January 24, 2021

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Football needs to catch up and get its house in order over concussion

For too long football has played tiki-taka with the issue of concussion, rather than tackling it head on. It has been passed around from committee to committee, governing body to governing body, without the authorities facing up to its pernicious threat. Perhaps the recent deaths of Jack Charlton and Nobby Stiles will sharpen the focus.

What happened at the Emirates on Sunday night certainly should. It was jolting enough to witness Wolves’ Raúl Jiménez receiving oxygen and leaving on a stretcher with a fractured skull following a clash of heads with David Luiz. It was almost as worrying when the Arsenal man got up and carried on for another 40 minutes, despite blood oozing through his head bandages.

Related: Concussion substitutes trial could begin in Premier League early next year

True, David Luiz passed all the required medical assessments. And the Premier League emphasises that doctors have a long list of clues they use to detect concussion, ranging from a “dazed, blank or vacant look” on a player’s face to asking questions such as: “What team did you play last week?” Gone are the days when a dose of smelling salts was applied to the nostrils before the player was shunted back into action.

Even so, was it an unnecessary risk? Scientists have long since established that concussion symptoms do not always show up immediately after a head impact – and that playing on can damage recovery. One study in the journal Pediatrics followed 69 high‑school athletes who sustained head injuries in American football, ice hockey, soccer and volleyball and found that those who stayed on the field took twice as long to recover (44 days compared with 22 days).

There also remains a wearing sense that football is lagging behind both rugby codes as well cricket, the NFL and horse racing when it comes to head impacts. As Alan Shearer put it at the weekend: “We are talking about life and death.”

He added: “Football needs to get real, it needs to wake up, it needs to get serious. Not next year, next month, now. It is not acceptable, it has been going too far too long.”

In rugby union, it used to be regarded as a badge of honour to battle on, no matter how groggy the brain or bloodied the shirt. Attitudes have changed. Incidents such as Wales’s George North appearing to be concussed twice in a Six Nations match minds – as did the year‑on‑year rise in the reported incidents of concussion in the Premiership from 2009-10 onwards.

Nowadays if there is any suspicion of a concussion then a player is removed from the pitch for a head injury assessment, which takes 10 minutes. If a player fails any of the cognitive tests, which are measured against a pre-season baseline, they are removed from play. The rules have also been changed in an attempt to make the game safer, particularly when it comes to tackling.

Of course rugby remains dangerous. Last year a study in the British Journal of Sports Medicine found that on average, a professional rugby union player is more likely than not to sustain a concussion after 25 matches. But at least there is a sense of the authorities recognising the seriousness of the problem – and trying to do something about it.

Cricket’s attitude to concussion also changed in 2014 after the Australia opener Phil Hughes died after being struck on the back of the head. Nowadays concussion substitutes are allowed – which enabled Australia’s captain, Steve Smith, to be replaced mid-match in last year’s Ashes Test at Lord’s after he was struck on the neck by a Jofra Archer bouncer.



Australia’s Steve Smith is hit by England’s Jofra Archer in the Ashes Test at Lord’s in 2019. He was replaced by a concussion substitute, although only after returning to finish his innings. Photograph: Tom Jenkins/The Guardian


© Provided by The Guardian
Australia’s Steve Smith is hit by England’s Jofra Archer in the Ashes Test at Lord’s in 2019. He was replaced by a concussion substitute, although only after returning to finish his innings. Photograph: Tom Jenkins/The Guardian

Horse racing has more concussions than any other sport, with an average of 25 per 1,000 hours in jumping and 17 in Flat races, but the British Horseracing Authority insists they have been “well ahead of the game” in recognising the dangers thanks to its former doctor, Michael Turner, a world authority on concussion.

Since 2018 any jockey who is involved in a fall is immediately assessed by a Scat5 test – and often again 25-30 minutes later, even if they are asymptomatic. “If they fail the test they are stood down for a minimum of six days,” says Robin Mounsey of the BHA. “Any rider with concussion shouldn’t be driving so they will also be helped to get home. Of course if it is a severe case of concussion, they will be sent to hospital.” The riders also do a two-yearly CogSport test to set a baseline and then to pick up any concerning shifts.

Football finally looks to be getting its act together with Lukas Brud, the chief executive of the International Football Association Board, telling the Guardian that new protocols, allowing additional substitutions if a player suffers a head injury, are likely to be passed on 16 December and trialled “as soon as possible” next year.

Related: Manchester City’s Ederson calls for concussion substitutes after David Luiz incident

It is a start. But there is still a sense that the game is skirting around the issue. That is despite a major Glasgow University finding last year that former professional footballers are three and a half times more likely to suffer from dementia than the general population. And another study, by scientists at Purdue in Indiana, showed when teenage girls head a football regularly there is a risk of low‑level brain injuries, which in some cases last for four or five months before the brain looks normal on MRI scans.

Perhaps the lack of X-rated collisions compared with other sports led football’s authorities to relax for too long. Thankfully attitudes are now changing. But the fact Watford’s Troy Deeney claimed on Monday that players know best when it comes to head injuries suggests there is still some way to go.

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