FIFA on Head Injuries

25 Aug

So, we finally have some information from FIFA on the topic of head injuries and concussions in football. And by some I mean lots. Be warned; this is going to be a wordy post. My inner editor is (sadly) on strike.

Back on August 12, FIFA provided an update on a 2013-14 head injury pilot study implemented for 120 players from the Swiss Football League. This study was carried out in collaboration with researchers from University-Hospital Zurich’s Clinic of Neurology and Zurich’s Schulthess Clinic.

One of their main findings from the study was that player’s suffering a mild head injury should ideally take six days of rest before playing again. That is significantly longer than the mere minutes players like Álvaro Pereira and Hugo Lloris took with their head injuries. The study also stated an experienced neurologist should decide within 72 hours or 3 days whether an early return is possible.

FIFA is continuing with the study this year, expanding the scope of the pilot to include most of the top clubs in the Swiss league.

As part of this collaborative project, Dr Nina Feddermann is currently leading a neurological and neuropsychological examination of male and female players from teams in Switzerland’s highest football leagues at the start of the 2014/15 season, as well as an examination of the players’ sense of balance and eye movements. If a player sustains a head injury during the course of the campaign, this will also be investigated and the results compared with the original examination. Determining differences in results before and after an injury will make it possible to identify slight impairments that even the player may not notice in everyday life.

Fantastic. I agree with the need for studies like this but what is FIFA waiting for? The MLS has been doing this baseline work for years already, and they implemented accompanying protocols to protect players while they continue with their research. The Premier League made a bunch of revisions to their rules for this season to include this type of testing, understanding that head injuries need to be taken seriously for the protection of players now and not later.

Former Manchester United captain Nemanja Vidic suffered a concussion during a game vs Arsenal in November 2013.

Now I know all too well the wheels of administrative-ladened organizations turn glacially slow, but it is ridiculous on FIFA’s part to not propose any rule changes based on the preliminary results alone. Moreover, why hasn’t FIFA made medical doctors the final authority on head injuries yet?

Dr. Jiri Dvorak, FIFA’s Chief Medical Officer and neurologist on concussions, wrote an article for the August 22 FIFA Weekly magazine stating the need for doctors to have the final say on head injuries. He summarizes FIFA has been monitoring concussions since 2001. Such monitoring led to the red card rule change for elbows to the head just before the 2006 World Cup. Great, but what I read between the lines is the last significant rule change related to head injuries by FIFA was eight years ago. Eight years.

Dvorak is solid in his position on medical doctors assessing and treating head injuries without interference:

The management of footballers with head injuries and the decision as to when to allow them to return to play remains largely a matter of medical judgement and decisions. Football doctors who are responsible for the players of a team have a special relationship, the same as a doctor-patient relationship. They are also considered to be responsible for the well-being
of players including their fitness and at the same time having expertise knowledge of the consequences of the injuries including concussion. They are also responsible for the appropriate assessment, management, the return to play decision and finally the follow-up treatment. This decision should not be over-ruled by non-medical persons with inferior medical knowledge such as managers or coaches. The decision of the responsible doctor must be respected by the player’s coach and the recommendation enforced.

Well said, Dvorak.

He concludes his article by indicating a “think tank” would be happening in New York August 23-25 to discuss how best to diagnose and treat head injuries and concussions. And it did happen. FIFA was there along with representatives from the NFL, NHL, NCAA, IRB, AFL, and FEI.

Dvorak met with the press this morning to discuss the meetings and he offered up these tidbits when asked about the five documented concussions at the World Cup:

We are not alarmed. The situation is about the same over the past 16 years with a drop (in concussions) in 2006 when we introduced red card (match disqualification for an elbow to the head).

You have to appreciate the situation we had at the world Cup. We had 36 cameras around the pitch. So the spectators are seeing with 36 eyes certain events, and it is not appropriate to make assumption or diagnosis based on TV images.

Hmmm mmmm. One of the changes the Premier League put in place this season was to have an additional medical doctor in the tunnel to watch replays and help assess injuries and injury severity. If that doctor uses “36 eyes” to make a preliminary diagnosis, will FIFA consider that wrong or inappropriate?

In respect to the authority of team doctors, he stated: “From FIFA’s side, we will strengthen the position of the team doctor, as we did already in the past.” Well, okay, you didn’t seem to really strengthen anything in the past if managers and players are still able to overrule the doctor on the pitch.

Argentinian defender Pablo Zabaleta during the World Cup semi-final vs Netherlands in July 2014.

Interestingly, Dvorak made mention that FIFA president (*cough sputter*) Sepp Blatter agrees that the doctor has the last word in the concussion decision. Apparently Blatter stated this in his Presidential Message which accompanied Dvorak’s article.

I’ve read Blatter’s message multiple times and nowhere does he make such a statement. He does however, suggest German midfielder Christoph Kramer was the only player who sustained a concussion at the World Cup because he’s “the only man with gaps in his memory.” Apparently not the only man, Sepp. Sounds like you need to consult FIFA’s Concussion Recognition Tool.

Blatter’s approach to head injuries is to continue with the Swiss pilot project, and to embark on instituting an additional player substitution. Another substitution “would give coaches greater personal leeway, as they could react more quickly and decisively in the case of injury.” That’s right Sepp; it’s all about the coaches having “personal leeway” rather than a player with a head injury being treated carefully and professionally.

That Sepp. Always with his fingers on the pulse of important footballing issues up his ass.


One Response to “FIFA on Head Injuries”


  1. FIFA Being Sued Again | Of Headbands and Heartbreak... - August 27, 2014

    […] to the World Cup which hit FIFA today. This one is all about my recently discovered passion topic: head injuries and concussions in football. Ohhhh, someone named Sepp is not going to be a happy baby. Guess I wasn’t the only one who […]

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