{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T13:55:06Z","timestamp":1792677306759,"version":"4.5.0"},"reference-count":29,"publisher":"National Athletic Trainers' Association","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,1]]},"abstract":"<jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>The National Federation of State High School Associations previously implemented 2 lacrosse rule modifications: Rule 5.4 in the 2012\u20132013 academic year to heighten the penalty for a head or neck hit to the head, face, or neck (HFN) and Rule 5.3.5 in the 2013\u20132014 academic year to minimize body checking.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To determine if the rates of overall injury, HFN injuries, and concussions due to intentional contact (checking) differed for boys' high school lacrosse players after Rule 5.4 and 5.3.5 modifications were enacted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Descriptive epidemiology study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Web-based online surveillance system.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients or Other Participants<\/jats:title>\n                  <jats:p>Boys' high school lacrosse players during the 2008\u20132009 to 2016\u20132017 seasons whose teams involved athletic trainers participating in the High School Reporting Information Online sports injury-surveillance system.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention(s)<\/jats:title>\n                  <jats:p>Rule 5.4 in the 2012\u20132013 academic year increased the penalty for any intentional hits to the HFN, and Rule 5.3.5 in the 2013\u20132014 year eliminated body checking to a player in a defenseless position.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measure(s)<\/jats:title>\n                  <jats:p>Overall, HFN, and concussion injury rate ratios (IRRs) by checking mechanism; overall and checking-related injury ratios by competitions and practices.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A decrease was shown in checking-related HFN injuries (IRR = 0.29, 95% CI = 0.13, 0.65) and checking-related concussions (IRR = 0.29, 95% CI = 0.12, 0.70) during practices in the seasons after both rule modifications were imposed, but no decreases occurred in any checking-related injuries during competitions. By injury mechanism, no decreases were evident after the Rule 5.4 modification. When both rule modifications (Rules 5.4 and 5.3.5) were enacted together, concussion rates due to delivering body checks (IRR = 0.51, 95% CI = 0.29, 0.91) and overall injury risk due to being body checked (IRR = 0.72, 95% CI = 0.53, 0.97) decreased.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>When both Rule 5.4 and 5.3.5 modifications were in effect, concussion and overall injury risks decreased for the body checker and the player being body checked, respectively.<\/jats:p>\n               <\/jats:sec>","DOI":"10.4085\/1062-6050-0489.19","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T05:32:17Z","timestamp":1618983137000},"page":"437-445","source":"Crossref","is-referenced-by-count":15,"title":["Rule Modifications to Reduce Checking-Related Injuries in High School Boys' Lacrosse"],"prefix":"10.4085","volume":"56","author":[{"given":"Stanley","family":"Guillaume","sequence":"first","affiliation":[{"name":"Department of Physical Medicine & Rehabilitation, Shirley Ryan Ability Lab, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew E.","family":"Lincoln","sequence":"additional","affiliation":[{"name":"Sports Medicine Research Center, MedStar Sports Medicine Research Center, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Hepburn","sequence":"additional","affiliation":[{"name":"Sports Medicine Research Center, MedStar Sports Medicine Research Center, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane V.","family":"Caswell","sequence":"additional","affiliation":[{"name":"School of Recreation, Health and Tourism, George Mason University, Manassas, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary Y.","family":"Kerr","sequence":"additional","affiliation":[{"name":"Injury Prevention Research Center, University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2557","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"key":"2022022515364830900_i1062-6050-56-4-437-b01","unstructured":"High school sports participation increases for 28th straight year, nears 8 million mark.\n\t\t\t\t\tNational Federation of State High School Associations Web site.\n\t\t\t\t\thttps:\/\/www.nfhs.org\/articles\/high-school-sports-participation-increases-for-28th-straight-year-nears-8-million-mark\/. Accessed September 9,2020."},{"key":"2022022515364830900_i1062-6050-56-4-437-b02","unstructured":"2016 participation survey.\n\t\t\t\t\tUS Lacrosse Web site.\n\t\t\t\t\thttps:\/\/www.uslacrosse.org\/sites\/default\/files\/public\/documents\/about-us-lacrosse\/participation-survey-2016.pdf. Accessed June 2,2018."},{"key":"2022022515364830900_i1062-6050-56-4-437-b03","doi-asserted-by":"crossref","unstructured":"Barber Foss\n              KD,\n            \n            \n              Le Cara\n              E,\n            \n            \n              McCambridge\n              T,\n            \n            \n              Hinton\n              R,\n            \n            \n              Kushner\n              A,\n            \n            \n              Myer\n              GD.\n            \n          \n          Epidemiology of injuries in men's lacrosse: injury prevention implications for competition level, type of play, and player position.\n\t\t\t\t\tPhys Sportsmed.\n\t\t\t\t\t2017;\n\t\t\t\t\t45(3):\n\t\t\t\t\t224\u2013\n\t\t\t\t\t233.\n\t\t\t\t\tdoi:10.1080\/00913847.2017.1355209","DOI":"10.1080\/00913847.2017.1355209"},{"key":"2022022515364830900_i1062-6050-56-4-437-b04","doi-asserted-by":"crossref","unstructured":"Lincoln\n              AE,\n            \n            \n              Caswell\n              SV,\n            \n            \n              Almquist\n              JL,\n            \n            \n              Dunn\n              RE,\n            \n            \n              Norris\n              JB,\n            \n            \n              Hinton\n              RY.\n            \n          \n          Trends in concussion incidence in high school sports: a prospective 11-year study.\n\t\t\t\t\tAm J Sports Med.\n\t\t\t\t\t2011;\n\t\t\t\t\t39(5):\n\t\t\t\t\t958\u2013\n\t\t\t\t\t963.\n\t\t\t\t\tdoi:10.1177\/0363546510392326","DOI":"10.1177\/0363546510392326"},{"key":"2022022515364830900_i1062-6050-56-4-437-b05","doi-asserted-by":"crossref","unstructured":"Marar\n              M,\n            \n            \n              McIlvain\n              NM,\n            \n            \n              Fields\n              SK,\n            \n            \n              Comstock\n              RD.\n            \n          \n          Epidemiology of concussions among United States high school athletes in 20 sports.\n\t\t\t\t\tAm J Sports Med.\n\t\t\t\t\t2012;\n\t\t\t\t\t40(4):\n\t\t\t\t\t747\u2013\n\t\t\t\t\t755.\n\t\t\t\t\tdoi:10.1177\/0363546511435626","DOI":"10.1177\/0363546511435626"},{"key":"2022022515364830900_i1062-6050-56-4-437-b06","doi-asserted-by":"crossref","unstructured":"Xiang\n              J,\n            \n            \n              Collins\n              CL,\n            \n            \n              Liu\n              D,\n            \n            \n              McKenzie\n              LB,\n            \n            \n              Comstock\n              RD.\n            \n          \n          Lacrosse injuries among high school boys and girls in the United States.\n\t\t\t\t\tAm J Sports Med.\n\t\t\t\t\t2014;\n\t\t\t\t\t42(9):\n\t\t\t\t\t2082\u2013\n\t\t\t\t\t2088.\n\t\t\t\t\tdoi:10.1177\/0363546514539914","DOI":"10.1177\/0363546514539914"},{"key":"2022022515364830900_i1062-6050-56-4-437-b07","doi-asserted-by":"crossref","unstructured":"Bartley\n              JH,\n            \n            \n              Murray\n              MF,\n            \n            \n              Kraeutler\n              MJ,\n            \n            et al.\n          \n          Epidemiology of injuries sustained as a result of intentional player contact in high school football, ice hockey, and lacrosse: 2005\u20132006 through 2015\u20132016.\n\t\t\t\t\tOrthop J Sports Med.\n\t\t\t\t\t2017;\n\t\t\t\t\t5(12):\n\t\t\t\t\t2325967117740887.\n\t\t\t\t\tdoi:10.1177\/2325967117740887","DOI":"10.1177\/2325967117740887"},{"key":"2022022515364830900_i1062-6050-56-4-437-b08","unstructured":"National Federation of State High School Associations.\n          2013 NFHS boys' lacrosse rules interpretation meeting.\n          \n            http:\/\/media.digitalsports.com\/80100\/files\/2013\/03\/2013-NFHS-Boys-Lacrosse-Interpetation.pdf. Accessed March 1,\n          2018."},{"key":"2022022515364830900_i1062-6050-56-4-437-b09","unstructured":"2017 Youth boys' rulebook: official rules for boys' lacrosse.\n\t\t\t\t\tUS Lacrosse Web site.\n\t\t\t\t\thttps:\/\/www.uslacrosse.org\/sites\/default\/files\/public\/documents\/rules\/2017-boys-youth-rules.pdf. Accessed March 1,2018."},{"key":"2022022515364830900_i1062-6050-56-4-437-b10","doi-asserted-by":"crossref","unstructured":"Kraeutler\n              MJ,\n            \n            \n              Currie\n              DW,\n            \n            \n              Kerr\n              ZY,\n            \n            \n              Roos\n              KG,\n            \n            \n              McCarty\n              EC,\n            \n            \n              Comstock\n              RD.\n            \n          \n          Epidemiology of shoulder dislocations in high school and collegiate athletics in the United States: 2004\/2005 through 2013\/2014.\n\t\t\t\t\tSports Health.\n\t\t\t\t\t2018;\n\t\t\t\t\t10(1):\n\t\t\t\t\t85\u2013\n\t\t\t\t\t91.\n\t\t\t\t\tdoi:10.1177\/1941738117709764","DOI":"10.1177\/1941738117709764"},{"key":"2022022515364830900_i1062-6050-56-4-437-b11","unstructured":"Centers for Disease Control and Prevention (CDC).\n          Sports-related injuries among high school athletes\u2014United States, 2005\u201306 school year.\n\t\t\t\t\tMMWR Morb Mortal Wkly Rep.\n\t\t\t\t\t2006;\n\t\t\t\t\t55(38):\n\t\t\t\t\t1037\u2013\n\t\t\t\t\t1040."},{"key":"2022022515364830900_i1062-6050-56-4-437-b12","doi-asserted-by":"crossref","unstructured":"Rechel\n              JA,\n            \n            \n              Yard\n              EE,\n            \n            \n              Comstock\n              RD.\n            \n          \n          An epidemiologic comparison of high school sports injuries sustained in practice and competition.\n\t\t\t\t\tJ Athl Train.\n\t\t\t\t\t2008;\n\t\t\t\t\t43(2):\n\t\t\t\t\t197\u2013\n\t\t\t\t\t204.\n\t\t\t\t\tdoi:10.4085\/1062-6050-43.2.197","DOI":"10.4085\/1062-6050-43.2.197"},{"key":"2022022515364830900_i1062-6050-56-4-437-b13","unstructured":"Census regions and divisions of the United States.\n\t\t\t\t\tUS Census Bureau Web site.\n\t\t\t\t\thttps:\/\/www2.census.gov\/geo\/pdfs\/maps-data\/maps\/reference\/us_regdiv.pdf. Accessed February 14,2018."},{"key":"2022022515364830900_i1062-6050-56-4-437-b14","doi-asserted-by":"crossref","unstructured":"Black\n              AM,\n            \n            \n              Hagel\n              BE,\n            \n            \n              Palacios-Derflingher\n              L,\n            \n            \n              Schneider\n              KJ,\n            \n            \n              Emery\n              CA.\n            \n          \n          The risk of injury associated with body checking among Pee Wee ice hockey players: an evaluation of Hockey Canada's national body checking policy change.\n\t\t\t\t\tBr J Sports Med.\n\t\t\t\t\t2017;\n\t\t\t\t\t51(24):\n\t\t\t\t\t1767\u2013\n\t\t\t\t\t1772.\n\t\t\t\t\tdoi:10.1136\/bjsports-2016-097392","DOI":"10.1136\/bjsports-2016-097392"},{"key":"2022022515364830900_i1062-6050-56-4-437-b15","doi-asserted-by":"crossref","unstructured":"Council on Sports Medicine and Fitness,\n\t\t\t\t\tBrooksA,LoudKJ,et al.Reducing injury risk from body checking in boys' youth ice hockey.\n\t\t\t\t\tPediatrics.\n\t\t\t\t\t2014;\n\t\t\t\t\t133(6):\n\t\t\t\t\t1151\u2013\n\t\t\t\t\t1157.\n\t\t\t\t\tdoi:10.1542\/peds.2014-0692","DOI":"10.1542\/peds.2014-0692"},{"key":"2022022515364830900_i1062-6050-56-4-437-b16","doi-asserted-by":"crossref","unstructured":"Krolikowski\n              MP,\n            \n            \n              Black\n              AM,\n            \n            \n              Palacios-Derflingher\n              L,\n            \n            \n              Blake\n              TA,\n            \n            \n              Schneider\n              KJ,\n            \n            \n              Emery\n              CA.\n            \n          \n          The effect of the \u201czero tolerance for head contact\u201d rule change on the risk of concussions in youth ice hockey players.\n\t\t\t\t\tAm J Sports Med.\n\t\t\t\t\t2017;\n\t\t\t\t\t45(2):\n\t\t\t\t\t468\u2013\n\t\t\t\t\t473.\n\t\t\t\t\tdoi:10.1177\/0363546516669701","DOI":"10.1177\/0363546516669701"},{"key":"2022022515364830900_i1062-6050-56-4-437-b17","doi-asserted-by":"crossref","unstructured":"Trofa\n              DP,\n            \n            \n              Park\n              CN,\n            \n            \n              Noticewala\n              MS,\n            \n            \n              Lynch\n              TS,\n            \n            \n              Ahmad\n              CS,\n            \n            \n              Popkin\n              CA.\n            \n          \n          The impact of body checking on youth ice hockey injuries.\n\t\t\t\t\tOrthop J Sports Med.\n\t\t\t\t\t2017;\n\t\t\t\t\t5(12):\n\t\t\t\t\t2325967117741647.\n\t\t\t\t\tdoi:10.1177\/2325967117741647","DOI":"10.1177\/2325967117741647"},{"key":"2022022515364830900_i1062-6050-56-4-437-b18","doi-asserted-by":"crossref","unstructured":"Lincoln\n              AE,\n            \n            \n              Hinton\n              RY,\n            \n            \n              Almquist\n              JL,\n            \n            \n              Lager\n              SL,\n            \n            \n              Dick\n              RW.\n            \n          \n          Head, face, and eye injuries in scholastic and collegiate lacrosse: a 4-year prospective study.\n\t\t\t\t\tAm J Sports Med.\n\t\t\t\t\t2007;\n\t\t\t\t\t35(2):\n\t\t\t\t\t207\u2013\n\t\t\t\t\t215.\n\t\t\t\t\tdoi:10.1177\/0363546506293900","DOI":"10.1177\/0363546506293900"},{"key":"2022022515364830900_i1062-6050-56-4-437-b19","doi-asserted-by":"crossref","unstructured":"Kindschi\n              K,\n            \n            \n              Higgins\n              M,\n            \n            \n              Hillman\n              A,\n            \n            \n              Penczek\n              G,\n            \n            \n              Lincoln\n              A.\n            \n          \n          Video analysis of high-magnitude head impacts in men's collegiate lacrosse.\n\t\t\t\t\tBMJ Open Sport Exerc Med.\n\t\t\t\t\t2017;\n\t\t\t\t\t3(1):\n\t\t\t\t\te000165.\n\t\t\t\t\tdoi:10.1136\/bmjsem-2016-000165","DOI":"10.1136\/bmjsem-2016-000165"},{"key":"2022022515364830900_i1062-6050-56-4-437-b20","doi-asserted-by":"crossref","unstructured":"Daneshvar\n              DH,\n            \n            \n              Nowinski\n              CJ,\n            \n            \n              McKee\n              AC,\n            \n            \n              Cantu\n              RC.\n            \n          \n          The epidemiology of sport-related concussion.\n\t\t\t\t\tClin Sports Med.\n\t\t\t\t\t2011;\n\t\t\t\t\t30(1):\n\t\t\t\t\t1\u2013\n\t\t\t\t\t17,\n\t\t\t\t\tvii. doi:10.1016\/j.csm.2010.08.006","DOI":"10.1016\/j.csm.2010.08.006"},{"key":"2022022515364830900_i1062-6050-56-4-437-b21","unstructured":"Hootman\n              JM,\n            \n            \n              Dick\n              R,\n            \n            \n              Agel\n              J.\n            \n          \n          Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives.\n\t\t\t\t\tJ Athl Train.\n\t\t\t\t\t2007;\n\t\t\t\t\t42(2):\n\t\t\t\t\t311\u2013\n\t\t\t\t\t319."},{"key":"2022022515364830900_i1062-6050-56-4-437-b22","doi-asserted-by":"crossref","unstructured":"Vincent\n              HK,\n            \n            \n              Zdziarski\n              LA,\n            \n            \n              Vincent\n              KR.\n            \n          \n          Review of lacrosse-related musculoskeletal injuries in high school and collegiate players.\n\t\t\t\t\tSports Health.\n\t\t\t\t\t2015;\n\t\t\t\t\t7(5):\n\t\t\t\t\t448\u2013\n\t\t\t\t\t451.\n\t\t\t\t\tdoi:10.1177\/1941738114552990","DOI":"10.1177\/1941738114552990"},{"key":"2022022515364830900_i1062-6050-56-4-437-b23","unstructured":"Yard\n              EE,\n            \n            \n              Comstock\n              RD.\n            \n          \n          Injuries sustained by pediatric ice hockey, lacrosse, and field hockey athletes presenting to United States emergency departments, 1990\u20132003.\n\t\t\t\t\tJ Athl Train.\n\t\t\t\t\t2006;\n\t\t\t\t\t41(4):\n\t\t\t\t\t441\u2013\n\t\t\t\t\t449."},{"key":"2022022515364830900_i1062-6050-56-4-437-b24","unstructured":"Certification.\n\t\t\t\t\tUS Lacrosse Web site.\n\t\t\t\t\thttps:\/\/www.uslacrosse.org\/coaches\/coach-development-program\/certification. Accessed July 30,2018."},{"key":"2022022515364830900_i1062-6050-56-4-437-b25","unstructured":"PCA courses.\n\t\t\t\t\tUS Lacrosse Web site.\n\t\t\t\t\thttps:\/\/www.uslacrosse.org\/coaches\/coach-development-program\/pca-courses. Accessed July 30,2018."},{"key":"2022022515364830900_i1062-6050-56-4-437-b26","doi-asserted-by":"crossref","unstructured":"Kerr\n              ZY,\n            \n            \n              Kroshus\n              E,\n            \n            \n              Lee\n              JGL,\n            \n            \n              Yeargin\n              SW,\n            \n            \n              Dompier\n              TP.\n            \n          \n          Coaches' implementation of the USA Football \u201cHeads Up Football\u201d educational program.\n\t\t\t\t\tHealth Promot Pract.\n\t\t\t\t\t2018;\n\t\t\t\t\t19(2):\n\t\t\t\t\t184\u2013\n\t\t\t\t\t193.\n\t\t\t\t\tdoi:10.1177\/1524839917700398","DOI":"10.1177\/1524839917700398"},{"key":"2022022515364830900_i1062-6050-56-4-437-b27","doi-asserted-by":"crossref","unstructured":"Chrisman\n              SP,\n            \n            \n              Schiff\n              MA,\n            \n            \n              Rivara\n              FP.\n            \n          \n          Physician concussion knowledge and the effect of mailing the CDC's \u201cHeads Up\u201d toolkit.\n\t\t\t\t\tClin Pediatr (Phila).\n\t\t\t\t\t2011;\n\t\t\t\t\t50(11):\n\t\t\t\t\t1031\u2013\n\t\t\t\t\t1039.\n\t\t\t\t\tdoi:10.1177\/0009922811410970","DOI":"10.1177\/0009922811410970"},{"key":"2022022515364830900_i1062-6050-56-4-437-b28","doi-asserted-by":"crossref","unstructured":"Sarmiento\n              K,\n            \n            \n              Mitchko\n              J,\n            \n            \n              Klein\n              C,\n            \n            \n              Wong\n              S.\n            \n          \n          Evaluation of the Centers for Disease Control and Prevention's concussion initiative for high school coaches: \u201cHeads Up: Concussion in High School Sports\u201d.\n\t\t\t\t\tJ School Health.\n\t\t\t\t\t2010;\n\t\t\t\t\t80(3):\n\t\t\t\t\t112\u2013\n\t\t\t\t\t118.\n\t\t\t\t\tdoi:10.1111\/j.1746-1561.2010.00491.x","DOI":"10.1111\/j.1746-1561.2010.00491.x"},{"key":"2022022515364830900_i1062-6050-56-4-437-b29","doi-asserted-by":"crossref","unstructured":"Sarmiento\n              K,\n            \n            \n              Hoffman\n              R,\n            \n            \n              Dmitrovsky\n              Z,\n            \n            \n              Lee\n              R. A\n            \n          \n          10-year review of the Centers for Disease Control and Prevention's Heads Up initiatives: bringing concussion awareness to the forefront.\n\t\t\t\t\tJ Safety Res.\n\t\t\t\t\t2014;\n\t\t\t\t\t50:\n\t\t\t\t\t143\u2013\n\t\t\t\t\t147.\n\t\t\t\t\tdoi:10.1016\/j.jsr.2014.05.003","DOI":"10.1016\/j.jsr.2014.05.003"}],"container-title":["Journal of Athletic Training"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/meridian.allenpress.com\/jat\/article-pdf\/56\/4\/437\/3019828\/i1062-6050-56-4-437.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/meridian.allenpress.com\/jat\/article-pdf\/56\/4\/437\/3019828\/i1062-6050-56-4-437.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T18:59:15Z","timestamp":1749668355000},"score":1,"resource":{"primary":{"URL":"https:\/\/nata.kglmeridian.com\/view\/journals\/attr\/56\/4\/article-p437.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,1]]},"references-count":29,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,20]]},"published-print":{"date-parts":[[2021,4,1]]}},"URL":"https:\/\/doi.org\/10.4085\/1062-6050-0489.19","relation":{},"ISSN":["1062-6050"],"issn-type":[{"value":"1062-6050","type":"print"}],"subject":[],"published":{"date-parts":[[2021,4,1]]}}}