Lacrosse – How to Optimize Performance & Prevent Injuries

close up of lacrosse player's stick

Lacrosse is the fastest game on two feet and the fastest-growing game on the West Coast. It’s also one of America’s oldest team sports, dating back to 1100 A.D., and it was significant in Native American culture. For some Native Americans, the sport is seen as part of their creation story and as a connection to their ancestors and the spiritual realm. It is typically played as a social event to help heal the community, often as a way to settle disputes, and sometimes to prepare warriors for battle.¹

What is lacrosse?

Lacrosse combines the speed and physicality of football with the finesse of hockey and the passing skills of basketball. It is a contact sport, but in a different way than football. In each full-contact moment, lacrosse players are contacting each other primarily with their shoulders and torso, but also often absorb stick checks to their hands and upper body regions during defensive maneuvers.  

Defenders are the biggest players on the lacrosse field, often rivaling NFL running backs and linebackers in their size.  

Midfielders and attack/forward players resemble wide receivers and quarterbacks in size and rely upon speed and quickness to elude defenders or to open up passing lanes through the defensive players in front of them. 

Offensive players absorb many stick checks while trying to score goals, so there is a component of inflammation reduction/recovery to this sport that is not overtly stated by many coaches. 

lacrosse goalie prepared to defend the goal from an incoming shot

Women’s lacrosse is strictly non-contact, and the athletic demands are similar to those of soccer players. Female lacrosse teams generally include more equally sized players than male teams and players’ running speed is the best indicator of success. 

What’s the best way to train for lacrosse?

Training principles can look different for lacrosse players based on the position they play, as each position has its own unique athletic demands.  

Some positions require the athlete to maintain flexibility in their muscles and joints to enable them to easily absorb contact as well as to change directions very quickly. Other positions require more brute strength and power for the athlete to be able to prevent another player from maneuvering to their goal. All players are required to be explosive and run fast, so incorporating plyometrics and flexibility into a fitness routine is imperative.  

Below is a plyometric and stretching program designed to help lacrosse athletes maintain performance and prevent injury before and during their season.

  • Begin in a lunge position.
  • Jump up into the air and switch legs in mid-air, landing on the opposite side.
  • Be sure to land softly as you absorb your weight.
  • Perform 15 times per leg (30 total for one set). Complete 3-5 rounds as tolerated. 
starting position to perform a split jump
Action shot of split jump exercise.
  • Begin in a curtsy lunge position.
  • Explode off your right leg up into the air and laterally 3-5 feet.
  • Land softly on your left leg, bending knee to absorb impact.
  • Quickly explode off the left and repeat the landing on your right.  
  • Perform 15 times per leg (30 total for one set)Complete 3-5 rounds as tolerated.
landing position of skater jump exercise
starting position for skater jump exercise
  • Raise one leg off the ground, balancing on the opposite leg. 
  • Hinge forward at your hip while maintaining balance and extend raised leg behind you. Try not to round your lower back as you reach the maximum of your range of motion. 
  • Activate the gluteal muscles above the leg you are balancing on and push your self back into a tall standing position following through with knee raised in front of you while maintaining balance.
  • Perform 15 times per leg (30 total for one set)Complete 3-5 rounds as tolerated. 
demonstration of start position for single leg deadlift body weight exercise
demonstration of action of a single leg deadlift body weight exercise
demonstration of finish position of single leg deadlift body weight exercise
  • Place one leg behind you, slowly lower down into a lunge position with your back flat.
  • Alternatively, place one leg on a chair behind you, slowly lower down into a lunge position with your back flat.
  • Tilt pelvis forward until you feel a stretch in your hip flexor and your quad.
  • Hold 1-2 minutes per sideComplete 3 rounds post workout.
demonstration of unassisted kneeling hip flexor stretch
chair assisted kneeling hip flexor stretch
  • Begin on hands and knees. Slide one knee forward between your hands with your heel positioned just beneath the opposite hip.
  • Extend the opposite leg out behind you with your toes tucked into the floor.
  • Keep your hips square and facing forward as you lean forward.
  • Hold this position for 1-2 minutes and each side to stretch out your glutes, hip flexors, and rotators. 
Front view of pigeon stretch
side view of pigeon stretch
  • Prop your foot onto a stable surface. With a flat back, lean forward until you feel a deep stretch in your hamstring on the back of your thigh/leg. 
  • For an added component, reach your arms overhead and then out beyond the extended leg, maintaining a flat back.
  • Hold this position for 1-2 minutes per side. Complete 3 rounds post workout.
demonstrating standing hamstring stretch with a chair
demonstrating standing hamstring stretch with chair and overhead reach

In addition to incorporating the above workout program into their training, including a dynamic warm-up before practices and games will help lacrosse players avoid injuries that could sideline them for the season.

What injuries are common in lacrosse?

Like with most sports and other physical activities, some Delayed Onset Muscle Soreness (DOMS) can be expected, especially early in the season when athletes begin training after time away from the sport. The effects of DOMS can be more significant if there’s been an extended hiatus from working out. 

Static stretching and even some Kinesio taping can be helpful in reducing pain and inflammation after active practices and competitive games. 

Risks of non-contact injuries in lacrosse are moderate, like other cutting sports with high participation in the US.³ Injuries most often occur in the lower body, primarily knee and ankle injuries, similar to those associated with soccer or football.³  

In addition to musculoskeletal injuries, lacrosse has had more than a few cases of commotio cordis, which is a sudden stopping of the heart due to a blunt impact to the chest at the exact right moment in the cardiac cycle.²,4  It was an ill-timed shot to the chest during a Baltimore-area lacrosse game on April 16, 2021, that caused high school freshman Peter Laake to collapse face-first on the field. The quick response of trainers and on-site doctors and the availability of an automated external defibrillator (AED) saved the student athlete’s life.2,5 While player safety has always been prioritized, after Laake’s near tragedy, chest protection gear became mandated under US Lacrosse for all players on boys’ and men’s lacrosse teams.6 Girls’ and women’s teams continue to mandate chest protection for goalies only, due to the non-contact nature of the game.  

As a physical therapist, I enjoy working with athletes to increase sports performance, focus on injury prevention and for treatment and rehabilitation after an injury.

 Commotio cordis is not something that can be avoided with physical therapy, exercise and training, however, and so I strongly support the required use of protective chest pads in all lacrosse leagues to reduce the risk of this sudden and fatal event. 

Furthermore, contact sports teams should invest in AED to have with them at practices and competitions, which the American Medical Society for Sports Medicine recommends, and US Lacrosse has long advocated for.5 

illustration of impact of commotio cordis in sports

In a recent study, the mortality rate associated with commotio cordis in lacrosse was 1.46 deaths per 100,000 person-years, which was similar to that in other sports including baseball, basketball, hockey, and football.4  

Most recently, the world saw a case of commotio cordis on live TV when Buffalo Bills safety Damar Hamlin collapsed on the field during an NFL game after a hit to his chest.

By sharing this information here, I hope to bring increased awareness of this rare but often fatal cardiac event, without implying it is a common risk while participating in lacrosse. If you or your children participate in lacrosse or other high-contact sports, please ask your coach and/or program directors if they have access to these pieces of equipment and push for the availability of their use.

Additional Resources

Youth Sports - Conditioning

Check out our 6-week return to sport conditioning program.
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Youth Sports - 5 Tips to Keep Them Safe

There are important areas for young athletes to focus on as they return to sports.
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References

  1. https://www.history.com/news/lacrosse-origins-native-americans 
  2. https://www.heart.org/en/news/2023/01/24/a-thump-to-his-chest-during-a-game-stopped-his-heart-textbook-response-saved-him 
  3. Xiang J, Collins CL, Liu D, McKenzie LB, Comstock RD. Lacrosse Injuries Among High School Boys and Girls in the United States. The American Journal of Sports Medicine. 2014;42(9):2082-2088. doi:10.1177/0363546514539914 
  4. Maron BJ, Doerer JJ, Haas TS, Estes NAM, Hodges JS, Link MS. Commotio Cordis and the Epidemiology of Sudden Death in Competitive Lacrosse. Pediatrics. 2009;124(3):966-971. doi:10.1542/peds.2009-0167 
  5. https://www.usalacrosse.com/news-media-blog/story-behind-positive-commotio-cordis-outcome 
  6. https://www.wbaltv.com/article/high-school-lacrosse-lifesaving-gear-chest-protector/36520897# 

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