Concussions are a problem? How about some more research? 

Soccer America

January 17, 2021

England coach Gareth Southgate had his say earlier this month: “We’re still in a position where we need more research to find out exactly the impact of concussion, of heading the ball, we’re still in the dark on a lot of those things.”

Southgate probably doesn’t read the British Medical Journal too much, so he won’t be aware that the much-respected BMJ has, for many years now, virtually banned the phrase “more research is needed.” If you’re going to demand more research, says the journal, you must be specific — give us details of what sort of research you have in mind.

The BMJ has recognized that “more research needed” is a vague, temporizing phrase used by big-pharma companies to delay action when one of their products — say, a drug accused of having dangerous side effects — is in danger of being banned by the government.

The parallel with soccer’s attitude to concussion is exact. For a decade or more now, plenty of research has been done — continues to be done — on concussion — which can be seen as soccer’s dangerous side effect. The results of all this research are not good news for soccer. To imagine that there is no concussion problem in the sport, you have to ignore a growing body of research that says otherwise.

So soccer — this means FIFA, IFAB and other ruling bodies like the English FA — have done just that. Their response to the imminent crisis is to do … nothing. Or to ask for “more research” — which amounts to the same thing.

Another recent plea — from former England captain Alan Shearer — has a more urgent tone to it: “Football needs to get real. It needs to wake up. It needs to get serious. Not next year. Not next week. Now. This has been going on too long. The protocols in football are not acceptable.”

But what action? Shearer singles out the protocols — those for concussion. A good start could certainly be made by getting rid of the myth that surrounds these protocols. Soccer’s job is to ensure that it is a safe sport, that it is not exposing its players to avoidable dangers. This it has completely failed to do.

The vaunted protocols have very little to do with preventing concussion injuries — they are mainly devoted to ensuring better care and treatment of players after they have been injured.

Where the protocol could be of value in reducing the risk of injury — i.e. in making sure that an injured player (an already injured player) is removed from a game — it is widely ignored. To the extent that it has become a joke.

It is only now that the sport — after a decade or more of alarm bells and lights ringing and flashing at growing intensity — has decided that it would a good idea to conduct a trial on the use of temporary substitutes, for use while players are undergoing the protocol testing.

Yes, soccer’s reaction to the concussion issue has been a joke. But it is much worse than that. It is a disgrace, and a dangerous one at that. As the world’s most widely played sport — and the only one that permits (though “requires” would be closer to the truth) players to use their heads to play the ball — soccer is bound to come under serious suspicion of being dangerous to play.

Soccer’s response — the obvious, logical response, designed to do the one thing that really matters here, to protect its players from serious immediate or long-term injuries — has yet to surface.

The correct response — the caring, humane response — must be for soccer to look at itself, to take a hard look at what happens on the field, to identify any obvious high-risk areas of play, and to reduce or eliminate them. Incredibly, soccer has simply failed to do anything like that.

Yet there are incidents of soccer action — frequent incidents — that simply shriek for attention if you’re searching for concussion risks. Head clashes for a start. Virtually every game includes an incident of this sort.

Most are minor, the effects quickly shaken off, the game goes on. Maybe we should be taking a closer look at those incidents, because we’re now unsure about long-term effects. But there are heavier head clashes where players collapse immediately to the ground, sometimes briefly unconscious. There may be blood to dramatize the injury. These more serious injuries do not occur in every game, but they are frequent enough, and perilous enough, to demand attention.

They get very little attention. They are greeted dismissively with a shrug, as “part of the game.” Yes, they are certainly that — but must they be? To make sure we know what we’re dealing with, a couple of recent examples from the English Premier League will drive home the point.

At the end of November, barely five minutes into the Arsenal-Wolves game, Arsenal’s David Luiz and Wolves’ Raul Jimenez clashed heads. Both men immediately collapsed. The incident was described as “sickening” in both the Express and the Daily Mail. “The sound of the collision could be heard on live TV” said the Express.

Even watching on TV, with the mute button on, the clash looked frightening. Luiz was the first to get to his feet. Jimenez never got that far, being removed — after 10 minutes of treatment — on a stretcher and taken straight to the hospital.

The sport cannot pretend that these are not alarming moments. It knows. And its TV partners know, too. According to the Express, Sky TV “refused to show a replay of the incident”.

The game restarted with Luiz on the field, his head swathed in a huge white bandage. It wasn’t long before blood seeped through the bandage. Luiz played on, but was removed from the game at half time. Jimenez, in the hospital, was being diagnosed with a fractured skull.

Sickening, indeed. How on earth can that be lightly brushed aside as “part of the game”? And if it is so accepted, then the game itself is surely getting something wrong. To underline the point, there was another “sickening” moment on January 12. Burnley’s Ben Mee ran to jump and head the ball, exactly as Manchester United’s Luke Shaw ran to jump and head the same ball. The inevitable clash of heads looked horrible. Both players went down and lay, face down and motionless on the field. Yet, less than two minutes later, the game restarted and both Mee and Shaw were on the field. Under two minutes is not nearly long enough to conduct any protocol procedure that I’ve ever heard about.

So that is what happens in today’s soccer, apparently without anyone — from coaches to players to referees to TV announcers — getting too put out. It is, it must be, soccer’s duty to find a way to minimize, if not totally eradicate, such clashes. Not by calling for more research — we already have all the research we need to convince any reasonable person that these are danger-charged moments.

But soccer, by refusing to examine its own complicity, has not behaved reasonably. What should soccer be doing, then?

It should abandon its policy of silence. It needs to acknowledge the problem — publicly. It must then examine the game itself, the way it is played and the way it is refereed.

That is the difficult bit for soccer. Being forced to make the admission — publicly — that it contains an element, heading, which has a highly dangerous side effect, concussion. The danger comes from: 1) the ugly head clashes that are described above; 2) from goalkeepers who recklessly attempt to punch the ball; and 3) from situations where a goalkeeper, diving at an opponent’s feet, gets kicked in the head.

Can anything be done, immediately, to banish, or at least lessen such clashes? Absolutely — and much more easily than you might think. Because the FIFA rule book (prepared by the eminently lethargic IFAB) already contains rules that would greatly lessen category 2 incidents, and totally eliminate category 3 fouls.

Category 2: because they are very rarely punished for it, goalkeepers have come to believe that it’s OK to jump violently, knee raised, into a group of opponents. The keepers need to be quickly disabused of that notion and told that in future it will likely be penalized as either reckless play (yellow card), or use of excessive force (red card). As for Category 3, a goalkeeper diving head-first at an opponent’s feet is guilty of “playing in a dangerous manner”, spelled out on page 107 of the rule book: “any action that, while trying to play the ball, threatens injury to someone (including the player themself) …”

It is really quite shocking to realize that rules designed to prevent serious injury are already there, in the rule book — but are simply not enforced by referees.

Clashes of the sickening variety present a much more prickly problem for soccer. In the examples already cited, no foul was called in either case. The players involved were all genuinely and legally trying to head the ball.

I can think of one measure, one change in the game’s rules, that would certainly reduce the overall number of headers per game: to ban goalkeepers from launching 50-yard long-and-high punts or goal kicks. These usually lead to heading duels, sometimes to a prolonged series of headers before the ball is brought under control.

As it appears quite possible that the sheer number of headers made by a player throughout a career is of (at least) equal significance as the occasional severe head clash, then this measure should be introduced at once.

One of the reasons why retired English players are showing an interest in the long-term effects of heading is the melancholy news that five of England’s 1966 World Cup winning team (Jack and Bobby Charlton, Martin Peters, Nobby Stiles and Ray Wilson) have all suffered from serious dementia problems in later life. The English FA’s typically half-hearted comment: “We are sad to hear this story.”

It should not be beyond soccer’s rule-makers to work out alternative ways for a goalkeeper to put the ball into play. Then again, we’re dealing with IFAB, so any level of ineptitude is possible.

The only other effective preventive measure that I can think of would be to ban heading altogether. Not a solution I want to see. Soccer without heading? Would that be real soccer? How about protective headgear, then? Possible, I’d say — though some new lightweight highly resistant material would probably be necessary, and brings its own problem: that of encouraging the wearer to be less careful, more reckless, in his play. And I’m stuck on the idea that I like soccer players to look like human beings, not Martians.

But clearly, it is absolutely within soccer’s powers to take action, right now, to reduce head injuries — not by massively rewriting the rules, but by doing a little tweaking, and simply by enforcing those that already exist. That would be a start. But if the sickening head clashes cannot be reduced, then soccer will have a major decision to make.

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