Sports Gazette

by sports journalism students at St Mary's University, London

Opinion: It’s Time to Take Concussion in Football More Seriously

Posted on 11 December 2020 by Lewis Pangratiou

Co-written with Lukas Flottmeyer

When two footballers’ heads collide, linear, translational, and rotatory forces rapidly move their brains inside their skull. In the worst-case scenario, the brain hits the skull which can cause major injury.

That is exactly what happened to Raul Jimenez in late November at the Emirates stadium. His sickening clash of heads with David Luiz not only made uncomfortable viewing, but it also served as a strict warning that concussions in football must be taken more seriously.

The Wolves striker was stretchered off and immediately rushed to hospital, where he underwent an emergency procedure after fracturing his skull. Luiz, on the other hand, was hit with the exact same force, yet was given the all clear to continue. He remained on the pitch until half-time, when Arsenal’s medical staff finally ordered he be substituted.

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Symptoms can vary from headaches to vertigo to memory loss. According to the NHS, “signs of a concussion usually appear within a few minutes or hours after a head injury.”

So then, why the need to take such unnecessary risks? Surely some things are more important than football?

Allowing players to continue when they are in potential danger just seems trivial.

Shaking Off the Tough Guy Exterior

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Sometimes though, it is the players who are the problem. Many are too often insistent on soldiering on out of fear of letting their teammates down. As admirable as that attitude can be, it is incredibly dangerous.

Luiz probably did feel fine. But if a bleeding head didn’t provide enough evidence that – at the very minimum – he required further assistance off the pitch, then what will?

Troy Deeney’s recent comments highlight just how much we need to address the issue of players staying on.

“At some point there has to be an element of trust between player and doctor,” he told TalkSport. “As a player, you know when something is not right.

“They [Arsenal’s doctors] followed all the protocols in terms of he’s ticked every box, and then afterwards you don’t see anything other than blood to suggest he’s in a bad way.”

We know Deeney has a reputation for being a tough guy. Unfortunately, that exterior isn’t going to help him if he suffers from a similar injury. As the Gazette has argued recently, player safety should always trump player opinion, no matter the circumstance.

Let’s compare his words to Ryan Mason’s, a player who was forced to retire aged just 26 because of a fractured skull sustained in a clash of heads with fellow Englishman Gary Cahill.

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“I’m very sensitive and I’m quite passionate about this subject, and I’ve spoken to many people about it over the last three years, but nothing had happened, nothing has changed,” he told TalkSport.

“You can’t keep having the same perception when people’s immediate and long-term health is in danger.”

You can hear how incredibly frustrated Mason sounds. So, it must be even more annoying for him to hear opinions like Deeney’s, particularly given that the Watford man is still fortunate enough to play professionally.

Footballers have to wise up. They can do that by simply being more cautious and less ignorant. They’re only endangering themselves.

Concussion Substitutions

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If the players have to be more aware of concussion, then the FA have to be too.

According to Healthline, 81-92% of concussions don’t involve a loss of consciousness. Symptoms can appear anywhere from the time of impact to several days after the initial injury.

Consequently, if we allow players to go back onto the pitch after a collision, we risk a second impact syndrome and, therefore, brain oedemas or herniations. Without a complete reduction of concussion symptoms, sending players back onto the pitch can be life-threatening.

It’s time then to seek possible on the pitch solutions.

One idea is substitutions designed specifically for concussion related injuries, as exists in cricket. This would give managers the opportunity to make a change without using up one of the three substitutions they are usually allowed.

Concussion substitutes were due to take place in the 2020 Tokyo Olympics before the competition’s unfortunate postponement. Positively though, FIFA have observed the growing importance of the issue and have said that trials could begin in January 2021 for any competition that is interested in taking part. Hopefully, the FA will register their interest.

An alternative proposal is temporary substitutions for concussion injury, as happens in rugby.

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Teams would be able to replace the injured player for a short period of time with another who plays that position. That would prevent a number imbalance and keep the game at 11 v 11 (usually at least).

If the player passes more thorough tests on the sideline and is declared fit to continue, then they can return to the field in place of the teammate who initially replaced them.

“It is not a perfect solution, but it gives you more time to make a considered decision about a head injury,” Luke Griggs, deputy chief executive of brain-injury charity Headway, told BBC Sport.

Even though this probably wouldn’t be the best answer long-term, it would certainly be an improvement on what we have at the moment. A proactive solution is on its way. It just needs to be implemented quickly.

SCAT5 and the Need for a Team of Specialists

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Current protocol allows doctors to assess a player on the field for three minutes. Yes, just three minutes, which is an undeniably pressurising time-constraint.

Think back to when Eva Carneiro was unfairly dismissed by Chelsea for treating Eden Hazard. Ex Blues boss Jose Mourinho hurled discriminatory abuse at Carneiro for immediately attending to the Belgian star.

Although a discrimination settlement was eventually reached between the two, her case still shows just how difficult it can be.

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Truthfully, three minutes is quite absurd.

The newest Sport Concussion Assessment Tool (SCAT5), developed by the Concussion in Sport Group, is a standardised tool used to evaluate concussion by physicians and health care professionals. It is supported by the International Ice Hockey Federation, World Rugby, the International Federation of Equestrian Sport, the IOC, and FIFA.

When following the present procedure, a doctor completes a couple of tests with athletes to ascertain a concussion. The SCAT5 emphasises that this check cannot be performed correctly in less than ten minutes.

Even if an athlete doesn’t show any red flags, SCAT5 tests can show whether or not a bad head injury has surfaced.

Worryingly though, in yet another reminder that this must be taken more seriously, athletes with a ‘normal’ SCAT5 outcome can have delayed symptoms in rare circumstances. That’s why hiring a team of specialist neurologists makes perfect sense, because they would help to provide better and more practical evaluation.

No Need to Gamble

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If these risks don’t ring the FA’s alarm bells, they should just take a look at what has happened to their 1966 World Cup winning squad.

The recent death of Nobby Styles and Sir Bobby Charlton’s dementia diagnosis show that the long-term impact of concussions in football are very severe.

Let’s not gamble with footballer’s lives. Instead, let’s protect everyone involved in the sport across all levels. Then, and only then, can we continue to enjoy the game that we love without fearing further repercussion.

If you or someone you know is struggling, UK mental health charity Mind maintain a list of helplines and services.

And if you’re reading this from outside the UK, you can find a service near you at CheckPoint.Org.