Concussions, Guidelines, and Realities

Article by Nathan Durec

On November 6, AVB came out on the defensive over the decision to leave Hugo Lloris in the match the weekend prior against Everton. To recap, in the 78th minute of the match, Everton striker, Roberto Lukaku, collided with Lloris causing the Tottenham goalkeeper to momentarily lose consciousness. To deny the seriousness of this issue speaks to a lack of knowledge on how concussive symptoms can exponentially increase. However, the issue is not what a concussion does to the brain. The discussion that must be had is whether enough is being done to protect players who find themselves in such situations.

Concussions are a nasty business. A person never fully recovers and is more prone to having concussions in the future. The Sports Concussion Institute, that specialises in diagnosis and academic reporting for sports concussions, states that a person who has had a concussion is twice as likely to get a second, four times as likely for a third, and up to nine times as likely for a fourth. Concussive symptoms can be mild, such as nausea, or more severe, such as memory loss and physical and mental changes, and in extreme cases, death.

Let’s be honest; concussions will happen in sport. This should not detract from finding ways to minimise them and their effects. While they are more likely to happen in some sports than others, rarity should not play into investigating means of prevention. The Centres for Disease Control and Prevention in the United States show that football has one of the highest incidences of concussion in all sport. It is the most common sport with concussive injuries for women and the second most common one for men. It should also be noted that loss of consciousness during concussions is also rare, only occurring in approximately 10% of all cases. The fact that Lloris is reported to have lost consciousness speaks to the severity of his particular case.

So, given that concussions in football are a reality, there should really be a mandate or a series of guidelines to follow. Well, there is. In 2001, the Consensus for Sport (CIS), along with FIFA, developed guidelines for clubs to follow in regard to concussions. However, when researchers working on a story for the British Journal of Sports Medicine investigated compliance in English league clubs (EPL down to League 2), they discovered that 28% of them didn’t even know such guidelines existed. This is scary given that the FA had adopted these guidelines and has referred to them in the past, most notably during a 2007 cup final where a very serious and well publicised concussion incident occurred.

Unfortunately, the CIS guidelines are not that clear. They offer no guidelines on how concussions should be managed during a season and do not list any requirement for club medical staff to be trained in concussion management. Perhaps this is why the British Journal of Sport Medicine also reported that approximately half of EPL clubs were not following the guidelines that are in place. However, FIFA’s chief medical officer argues that the guideline is clear for this case. It states that any player who leaves the field with a head injury, “shall not be allowed to resume playing or training without the clearance of a qualified medical practitioner.” Given that a proper concussion exam cannot occur without adequate testing, which cannot be done on a pitch, this is being argued as being as clear cut as it gets.

If anyone wants to consider the implications of concussions, all you need to do is see what is happening in other sports. In the MLS, there is a $12 million US lawsuit currently pending against the league from a player who states he was made to finish a game after receiving a concussion, which ultimately led to the end of his career. A class action lawsuit between the National Football League (NFL) and over 4,500 former players recently finished with the players winning and being awarded a settlement of $765 million US. The National Hockey League (NHL) and their players association is in the process of considering a similar action against their league.

So, was the club right in letting Lloris continue to play? This is the weird grey squishy area. The guidelines say he must be replaced if he is removed from the pitch. It doesn’t state what to do if the player doesn’t leave the pitch or is unable to do so because they are unconscious. However, a medical assessment should have been done. What did occur was a determination from AVB and medical staff that Lloris “showed great character and personality.” I’m not sure of any medical test for great character and personality, but if there is one, I really hope that it is not a part of a serious medical assessment. Thankfully, he had a proper assessment after the game finished and was given an all clear then.

It goes without saying that we are all happy that Lloris appears to be recovered and healthy. However, concussions can rear their ugly heads a week, month, or even years down the road. Let’s hope Lloris continues to remain healthy and in between the sticks. Let’s also hope that concussive guidelines are made a lot clearer because right now, they are watered down at best.

© e-Spurs 2013 All rights reserved no part of this document or this website may be reproduced without consent of e-Spurs

Share on Google Plus