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Does Álvaro Pereira’s Concussion Imply Change In FIFA Policy?

During the Uruguay – England game, we saw Alvaro Pereira knocked unconscious by Raheem Sterling’s knee.Despite team physicians signaling for a substitution,the player waived them off and was allowed to continue.Later, the Uruguay physician would sign a statement stating that he completed a full neurological exam and that it was normal. Read about the article from the NY Times here.

In pro sports, handling concussions is simply tough

Having worked over 200 professional and international matches where substitution limits are in place, I can attest to the challenges of helping physicians perform sideline concussion evaluations.More often than not, the medical staff would stall to everything possible to complete a proper assessment on the pitch before the referee would ask us to move.The greatest challenges in the evaluation in my view is that it relies heavily on a player being honest with how they feel.While there has been progress over the past few years in player’s truthfulness as well as how sports organizations and leagues manage concussions, it is still common for players to hide their symptoms if the game was big enough, (i.e. World Cup), making self-reporting of concussions a continual problem in sports.Additionally, delayed memory tests can have limited effectiveness because of the overall shortened evaluation time frame. As the game wears on player's fatigue and mental function can easily decrease. It is not uncommon to have players appear normal on the sideline only to begin to exhibit symptoms upon return to the pitch when his/her heart rate is elevated.In my experience, if a player was diagnosed with having a concussion he was removed from play immediately.If a player is unconscious then there is little doubt that he is concussed.

Fear of litigation

There is an ever present mentality within professional sports that when a player feels that he is healthy enough then he should be allowed to play. After all, in professional sports, this is their livelihood.At what point then,can an individual consent to the risks especially to that of playing with a head injury? It will be the basis of one of many lawsuits that have arisen for which informed consent will be defense. For this reason, FIFPRO has made the suggestion of allowing a “free” substitution to allow for proper evaluation, a rule that is currently in the NCAA rulebook.This is a great idea in theory for FIFA. However, teams can take advantage of this loophole and use it to rest a player or to make an extra sub late in a game. For example, a team down a goal late in a game could have its center back go down holding his head and sub on a forward while the defender is “evaluated”. Think back to Bob Bradley taking advantage of the MLS GK substitution rule.

So what should be done?

Even within FIFA, there are issues about how to handle these injuries.Chief Medical Officer Jiri Dvorak stated that Lloris should have been removed from the game after being knocked unconscious in an EPL game this past season yet stands behind the evaluation and allowed continuation of play by Pereira. Standard practice in the US is to spine board an unconscious athlete maintaining cervical spine stabilization to ensure they do not have a spinal fracture.Had Pereira been placed on a spine board, then there would have been no doubt about his removal from the game.Other options would be to allow more substitutions in the game or allow for one re-entry.Not only would this increase the likelihood proper sideline evaluation but would also likely lower overall injury rates. 

In the end,this all bodes one final question.With the general consensus that Pereira suffered a concussion, will he play in the next game or will Uruguay continue to risk this player’s health? According to the 4th Consensus Statement on Concussion in Sport,an athlete should follow a progressive return to sport.If the protocol is followed, returning within 5 days, the time until Uruguay’s next game, is nearly impossible.  

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