Box lacrosse is typically penalized with expulsion and suspensions. In 1990, when the Six Nations created the new Mohawk lacrosse league, fighting was specifically targeted as unacceptable. Violators were ejected from the game in which the altercation occurred and given a minimum three game suspension. Box lacrosse is the most popular version of the sport in the Czech Republic. It is also played to a marginal degree in Australia, primarily by players who have played field lacrosse. Club level box lacrosse leagues in the United States have increased the number of players exposed to the sport, including the: Baltimore Indoor Lacrosse League,
Box lacrosse yet to lose an international game in box lacrosse. Other international tournaments have been played. Annually, the European Lacrosse Federation holds the Aleš Hřebeský Memorial tournament in Prague. This is the largest European box lacrosse tournament. In 2002 and 2004, the Heritage Cup was played between the United States and Canada featuring mostly players that were members of NLL teams. Historically, box lacrosse has been exclusively a men's sport. Women who played the sport of lacrosse typically played the women's field lacrosse version. Recently, Ontario, Alberta, Nova Scotia and British Columbia have established girls' and women's box lacrosse leagues. During