research Council).
Adolescents have also been found to be predisposed to head trauma because of their
underdeveloped muscle structure around the head, neck, and shoulders, a malleable cranium,
developing brain, and it is also speculated that the brain undergoes gains in weight and mass
during growth that may be disproportional to the rest of the body and therefore have greater
foreword velocity and momentum during collisions (National Research Council).
Another predisposition factor is related to the position of play. In lacrosse there are defenders,
midfielders, attackmen, and a goalie on the field. Midfielders can have offensive and defensive
responsibilities, as well as be involved with the faceoff to start the game, and that follows every
goal. These positions incur large amounts of contact. Midfielders were found to experience

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concussive like symptoms and be diagnosed with one nearly half of the time, with a rate of
47.6% (Marar, Mcllvain. Et. al. 2012).
Enabling factors
The level of education, availability of trained individuals, contact rules, referee conduct, and the
culture of the game are some enabling factors. Game time has been shown to have a higher
occurrence rate of concussions than during practice and this could be due in part to the referees.
They in part hold the players accountable for following and adhering to the rules and values of
the game. Lacrosse, being a fast paced game, is exactly that, fast paced. A lot of the time refs will
let the game and situations play themselves out rather than throwing a flag and stopping the pace
of play.
Teammates and coaches are also an enabling factor. As an athlete it is very hard to bring yourself
to sit out, even with the recommendation from an athletic trainer or doctor, but players and
coaches may not be fully aware of the degenerative and long lasting effects of a head injury and
may guilt a player into continuing through and returning to play too soon.
Reinforcing Factors
People within the lacrosse community that would be able to reinforce awareness and culture
change would be players, coaches, parents, the NCAA, the MCLA, MLL, US Lacrosse, media
outlets such as Inside Lacrosse, Lax Allstars, Lax Idaho, leagues such as the Idaho Lacrosse
Association, Treasure Valley Youth Lacrosse, and collegiate club programs such as the
University of Idaho, Boise State, and the College of Idaho teams. Lacrosse needs a well-known
and respected player to be the face and voice of promoting concussion education and awareness.
This well-known figure could reinforce to the youth players that it is a prevalent phenomenon
and that they should seriously consider playing through it and returning too early.

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Step 7- Validating Needs/Conclusion

The most important target for my health issue is youth lacrosse players. Any amount of education
will help, but will only resonate so much. Until players start advocating for themselves and
practicing safe return to play guidelines and self-reporting symptoms, nothing will change. It is
important to limit enabling and reinforcing factors such as holding players and referees
accountable for following the rules of contact and also to enhance understanding and education.
It is also important to change the culture and mindset that it is okay to play just for the sake of
winning the game. There needs to be a paradigm shift in understanding and recognition. Youth
sports are a great outlet for shaping discipline, respect, hard work, effort, teamwork, and a
multitude of other things, but concussions can impair these cognitive connections and have long
lasting effects that may remain with a person for the remainder of their lives.

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10
References

American Fact Finder. Community Facts. United States Cencus Bureau. Retrieved March 8,
2016, from http://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml
Centers for Disease Control and Prevention. Basic Information about Traumatic Brain Injury and
concussions. (2016, January 22). Retrieved March 8, 2016, from
http://www.cdc.gov/traumaticbraininjury/get_the_facts.html
Healthy People 2020. Reduce Fatal Traumatic Brain Injuries. U.S. Department of Health and
Human Services. (2016, March, 9) Retrieved March 10, 2016, from
https://www.healthypeople.gov/2020/topics-objectives/objective/ivp-21-0
Idaho Vital Statistics. Annual Report. Department of Health and Welfare. Retrieved March 9
2016, from,
http://www.healthandwelfare.idaho.gov/Health/VitalRecordsandHealthStatistics/
Marar, M., Mcllvain, N.M., Fields, S.K., Comstock, D. Epidemiology of Concussions among
United States High School Athletes in 20 Sports. The American Journal of Sports
Medicine. Jan. 27, 2012. Retreived March 8, 2016 from,
http://ida.lib.uidaho.edu:3553/content/40/4/747.full#F3
National Research Council, Institute of Medicine, and Board on Children, Youth, and Families.
Sports-Related Concussions in Youth : Improving the Science, Changing the Culture.
Washington, DC, USA: National Academies Press, 2014. ProQuest ebrary. Web. 10
March 2016.
US Lacrosse. Concussion Awareness. 2015. Retrieved 8, March 2016 from,
http://www.uslacrosse.org/about-the-sport/health-safety/concussion-awareness.aspx