Do sporting bodies take head injuries seriously enough?

Jan Vertonghen and Christoph Kramer.  Both are professional football players who have suffered injuries whilst playing in high-profile matches; both players were assessed off the field of play before being allowed to return to the action; both then had to be helped from the field a short while later, whilst visibly suffering from the effects of their head injury.

In Vertonghen’s case, he was injured whilst clashing heads with a teammate whilst paying for Tottenham in the first leg of their recent Champions League semi-final against Ajax.  He was assessed off the pitch by club medical staff for around 5 minutes before being allowed to return to the game.  Moments later he had to be helped from the pitch by the Tottenham manager, Mauricio Pochettino, before appearing to wretch by the side of the pitch.

Christoph Kramer was injured in a collision with an opposing player in the 2014 World Cup final, whilst playing for Germany against Argentina.  He received a much shorter off-pitch assessment than Vertonghen before returning to the action.  He remained on the pitch for a further 14 minutes before falling to the ground in a heap and then finally being taken off the pitch.  During those 14 minutes, he reportedly asked the referee to confirm whether it was the final he was playing in, and has since said that he cannot remember much of his participation in the match.

Governing bodies, UEFA and FIFA, were criticised in the wake of these incidents for not having sufficient procedures in place for dealing with head injuries during matches.  These two examples are by no means the only ones from recent years, but what else can the footballing authorities do, and is the criticism of them justified?

 In short, much more and yes.

Head injury assessments of players

In the wake of Vertonghen’s injury, which occurred on 30^th April 2019, there have been repeated calls for the football authorities to introduce temporary concussion substitutions to enable a fuller assessment of an injured player’s condition.

Part of the problem with the current method of a 5-minute assessment at the side of the pitch (and Vertonghen’s 5-minute assessment was longer than many previous head injury assessments in football have been) is that concussion is very difficult to diagnose quickly.  It depends upon the player being honest about how they are feeling and communicating this to the medical team.  In the case of Vertonghen and Kramer, both players were involved in one of the highest profile, most important, matches of their professional careers, and so it is understandable that players are not always entirely forthcoming about what they are feeling whilst being assessed.

 Concussion substitutes

Club doctors are also under huge pressure, carrying out their assessment with a 60,000-strong live audience looking on, and club management is desperate for their star player to return to the field of play as quickly as possible, with their team a player short for the entire time that the assessment is taking place.  This is an unfair burden placed on both the medics and the players.  Allowing temporary concussion substitutions would at least enable an assessment to be made over a longer 20-minute or so period, away from the glare of TV cameras and without the pressure of knowing that the doctor’s employer’s team is playing with one player less for the duration of the assessment.

Cricket introduced concussion substitutes in 2018 and rugby introduced an 8-point plan also in 2018 to try and better deal with the risks posed by head injuries to players.  Football is perhaps, therefore, lagging behind in this respect.

In addition, following studies in the US over the last few years suggesting a link between heading footballs and the development of chronic traumatic encephalopathy (CTE), the FA and PFA have now given their support to a study, started last year, being carried out jointly by the London School of Hygiene and Tropical Medicine and Queen Mary University and led by Professor Neil Pearce, to investigate the link between the repeated heading of footballs and CTE, the results of which will be made public.

Brain injury and sport – more action needed

 There is therefore hope of progress in this area, but for many this is still too slow, coming 17 years after an inquest into the death of Jeff Astle, the former West Bromwich Albion player known for his heading ability, gave a verdict of death by industrial disease.  A re-examination of Jeff Astle’s brain in 2014 found that he had suffered from CTE.

With some way still to go then, it is hoped that the footballing authorities will at least seriously consider introducing concussion substitutes at the earliest opportunity.

Headway’s Action for Brain Injury week runs from 20-26 May This special campaign week raises awareness of brain injury and gives a voice to those affected. Their focus is on the debilitating and stigmatising effects of fatigue after brain injury.

To find out more visit www.headway.org.uk