By Ken Reed

During the recent World Cup, there were multiple times when injured players appeared to have classic symptoms of concussion. However, rather than being removed from the game they were allowed to continue playing.

Part of this can be attributed to the substitution rules in the World Cup. Only three substitutions per game are allowed and once a player comes out he must stay out. As such, coaches don’t want to pull a player with a possible injury unless they absolutely have to. And they don’t want to play a man short while an injured player is getting evaluated for a possible concussion. Based on these formal rules, the unwritten rule for the players is “Don’t come out!” and for the coaches “Don’t take the player out!”

So, given this reality, FIFA’s rules in this area clearly need to be seriously examined.

What went on at the World Cup when it comes to brain trauma is inexcusable. There were many cases when it was clear that a player had sustained a head injury and at the very least should be given a 10-minute evaluation by a medical professional.

In the World Cup final, Germany’s Christoff Kramer suffered what appeared to be a concussion after a collision with a player from Argentina. Nevertheless, he played for 14 more minutes before falling to the ground. He was then removed from the game after being escorted off the field. He later said he remembered very little of what happened while he was playing. This type of scene played out many times during the tournament. (See FIFA’s Dazed and Dated)

Playing with a concussion isn’t something that should be applauded. It isn’t bravery. It’s stupidity. And it is extremely dangerous. Playing with a concussion can lead to death from Second Impact Syndrome (SIS), a condition in which the brain swells, shutting down the brain stem and resulting in respiratory failure.

FIFA is seemingly the last to the table among major team sports when it comes to a legitimate concussion protocol. The organization’s lack in this regard is shameful.

FIFA has provided recommendations regarding concussions to soccer clubs around the world but maintains that the ultimate responsibility lies with the team’s doctor — who may or may not follow them. (See FIFA’s Cowardice) This leads to dangerous situations in which the team doctor’s judgment might be compromised by their emotional and financial investment in the situation — especially during a critical World Cup game. And players certainly shouldn’t have any input on whether they stay in a game or not if concussion is a possibility. Their judgment is very often warped while in the midst of competition.

“FIFA has had the eyes of the world look at them and has rather unanimous criticism from concussion specialists in this country, who were kind of appalled at the way they handled concussions,” said Dr. Robert Cantu, one of the leading sports concussion experts in the United States. “I do think it’s time for them to change.”

Indeed it is.

“The simple solutions is that FIFA is going to have to allow special temporary substitutions when a head injury is suspected, something already being tested in Rugby,” says sportswriter Cork Gaines.

“Allow teams to enter a substitute while the injured player is tested along with a time limit on the return of the player (e.g., if the player is not cleared to return in 12 minutes, he cannot return). To minimize abuse of the rule, these substitutions could count toward the allotted three substitutions. Another possibility is to give each team one such concussion substitution per match. Teams will still abuse the rule, but this is a risk FIFA must take for the safety of the players.”

ESPN analyst Taylor Twellman, a former U.S. national team member and MLS star tweeted the following during the championship match: “Here we go again FIFA … #WorldCupFinal and your ineptitude to address the head injury problem is for everyone to see. Kramer was concussed! Before I die, I will get FIFA to change their ways and get an independent doctor on the sideline.” (See US Concussion Expert)

We need more people — in and out of soccer — with similar passion to change FIFA’s inexcusable approach to brain injuries.

Ken Reed, Sports Policy Director, League of Fans


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