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Concussion in Football: What Needs to Change



No football fan could unsee Tottenham Hotspur’s Jan Vertonghen wobbling and retching on one side of the pitch following a collision with Toby Alderwiereld, his teammate.

Vertonghen initially fell to the ground, slammed his face into the turf. His nose also bled moments after.

However, after three minutes of assessment, he was back in the game for a few minutes only to be escorted back to the tunnel.

What happened to Vertonghen is a medical scare no one should witness. But everyone did, raising questions on the efficiency of concussion protocols. It also irks the fans who criticised how the situation was handled.

Medical team to the Spurs, however, claimed that they indeed followed the protocols. It was announced right after that the Belgian player was not suffering a concussion.

Why these protocols are established in the first place? Are they being followed diligently or not?

‘Worst concussion protocols in the world’

Chris Nowinski, co-founder and CEO to the Concussion Legacy Foundation, pointed out three things. These are 1) the worst concussion protocols, 2) the archaic substitution rules and 3) the apparent disregard of the clinical care for concussion. 

If there was no perceived lack of concussion protocols, the medical scare that Vertonghen should not have happened.

Also, in improving concussion protocols, consider these options.

Replays for concussion signs

The medical team should be allowed to request replays if the signs of concussions are present.

FIFA outlines a list of visible signs of concussion including

  • Loss of consciousness
  • Lying motionless for 5 seconds or more
  • Confusion or disorientation
  • Vacant look
  • Incoordination  
  • Tonic posturing
  • Impact seizure
  • Ataxia

The Football Association (FA) also mentions other player-reported signs to consider such as severe neck pain, repeated vomiting, double vision, tingling or burning in arms and legs, and unusual behaviour change.

The player must be immediately removed from the field for further assessment. FIFA also requires that if these mandatory signs are present, the player must not be permitted to return to the game.

Temporary (10-minute) substitution

On October 23, 2019, the International Football Association Board (IFAB) will discuss the possibility of extending temporary substitution. In this way, the medical team would have enough time to assess the severity of the concussion, if there’s one. 

The current concussion assessment allotment is three minutes.

Within the 10-minute window, medical substitution should be allowed. Otherwise, the team would have to play ten versus 11.

Dr Edwin Goedhart, Dutch Football Federation’s sports medicine head, on the other hand, considers the combination of three and ten-minute assessments. Now all concussion would need a full 10 minutes to evaluate.

To seek a second opinion, there must be an outside medical team on standby to assist the club’s medical staff.

Educating team physicians, coaches and players

Screening all players for baseline tests is vital in determining whether a concussion happens during the game. This will serve as a comparative basis.

More importantly, the team physicians, as well as the coaches and players themselves, must be educated about concussion, its consequences, and what must be done when someone experienced it.

This is crucial today especially after a landmark study proved the link between dementia and death among football players.

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As a fan, how would you want to contribute to improving football concussion protocols? Please let us know.