Letters from Maine

The price of protection


It’s very likely that you have at least one or two female patients who play lacrosse. The sport has been reported to be the fastest-growing high school sport in the United States. (“Lacrosse is Actually America’s Fastest-Growing Sport,” by John Templon, BuzzFeed News, June 30, 2014). When I played in college, most of my teammates were products of prep schools in the Northeast or one of the few local hotbeds in Baltimore, Long Island, or the Finger Lakes Region of New York. But pickings were slim, and there was room for walk-ons like me looking to learn a new sport and stay in shape for football. Now hundreds of high schools in all parts of the country offer the sport for both boys and girls.

Dr. William G. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years.

Dr. William G. Wilkoff

Although the two versions of the sport use similar-appearing sticks, the same ball and goal, confrontations between the players and their sticks are forbidden in the girls’ game. Women are not even allowed to windup and fire the hard rubber ball with maximum force because it might injure an opponent. Surrounded by a surplus of rules governing body contact and stick control, female lacrosse players have traditionally played without protective equipment other than a lightweight eye cage. The goalies, however, are amply padded and helmeted.

With growing awareness of the long-term effects of repeated head trauma, there has been a call from some parents and organizers of women’s lacrosse to require helmets on all players (“As Concussion Worries Rise, Girls’ Lacrosse Turns to Headgear,” by Bill Pennington, The New York Times, Nov 23, 2017). To those of us who have committed our professional lives to the health of children, the inclusion of helmets to the standard equipment for a female lacrosse player sounds like a good idea.

However, the proposed mandate has its critics, including several college coaches. Karen Corbett, women’s lacrosse coach at the University of Pennsylvania, has said that, players “will start to lead with their head because they feel protected, and that causes more injuries. We’ll become a more physical sport and a very different sport than we are today.”

Girl playing lacrosse kjuniper/Thinkstock
This is not some old-school traditionalist, no-change-is-good blather. One only has to look at the evolution men’s ice hockey to validate her concern. In 1977, Dr. Daniel Hanley, the chief physician of the United States Olympic Team, told me he was sure that, in the wake of the National Collegiate Athletic Association’s upcoming mandate of full face masks for college hockey players, the character of the game would change, and not for the better. He felt that sticks would come up off the ice more often and be wielded more carelessly. Of greater concern to him was that players, emboldened by their false sense of invulnerability from behind their masks, would begin to take more risks with their head and neck.

Although I’m afraid that there are few data to support the validity of Dr. Hanley’s prediction, any observer of college hockey over the last 3 or 4 decades will tell you that he was unfortunately correct. There have been certainly fewer lacerations and eye injuries since face masks were introduced, but the game has become far more violent, and head, neck, and spine injuries have become more frequent. I think part of the problem is that game officials have been duped by the same false assumption as the players that more protection would make the game safer, and enforcement of the rules has not kept up with the technological changes.

There will always be injuries in any sport, but before we as physicians lend our support to a proposed change in protective equipment, we should step back and look at the broader picture. While the loss of an eye for an individual player is a tragedy, did we put several dozen more players at greater risk for spinal injury in college hockey with more protective gear? If adding headgear protects female lacrosse players from concussions, what might be the result if play becomes more physical? Protection can come with a price.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at pdnews@frontlinemedcom.com.

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