FAQs: About Helmets and Head and Neck Injuries

Lacrosse Magazine Article: Nov./Dec. 2004 Issue

by: Dr. Trey Crisco

Helmets play an important role in keeping men’s lacrosse players and women’s lacrosse goalies safe, but they are not fail-safe nor an excuse for careless play. As a piece of athletic equipment, a helmet’s specifications are set and required to be met by the National Operating Committee on Standards for Athletic Equipment (NOCSAE). The committee’s new standard for lacrosse helmets will go into place in 2005.

Below are some frequently asked questions about lacrosse helmets and head and neck injuries.

Q: Can I wear my hockey helmet when I play lacrosse?
A: No. Different sports possess different risks. Standards for helmets have been developed and have evolved specifically for the intended sport, based upon the nature and history of the sport. Wearing helmets not certified for that sport places the player and, possibly other players, at an increased risk of injury, possibly severe and catastrophic.

Q: What helmet must I wear?
A: Helmets bearing the NOCSAE logo must be worn by all boys youth, boys high school, men’s collegiate lacrosse players and, beginning in the 2005 season, by women’s lacrosse goalies at all levels of play. The NOCSAE standard is the same for all helmets in lacrosse; it does not distinguish between youth and adult helmets.

Q: Who is NOCSAE and what is the NOCSAE standard?
A: The National Operating Committee on Standards for Athletic Equipment (pronounced "noxee") is a non-profit organization founded in 1969 with the mission of commissioning research on and establishing standards for protective sports equipment. The NOCSAE Board of Directors consists of representatives from the American College Health Association, American College of Sports Medicine, American Orthopaedic Society for Sports Medicine, American Football Coaches Association, American Medical Society for Sports Medicine, Athletic Equipment Managers Association, National Athletic Equipment Reconditioners Association, National Athletic Trainers Association, and the Sporting Goods Manufacturers Association International. NOCSAE standards are documents that define performance criteria for a specific piece of sports equipment and the test method for measuring that performance. All NOCSAE standards are voluntary compliance guidelines until a governing body, such as US Lacrosse, the NCAA or the National Federation of State High School Associations (NFHS), adopts the NOCSAE standard in its rules.

Q: Which helmet is safest?
A: The NOCSAE standard is a pass/fail criterion so there is no determination as to which helmet is "better." If your helmet has the NOCSAE logo then it meets the NOCSAE standard.

Q: Is there a new NOCSAE Lacrosse helmet standard?
A: Yes. A revised standard has been approved by the NOCSAE Board of Directors and is scheduled to go into effect sometime in 2005.

Q: Do I need to buy a new helmet that meets the new NOCSAE standard?
A: No. Each helmet manufacturer certifies that their helmet meets the NOCSAE standard at the time the helmet was manufactured. So every helmet that bears the NOCSAE logo meets the standard, is legal now and until the life of the helmet, as stipulated by the manufacturer, has expired.

Q: When do I need to buy a new helmet or recondition my current helmet?
A: There are no scientific guidelines or standards for when a helmet should be reconditioned. This is because the construction of each helmet varies from manufacturer to manufacturer. Contact the manufacturer of your helmet to determine the life of your helmet, and if it can be or when it needs to be reconditioned and recertified.

Q: So why did NOCSAE revise the lacrosse helmet standard?
A: The NOCSAE Board of Directors is continually looking for ways to improve athlete safety and routinely reviews its standards and technology with emerging data on injuries, possible interventions and preventions that may be implemented through standards development. Fortunately in lacrosse there have been no reports of severe brain injuries, so the revision of the helmet standard was not due to helmet failures or to increased injuries. Rather the revision was part of NOCSAE’s efforts to continually refine and improve the implementation of its standard. In addition the new standard clarifies impact locations, pass/fail criteria, ball impact specifications and new temperature conditioning environments. NOCSAE standards are frequently changed and updated and typically purchasers and players are not aware of the changes. This change is the first revision to the lacrosse standard in 14 years thus it is getting additional attention. Some of this attention is do to the wonderful success and growth of the sport. The reason the standard went so long without change is because the injury stats indicate lacrosse is not a sport that results in a significant risk of head injury. The revision does require some additional tests and performance specifications that NOCSAE feels will reduce the risk even lower, but these changes are not a reason to eliminate any certified helmets now in use.

Q: My friend received a concussion injury the other day in practice. How come his brand new helmet did not prevent it?
A: This is an important question and the answers and facts below may help prevent future injuries – if you understand them and play accordingly.

• Helmets do the job they are designed for very, very effectively. Helmets are designed to reduce lacerations, contusions, cerebral hematomas (also referred to as severe brain injuries that result in permanent brain damage or death), as well as reducing orbital and nasal injuries, primarily resulting from inadvertent contact with the ball or stick. The NOCSAE lacrosse helmet standard was developed primarily to reduce the risk of the severe brain injuries, not concussive injury.

• No existing sport helmet standard in the world, including the NOCSAE lacrosse helmet standard, was or is intended to reduce the risk of concussions. This is because there is currently a lack of scientific data and understanding on the cause of concussions, but many scientists and physicians are working on it.

• No helmet will ever prevent all head and brain injuries. Every one is different and everyone has different tolerances so it is impossible to protect everyone to the same degree.

• No helmet will ever prevent neck injuries. Catastrophic neck injuries leading to paralysis or death occur when a player typically lowers his head and receives or delivers a blow to the top of their head/helmet. Neck fracture ensues because the torso is still moving and the only thing that can stop it is the neck, which is not strong enough to bear such loads. Play heads up! See what you are doing.

• Don’t play hurt: "no pain, no gain" may be true for bodybuilding, but it is just the opposite for mind building. You must tell your coach, parents, and medical professional if you are experiencing headache or suspect you have suffered even a minor "ding" or "bell ringer."

Q: So, if my helmet can’t prevent all brain injuries, can’t prevent any neck injury and is not certified to prevent concussion, how do I keep from getting hurt?
A: Men’s lacrosse is a relatively safe sport but it is a contact sport so there is always a risk of injury. To reduce your risk of head and neck injuries:

• Keep your eyes on the ball and on the other players at all times. Play "heads up lacrosse!"

• Never lower your head to contact another player. If you lower your head you can’t see the ball or the player and therefore you significantly increase your risk of neck fracture. Don’t butt other players with your helmet.

• Never use your head for any kind of contact and always avoid head/helmet contact. Direct contact to the head or helmet is the major cause of severe brain and concussion injury, so avoid intentional contact with your head/helmet.

• Observe the rules of the game no matter what the sport. The rules have been put into place for reasons, many of which, are to reduce the risk of injuries to the players.

• Be sure your helmet is fits properly. Ask you coach or equipment manager to check the fit of your helmet.

–Dr. Trey Crisco is the director of the bio-engineering laboratory at Brown Medical School. He is a member of the US Lacrosse Sports Science and Safety Committee.

This article was published in the November/December 2004 issue of Lacrosse Magazine.