Lacrosse injury prevention for girls.
A non-contact-by-rule sport with a stick-and-ball head injury profile unique to the girls' game.
Stick/ball
The dominant mechanism for head, face, and eye injuries in the girls' game — not body contact.
Eyewear
Mandated protective eyewear is associated with a substantial reduction in eye injuries in girls' lacrosse.
12 min
Field warm-up covering landing, cutting, and deceleration.
Girls' lacrosse is governed by different rules from the boys' game — no body checking, no hard helmets historically — and its injury profile follows. Prospective scholastic and collegiate surveillance found head, face, and eye injuries in girls' lacrosse were caused predominantly by stick and ball contact, and mandated protective eyewear substantially reduced eye injuries in the girls' game.
Below the head, the pattern resembles other cutting and dodging field sports: ankle sprains and non-contact knee injuries produced by deceleration and change of direction, on grass and increasingly on turf. The prevention program is the field-sport neuromuscular warm-up, plus rigorous attention to protective equipment and rule enforcement.
What actually injures lacrosse players
Head, face, and eye injury
Distinctive to the girls' gameMechanism: Stick contact to the head and face, and direct ball impact.
Female-specific: Because girls' lacrosse restricts body checking, the head injury mechanism is equipment-and-stick driven, which makes eyewear mandates and stick-rule enforcement the primary levers.1,2
Concussion
Meaningful and often under-reportedMechanism: Stick or ball to the head, or incidental player and ground contact during dodges.
Female-specific: Female athletes report higher concussion rates and longer symptom duration; the absence of a hard helmet makes recognition and removal-from-play discipline more, not less, important.3,4
Why the risk is different for girls
These factors change what prevention has to address — they are not reasons to train girls less.
Different rules, different prevention priorities
Applying boys' lacrosse assumptions to the girls' game misses the point. In the girls' game the head-injury lever is equipment and stick-rule enforcement rather than checking technique, while the lower-limb lever is the same neuromuscular warm-up used across cutting sports.1,2
Energy availability comes before every other adaptation
When an athlete does not eat enough to cover the energy her training burns, the body downregulates the systems it treats as optional first — menstrual function, bone remodeling, immune response, and tissue repair. The IOC calls this Relative Energy Deficiency in Sport (REDs), and it raises bone stress injury and soft-tissue injury risk independent of how good her mechanics are. Amenorrhea (no period for three or more months) in an athlete is a clinical finding, not a convenience.8,9
Puberty changes the machine mid-season
The adolescent growth spurt lengthens the levers (femur, tibia) faster than the neuromuscular system recalibrates, and in girls the strength gain that accompanies growth is smaller than in boys. The result is a two- to three-year window of reduced dynamic knee control, wider dynamic valgus on landing, and higher relative injury risk. Programming should get more — not less — landing and single-leg work through this window.5,7
Menstrual-cycle phase is a variable, not a taboo
Hormonal fluctuation across the cycle affects laxity, neuromuscular control, thermoregulation, and perceived exertion, and prospective data in international footballers found injury incidence differed by cycle phase. The practical action is not to restrict training but to track: a simple cycle log next to load data lets athletes and staff see patterns and adjust intensity, hydration, and fueling.10
The protocol, block by block
Run before every practice and game, replacing the existing warm-up.
- 3 min
Dynamic running
Jog, hip openers, shuttle runs, backward running the length of the field.
- Chest tall
- Quick feet
- Build gradually
- 3 min
Posterior chain and hip
Nordic lowers, single-leg RDLs, lateral band walks, glute bridges.
- Slow lowering
- Hips level
- Knees out
- 2 min
Balance and single-leg control
Single-leg stance with a partner pass, hop-and-stick, lateral bounds — with a stick in hand.
- Stick every landing
- Eyes up, not on the ball
- Soft knees
- 2 min
Landing and deceleration
Jump-stops, one-leg stick landings, sprint-to-stop drills.
- Land quiet
- Chop the steps
- Hips back
- 2 min
Reactive dodging
Planned dodges progressing to reactive dodges on a defender's movement, at game speed.
- Wide base into the cut
- Turn the whole body
- Protect the stick, keep the head up
What to check, and when to escalate
Drop vertical jump
30 cm box drop to maximal jump, filmed from the front.
Red flag: Knee inside the big toe on landing, or side-to-side asymmetry.
Reactive cut observation
Watch a reactive dodge drill from the front; score trunk position and knee alignment.
Red flag: Trunk lateral lean with the knee collapsing in during unplanned cuts.
Equipment and baseline concussion check
Confirm ASTM-compliant eyewear and mouthguard fit; document baseline symptom and history data.
Red flag: Non-compliant or damaged eyewear, or a prior concussion within the last year.
Load rules that prevent overuse
- Cap combined school and club field hours; spring overlap is where the highest weekly loads occur.
- Increase running and dodging volume gradually after any break, especially at the grass-to-turf transition.
- Keep one full rest day per week and a genuine offseason block from lacrosse activity.
- Reduce high-intensity dodging volume in the practice after a tournament weekend.
Gear & equipment
- ASTM-compliant protective eyewear, correctly fitted — the best-supported equipment intervention in the girls' game.
- A properly fitted mouthguard, which protects teeth and jaw but does not prevent concussion.
- Headgear meeting the applicable standard where permitted or required by the governing body.
Stages, not dates
Progression is criteria-based and clinician-led. A calendar date is not a clearance.
- 1
1. Symptom-free daily function
For concussion: symptom-free at rest and through return-to-learn steps before physical progression.
- 2
2. Strength and symmetry
Strength and hop testing within 10% side to side for lower-limb injury.
- 3
3. Non-contact field work
Running, stick work, planned cutting with clean mechanics.
- 4
4. Full-contact practice
Reactive dodging and full practice tolerated; concussion clearance obtained from the treating clinician.
- 5
5. Graded game exposure
Limited minutes first; no same-day return after any suspected concussion, without exception.
Questions coaches and parents ask
Do girls' lacrosse players need helmets?
Requirements vary by governing body and level. What the evidence clearly supports is mandated ASTM-compliant protective eyewear, which is associated with a large reduction in eye injuries, and rigorous enforcement of stick and contact rules — the primary mechanism of head and face injury in the girls' game.
Why do girls' and boys' lacrosse have different injury patterns?
The rules differ. Boys' lacrosse permits body checking and mandates hard helmets, so its head injuries are largely contact-driven. The girls' game restricts checking, so head, face, and eye injuries come mostly from stick and ball contact — which is why eyewear and rule enforcement carry so much weight.
How often does this program need to be run to work?
Meta-analyses of neuromuscular training find the protective effect tracks with dose: roughly two or more sessions per week, sustained across the full season, is the threshold where injury reductions become reliable. Programs run only in preseason lose most of their benefit by mid-season.
Should girls train differently from boys?
The exercises are largely the same; the emphasis and the dose differ. Female athletes get disproportionate benefit from posterior-chain strength, single-leg landing control, and trunk stability work, and they need explicit attention to energy availability, bone health, and menstrual function — areas boys' programs typically ignore entirely.
Is strength training safe for adolescent girls?
Yes. Supervised, technique-first resistance training is safe from pre-adolescence and is one of the most consistently protective interventions in sports medicine. The risk in youth sport is under-training strength, not over-training it.
Every claim, sourced
13 peer-reviewed sources. Each links to a PubMed search so you can read the original.
- 1
Lincoln AE, Hinton RY, Almquist JL, Lager SL, Dick RW. Head, face, and eye injuries in scholastic and collegiate lacrosse: a 4-year prospective study. Am J Sports Med. 2007;35(2):207-215.
PubMed - 2
Hinton RY, Lincoln AE, Almquist JL, Douoguih WA, Sharma KM. Epidemiology of lacrosse injuries in high school-aged girls and boys: a 3-year prospective study. Am J Sports Med. 2005;33(9):1305-1314.
PubMed - 3
Covassin T, Moran R, Elbin RJ. Sex differences in reported concussion injury rates and time loss from participation: an update of the National Collegiate Athletic Association Injury Surveillance Program from 2004-2005 through 2008-2009. J Athl Train. 2016;51(3):189-194.
PubMed - 4
Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711.
PubMed - 5
Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492-501.
PubMed - 6
McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34(7):1103-1111.
PubMed - 7
Emery CA, Roy TO, Whittaker JL, Nettel-Aguirre A, van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med. 2015;49(13):865-870.
PubMed - 8
Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097.
PubMed - 9
De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad. Br J Sports Med. 2014;48(4):289.
PubMed - 10
Martin D, Timmins K, Cowie C, et al. Injury incidence across the menstrual cycle in international footballers. Front Sports Act Living. 2021;3:616999.
PubMed - 11
Sugimoto D, Myer GD, Foss KDB, Hewett TE. Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses. Sports Med. 2014;44(4):551-562.
PubMed - 12
Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.
PubMed - 13
Jayanthi N, Pinkham C, Dugas L, Patrick B, LaBella C. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013;5(3):251-257.
PubMed