Head Impact Exposure and Mechanisms in Female High School Lacrosse via an Instrumented Mouthguard

Objective To quantify the head impact biomechanics, by impact mechanism, of female high school lacrosse players during games using an instrumented mouthguard. Background There is growing concern for the neurologic effects of repetitive head impacts in sports, which have been linked with several short-term neurophysiologic deficits. Girls' lacrosse represents a popular but understudied sport with regard to head impact exposure and current debate exists as to the need for enhanced protective equipment. Design/Methods A female high school varsity lacrosse team wore the Stanford Instrumented Mouthguard during competitive games for the 2019 season. Video footage was reviewed to confirm head impact events and remove false-positive recordings. For each impact event, the mechanism was coded as stick contact, player contact, fall, or ball contact. Head impact rates were calculated per athlete exposure (AE, defined as a single player participating in a single game). Results Sensor data were recorded for 15 female varsity lacrosse players for 14 games and 97 AEs. During games, 31 sensor-recorded head impacts were video-confirmed resulting in a pooled average head impact rate of 0.32 impacts/AE. The video-confirmed impacts were distributed between stick contact (17, 54.8%), player contact (12, 38.7%), and falls (2, 6.5%). There were no ball impacts. Overall peak kinematics were 34.0 26.6 g, 12.0 +/- 9.1 rad/s, and 3,666.5 +/- 2,987.6 rad/s2. Stick contacts had the highest peak linear acceleration (42.7 +/- 32.2 g), angular velocity (14.5 +/- 11.1 rad/s), and angular acceleration (4,242.4 +/- 3,634.9 rad/s2). Conclusions Stick impacts were the most common impact mechanism and resulted in the highest peak linear and angular kinematics, which may help explain why they are the most common cause of head injury in female lacrosse. By quantifying the head impact exposure, kinematics and mechanisms in female high school lacrosse, targeted injury preventions can be developed, such as rule changes and protective equipment.