Correlation of Head Impacts to Change in Balance Error Scoring System Scores in Division I Men’s Lacrosse Players

BACKGROUND: Investigation into the effect of cumulative subconcussive head impacts has yielded various results in the literature, with many supporting a link to neurological deficits. Little research has been conducted on men’s lacrosse and associated balance deficits from head impacts. HYPOTHESES: (1) Athletes will commit more errors on the postseason Balance Error Scoring System (BESS) test. (2) There will be a positive correlation to change in BESS scores and head impact exposure data. STUDY DESIGN: Prospective longitudinal study. LEVEL OF EVIDENCE: Level 3. METHODS: Thirty-four Division I men’s lacrosse players (age, 19.59 ± 1.42 years) wore helmets instrumented with a sensor to collect head impact exposure data over the course of a competitive season. Players completed a BESS test at the start and end of the competitive season. RESULTS: The number of errors from pre- to postseason increased during the double-leg stance on foam (P < 0.001), tandem stance on foam (P = 0.009), total number of errors on a firm surface (P = 0.042), and total number of errors on a foam surface (P = 0.007). There were significant correlations only between the total errors on a foam surface and linear acceleration (P = 0.038, r = 0.36), head injury criteria (P = 0.024, r = 0.39), and Gadd Severity Index scores (P = 0.031, r = 0.37). CONCLUSION: Changes in the total number of errors on a foam surface may be considered a sensitive measure to detect balance deficits associated with cumulative subconcussive head impacts sustained over the course of 1 lacrosse season, as measured by average linear acceleration, head injury criteria, and Gadd Severity Index scores. If there is microtrauma to the vestibular system due to repetitive subconcussive impacts, only an assessment that highly stresses the vestibular system may be able to detect these changes. CLINICAL RELEVANCE: Cumulative subconcussive impacts may result in neurocognitive dysfunction, including balance deficits, which are associated with an increased risk for injury. The development of a strategy to reduce total number of head impacts may curb the associated sequelae. Incorporation of a modified BESS test, firm surface only, may not be recommended as it may not detect changes due to repetitive impacts over the course of a competitive season.