Coaches, Doctors or Refs: Who to trust with players' health?

By Paul Gardner

LONDON -- You may have noticed that Jose Mourinho has plenty to say. You may also have noticed that virtually everything he says has Jose Mourinho as its focal point.

A nice example of just how greatly Mourinho values his own contribution to everything cropped up last week. He was talking about Chelsea's upcoming game at Manchester City. A super-big game, obviously, so Mourinho was explaining the difficulties that the team faced.

Well, not quite -- he was explaining the difficulties that he faced.

The most vexing problem concerned the fitness of the club's new striker, Diego Costa. Would he be ready to play? According to Mourinho, he, Costa and the team doctor got together and jointly decided that Costa could play. Evidently with some trepidation. "It's a risk, but one I have to take," said Mourinho. He's decided to put a possibly unfit Costa on the field, jeopardizing the player's recovery from a hamstring injury ... but we are supposed to feel sorry for Mourinho because, in his egocentric view of things, he -- and not Costa -- is the one taking the risk. It's a risk "I have to take."

He could have said "We have to take." Not him. Oh, poor, hard-done-by Mourinho.

Setting aside the agonies faced by Mourinho (it's not difficult to do that) the incident has a much greater significance.

Something similar happened on Saturday during another EPL game, between Newcastle and Hull. With Newcastle trailing 2-0 and Coach Alan Pardew's job on the line ... a risk had to be taken. So Pardew sent on Papiss Cisse. What a move -- Cisse scored twice, the game was tied, and, quite probably, Pardew's job was saved.

But Pardew had gone further than Mourinho. He had actually ignored the advice of the team's medical staff. They, it appears, were advising ("imploring" is the word used in The Observer) Pardew not to put Cisse on the field.

“Papiss shouldn’t have played,” Pardew admitted, “My medical staff did not agree with my decision to involve him. He’s had five days’ training and they told me he wasn’t ready, but my eyes told me different."

I'm wondering whether Mourinho's words ("A risk I have to take") or Pardew's ("My eyes told me different") would be, could be, used these days in the USA -- by an NFL or an NBA coach, for example. I don't think so. The threat of legal action should things go wrong is much more clearly understood in the USA. Of course, not-fully-fit players are used in the NFL or the NBA. We've heard about too many cortisone injections to have any illusions on this point. But a flat-out admission is not likely.

Soccer has a lot to learn. We saw, during this summer's World Cup, the Uruguayan team doctor -- who judged that an injured player should be removed from the game -- being over-ruled by the player himself. So who has the final say, whose is the authoritative voice? Surely, it ought to be the doctor's -- the only one with the medical knowledge to assess the seriousness of an injury, to calculate the risk of long-term damage.

This is, to put it mildly, a very tricky situation. If a player says he's OK to continue playing, if the coach feels that the player's presence on the field is vital ... what an impossible situation for the doctor. The pressure on him to OK the player's return to action will be immense, while his own resolve may be undermined if he knows he is simply acting with caution -- employing a better-safe-than-sorry approach.

I've been talking about pro soccer, obviously. But the vast majority of worldwide soccer games take place without a doctor in attendance. Then what? It gets even trickier because the person likely to become involved in decisions of this sort is the referee. So maybe the referee -- particularly a referee of youth soccer -- should receive special medical training? Maybe that would work -- if the coaches are ready to accept his word, and to realize that he's going to be even more cautious than a doctor.

But realistically, this is not the referee's job. Doesn't he have enough to do, enough responsibility, already? So we're back to the coaches. Can they be relied upon? I would like to think so, but ... when the game is a crucial one, when the guy's job is on the line?

All of this has recently become an absolutely central issue in sports. Because of the growing concern over the dangers of concussion. Soccer, as the only sport in which the head is used to play the ball, should be paying close attention to the medical and legal developments.

It should be making all players and coaches and referees aware of the intricacies of the situation. It should be issuing detailed guidelines for coaches and referees and players. That is a role for FIFA. A role that has not been taken up.

I have yet to see a statement from FIFA that acknowledges the seriousness of the issue. The general tone of FIFA's approach is one of complacency, that there is no reason for concern, that there might have been, years ago, but things are different now, the equipment is better, the players are better trained ... so just keep on playing.

Without any guidance from the top, it is inevitable that individual leagues or clubs or federations will take their own measures to address the matter -- both as a health issue and as a legal liability. And it is just as inevitable that such moves will begin in the USA. They have begun, with the so-called soccer moms' lawsuit. That is directed at FIFA -- but it should be seen as a friendly lawsuit, a timely reminder to FIFA to do what it has so far failed to do -- to issue a detailed concussion policy.

And at this stage of the discussion, my feeling is that there is only one course to be adopted. By everyone. Extreme caution. At youth and amateur level, players suffering blows to the head must be taken out of the game. At the pro level the doctor's opinion must be final.

FIFA should also be considering changes in the rules of the game. It should be looking into ways of reducing the frequency of heading in regular play, even facing up to the extreme possibility that heading the ball may have to be banished from the sport. The necessary reminder: We're talking about brain damage.

8 comments about "Coaches, Doctors or Refs: Who to trust with players' health?".
  1. Tom Symonds, September 21, 2014 at 9:01 p.m.

    150 years of football history, a game played by countless millions across the world, surely, Paul, you've got some stats from that century and a half to firmly establish the magnitude of the "heading causes brain damage" problem you're so adamantly asserting. Present the evidence. The necessary reminder: We're talking facts, not fiction.

  2. R2 Dad, September 21, 2014 at 9:47 p.m.

    Important topic, thanks for taking this up, PG. Not long ago I refereed a match in Cal-N, I think it was the final for BU15 for one of these lower-level Cup series (not state cup). Let's call it the most skilled kick-and-run teams in NorCal. One team's captain, a center back, clashes heads with an opponent (there were a million headed balls, since kick-and-run). The kid stays down. I stop play, the centerback comes out for treatment, and the half ends. At the half, the officiating crew discusses this incident, with the AR informing me that the kids was kind of out-of-it on the sideline. Regardless, the coach wants to insert him back into the game. Our position (supported by league officials on-site) was that we needed independent medical evaluation to approve this before he was allowed to continue play. The coach, who was the kid's dad, insists the kid was fine. We asked if he had any previous head injuries, and the coach says, "Yes, a month or two ago, but he's fine now". I knew enough from attending a seminar on head injuries in 2013 (2014 link: that I was in no position to determine player health, plus the liability issues here are Huge. The player did not continue, but if the coach has his way that kid would have gone back in. The big take-away for me is that repetitive head injuries might not always happen at the professional level--it's the middling youth players who don't know better who might be most at risk. Go find out what's happened to really good rec players who have a low soccer IQ and skills. Maybe that's where the most damage is being done.

  3. Allan Lindh, September 21, 2014 at 10:10 p.m.

    Right on Mr. Gardner, you've come right out and said it. Heading will be gone in the coming decade, start now by banning it from youth soccer, then move the cutoff age up, year by year. And without heading, kids can start wearing soft helmets to protect them from hitting the ground, the post, boots, etc. The beautiful game is played on the ground, with feet, and traps -- without heading the box will no longer be clogged with low skill, low IQ behemoths smacking each other around. Viva le beautiful game.

  4. Kent James, September 21, 2014 at 10:39 p.m.

    In a game I played last night, I headed a punt; the ball was very high, it was windy, the lighting was bad so I was having some trouble seeing it to head it properly...I got it, but a little higher on my head than I would have liked, and it was quite jarring, and my first thought was "yeah, there's probably something to this heading and brain damage thing", but of course, the pain was momentary (and mild), so my second thought was "nah...". I do think heading is one of the unique things about soccer, and makes it more of a three dimensional sport. On the other hand, I understand Allan's point about "low skill, low IQ behemoths smacking each other around". Heading punts is rarely pretty (though one deftly flicked on is nice). But heading (and the equally important crossing of the ball, another PG pet peeve...he does have a few, doesn't he?) can be skillfully done. Dumping the ball into "the mixer" to see who can crash it into the goal is ugly (though sometimes exciting for a bit), but precisely aimed crosses that are hit home with precision and power are beautiful to behold, and should only be banned with there is evidence that it is unhealthy. Most young kids don't have to worry about heading the ball because they can't get the ball in the air to begin with, but it might be wise to eliminate heading the ball below U14, just to be safe.

  5. uffe gustafsson, September 21, 2014 at 11:42 p.m.

    Sorry but your comments are really sad.
    There is plenty of balls hitting players in the head how about a rocket in your face had that happen on more then one occation. Took the player out and told coach I don't want her back on the field, sure enough a few minutes she was back out, send her back to the bench at next break.
    Really we want kids out on the fields with head injuries, as in you can see they are woosey after a ball in the head area.
    We now have orders as refs in our club to take em out and it over rides any coach. That is the proper way to do it.

  6. James Madison, September 22, 2014 at 7:38 p.m.

    Head to head, head to body and head to ground is one set of things. Ball to head or face(or some other vulnerable part of the body)is quite another, except for a point-blank shot. Obedience to medical advice is wise when injury may have occurred. Taking heading out of the game is nonsense.

  7. Rick Estupinan, September 22, 2014 at 10:49 p.m.

    If it looks like the Portland flag it is great then , In America , there are no better fans than the Portland fans, They are even more vociferous,colorful and entertaining than the best in England.And most of all,very knowledgeable of FOOTBALL / Soccer, as they call the sport here . I am tired of looking at that logo - cliche , of the ball and the boot . A school kid could have designed that .

  8. Rick Estupinan, September 22, 2014 at 11:37 p.m.

    dental bills would be.

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