Tuesday, November 5, 2013

Lloris injury highlights need for soccer concussion protocols

When Hugo Lloris shrugged off the Tottenham training staff and put himself back into Sunday’s game against Everton to save  the decisive penalty, public reaction moved quickly from curiosity to disbelief and then to rampant rationalization. 

The shot-stopper had recently concussed by an errant knee by Toffee forward Romelu Lukaku and despite his save, we must now ask whether players should input into such decisions.

Lloris, captain of France and number one at White Hart Lane, essentially pulled rank on educated medical professionals and convinced manager Andre Villas-Boas he was fine to continue despite obviously losing consciousness. It’s a fair bet Lloris couldn’t have named the President of France, the date or even his name and thus been assessed as having a (probably mild) head injury. 

Plaudits are often paid to those who play on despite injury. This is not one of those times. Alongside dizziness, visual dysfunction and sometimes vomiting, one cardinal sign of head trauma is reduced executive function (decision making).

Automatically, klaxons sound: if a player with diminished cognitive capacity has the loudest voice in whether he continues playing, serious consequences are close at hand. The decision must rest with medical professionals alone, usually by applying a concussion assessment tool. Altered executive function may result in the concussed player’s condition worsening, or him putting himself or other players at further risk. The best solution would be to remove such a player from the game and, if necessary, adding a fourth substitution mediated by the umpire.

British jockeys and NFL players have strict rules in place for the management of head injuries; if an athlete can’t pass the famed “concussion protocols”, they don’t play. The same must apply to football players both during and after matches – even though there’s less chance of such catastrophic impact, it can and does happen.

The reasons are simple. While manager Villas-Boas stated the final call rested with him, he is only sort-of right. The final tactical decision may rest with the manager, but had further injury occurred either to Lloris or another player due to Lloris’ reduced capacity then liability rests with the medical team. Ergo, the ultimate decision has to be made by trained healthcare providers rather than a coach or a motivated player with faculties perhaps already below 100%. Despite Spurs' protestations that they did clear the player, the time taken to do so on Sunday - in comparison with kayoed NFL players - seemed remarkably short even considering the circumstances.

The support staff for a club want the team to win just as much as players and coaches do. However, they must also balance this with the wellbeing of the individuals. While one would hope coaches and players also have player welfare foremost at heart, several past examples suggest this may not always be the case. With head injuries, especially in light of the recent spate of Chronic Traumatic Encephalopathy diagnoses, safer is better than sooner.

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