Do girls need lacrosse helmets?

Joseph Crisco, professor of orthopaedics, wanted to measure the impact of hits to the head in girls’ lacrosse. He invited some players into his lab to take some shots at a test dummy. The data could inform an eventual standard for girls’ and women’s lacrosse.

A little more to the left
To analyze what happens in a girls' lacrosse game when
stick meets head, Joseph Crisco equipped a test dummy
with accelerometers and invited players to take some shots.
Credit: Mike Cohea/Brown University

PROVIDENCE, R.I. [Brown University] — Dr. Joseph "Trey" Crisco, the Henry F. Lippitt Professor of Orthopaedics and Director of the Bioengineering Lab, recently invited female lacrosse players ranging in age from 12 to 28 into his Rhode Island Hospital lab to swing their sticks for a project titled “Head Accelerations from Various Stick Checks in Girls’ Lacrosse.”

The research, funded by US Lacrosse, the national governing body of men’s, women’s and youth lacrosse, and by the National Operating Committee on Standards for Athletic Equipment, will provide data on how the head is accelerated after being hit by a stick. Video analysis of players taking whacks at a helmeted dummy, taken at 1,000 frames per second, could inform an eventual standard for girls’ and women’s lacrosse headgear.

For years, Crisco has studied head impacts in sports such as football, hockey, and lacrosse by embedding accelerometers in the helmets of collegiate teams and gathering data from actual practices and competition.

by David Orenstein

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Brown conducts helmet study for girls lacrosse

Joseph "Trey" Crisco, Henry Frederick Lippitt Professor of Orthopaedic Research and Director of the Bioengineering Lab, who has done pioneering research with concussions and football helmets is now studying girl's and women's lacrosse, which does not require helmets. 

Crash-test dummies subjected to a barrage of sticks to the head may help settle the debate over whether helmets should be required in girl's lacrosse.

There has been increased concern over concussions in a sport that prohibits the use of hard helmets, while soft headgear in the girls' game is allowed. Hard helmets are required in the men's version of the game.

Brown University in Rhode Island will conduct a study during the third week of July to try to determine whether helmets will help protect girls from concussions caused by stick-to-head contact, and if so, what type.

"Right now, there is no standard for head protection in the women's game," said Ann Kitt Carpenetti, the managing director of game administration for US Lacrosse, the sport's governing body. "There is an allowance in our rules for soft headgear, but no testing has been done and little or no research."

The issue of requiring helmets in girl's lacrosse, at the high school and college levels, remains a hot-button issue. Many of the players and coaches fear that mandatory helmet use, especially of the hard-shell variety, would make their sport too physical and more like the boys game. But some in the medical profession are fearful of the danger of concussions and are in favor of required helmet use.

Females use more 'finesse'

"The girls' sport was meant to be a finesse sport, an athletic sport, and not a power sport or a brute-force sport," said Shoreham-Wading River coach Mary Ann Bergmann. "US Lacrosse and the referees' associations need to come together and figure out what's best for the sport."

Long Island, which has about 2,000 girls playing lacrosse on 104 high school teams, was the focus of the debate last spring, when Alexandra Fehmel, a star player on Bergmann's team, began playing with a soft helmet designed by a family friend. Before wearing the soft helmet, Fehmel had suffered two concussions playing lacrosse.

Fehmel, whose team won the Class C state championship in June, said wearing the soft helmet "has definitely helped me with my confidence. It protects me from stick-to-head injuries and any concussion I might get from that. I'm not scared to go to goal anymore. I'm not afraid to be aggressive."

Could the results of this summer's testing be the first step toward requiring helmets?

"I would not say that helmet use is inevitable. I would say that what's inevitable is that there will be a standard, hopefully by next year," said Carpenetti.

She said that US Lacrosse, in conjunction with the National Operating Committee on Standards for Athletic Equipment, which established national standards for football and baseball helmets, has funded the research project at Brown.

Project director Joseph "Trey" Crisco, a professor of orthopedics at Brown, said his study's goal "is to try to understand what head accelerations girls receive during games. How hard is the head being impacted by ball or stick?"

He said he had hoped to use sensors to measure that impact, but there was no place to effectively attach the sensors on players' heads.

"So we decided to use dummies, like they use in car crash simulations," Crisco said. "We have a model and we will have girls lacrosse players from the [Rhode Island] area come into our lab and whack away from different angles. They'll be whacking on the top of the 'head' and the side of the 'head.' They'll use the tip, the shaft and the middle of the stick so we can determine the severity of stick checks."

Crisco noted that the head forms are gender-neutral, "but they do have sizes, and we're using the smaller size."

Crisco said that once the data is compiled, "it will help US Lacrosse determine the type of helmets or whether there is even a need for them."

Crisco said results will require four to six weeks to be analyzed, and he estimates it will take several months before the report is ready.

One player's decision

For Fehmel, the question of requiring helmets has already been answered. She said she favors requiring soft helmets but not hard ones.

"Hard helmets would hurt players even more, just from bumping into each other," she said.

Bergmann, who currently is playing lacrosse in Europe where no headgear is worn, said she isn't sure where she stands on the issue of helmets.

"If you give everyone helmets, is the game going to become more aggressive?" she asked. "That's why I'm still in between."

Dr. Karl Friedman, Nassau County's supervising physician for football and lacrosse championships, is not a helmet advocate. "We don't need the helmet," he said. "We don't want to change the game. . . . The more equipment you put on them, the more you can let them play because now the safety is covered by the equipment. Absolutely they'll be more careless with their sticks . They'll be more fearless and the referees will loosen up."

Getting a second opinion

However, there are those in the medical community who feel strongly that hard-shell, boys-style lacrosse helmets are not only essential in the girls' game, but inevitable.

"When rules for girls lacrosse were written, they were written to keep the ball and stick out of the sphere of the head," said Dr. Jack Marzec, team physician for West Islip and East Islip high schools and consulting orthopedic physician for the Long Island Lizards professional men's lacrosse team.

"Girls are getting quicker, stronger, more aggressive," he added. "They're looking for scholarships and they want to win, just like the boys. I am adamant that hard helmets must be instituted in girls lacrosse because it's impossible to keep the stick and ball off the head."

Nationally known concussion expert Dr. Micky Collins, of the University of Pittsburgh Medical Center, said he can't make up his mind whether requiring female players to wear helmets is a good idea.

"I'm sitting on the fence," he said. "We know girls are more at risk for concussions. . . . There are a lot of issues on the table here. The only way to answer these questions is to do the research and find out, scientifically, where we're at. There is no good science leading us right now."

Originally published in Newsday
by Bob Herzog
with Stephen Haynes and James Crepea

RULES FOR GIRLS

Players must wear a mouthpiece and protective goggles. They may wear a soft padded helmet but not hard-shell headgear.

Checking is permitted on the head of the lacrosse stick only.

No deep pocket in the stick is allowed. No mesh pockets.

Length of stick is the same for all field players (typically 42 inches).

Played with 12 members on each team: a goalie, five defensive players and six attack players.

At least five players must remain on the defensive side of the field and four on the offensive side at all times.

Shooting is permitted only when pathway to goal is clear.

Defenders cannot block an attacker's pathway to shoot on goal unless they are within one stick-length of the attacker.

Cannot shoot a loose, uncontrolled ball; cannot hit another player with the ball; cannot hit the goalie in the head with the ball.

RULES FOR BOYS

Players must wear a hard-shell helmet with face guard.

Stick-to-body contact is integral to the game.

Checking is permitted anywhere on the stick.

Pockets in sticks are allowed because of the checking.

The length of the stick is different for different positions.

Played with 10 members on each team: a goalie, three defenders, three midfielders and three attackmen.

At least four players must remain on the defensive side of the field and three on the offensive side at all times.

Players may shoot at anytime.

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Bioengineering Professor Leads Research on Head Impacts and Concussions in Football

Researchers, including biomedical engineering Professor Joseph J. "Trey" Crisco,  gathered data on the frequency, direction, and magnitude of head impacts from players who wore sensor-equipped helmets during three football seasons at Brown University, Dartmouth College, and Virginia Tech. The data amount to a measure of players’ exposure to head impacts, which can ultimately help physicians and scientists understand how concussions occur.


PROVIDENCE, R.I. — Thousands of college football players began competing around the nation this week, but with the thrill of the new season comes new data on the risks of taking the field. A new study reports that running backs and quarterbacks suffer the hardest hits to the head, while linemen and linebackers are hit on the head most often. The researchers measured head blows during games and practices over three seasons at Brown University, Dartmouth College, and Virginia Tech.

The study, led by Joseph J. Crisco, professor of orthopaedics in the Warren Alpert Medical School of Brown University and director of the bioengineering laboratory at Rhode Island Hospital, documented 286,636 head blows among 314 players in the 2007-09 seasons. Crisco said the new data on the magnitude, frequency, and location of head blows amounts to a measure of each player’s head impact exposure. Ultimately it can help doctors understand the biomechanics of how blows to the head result in injury.

“This allows us to quantify what the exposure is,” Crisco said. “It is the exposure that we need to build upon, so that we can then start understanding what the relationships are with acute and chronic head injury.”

The study appears online in advance in the Journal of Biomechanics.

Concussions and other head injuries have become a source of elevated concern in football and other sports in recent years, with various leagues revising policies to protect players better. In part based on seeing this new data, said Robin Harris, Ivy League executive director, league officials announced earlier this year that full-contact practices would be limited to two a week.

Hits by position

The new study documents the nature of head blows by player position. Players on the three teams wore helmets equipped with wireless sensors that measured acceleration in various directions. That data allowed the team of researchers from Brown, Dartmouth, Virginia Tech, and sensor-maker Simbex to discern how hard the hit was, how often each player was hit, and where on the helmet they were hit.

Crisco devised the algorithm that Simbex’s Head Impact Telemetry System uses to measure head impacts. The system’s development and this study were funded by the National Institute of Child Health and Human Development and the National Operating Committee on Standards for Athletic Equipment.

The data on head acceleration and hit direction are used to calculate a composite score of exposure called HITsp that researchers believe might be a good predictor of concussion. On average, running backs had the highest HITsp, 36.1, followed by quarterbacks with 34.5 and linebackers at 32.6. Offensive and defensive linemen had the lowest HITsp numbers, with 29.0 and 28.9 respectively, but along with linebackers, they were hit on the head most often. Doctors worry not only about hit severity, but also hit frequency, because repeated head impacts may cause “subconcussive” neurological damage over time.

By analyzing head impacts by position, Crisco said, researchers can help football league officials and equipment designers begin to think about ways to make players safer.

“It will allow us to begin to understand how to control the exposures,” Crisco said. Controlling head impact exposure is critical, he added, because there are currently no treatments for acute or chronic brain injuries, and helmets cannot prevent injuries for all players in all situations.

One possibility could include rule changes. Another could include designing helmets for specific positions.

Crisco and his colleagues are now analyzing data about concussions during the three seasons to determine how and whether head impact exposure is associated with injury. He recently co-authored another paper about male and female collegiate hockey players, which reported that although women were diagnosed with more concussions, they sustained fewer and less severe head impacts.

Although Crisco’s analysis is still underway, his insights into head impact exposure led him and co-author Richard Greenwald, a Dartmouth engineer, to write a commentary earlier this year in Current Sports Medicine Reports, in which they argued that intentional use of the head in sports must be curbed.

“We propose the adoption of rules — or in some sports, we champion the enforcement of existing rules — that eliminate intentional head contact in helmeted sports,” they wrote. “When coupled with education that leads to modified tackling, blocking, or checking techniques, these rules will reduce head impact exposure and have the potential to reduce the incidence and severity of brain injury.”

Crisco, a former college football and lacrosse player, said he is passionate about contact sports and believes they have many benefits.

“Hitting is an essential component,” he said. “But intentional hitting with your head was never part of any sport and is poor technique.”

In addition to Crisco and Greenwald, other authors of the paper are Bethany Wilcox of Brown; Jonathan Beckwith and Jeffrey Chu of Simbex; Stefan Duma and Steve Rowson of Virginia Tech and Wake Forest; and Ann-Christine Duhaime, Arthur Maerlender, and Thomas McAllister of Dartmouth.

By David Orenstein

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STAC Awards Brown Engineers Funding for Collaborative Projects

The Rhode Island Science and Technology Advisory Council (STAC) announced the awardees of the 2011 Collaborative Research Grant program. The awards will support eight projects representing the efforts of 23 scientists from 13 educational institutions, hospitals and private companies throughout Rhode Island. The Brown School of Engineering had scientists on two of the eight projects. Those projects will receive nearly $400,000 of the $1,435,822 that was awarded.  

Since the program's inception in 2007, STAC has awarded approximately $6.5 million to 38 teams of 97 researchers from 35 organizations -- and the program is returning dividends on this state investment. To date, STAC grant recipients have reported nearly $10 million in follow-on funding from federal and private sources. This outside investment has supported additional research efforts, new patents, new equipment and products and the formation of new companies.

Professors Christian Franck, Janet Blume, and Trey Crisco are working on concussion and traumatic brain injury and collaborating with Cheryl Liu, and Subham Sett from Simulia. They hope to work with companies in designing safer and improved protective gear and to aid the medical community in producing improved quantitative traumatic brain injury (TBI) diagnosis and assessment tools. They were awarded $194,809. 

Professor Bob Hurt and Love Sarin ScM'05 PhD'10 of Banyan Environmental will work to develop new technologies for reducing human health risks associated with anthropogenic mercury emissions from coal-fired power plants and cement kilns. They were awarded $200,000.

The 2011 award recipients include academic and industry scientists pursuing research in disease prevention, mercury emission control, neurology and engineering and demonstrate the vitality and promise of the state's health, science, marine and technology sectors. Priority was given to high-impact projects that are collaborative across Rhode Island institutions, well positioned to receive follow-on funding, and aligned with the Rhode Island Science and Technology Plan.

Read the full press release (PDF) from the STAC
View presentation by Brendan McNally, Executive Director, RI-CIE (PDF)
Read the Providence Business story on the event
Read the Providence Journal story on the awardwinners

More about the 2011 Collaborative Research Grant Awardees:

Project 1: Development of multi-scale brain injury models for concussion and traumatic brain injury

This team is working to aid companies in designing safer and improved protective gear and to aid the medical community in producing improved quantitative traumatic brain injury (TBI) diagnosis and assessment tools.

Collaborators:
Christian Franck, Ph.D., Brown University
Janet Blume, Ph.D., Rhode Island Hospital
Joseph J. Crisco, Ph.D., Warren Alpert Medical School and Rhode Island Hospital
Cheryl Liu, Ph.D., Simulia
Subham Sett, Simulia

Project 2: Marine biofouling on high-performance molded materials

Researchers will use microscopic and molecular techniques to characterize the development of marine biofilms. By collaborating with a research university, Ametek SCP will be able to evaluate novel coatings and to expand its markets.

Collaborators:
Lucie Maranda, Ph.D., University of Rhode Island
Keunhan Park, Ph.D., University of Rhode Island
William Mildon, Ametek SCP

Project 3: A novel efficient technology for mercury emission control application

This team will work to develop new technologies for reducing human health risks associated with anthropogenic mercury emissions from coal-fired power plants and cement kilns.

Collaborators:
Robert Hurt, Ph.D.,Brown University
Love Saran, Ph.D., Banyan Environmental Inc.

Project 4: A wound healing product for diabetic ulcers containing choroid plexus growth factors

Researchers will collaborate on development of a topical regenerative product for wound healing and will work to expand and strengthen preclinical research studies on the topic.

Collaborators:
Kim Boekelheide, MD/Ph.D.,Brown University
Moses Goddard, MD, CytoSolve
Chris Thanos, Ph.D., CytoSolve

Project 5: Antigenic targets of Candida albicans specific antibody fragments

The grant will support work to identify the molecular structure on the surface of the fungus Candida albican that are recognized by previously discovered antibodies to stop infection. This collaboration will support infrastructure at Bryant University, preliminary research for future federal grant dollars, and collaboration between universities.

Collaborators:
Joseph Bliss, MD/Ph.D., Women & Infants Hospital
Christopher Reid, Ph.D, Bryant University

Project 6: The inner-space classroom - Innovation for research and education in the ocean state

This group will develop software to provide access to marine science data and information through the University of Rhode Island's Inner Space Center. The grant will provide for increased marine science educational opportunities and enabling of research and education projects for federal funding.

Collaborators:
Dwight Coleman, Ph.D.,University of Rhode Island
Sara Hickox, University of Rhode Island
James Ferguson, RITE-Solutions

Project 7: Tick bite patch: Proof of concept for a first generation immunoinformatics derived anti-tick vaccine with transdermal delivery

This group will work to establish proof-of-principal for a catalytic approach to accelerate bench-to-clinic translation of a novel anti-tick vaccine for humans.

Collaborators:
Thomas Mather, Ph.D., University of Rhode Island
Keykavous Parang, Ph.D., University of Rhode Island
Anne DeGroot, MD, EpiVax, Inc.
William Martin, EpiVax, Inc.
Michael Jordan, Isis Biopolymers, Inc.
Leonard Moise, Ph.D., University of Rhode Island

Project 8: Tracing business-critical web applications

Researchers will develop techniques for comprehensive measurement of the performance of rich web applications by applying causal tracing techniques to both the server and client. This effort will combine the strengths of a university research setting with real client data.

Collaborators:
Rodrigo Fonesca, Ph.D., Brown University
Chris Erway, Ph.D., Tracelytics Inc.

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