Soccer & Concussion (Part 1): A Disgraceful Lack of Action -- Protocols are not enough

By Paul Gardner

There is, it seems to me, one thing above all others that soccer totally failed to get right in 2016. And I can see little to suggest that things will be any better in 2017.

Head injuries. Specifically, concussion. Not a minor matter. A deeply serious problem that keeps getting more serious as research exposes new dangers.

Now, it is not unknown for early research in medical matters to be unbalanced, even to be unduly alarmist. That may turn out to be the case with some of the more dire warnings that we are getting about concussions. But for the moment, uncertainty rules. Given what is at stake here -- serious medical issues, the end of a career, a post-career life full of mental problems -- there is only one approach that can be justified: caution.

Caution which soccer needs to apply in two ways: 1. By taking steps to reduce the incidence of head injuries during games, and 2. By making sure that the dangers of concussion are fully understood, and that specialized medical advice and treatment is available wherever possible.

How does soccer score on those two fronts? Very poorly. This is worse than disappointing, it is disgraceful. Soccer, as the only sport in which the head is repeatedly used to play the ball, is always going to be regarded, rightly or wrongly, as a likely source of concussions. Because of this unsought prominence, it has a leading role to play in the search for safe sporting activity.

Yet it has done virtually nothing to look at itself and ask whether changes in the way the game is played might reduce head injuries. I say “virtually nothing,” because there is one exception: U.S. Soccer, which has issued a diktat banning heading in under-11 and younger age groups, and has made a number of other moves showing that it is aware of what needs to be done.

Elsewhere the sport has made no effort at all to cut down on head injuries. It has made some moves to promote better understanding of the problem with the aim that concussion injuries are quickly detected and that medical help is available as soon as possible.

Frankly, that is putting the cart before the horse. If you have a traffic black spot where accidents and serious injuries are frequent, you need to install traffic lights. To say Sorry, no lights, they would impede traffic flow ... but we will offer better hospital treatment to the victims, is a callous evasion of responsibility.

Yet that is exactly what soccer is doing. Rather than taking steps that might -- or would -- reduce the number of concussion injuries, soccer is instead relying its so-called “concussion protocols.”

Words, of course. Words. Dressed up with that legal-sounding protocol title. But where concussions are concerned, when players’ futures are at stake, words are not enough. Words are only helpful if they lead to action.

If no action follows the words, then we are surely entitled to look askance at the protocols, to wonder if they are being used as a smokescreen to avoid rather than to initiate action.

I am basing that opinion on my own observations of the pro scene. That is where the money and the personnel are available to make sure that the protocol can be most vigorously enforced. That is where the standard should be set.

And what do we see? Because soccer has made no effort to ensure otherwise, we see what we’ve always seen, plenty of heading and plenty of head clashes. Then, we are likely to see something different: Referees are now quicker to stop play and wave “medical personnel” on to the field. (Incidentally, does “medical personnel” include the physio? Or must a physician be present? The protocols and guidelines that I have read are not helpful on this point).

Anyway, so far so good. So far -- and, it seems to me -- no further. How many of you have seen an incident in a pro game where, after “medical personnel” have entered the field to inspect a head injury, the player has been withdrawn from a game? Possibly it has happened. I have not seen it.

Much more frequent is the type of incident that happened in a recent EPL game between Manchester City and Crystal Palace. The Man City captain Vincent Kompany took a tremendous whack to the head, a frightful blow that sent him crashing heavily to the ground. Play was stopped immediately, on came the Man City physio. I suppose some sort of rather superficial tests were conducted, then Kompany -- who had looked decidedly shaken in the TV close-ups -- got to his feet, walked off -- and within a minute was back on the field.

How on earth could that be? Kompany had just taken a ferocious, sickening blow to the head -- yet within a minute or two he had been judged fit enough to continue in a game where he was quite likely to take further hits. As far as I could see, Kompany did not get hit again but within six minutes he was crouching on his haunches, unable to go on. This time he left the game for good.

This incident raises a couple of crucial points about the protocols. As so often happens when objective scientific detail starts to take over from personal observation, the much derided “common sense” is abandoned. Yet in the Kompany case, my strong feeling is that the protocol was unnecessary -- worse, an obstruction -- to the taking of the correct action. Surely, no one who saw the collision needed to consult a protocol, or ask some simplistic questions (“What venue are we at today?”… “Which half is it now?” are two of the recommendations) to know that Kompany needed to come off the field?

But the protocol tests were duly applied and Kompany went back in -- presumably with the approval of the ManCity doctor. That is what the protocol recommends “in all cases of suspected concussion” - and it is inconceivable to me that a player who took the almighty wallop that Kompany took could not be suspected of having concussion ... whatever the protocol tests might show.

Another vital point raised by the Kompany incident concerns the role of team doctors. Can they be trusted to give an objective assessment of the player’s condition? Are they not under pressure by their employers -- the pro club, that is -- to favor getting a key player back into the game?

There was a famous first-half incident during the World Cup final in 2014 when the German player Christoph Kramer took a heavy blow to the head. TV viewers could see an obviously dazed player -- yet, after inspection, he was sent back on to the field. Later, referee Nicola Rizzoli reported that Kramer had asked him “Is this the final?” After 13 confused minutes, Kramer, thoroughly disorientated, was substituted. How can anyone believe that he should have been allowed to return to the field?

An even more baffling and worrying take on the medical requirements came from, of all people, FIFA’s chief medical officer, Jiri Dvorak. During an EPL game in November 2013, Spurs goalkeeper Hugo Lloris, diving at the feet of Everton’s Romelu Lukaku, had taken a severe bow to his head from Lukaku’s knee. Although obviously dazed, Lloris was allowed some time to recover, and the game then continued with him still in the Spurs’ goal. Dvorak’s criticism of Spurs was uncompromising. He asserted that there was a 99% probability that Lloris would have had a concussion and "should have been substituted.”

Yet, some six months later, Dvorak supported the German decision to send Kramer back on to the field in the World Cup final. The close parallels with the Lloris incident were too obvious to ignore. So how come Dvorak could flay Spurs, then support Germany for doing the very same thing? It has been pointed out that there was one glaring difference in the two incidents: Lloris’ injury had occurred in a game under the aegis of the English Premier League, whereas Kramer’s injury came in a game controlled by FIFA ... which was, at that time, Dvorak’s boss.

Thus, the whole idea of a protocol -- any protocol in any sport -- is bound to be suspect if it needs to be enforced by staff members whose employers might well think differently.

Soccer & Concussion (Part 2): What needs to be done -- before the lawyers move in
28 comments about "Soccer & Concussion (Part 1): A Disgraceful Lack of Action -- Protocols are not enough ".
  1. Bob Ashpole, January 8, 2017 at 3:12 p.m.

    USSF doesn't even follow its own protocols. I am still upset about Michelle French's actions during the U20 WNT match with North Korea. The officials deserve at least as much blame. I have no respect at all for a doctor who clears players to play and then sends them to the hospital after the match. I suspect Ellis already regrets her choices. Probably 99% of coaches would have done the same thing, but that doesn't make it right.

  2. Bob Ashpole replied, January 8, 2017 at 3:13 p.m.

    Given the nature of official soccer in the US, I don't expect the press to cover that story any time soon.

  3. Ed M, January 9, 2017 at 10:01 a.m.

    Concussions are a problem all over not just with soccer. This "article" fucoses on the issue only in soccer while claiming that soccer is the only sport that has an issue when it isn't.
    The writer also makes a claim that nothing had been done and leaves out the most important piece of youth soccer. The issue in professional and international must be separated from youth soccer to be able to give a fair and more accurate portrayal of the concussions in soccer. There is much more at stake at the pro and international level than in youth and the not so frequent head injuries in that level(unlike the implication by this author that it is happening all over the place). Coaches lose their jobs if their team loses. A mandatory period of time that each player involved in a head injury would solve that problem.
    It's nice to write about an issue in soccer and make it sound written with some authority. However, this article leaves out and suggestions while only mentioning a few incidents that have occurred over almost a 4 year period.

  4. Jay Wall, January 9, 2017 at 10:02 a.m.

    The vast majority of soccer participants in the United States are over 4,000,000 youth, teen and young adult players.

    A child's brain at birth is enclosed in a skull that has 5 inmature bones and a lot of soft tissue between them. The brain is at high risk of injury when not protected by a mature skull. The bones on a human child DO NOT MATURE until they reach skelatal maturity as late teens.

    The vast majority of players are young and at higher risk of injury, including brain injury when well intented coaches and parents yell at them in games breaking their focus and keeping them from being aware of their surroundings including where the ball, players and the goal post are. As long as coaches and parents yell players will not be safe because they will not be able to focus.

    In addition players under the age they reach skelatal maturity should not be allowed to use their elbows to push off players when heading, head hard fully inflated balls and should be taught to tuck and roll when falling to the ground to break the impact of hard falls.

    Soccer should teach all coaches and parents what is required to keep children who have not reached skelatal maturity safe.

    With respect to heading players should not be permitted to head until their early teens and even then only be premitted to head with underinflated balls or beach soccer balls, which are very much like volleyballs.

    Heading wet balls which weigh much more should never be permitted prior to skelatal maturity which give or take 2 years is in the late teens.

    Nice artcle but the focus on professional high level adult players misses the 4,000,000 players at the greatest risk of the injury.

  5. Barry Ulrich, January 9, 2017 at 10:41 a.m.

    Why are concussed GK permitted to remain on the field after being attended to by a "doctor" on the field? Why should a GK be any different from a field player when we're addressing the concussion issue? I know that a game cannot be played without the requisite GKs. There should be discussions about what to do in these instances. Another component of the serious injury (concussion, broken bone, etc.) is the 3-player substitution in TLOTG. Had the player not been injured, s/he would not have had to be substituted. Yet the player's team must use one of their three subs. I would argue that the substitution should not be counted as one of the three players.

  6. Robert Parr replied, January 9, 2017 at 2:30 p.m.

    The obvious concern with adding an allowed substitute following an injury is that players then have an incentive to fake injuries to gain an additional substitution. I'd suggest a reasonable compromise to align incentives is to allow the extra substitution only if (A) the referee has stopped play to have a player examined for a possible concussion/head injury, and (B) that player is pulled from the game immediately and does not return. If the medical/coaching staff elects to return the player to the game, then the option to later replace without using an allowed substitution should no longer be available.

  7. Dennis Mueller, January 9, 2017 at 11:41 a.m.

    Leaving any decision to medical staff employed by the clubs involved is fraught with conflicts of interest. What are needed are simple non-subjective tests to determine concussion. There is one I know of; it involves dropping a ruler positioned between the player's thumb and fingers and measuring how far it falls before he can catch it, then comparison with a pre-season value (when presumably there was no concussion). One down-side is that players could game the system by being slow in the pretest so they would not be forced out of a game by the test. Other non-subjective tests must be developed, because I doubt this test is perfect and confirmation of a concussion by other means would increase the accuracy. Prevention, at the professional level would likley include what is allowed in challenging for a head ball. For example, banning non-vertical jumps or using the arms to assist the jump are things that would require a major retraining of players to avoid what are natural actions when trying to win a head ball.

  8. Bob Ashpole replied, January 9, 2017 at 4:50 p.m.

    I support your approach, but I taught jumping vertically with a shoulder turned toward the marker (to make your space larger) as technique. The shoulder really worked for me and is much more effective (and safer) than using arms to fend off other players. Even if a player has narrow shoulders, the shoulder still acts as a buffer compared to letting an opponent approach from the front or rear.

  9. beautiful game, January 9, 2017 at 11:50 a.m.

    It's time to bring global football into the 21st Century...if a player is stretched out after a head injury, he needs to be substituted and evaluated properly; it's better to err on the side of addition, the nebulous LOTG need to be restructured in order to put all officials on the same page; i.e., all professional fouls are cautioned, off-side is dictated only if there is clear & total advantage, delay of game cautions for defenders picking up the ball after a foul, etc.

  10. Doug Broadie, January 9, 2017 at 12:21 p.m.

    Most head injuries occur when a player goes over another player to win the ball. When I took my ref courses many years ago, I was taught that the space above a player is his and if it is invaded, then it's a foul and free kick given to the offended. If this were the case today, you would have less head injuries. Of course, you would need to have the referees actually enforce this and they can't seem to actually follow the laws of the game as it is.

  11. frank schoon, January 9, 2017 at 12:36 p.m.

    I think we better take a step back before we get to a point
    of no return where upon we mess up a game that has been around for over a hundred years in which heading has always been part of the game. Being from Europe and seeing how Americans react to things with the end result usually going to extremes. For example It is unbelievable when I see kids here 6 or 7 year olds on a little razor scooter going about as fast as when walks wearing a helmet or a kid on tricycle wearing a helmet. We're getting to a point that these kids need to be bubble wrapped.
    For example look what happen to PC "political correctness' which began sometime in the 80's and see how it has effected things. This is what I'm afraid of happening to the game
    I never liked heading the ball . As a matter of fact I tell my players head (if it is a sure shot) the ball only for a goal or to pass . I tell them never go up for a head ball with an opponent around midfield for it is a total waste of time and effort for several reasons. One, most of the balls won and headed at midfield, the person heading has no clue where it is going next or have any control of it. Two , winning the header at midfield is so ridiculous for half of the time it goes to the opponent. Three, winning a headball 50 yards from goal doesn't prove anything. (look at Barcelona's midfielders they are not players build to win headballs). Three, who wants his nose broken going up for a headball at midfield. Four , I was taught at Ajax as a youth to not try going up for a headball with an opponent around midfield, but instead take a couple steps although pretending to go up and a lot of times times the opponent will end up heading it right to you. Five, if you go up with someone for a headball do so to impede him but so much as to win it.
    And of course, there are situations that should have been handled better when it comes to injuries..granted but be oh, so careful of the slippery slope.

  12. Bob Ashpole replied, January 9, 2017 at 5:08 p.m.

    I agree with you Frank. As far as head injuries go, I saw more eye injuries than concussions. Yet no one talks about symptoms of a detached retina.

  13. frank schoon replied, January 9, 2017 at 6:23 p.m.

    Bob, I think one of the problems we have in America is that here the players play more physical. The more skilled and technical a player becomes the less fight. Just look at Barcelona, their players are not wild and think the game a step ahead for that is required playing a positional style soccer. I remember soccer beginning in high school in the northern virginia. I found that the popularity of the game in the early 70's began to grow because players were beginning to get injured. remember in the early days soccer was thought of a game as for girls. But seeing soccer players in HS walking the halls injured in a cast or other like the football team players gave them a right of passage as well thereby giving soccer a more masculine identity. I see the same problem with soccer injuries with girls. Girls get injured because they don' t anticipate and go in to a situation with wild abandon when they don't need to. This is another aspect why street soccer was so good in a youth's development in my days for you can't play wild on concrete but smart. By playing on concrete you settle down as a player and which carries over on a grass surface.

  14. Bob Ashpole replied, January 10, 2017 at 12:08 a.m.

    I never had the youth soccer experience. I grew up in Michigan in the 50s and 60s. When Pele became a teenage sensation in 1958, I was 7 years old. There was no organized soccer. I blame the violence in the game on the adults. The kids attitudes are learned. In my view a lot of coaches have been teaching life lessons that are the opposite of what I taught. How to compete within the rules vs. how to win by cheating. I blame the movement of youth sports away from an educational setting into private clubs run by parents.

  15. beautiful game replied, January 10, 2017 at 9:20 p.m.

    You guys want to see headballs; watch an MLS game when 75% of the headed balls can be settled or redirected.

  16. frank schoon replied, January 11, 2017 at 12:38 p.m.

    I W , Please don't get me started on the MLS

  17. Pasco Struhs, January 9, 2017 at 12:46 p.m.

    I'm probably going to get hammered with comments on this but here are my thoughts. First, we need to better understand what does and does not cause a concussion. Not sure what entity should undertake this. This should be a FIFA issue, but I'm not sure I would trust FIFA to undertake such a study due to the obvious conflict of interest. Perhaps FIFA should pay for a third party to perform an independent study. Here are two rules to consider. RULE 1: Player's suffering a concussion should be required to leave the field for the remainder of the game. Referees, with the assistance of an on-field medical representative, should be in charge of enforcing this rule. I agree that some rule should be put in place so as not to penalize a team for replacing a player who suffers a concussion. We can debate about why a concussion should be handled differently than say a torn hamstring or broken leg, but perhaps we should simply evolve to the thinking that any substitution for medical reasons should not count against the number of substitutes that a team can have. I'm certain that FIFA could come up with a workable rule that would prevent players faking injuries simply to allow for a substitution. RULE 2: There are many ways to suffer a concussion (e.g., body collisions resulting in a head hitting the ground, goalkeeper collisions with knees, feet or end posts, etc.) but certainly one way is the result of heading the ball because either (1) the ball hits the head with excessive force or (2) the more likely event, the head collides with another's head when attempting to head a ball. If after the study mentioned above, it is determined that concussions are likely to occur as a result of either (1) or (2) above, shouldn't we consider eliminating or limiting the act of heading in all of soccer (professional and youth). One can make an argument that professionals are paid handsomely to assume the risk, but I'm not sure how you square that with the common belief that PEDs should be banned because, if they are not, it forces athletes to take them and risk harm in order to be and remain competitive.

  18. Robert Parr replied, January 9, 2017 at 2:35 p.m.

    Very, very, very few concussions are the result of deliberately heading the ball. The vast majority of concussions are the direct result of foul play. Granted, many of these fouls occur when players are attempting to head the ball, but that doesn't change the root cause. The concussion usually comes from being struck in the head by an opponent or by the ground. Enforce the Laws as they exist more diligently (esp. through the use of cautions and ejections), and you'll do more to reduce serious head injuries than you can achieve through any other means.

  19. Bob Ashpole replied, January 9, 2017 at 5:03 p.m.

    The problem with your suggestions is that concussion is defined by symptoms, not by a cause. So if someone sneezes and has the symptoms, they have a concussion. Determining a cause is difficult because there may be no single cause of a concussion. The other problem is that the clubs and coaches put form over substance in order to allow players to re-enter the match irregardless of the danger. At any level, the players well being should be placed above a match. Putting a player back into a match after displaying symptoms of a head injury is putting that player's playing career at risk, not to mention their quality of life outside of soccer. What is required is simply prudent coaches and competition rules. LOTG don't need to change.

  20. Filip Bondy, January 9, 2017 at 1:16 p.m.

    I would start by banning all head balls everywhere but inside the box. Think about it. There really aren't that many headers at midfield that determine much of anything -- particularly when they are contested. Contest them with chests and feet instead. At the very least, this should be the rule right through high school.

  21. R2 Dad replied, January 9, 2017 at 4:54 p.m.

    "If the keeper can't boot the ball 40+ yards with all their players huddled around midfield awaiting that prized 2nd ball, it's no longer soccer.It's useless keepaway possession shuffle ball, balls going side to side and backpasses to the keeper. Not very manly, macho or aggressive. Weenie ball, for teams full of players that can't run a 10K every match. Keepers passing? That's for weenies. Manual Neuer is just a big dribbling softy! Joe Hart is how real keeper play! Big and manly, with a 70 year clearance in that foot of his. Trapping with your feet and chest? Useless when a good hard head is all that's needed. Real soccer players run around dazed and bleeding half the time anyway." Michelle French U20 WNT coach, thrilled with her team's 4th place finish at the U20 World Cup in Papua New Guinea, on her team's style of play and heading prowess.

  22. Ben Myers, January 9, 2017 at 6:03 p.m.

    US Youth Soccer took a half-step forward recently by banning (intentional) heading during matches at ages below U14. Still, the way in which they did it muddies the waters, because it is still OK to practice heading.

    I came to the same conclusion a few years ago while running a training session for some talented U12 boys. Talented they were, but after 3 or 4 practice headers and complaints by some that their heads hurt. They simply did not have the motor coordination to contact balls with the forehead, and some did not get the idea that the forehead was the best and only point of contact. Too many balls hit the tops of heads, where the seams in the skull come together. I called a halt to heading, and we never even practiced it again thru both fall and spring seasons.

    The Center for Disease Control has first-rate materials about concussions and their risk, plus a very good on-line Concussion Awareness test, now required by many youth leagues and state associations. Many state high school sports associations now mandate that at least one parent of a student athlete take the Concussion Awareness.

    So what is next? Bend the minds of the elite coaches, both amateur and professional, to understand that winning matches and their careers are less important than a player who stays in the game with a concussion and feels the worse for it.

    Better still, change the three-substitute rule in force in most competitions and pro leagues to allow additional substitutions for concussed players.

  23. Bob Ashpole, January 10, 2017 at 12:13 a.m.

    Concussions cannot be eliminated from contact sports and are not really the problem. The problem is in what happens after a player is injured.

  24. uffe gustafsson, January 10, 2017 at 5:21 p.m.

    R2 dad that was a comment made to make fun, I hope.
    Correction on heading the ball not getting concussions, our girls team in the last 2 years have 3 girls concussed all by heading goalie punts. None by clashing heads.
    So not really sure where some of got your info.

  25. Robert Edwards, January 11, 2017 at 10:48 a.m.

    This Year in The House Of Representatives State House Boston Mass I have filed a bill to allow soccer players to wear head gear to prevent concussions in soccer/ High School and college under federal standard.

  26. frank schoon replied, January 11, 2017 at 5:19 p.m.

    Leave it up to the LIBERALS to mess up things with more rules and regulations to boot

  27. uffe gustafsson, January 12, 2017 at 5:22 p.m.

    Let me remind you of hockey, back in the days you seem to long for, they had no helmets or any head protections.
    I remember every hockey player had no teeth left in their mouth and noses that never looked straight. Today they have helmets and visors to protect head and face.
    You think hockey players like to go back to no protections. How about the goalies now with facemasks and throat protection.
    I would like to see u out on the ice w no protection. It's called progression and soccer need that as well.

  28. frank schoon, January 12, 2017 at 6:22 p.m.

    Uffe, On hockey ,I can understand it for they play on a hard ice surface which in itself is dangerous to play on and they continually hit each other. I don't like it as a sport for I think it is way to violent. No comparison to soccer. Most of the head injuries can avoided when two players go up for a head ball, very simple. Yes, there will be injuries at times like in most sports. ( read my first comment near the top on how to avoid head butts in soccer). I can see a goalie wearing something like the goalie for Arsenal ,I think, or a field if he feels comfortable wearing one. But I feel uneasy making laws and rules or regulations by people who have never played a decent high level

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