Other sports think ahead, but soc­cer in dif­fer­ent head space

Sunday Times - - Sport Rugby - By LIAM DEL CARME

● Rugby, Aussie Rules and NFL have pro­to­cols to ac­com­mo­date a 10-minute field-side con­cus­sion test. Tellingly though, soc­cer is ig­nor­ing this.

The 10-minute rec­om­men­da­tion set by the in­ter­na­tional con­sen­sus group on con­cus­sion has been adopted by 11 codes but not ev­ery­one is buy­ing in.

“They are uni­formly good with one ex­cep­tion — and that’s Fifa,” said in­ter­na­tion­ally recog­nised ex­pert on the sub­ject Jon Pa­tri­cios. “They are al­ready be­hind the curve. They sent a rep­re­sen­ta­tive to our im­ple­men­ta­tion meet­ing but re­fused to ac­cept the rec­om­men­da­tions. They are not part of the pa­per we just pub­lished.”

Fifa had been part of pre­vi­ous con­sen­sus papers but they have changed their fo­cus.

“The rec­om­men­da­tion for a field-side eval­u­a­tion of con­cus­sion is to re­move the player from the field and that eval­u­a­tion takes at least 10 min­utes. It’s sim­i­lar to rugby where we have a HIA (head in­jury as­sess­ment).

“Soc­cer only fa­cil­i­tates a three-minute on-field eval­u­a­tion. It is im­pos­si­ble to do a proper eval­u­a­tion in three min­utes. Un­til Fifa wakes up they are go­ing to ex­pose them­selves hugely. They’ve had in­ci­dents. At the pre­vi­ous World Cup they had three in­ci­dents where play­ers were clearly con­cussed but played on.

“They are aware of the prob­lem and changed the rules so that you can­not go up with your el­bows when head­ing the ball. That re­duced the in­ci­dents a lot.”

Rugby fully com­pli­ant

Pa­tri­cios sug­gested that soc­cer may be re­luc­tant to change be­cause they are try­ing to avoid rolling sub­sti­tu­tions which soc­cer bosses be­lieve will dis­rupt the game. “They are also scared it might cause ma­nip­u­la­tion of the rules as coaches get play­ers to feign in­jury. They need to work around that.”

He noted that rugby was fully com­pli­ant with the pro­to­cols and that lo­cally the sport had not suf­fered a head-in­jury fa­tal­ity in years un­til club player Wayne Sibanda died last month. Pa­tri­cios is yet to fa­mil­iarise him­self with all the de­tails around that case.

He is how­ever a firm pro­po­nent of the pro­to­cols cur­rently ap­plied in rugby.

“There is no rea­son why any­body should die from con­cus­sion,” Pa­tri­cios said. “We have very good clin­i­cal guide­lines.

“The play­ers who have died of a con­cus­sion are usu­ally young, and they are usu­ally un­di­ag­nosed. They’ve ei­ther played on with a con­cus­sion or have gone back to play­ing be­fore the con­cus­sion has re­solved.

“We have not had a head in­jury (fa­tal­ity) in rugby for years. That’s largely due to the Bok smart pro­to­cols. Ref­er­ees and coaches are trained to recog­nise head in­juries.”

Pa­tri­cios says there are two ar­eas where he and his group are look­ing for break­throughs in tack­ling con­cus­sion. “Fluid biomark­ers are pro­teins found in blood, saliva and cere­bral spinal fluid. Those are pro­teins as­so­ci­ated with nerve dam­age. You can test them and, in time, they may pro­vide a clue to di­ag­no­sis and re­cov­ery.

“The other is in imag­ing tech­niques. We have brain scans which are al­most al­ways nor­mal in the case of con­cus­sion, but the area of re­search is in func­tional MRI scans which show changes in brain func­tion and phys­i­ol­ogy, as well as more sub­tle dam­age that we as­so­ciate with con­cus­sion. It is ex­pen­sive tech­nol­ogy, in­ac­ces­si­ble at the mo­ment and es­sen­tially a re­search tool.”

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