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World Cup 2014

FIFA and FA Face Concussion Headache

  • Players’ union FIFPro criticises FIFA over its handling of head injuries during the World Cup and demands ‘thorough investigation’
  • Sideline treatment of Christoph Kramer and Alvaro Pereira show head injuries are not taken seriously enough
Christoph Kramer: “In my mind, the game begins the second half”

Christoph Kramer looked as if he was about to throw up. A few seconds earlier the shoulder of Ezequiel Garay had smashed into the side of German midfielder’s head, causing his legs to visibly buckle. His brain, having been jarred against the inside of his skull, was unable to command his hands to break his fall.

Kramer hit the floor 16 minutes and 15 seconds into the first half, less than 20 feet from the linesman. It took a full 28 seconds for his teammates to roll the ball out of play, with referee Nicola Rizzoli apparently oblivious. After the German medical staff appeared test the range of movement of the 23-year-old’s neck, Kramer returned to the field for a full 15 minutes before being helped off the field, eyes glazed. Frighteningly, he has since said he “can’t remember much” of the first half.

Kramer’s treatment echoed that of several players during the World Cup whose injuries were not deemed serious enough to withdraw them from play. Argentina’s Javier Mascherano and Pablo Zabaleta both sustained head injuries and continued to play, while Uruguay’s Alvaro Pereira refused to leave the field against England after being knocked unconscious by the swinging knee of Raheem Sterling. Though Brazil has undoubtedly been the scene of one of the best World Cups in recent memory, the incidents have produced a surge of concern over how these injuries are dealt with.

Causing the biggest concern – at least until the Kramer injury – was Pereira. The submission to the player’s understandable if misguided warrior-mentality and his apparent authority to overrule the team’s medical staff was worrying. It was almost a carbon copy of when Tottenham goalkeeper Hugo Lloris was allowed to continue playing by then-coach Andre Villas Boas with the apparent agreement of the team’s doctors, actions which generated a good deal of protest from the PFA and the head injury charity Headway.

The Pereira injury was of particular concern to the players union FIFPro, who released a statement after the Uruguayan’s concussion saying not only that football was “awash with incidents in which players suffer potentially concussive blows to the head and stay on the pitch” and that players such as Pereira essentially needed to be protected from themselves.

No-one can quite seem to agree what the rules are. Whilst one news outlet reported that FIFA does have an independent doctor at every World Cup venue, one of FIFPro’s specific demands calls for “the presence of an independent medical professional on the sideline during competition matches to assess a player with suspected concussion”. There appears, at the very least, to be a significant lack of clarity over who – player, manager, team doctor, Fifa doctor, independent doctor – has the final say on whether a player is allowed to continue.

Lessons from the past…

The clamour over World Cup concussions comes a little over a month since a parliamentary report entitled “Concussion Can Kill“, co-authored by Labour MP Chris Bryant and Baroness Tanni Grey-Thompson among others, accused British sport of “turning a blind eye” to the issue of concussions. The report focused on the danger posed to the new generation of British children taking up football and rugby, saying that football could not afford to be faced with a lawsuit similar to the £765 million action brought against the NFL by a group of former players.

By failing to act quickly, Fifa could potentially open themselves up the accusation that they are ignoring the problem, or worse. Bryant’s report was scathing in its criticism of the FA, who it said promised the family of Jeff Astle, a player who died in 2002 from brain injuries sustained through repeated heading of footballs, a 10-year long joint study with the PFA of the effect of heading on player’s brains. 12 years later and no report has been forthcoming.

…and from abroad

Fifa and the FA should also pay heed to developments in NHL ice hockey. In February a joint study conducted by several universities in the US and Canada found that players who sustained concussions experienced microscopic changes to their brain structure, which the researchers said could reflect microhaemorraging or neural injury. The study focused on the long-term effects of repeated head trauma which both  with, and brutally exposes, the irresponsible short-term thinking of football when it comes to head trauma.

The idea that footballers are less vulnerable to concussions than athletes of more violent sports like American football or hockey are undermined by a series of studies in the US, which is leading the way when it comes to taking the issue of concussions in the game seriously. Earlier this year Patrick Grange, a US footballer who died in 2012 aged 29, was posthumously diagnosed with Chronic Traumatic Encephalopathy (CTE). Like Astle before him, Grange prided himself on his heading ability.

In a New York Times article focusing on Grange’s case, the neuropathologist who examined Grange’s brain warned against drawing broad conclusions about the effect of heading footballs on brain trauma, noting that Grange had experienced “a few memorable concussions” that would have contributed the “extensive frontal lobe damage” suffered by the player. Kramer, Pereira, Zabaleta and Mascherano have shared four between them in the space of a few games and it’s a safe bet they’ve experienced others in the past.

The most dangerous aspect of concussions is that the worst effects can sometimes not be realised until it is too late. If football in Britain and elsewhere wants to avoid concussion oblivion, the issue needs to be taken seriously. In the NFL, they’ve started to act. Trauma consultants who are concussion specialists now stand by on the touchline to aid the teams’ medical staff and sweeping rule changes in the NHL have sought to bring tougher penalties on players who hit opponents in the head, deliberately or not.

Whilst rule changes in football would be a longer, tougher and generally more painful process, the total inaction over the Astle case shows that concussions are yet to be given the consideration they command by the FA. Both the FA and Fifa, organisations hardly known for the speed of their reform capabilities, cannot bury their head in the sand over the issue. Like a concussion, if action is not taken, things could get worse before they get better.

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