July 19, 2014
World Cup – The Wrong Kind Of Knockouts
The later games of the soccer World Cup are named the “knockout” stages, possibly for the wrong reasons. Have you ever suffered from concussion? It’s not a great place to be is it? I have a few lumps and scars on my old head to remind me of the occasions when I’ve been out cold. As one of the world’s worst ever Rugby players (League and Union), I was too slow to get out of the way and got knocked out twice. I must also be one of the few people who got KO’d by a cricket ball. For non-believers, cricket is an ancient English rain-making ceremony. Two batsmen from one team and eleven “fielders” from the other team walk onto the carefully manicured grass pitch, throw a bright red leather ball around for a while and thereby almost inevitably precipitate the precipitation that results in the familiar “Rain stopped Play” notice. Back to concussion – I also experienced a more serious loss of consciousness in my 20s when a motorcycle hit me (I told you I was slow) as I was sauntering across a busy road. Witnesses described my graceful ballistic flightpath and elegant pirouette (for which, sadly, I can take no credit) and a rather less elegant landing as my left temple hit the roadside curb edge after a fall of about six feet. I came around in the ambulance and further distinguished myself by projectile vomiting on the crew. This time I felt ill, very ill. In those days, I’d do anything for attention.
I may seem to be making light of my own experience, but concussion is really no laughing matter – recovery takes time and the harmful long-term effects are only now being researched properly. All this came into focus in the World Cup in Brazil when the conflict between player safety and team success became evident following one particular incident. In the game between England and Uruguay on June 19th, the Uruguayan player Alvaro Pereira took a nasty blow to the head in a tough tackle situation with England’s Raheem Sterling. Pereira certainly appeared to lose consciousness. At times like this, the stakes are high and no player wants to come off the pitch. In spite of the advice of his team’s medics, Pereira wanted to stay on and did – this was the World Cup after all. With so much pressure around – the player wants to continue, his team management wants their best players on the pitch – reason can fly out of the stadium. I am convinced of one thing – the last person who should have any input into the decision is the player whose brain has just been scrambled.
The Pereira case was by no means an isolated incident. But the decision to allow him to remain on the pitch caused the World Player’s Union (FIFPro) to call for FIFA, international soccer’s governing body, to review its concussion protocols, which they claim “failed to protect” the player. Leaving the decision solely to the team’s own medical assessment is, they say, fraught with danger and they would like to see independent input into the process. One innovation they suggest is that when a player is suspected of having a possible concussive injury, they should be allowed to leave the pitch and be replaced by a temporary substitute. If, after independent examination that uses pre-formulated guidelines, the player is found to be free of concussion, the substitution can then be reversed. This would take the heat out of the process and allow time for proper evaluation. A similar procedure already exists in some sports. In Rugby League, for instance, there was the “Blood Bin” system whereby a player with an injury resulting in bleeding could have a temporary sub.
Pereira’s case raises concerns far beyond that one particular game. The UK medical journal The Lancet has taken up the issue. It takes FIFA to task over its apparent failure to implement its own proclaimed “recognise and remove” policy. As The Lancet points out, not only are there immediate and serious risks following concussion, the long-term dangers are worse. Sports that involve repeated head injuries (boxing being the classic example) could result in a range of conditions, including “dementia, amyotrophic lateral sclerosis, or other neurological disorders”.
Back in May of this year, this issue was considered, so important, that US President Barack Obama headed up a conference to tackle the problem as it affects children’s sports. The Healthy Kids and Sports Concussion Summit was set up to promote better safety in children’s sports. With an estimated 250,000 children and young adults attending hospital emergency departments in the US each year with brain injuries caused by sport and recreation, there is a lot of work to be done.
Maybe the FIFA 2014 World Cup will be the tournament that will trigger a change in the understanding and management of sports head injuries.
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