Men’s lacrosse is a contact and collision sport with hitting allowed by the body and stick.

In boy’s lacrosse, stick checks are permitted at the U11 (age 9–10 years), U13 (age 11–12 years), and U15 (age 13–14 years) levels. Body checks are allowed at the U13 and U15 levels.

Women’s lacrosse is a noncontact sport, although controlled checking with the stick is allowed and incidental contact does occur.

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  In women’s lacrosse, intentional body contact is not allowed.

There is a theoretical 7-inch “bubble” around the head that cannot be invaded by the opponent. Stick handling is not permitted in this “bubble.”

The women’s stick pocket is shallower, allowing easier dislodging of the ball by an opponent and potential differences in ball velocity as it is passed or shot on goal.

Men’s lacrosse equipment protects against trauma caused by the stick, ball, and body contact.

In men’s lacrosse, field position players are required to wear a mouth guard; the National Operating Committee on Standards for Athletic Equipment (NOCSAE) has approved a helmet with a full face mask and a four-point chin strap, gloves, and arm, elbow, and shoulder pads ( Fig. 69.1 ).

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  In 2014, US Lacrosse mandated rule changes that required young male players to wear protective cups.

  
  
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  Goalkeepers are required to wear arm pads, throat and chest protectors, and an athletic cup ( Fig. 69.2 )

  
  

  
  

  
  

  

  
  

  
  

  Men’s goalkeeper.

  
  

  (Courtesy of Sideline Photos, LLC.)

  
  

Men’s lacrosse.

(Courtesy of Sideline Photos, LLC.)

In women’s lacrosse, goalies are required to wear a helmet with a full face mask, throat protector, and chest protector. Field position players must wear a mouth guard and an eye protector ( Fig. 69.3 ).

Women’s lacrosse.

(Courtesy of Sideline Photos, LLC.)

In 2014, the three rule-making bodies for lacrosse play in the United States—the National Collegiate Athletic Association (NCAA), US Lacrosse, and the National Federation of State High School Associations (NFSHA)— mandated the use of a ball meeting the NOCSAE standard.

Men’s lacrosse has both technical and personal fouls, which may result in 1- to 3-minute penalties (removing the offending player from the game temporarily creating a “man down” situation), loss of possession, and even ejection.

Women’s lacrosse has minor and major fouls, which result in free position and possible loss of possession.

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  US Lacrosse has planned implementation for 2016 of a new foul for dangerous contact in girls’ high school and youth lacrosse.

  
  
  
  
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    Dangerous contact is defined as any action that thrusts or shoves any player, with or without the ball, who is in a defenseless position.

  
  

The NFSHA published rule changes for the 2016 boys lacrosse season, with the following points of emphasis:

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  Penalties for excessive contact to the head/neck area and hits on defenseless players

  
  
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  Appropriate helmet fitting

  
  
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  Final 3 minutes of halftime to be used as a warm up to help with injury prevention

  
  
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  Safety equipment use during pregame and practice

  
  
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  Discouraging field players from defending the crease because they do not have the same degree of protective equipment as goalies to defend shots on goal

These NFSHA rule changes add to previous years’ rule changes prohibiting excessive body checks, minimum penalties for checks involving the head/neck, and emphasis on prohibition of slashing.

NCAA rule changes, aimed to reduce head injuries, implemented in 2014 include increased, and nonreleasable penalty time for offending players who target an opponent’s head or neck by initiating contact with a stick or any part of the body.

The NCAA Injury Surveillance System collects data on collegiate lacrosse injuries.

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  In 2009, men’s lacrosse had practice and game injury rates of 4.7 and 16.4 per 1000 athlete exposures (AEs), respectively.

  
  
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  In 2009, women’s lacrosse had 2.8 and 6.8 per 1000 AEs for practice and game injury rates, respectively.

Data published in 2014 on high school lacrosse injury rates showed a rate of 1.96 per 1000 AEs. Injury rates were higher during competition than during practice (3.61 vs. 1.23 per 1000 AEs, respectively)

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  Boy’s had a higher rate than girls (2.26 vs. 1.54 per 1000 AEs)

  
  
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  Common injuries among both boys and girls were strains/sprains (boys: 35.6%; girls: 43.9%) and concussions (boys: 21.9%; girls: 22.7%).

Top three collegiate game injuries for men’s and women’s lacrosse are ankle ligament sprains, knee internal derangement, and concussion.

Most common collegiate practice injuries are ankle ligament sprains, muscle–tendon strains, and internal knee derangements.

Although less common, upper extremity injuries such as hand or finger fractures are also significant, particularly in the women’s game.