Concussions have long been an unwelcome byproduct of sports.
And while more attention has been paid in recent years to preventing the mild brain injuries among professional and school-age players, much of the focus, as well as the studies, have been limited to the high-profile and prime-offending game of football.
Officials at US Lacrosse, the sport's governing body, said they also need to step up efforts to learn how players get hurt and how to minimize risks. One recently released study has helped the group understand the frequency of injury and differences between males and females.
The results form the basis for further research that could eventually lead to changes in equipment or rules for one of the most popular sports in Maryland and one of the fastest-growing sports in the country. About a half-million play organized lacrosse.
"Lacrosse is growing so fast, and we really need to play catch-up," said Steve Stenersen, executive director of Baltimore-based US Lacrosse. "We want to maintain the integrity of the sport and improve the safety of the sport."
The U.S. Centers for Disease Control and Prevention defines a concussion as a mild traumatic brain injury resulting from a jolt to the head that causes the organ to move rapidly inside the skull.
Impacts can be short-lived or long-term, and symptoms can surface immediately or days later. At first, they can include sensitivity to light and noise, headaches and memory loss. Delayed symptoms include fatigue, confusion, mood changes and depression.
The CDC estimates that there are between 1.6 million and 3.8 million sport-related concussions a year. More than half of the concussions among high school athletes are caused by football.
And while Stenersen said there is much to be gained from football studies, officials want to better understand lacrosse-related concussions. The group formed the Sports Science and Safety Committee and partnered with MedStar Research Institute.
A study published last year in the American Journal of Sports Medicine and just released revealed that concussions were the most common type of head, face and eye injury for both male and female lacrosse players in high school and college.
Male high school and college players suffered more concussions than their female counterparts, although females had more head, face and eye injuries in general. That may be because men wear helmets with face masks, but women do not and only began wearing goggles in 2004, after data was collected for the study. Also, males were more likely to sustain an injury from player-to-player contact, and females were hurt more often from contact with a stick or a ball.
Andrew Lincoln, director of orthopedic and sports health research for MedStar and the study's lead author, said concussions are tough to study because they are broadly defined and not easy to diagnose.
Symptoms can take a while to surface, and players might deny they are hurt to stay in the game. Athletic trainers can recognize symptoms, but not all schools have one. That leaves coaches and other players to spot a problem.
Many pro and amateur players take computerized tests to establish a baseline of their cognitive abilities before the season starts; after an injury, a second test shows a loss of abilities. The test is mandatory in the National Football League, but too expensive for many colleges and schools.
Lincoln said more studies are planned. One will study the effectiveness of the goggle rule for females.
On Feb. 13, US Lacrosse also said it and MedStar were awarded a $328,000 grant from the National Operating Committee on Standards for Athletic Equipment to study boys' and girls' high school lacrosse for situations that might result in concussions. Research will incorporate computerized video analysis of 800 games played in the Fairfax County, Va., school system this year and next.
"Our whole purpose is to inform the lacrosse community about risks and to offer data for intervention," Lincoln said.
The field is waiting, said Andrew Tucker, medical director at the Union Memorial Sports Medicine at Union Memorial Hospital and physician for the Ravens and the University of Maryland, Baltimore County lacrosse team.
Most of the college and professional athletes he sees have been playing for most of their lives, and at least one or two per team usually have had one or more concussions. But, he said, research has lead to changes.
For example, in the past few years, research based on pro football has led helmet manufacturers to adjust padding and face guards. Another change to game rules has helped protect the vulnerable quarterbacks.
Lacrosse officials are trying to determine if there is a better way to protect athletes' chests after a handful died over several years from shots to the heart, though more baseball than lacrosse players have suffered from the resulting commotio cordis, a disruption to the heart's activity.