Commentary

Rugby, not soccer, pursues promising concussion test

By Paul Gardner

I am being reluctantly forced to the opinion that official soccer’s attitude to concussions entails the utmost cynicism.

I have read, with care, the so-called concussion protocol -- the series of tests that are -- we are told -- required to be administered to players suspected of suffering from a concussion. A complicated business. As it should be ... because we are dealing with possible brain damage here.

If I am reading the protocol correctly, it must be a medical doctor who makes the final decision on whether a player can re-enter a game. I must, by now, have watched dozens of players undergoing these tests, on the field and on the sidelines. Often it is unclear whether the people conducting the tests are medical doctors. Which already throws doubt on the validity of the tests and the decisions. But that is not the most serious doubt. 

The protocol reads like a lengthy procedure. How lengthy? I have asked around, among people who should know, just how long it takes to complete the tests. Twenty minutes minimum was one answer. Another came in at six minutes. That was the quickest.

I’ll go with six minutes. I am quite certain that I have never seen a player being assessed for as long as six minutes. Not in any game, at any level, in any league.

Let me underline that most of the games that I watch are pro games, at the top level of the sport. Games where all the necessary facilities are available, where doctors are on duty.

If the protocol is being ignored at that level, it is reasonable to assume that it is even less observed in the vast  majority of amateur and recreational games throughout the world.

A recent MLS game between the Montreal Impact and Toronto featured a typical -- it could almost be called classic -- incident of a goalkeeper (Toronto’s Alexander Bono) diving at the feet of an opposing attacker (Montreal’s Dominic Oduro).

I have stated my opinion before that under FIFA rules, in such a play the goalkeeper should be penalized for dangerous play. They never are. In this incident, Oduro -- trying to play the ball, as he was perfectly entitled to do -- and Bono collided. Bono, with his head down near Oduro’s feet, was injured. As one would expect.

The replays were clear and alarming. Bono had taken a heavy knock to his head from Oduro’s knee. It looked very bad.

An incident that urgently cried out for the immediate application of the protocol. Or even made one think that the protocol was superfluous -- that, after such a heavy hit to his head, Bono should be quickly sent to the hospital.

Whatever, on came the medical staff. Bono was treated on the field. And presumably tested. The game restarted with Bono still on the field.  Bono’s assessment -- the protocol -- had taken just over three minutes.

Referee Robert Sibiga called a foul on Oduro. Of course. But at least he avoided bigger fault of giving Oduro a yellow.

There is even more to complain of. At a purely practical level, the protocol is unlikely to be applied properly because it requires a team to play for six or more minutes with only 10 men, or -- if the injured player is a goalkeeper -- for the  game to be halted for that period. 

The Oduro-Bono incident, with its permission of a play which virtually invites head injury, with its faulty referee call, and with its surely too-brief protocol procedure demonstrates clearly just how little thought soccer is putting into the concussion issue. 

A sport that does much better is rugby. It is the rugby people who have announced that they are to conduct trials of a totally new approach to diagnosing concussions: a saliva test.

We’ll look at that in a moment, but first a pause as we try to understand why it was rugby, and not soccer, that responded to the new research.

Simply this, I think. Because rugby is a sport that takes concussions very seriously. While soccer -- which, as the only sport that allows the head to be used to play the ball, ought to be greatly concerned -- shows little interest.

The saliva test being investigated by rugby, is a result of research conducted by Tony Belli, a neurosurgeon at Birmingham University in England. He has found that an increase in certain molecules -- called microRNAs -- occurs as a response to traumatic injuries. The increase can be detected in saliva, and can be used to judge the seriousness of an injury such as a concussion.

Rugby players will be asked to provide saliva samples at the beginning of the upcoming season, to serve as a “normal” baseline standard against which increases in microRNA’s can be measured.

The possibility that the saliva test will be reliable is an important one, because it would mean that a scientific assessment of concussions could replace the subjective assessments involved in protocols.

Optimistic visions of the future are not lacking: a small hand-held device into which a player would spit and which would come up with a reading within two minutes that would identify any serious injury.

Well, the history of medicine is strewn with promising ideas and theories that didn’t pan out. The work done so far by Belli is surely promising. Promising enough to warrant support. It is rugby, not soccer, that will be pursuing what has already been described as a potential “game-changer” in the treatment of sports concussion injuries.

13 comments about "Rugby, not soccer, pursues promising concussion test".
  1. Stephan Fatschel, August 31, 2017 at 10:55 a.m.

    Majority of concussions I have seen as player/coach are body/ground to head. And by far the worst ones requiring ambulance coming from keepers body to head. Refs need to start calling penalties on keepers or adopt new rules to avoid pk on every corner.

  2. Jay Wall, August 31, 2017 at 12:19 p.m.

    Since brain injury to our youth players is a primary concern made a quick search for studies published reference using saliva testing for pediatric Traumatic Brain Injury as compared to CSF testing. Found the following study published this month. See conclusion at end in quotes: . . . . . JOURNAL OF NEUROTRAUMA, 1 AUGUST 2017 . . . . . doi: 10.1089/neu.2017.5111. "Overlapping microRNA expression in saliva and cerebrospinal fluid accurately identifies pediatric traumatic brain injury" . . . . . . Hicks SD1, Johnson J2, Carney MC3, Bramley H4, Olympia RP5, Loeffert AC6, Thomas NJ7. Penn State Milton S Hershey Medical Center, 12311, Pediatrics , 500 University Drive , PO Box 850 , Mail Code HS83 , Hershey, Pennsylvania, United States, 17033-0850 . . . . . "DIANA mirPath identified related mRNA pathways. Results There were 214 miRNAs detected in CSF and 135 (63%) were also present in saliva. Six miRNAs had parallel changes in both CSF and saliva (miR-182-5p, miR-221-3p, mir-26b-5p, miR-320c, miR-29c-3p, miR-30e-5p)" and "Conclusions Salivary miRNA represents an easily measured, physiologically relevant, and accurate potential biomarker for TBI. Further studies assessing the influence of orthopedic injury and exercise on peripheral miRNA patterns are needed."

  3. Nick Daverese replied, September 1, 2017 at 1:37 a.m.

    Jay I have found that study very interesting. Translating it to the older person is very interesting. Brain injury is hard for even doctors to actually know how it happen when a person goes under observation in a hospital. I seen it many times. Go into emergency room and they keep you the first thing they put on you is a heart monitor. They do that even with perfectly conditioned athletes because they don't really understand how a real athele breaths it is not the same as your average person. Some times brain can get bruise in a fall when the back of the head hits something hard. When that happens the front of the face and eyes look injured. Face is swollen and the eyes go black. So they see that they assume they were hit in the face. If they bring in someone who has seen this before he checks the face for broken bones and finds nothing. It was just swollen with black eyes they check the eye sockets. Knock out brain injuries can change a persons personality for life. It could take months for the brain to heal. So you might not be able to play again for a year. Get a few concussions in a year you may not be able to play at all. Get a second too soon after the first the second one can kill you.

  4. Jay Wall replied, September 1, 2017 at 7:50 a.m.

    Nick, Had a center defender a few years back who was well focused on the game, but as the opponent was attacking their goal the father yelled an unnecessary instruction, they turned to hear, a very hard shot hit them in the back of the head and they went down hard hitting their head on the ground. Ambulance ride to hospital, missed the next 6 months of high school and was out of contact athletics for just over a year. >> A good example of why coaches and parents shouldn't yell from the sideline breaking the focus of a player trying to play safely and well.

  5. Glenn Auve, August 31, 2017 at 12:37 p.m.

    I believe most other sports use a 20 minute protocol. The NFL and AFL (Aussie Rules) require the player to be taken into the locker room or other facility away from the field for the testing to be done. I believe they use neutral doctors but I might be wrong about that. Of course in most other sports there is the option of replacing players during the match and allowing them to rejoin the match if they are deemed to be well enough to do so. I think that is the biggest hurdle soccer faces.

  6. Kent James, August 31, 2017 at 2:12 p.m.

    One simple rule change would allow the appropriate assessment to take place; if the referee sees a blow to the head, the team could use a temporary replacement while the player is being assessed. The tricky part would be determining if the player is required to come off (the ref being put in the position of making that decision, which is a lot to ask and should probably be avoided) or if the team is allowed replace the player (letting a neutral doctor make the decision). But the saliva test may make it a moot point.

  7. Ric Fonseca, August 31, 2017 at 2:39 p.m.

    Any of you out there play rugby? I have and can say it is a pretty violent sport so it it is no wonder that concussions and the protocol that PG writes above, IMHO is a "johnny-come-lately" protocol, and I sure as heck welcome it. Jeez, way back when I was recruited to take part in a tournament for the college I was teaching, as several of the ruggers were short of players for the UC Santa Barbara winter rugby invitational. I went, played and suffered a broken rib on my lower back; then while practicing at the UCLA north field, I got the ball, tried to juke out a defender who just happened to be former QB Rob Scribner, who tackled me up-ending me and I landed on my back with my breadth knocked out. Oh, I just thought I mention this 'cause historically back in the early 20th Century President Roosevelt outlawed the playing of football, as he deemed it too violent. After all, back in jolly England, association football (letter to be called "soccer") was played by ruffians while "rubgy football" played by gentlemen. Anyhow just saying, good article PG, I must admit!

  8. Nick Daverese, September 1, 2017 at 1:49 a.m.

    Ric I never played rugby but as a kid I player American football without equipment. On broken ribs I had them a few years ago after a fall on ice. Hurts to breath. It hurst when your sitting and try getting up out of a chair. They don't even tape up the rib cage any more. They tell you to keep a pillow near you when you get off a chair to squeeze the pillow and that works for some reason. When you played rugby they did not let you wear a rib cage underneath your uniform?

  9. Nick Daverese, September 1, 2017 at 12:40 p.m.

    Jay remember the Trayvon martin shooting by Zimmerman. The police called it justified. They showed a picture of the back of Zimmerman's head his head hit the concrete curb that was the reason why the front Of Zimmerman's face was all bruised up. Martin was not trying to kill him. But Zimmerman was scared and had a gun so he used it. That was not a justified killing by Zimmerman. So a guilty man went free because of it.

  10. Ric Fonseca replied, September 1, 2017 at 3:47 p.m.

    Nick, first thank you for your note re: broken ribs. Second, I do not know why you even mention the second comment in light of the rugby protocol, sorry but it reads a bit convoluted as I cannot see the correlation.

  11. Mark Calcat replied, October 1, 2017 at 3:30 p.m.

    "According to law enforcement authorities, Zimmerman, who maintains he shot the teen in self-defense, told local police that Martin punched him in the face, climbed on top of him and slammed his head into the sidewalk. When the local police arrived at the scene, they found Zimmerman with a bloody nose, swollen lip and lacerations on the back of his head. Although paramedics gave him first aid, he said he did not need to go to the hospital and sought medical treatment the next day."
    The quite is from the white supramacist Huffington Post. I believe you have had more than rib injuries.

  12. Nick Daverese, September 1, 2017 at 7:04 p.m.

    It went back to my head injury post when you get hit from behind. It looks like you were hit in the face. That is why I knew that kid was not trying to kill Zimmerman. Soon as I saw the marks on the back of his head near the curb I knew what probably really happened.

  13. Footballer Forever, September 1, 2017 at 11:36 p.m.

    Man, let met tell you , this "Get off my lawn" blogger is one whiner when it comes to football.....I don't bother fully reading any of his blogging columns as the beginning tone of his words pretty much sums it up.....always a bitter soul complainer. Drop dead, old grumpy man!

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