As those who play the sport like to say, Lacrosse is the fastest game on two feet. It’s also among the fastest-growing sports in the country.
But the game’s rapid growth also coincides with a deeper understanding of concussions and traumatic brain injuries, and like most sports, the lacrosse community is grappling with how to keep players safe.
At the forefront of that debate is whether headgear – the soft-shell helmets approved for optional use in the girls’ game – should be mandatory for all players.
Two years ago, recognizing the demand for improved brain safety in youth athletics, US Lacrosse set a standard for headgear that could legally be worn by female lacrosse players at all levels. But most players choose not to wear the extra piece of protective equipment, and there’s a growing chorus of those who say it’s time for a mandate.
“If I could have had headgear and had this [concussion] seriously mitigated or prevented, it would have changed my life,” said Sophia Kofoed, a San Francisco Bay Area high school senior who suffered a serious brain injury playing lacrosse her freshman year of high school.
Kofoed, a lacrosse standout, said she took a blow to the temple from an opposing player’s stick. Seconds later, as she charged down the field, Kofoed was struck in the head for a second time. This time she blacked out, crashing to the ground as her parents watched from the stands in horror.
“I was told I had a brain injury and I would have to drop out of school and lacrosse for the rest of the year, so it was one of the most difficult times in my life,” Kofoed said.
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Kofoed said couldn’t remember how to read, write, or have a basic conversation. Three years later, Kofoed said she finally feels like her old self again, although doctors said she may suffer headaches for the rest of her life.
Since the injury, Kofoed and her father Brad, a former lacrosse player and coach himself, created an organization called the Brain Safety Alliance, and have been pushing for a headgear mandate in the sport. They recently convinced three Northern California club teams to adopt headgear, and have their sights set on more.
“I think it’s the best sport there is,” Brad Kofoed said. “And I don’t think it’s more dangerous than other sports. And if we can prevent a brain injury like the one Sophia incurred, we should. That’s just a no brainer.”
While a headgear mandate may be a no-brainer to the Kofoed family, the issue remains controversial and opinions on a headgear mandate are nuanced.
There are fears introducing a mandate might change the game, and some, including officials at US Lacrosse, say the jury is still out on whether headgear actually reduces concussion risk.
Some purists say mandating headgear will transform the sport into a mirror of the boy’s game, where the rules allow players adorned in pads and hard-shell helmets to forcefully smash into opponents.
That’s what worries Team NorCal Lacrosse Coach Colleen Niklaus, who said she’s already seen the game get more aggressive and physical over the past few years, in part due to an influx of coaches from the boy’s game.
“I feel like it’s important to have them protected, but my big fear is they will start changing the way of the game and it will become more physical like the boy’s game,” said Niklaus, who’s coached for more than 20 years. “I don’t want people to go for the head and get more physical just because they see a helmet now on the head.”
But Niklaus, who's also a parent, said she understands the desire for a headgear mandate and she’d be open to it if referees strictly enforced the rules and coaches didn’t encourage more physical play.
“I just want to make sure that the boy’s and girls’ game stay fun and safe and dynamic,” the veteran coach said. “It’s the fastest game on two feet so I want a lot of girls to continue to play and grow the sport out here on the West Coast.”
US Lacrosse, the sport’s governing body, has made no indication a headgear mandate is imminent. Officials say there’s not enough data yet to prove headgear makes the sport any safer. But that could soon change.
The organization said it will be studying Florida closely this year, the only state in the country with a headgear mandate for girls’ lacrosse players. Florida’s controversial rule change, which US Lacrosse initially opposed, will provide a mountain of data for researchers to compare concussion rates between helmeted and non-helmeted players.
“The organization is committed to ongoing studies and research leaving ourselves open for the potential for a mandate if we find that the evidence proves that this is going to be beneficial,” said Ann Carpenetti, VP of Lacrosse Operations for US Lacrosse.
Recent studies, mostly relying on data from the National High School Sports-Related Injury Surveillance Study (LINK), shows Lacrosse is in the top three girls’ sports with the highest concussion rates, behind soccer and tied with basketball. Cheerleading is close behind.
Carpenetti said US Lacrosse wants to reduce concussions in the sport, but said headgear is not a panacea.
“To mitigate risk and injury, we do so with great care, not just focusing on the headgear and equipment implementation, but also on the emphasis of training our coaches, training officials, and making sure the rules are consistently enforced.”
While US Lacrosse said it needs to see more data before forcing headgear on all female athletes, others are already convinced a mandate would significantly reduce concussions in the sport.
“Our research shows that if girls’ lacrosse players were required to wear the same helmets the boys’ lacrosse players are required to wear, we would expect a third of all concussions sustained over the last decade could have been prevented,” said Dr. Dawn Comstock, a sports concussion expert and professor of Epidemiology at the Colorado School of Public Health.
Comstock said helmets will never eliminate concussions completely and are ineffectual at preventing concussions caused by player-on-player contact or a player’s head hitting the ground. But data shows most of the concussions in the girls’ game are caused by blows to the head from balls or sticks – exactly the type of concussions Comstock said helmets are good at preventing.
“Over 70 percent of the concussions [in the girls' game] are sustained when the athlete is struck in the head by the stick or the ball, and only 20 percent occur from athlete on athlete contact,” Comstock said.
Comstock also discounted the so-called “gladiator effect,” the notion that putting headgear on female athletes will make the game more violent.
“There’s no basis for that,” Comstock said. “It sounds good, but there’s no research to support it. Additionally, sports have rules for a reason, and girls can’t play more aggressively unless their coaches and the officials allow them to do so. So, the gladiator effect, in my opinion, is only a myth.”
While US Lacrosse continues to study the issue, the Kofoed family can only wonder how many other girls might suffer concussions they say could be prevented by a headgear mandate. As Sophia knows all too well, just one can alter a life forever.
“I always wonder what it would be like if I could take it all back and I could just start fresh and not have this experience,” she said.
Kofoed, now preparing for college, had to stop playing the game she loves. But she hopes her message will make an impact on the sport and protect the brains of young athletes to come.
“I have this opportunity now to make a positive impact on the game,” Kofoed said. "I have the support of my parents and I have the support of these amazing doctors and coaches and players that I’ve talked to and met. And I feel like the Brain Safety Alliance is only the beginning.”
