Problems with Concussion Treatment at the Highest Levels of Soccer

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The UEFA Champions League is one of the pinnacles of soccer (football), largely judged as the best yearly soccer competition, and second only to the FIFA World Cup in terms of pedigree. While the NFL is larger in the United States, the viewership for the Champions League dwarfs even the Super Bowl viewership numbers. Even the semi-finals of the UEFA Champions League regularly draws over a quarter of a million viewers and an increasing share of viewership in the United States.

This large viewership makes the Champions League a global event, influencing many issues including UEFA sports concussion treatment. On April 30th, in the 32nd minute of the semifinal game between Tottenham Hotspur (from London) and Ajax (from Amsterdam), three players jumped for the ball. The players were Tottenham defenders Jan Vertonghen and Toby Alderweireld, as well as the Ajax goalkeeper.

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This play resulted in Alderweireld knocking the back of his head into Vertonghen, bloodying Vertonghen’s nose and leaving him laying on the ground as he was treated by the medical staff. When the trainers stopped the bleeding, Vertonghen sat up and walked off the field, where he was brought a clean shirt, and the medical staff walked him over to the area where he could re-enter the game. The referee came over to confirm with the Tottenham physiologist that Vertonghen was OK to re-enter the game, and Vertonghen was allowed to re-enter the match in the 38th minute. Within a minute, Vertonghen walked off the field and retched violently before almost fainting and being caught by the coach. After the match the coach was asked about his decision to send the player back onto the field despite the collision; he defended the decision as coming from the medical staff, and not from him.

This incident created news headlines. After a serious head injury and only cursory medical attention, a player was allowed to re-enter play within 6 minutes of falling to the ground. Although this incident displays problematic choices made by the player, the coach, and the medical staff (they all could have made safer choices), the incident highlights in particular how soccer regulates the medical treatment of concussions.

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New rules were implemented in 2014 requiring stoppage of play, medical attention, and at least temporary removal of the player from the field. However, there is no allowance for a concussion substitute, so coaches are motivated to get the player back on the pitch as quickly as possible.

In this incident, Vertonghen was assessed and returned to the game in six minutes; is there really enough time to assess the condition of a recent head injury in 6 minutes?

Clearly, as shown in Ventonghen’s case, players are falling through the gaps. These are difficult decisions influenced by the huge pressure to remain in the game, the pressure on the medical staff (employed by the team, not the league) to clear the player, and the desire of the league to not be seen as dangerous to players. However, it is unacceptable for a player with a potential traumatic brain injury to re-enter a game where they could receive a much more dangerous second impact.

Solving this problem is not easy, but stricter regulation of medical treatment is needed. However, people are beginning to speak out. Luke Griggs from Headway Foundation has said that the problem isn’t the rules but the implementation of the rules; "We are concerned that the safety first, 'if in doubt sit it out' approach isn't necessarily being adopted in all cases." It is crucial that FIFA, UEFA, and the other governing bodies in soccer don’t disregard the serious implications of concussions because it’s not just the NFL which deals with CTE and other serious brain injury issues. Luckily, FIFA has recently said it is prepared to discuss concussion-related rules changes.

For additional information, see these articles:

Spurs star Vertonghen undergoes tests amid fears he has suffered delayed concussion which could rule him out of Ajax return

Pochettino backs Tottenham medical staff over Vertonghen treatment

Premier League head injury and concussion rules explained

TAYLOR TWELLMAN – Career Cut Short By Concussions

Jan Vertonghen blow prompts Fifa to look at concussion substitutions