As the top athletes in soccer gather to play in the World Cup, we’ve seen both good decisions and poor decisions made in relation to brain injury and its effects. Let’s start with a remarkably poor decision. During the Uruguay-England match, Uruguayan midfielder Alvaro Pereira was knocked unconscious after accidentally being hit in the head by the knee of an English player. Once Pereira regained consciousness, he argued with the doctor against being substituted out and was allowed to finish the game. This is problematic on a number of levels. First, a player should never be allowed to overrule a doctor regarding medical issues. Players are not medical experts, they are experts at playing the game. Moreover, with adrenaline flowing the athlete is unlikely to give sufficient consideration to potential health risks. Second, a player with a concussion should always undergo testing in order to properly evaluate the seriousness of the injury. Since the brain is inside the skull, it is difficult to assess the level of severity of such an injury or determine if swelling of the brain is beginning to occur. Third, this is a terrible example to provide for young players as to the care one should afford oneself after receiving an injury.
In contrast, Netherlands player Bruno Martins Indi’s Word Cup concussion was handled very differently. Martins Indi suffered a concussion while playing Australia. He was immediately taken off the field and sent to the hospital for testing. He was allowed the entirety of the next week to slowly recover and his coach even insisted that he miss his team’s next game against Chile. Both Martins Indi and Pereira are world-class players who play in top European leagues yet the quality of treatment each received was light years apart.
In reaction to Pereira’s injury, the international soccer player’s union FIFPro wants to have all players suspected of having a concussion be temporarily substituted out in order to have an evaluation. Perhaps a better idea would be to follow a protocol similar to that which is followed by Major League Soccer (MLS) here in the United States. League protocols include:
“Any player suspected of having sustained a concussion shall be removed from play immediately and evaluated by team medical staff. If the initial evaluation results in a concussion diagnosis, he will not be returned to play in the same game or practice…Every MLS club has a designated Team Consulting Neuropsychologist, one of whom will conduct the post-concussion neuropsychological evaluation when an injured player is symptom-free at rest, prior to his return to play. Any player diagnosed with a concussion will be free of somatic and cognitive symptoms for at least 24 hours before starting an individualized, graded return-to-play progression under the supervision of the team physician.”
Moreover, MLS mandates that players have baseline neuropsycological testing performed so as to have those results on hand for later comparison with post-injury results. The MLS protocol is very similar to protocols used by the NBA to evaluate basketball players suspected of having suffered a concussion.
Competing in the World Cup is an exciting opportunity, but nothing justifies any level of disregard for player safety. Any game is, after all, ultimately just a temporary set of circumstances. A poorly managed injury however, can leave its mark for a lifetime.
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