As a keen follower of the NFL it has come to my attention just how nonchalantly football treats serious head injuries, and the frightening disparity between doctor's advice and manager's action. The most famous example of this in recent times was Christoph Kramer, the Germany midfielder who was knocked out in the World Cup final and can't remember playing. After sustaining a blow to the head that left him asking the referee where he was and clearly unstable on his feet he was allowed to play on regardless. The player wanted to play; the manager wanted him to play; medical staff had said on absolutely no grounds should he have stayed on the pitch.
Another blow to the head could have killed Kramer, or the exertion of running around could have caused him to collapse. The risk of very serious injury was naturally extremely high after the initial collision but instead of heeding medical advice Joachim Löw allowed him to play on. This is not his fault: I believe any coach would have done the same. It is, however, indicative of the attitude in football that the team and the wishes of the player are valued more highly than the medical advice and future health of the player.
A huge lawsuit in the NFL (we are talking billions of dollars here) has made concussions one of the hottest topics over there and the amount of damages paid out to players whose mental health has been affected by continuous hard knocks to the head is extraordinary. It can only be a matter of time before football players start experiencing serious issues after years of heading the ball and the ruling by the FA on Tuesday certainly makes steps in the right direction. With heading now outlawed for younger players and limited for teenagers it is protecting against initial damage and means that impact will only start becoming an issue once the skull is more fully developed. On this count I believe the FA have made a very strong statement about the health of young players and the importance of protecting young heads.
With regards to the professional game I believe there is still a long way to go. There is still no specific concussion protocol; in the NFL, if a player is suspected of a head injury they are taken out of the game and assessed. If it is decided that they are concussed then they can't return to the game and occasionally players miss weeks of action as a result of not being able to prove they are no longer concussed. This is a better system than that in rugby, whereby players are measured against a previous test rather than a medical standard. This has led to some suspect results where players have "passed" the concussion test because their initial test was either faked or exaggeratedly low. It is amazing what a loss of a lot of money will do to safety standards, but that's what has happened in America and I'm sure we will see a reduced number of serious long term head injuries in the NFL as a result. Football needs to catch up.
Constant collisions and aerial duels are a part of the game that no one wants to lose, but more has to be done to protect the players in these situations. If a player is down with a head injury it should be compulsory to remove him from the pitch and face a concussion test; if he fails it he should be substituted, no questions asked. Regardless of whether he is the best player on the team or not, he should be removed from play if he has a serious head injury. I'm not advocating taking players off whenever they take a knock to the head as these things happen in football and it is not the intention of anyone involved to make it less competitive or physical. There does, however, have to be a national standard which can be applied to every situation in order to protect players who are concussed from further risks.
Experts on mental health have combined to create this new advisory documentation and without any medical expertise it is difficult to find faults with their rulings. The steps they have introduced for youth football will make a huge difference to the safety of the game at that age but the 'if in doubt, sit them out' ruling just isn't solid enough for the professional game. With medical staff around football doing their best to keep players fit and healthy for more games, more competition and more difficult conditions than ever before it is time for FIFA to take head injuries more seriously and issue directives for a global standard of concussion protocol. The FA is leading the way and must continue the drive for change across the sport if the safety of the players is truly as important to those in charge as they say it is. The initial signs are good but this can't be the end.
Ali Haggis, Editor
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