Football failing in its duty of care
James Milner is football’s Mr Durable. Approaching 37 years of age, after 599 Premier League games, he is widely regarded as indestructible.
Head injuries are no respecters of age or status though. Against Napoli on Tuesday Milner, Liverpool’s captain on the night, was hurt in the first half but, after treatment, played on until the interval.
He returned for the second period only to sink to the ground away from the ball not long after the restart because of the continuing after-effects of the head clash. He was then replaced.
It would be logical to conclude Milner was concussed – although as European competition does not have anything as up to date as a concussion substitute that would have to be an unofficial diagnosis.
If he was, he will miss Liverpool’s Premier League clash against Spurs on Sunday while he goes through the sixday return-to-play protocol for a professional player.
That would be a shame – it’s a big game – but it is still a game and one that has a duty of care to its participants.
At the moment it is failing in that duty of care.
It is ludicrous that the biggest club competition in the world does not yet have concussion subs, but then again the sport’s entire approach to the issue remains woefully uneven.
Last Saturday, Aston Villa goalkeeper Emiliano Martinez played on after medical attention against Newcastle following a head injury only to have to retire later in the match.
In Martinez’s case, because it was a Premier League game, a permanent concussion sub was available and deployed when he was eventually removed. But as in the Milner instance, it was the dangerous gap between injury and withdrawal that was the cause for concern.
Had either player sustained a second head impact in that period the consequences could have been serious.
Second Impact Syndrome, when a follow-on concussion is sustained before the symptoms from an earlier concussion have dissipated, can lead to brain damage or even, in rare cases, be fatal.
The FA recommends the ‘if in doubt, sit them out’ approach employed in other sports. But too often in football it appears the benefit of the doubt appears to be going in the wrong direction. The correct medical call has to be made. There is a bigger picture to look at than the three points. It would be best for all concerned if head injuries are taken out of the hands of a team’s own staff.
No one is saying that club medics are deliberately turning a blind eye, but it is far from straightforward operating in such a highly pressurised environment.
Players will always want to play on and managers will always want their best players to remain on the field. In the NFL, every team is now assigned an unaffiliated neurotrauma consultant, whose job it is to work alongside club medics in helping to identify and check for concussion.
Football should go further and allow an independent doctor to take over and carry out the assessment in all possible concussion cases. The current permanent concussion sub rule, which is in its second trial season domestically, does not allow the medics time to do their job properly.
Assessing a player quickly on the field with thousands of impatient fans awaiting a restart is asking for trouble.
The checks should be carried out at leisure off the field while a temporary substitute comes on in the injured player’s place. If the player is deemed fit to continue they can return to the field; if they are not then the temporary change becomes permanent.
It is the system both rugby codes employ and it works well there.
IFAB, football’s law overseers, remain stubbornly unwilling to go down the temporary sub route.
How much more evidence do they need?