When it comes to concussion in sport, misguided notions of bravery have clashed with medical evidence. But the science is winning, says Craig Moore
Bert Trautmann’s heroics for Manchester City during the 1956 FA Cup Final have acquired legendary, almost mythical, status in football folklore.
Despite sustaining concussion and a broken neck during a collision with an opposing player, Trautmann continued to play as goalkeeper for the final 15 minutes of the game and helped his team to win the Cup. The fact that he had dislocated five vertebrae and risked further catastrophic, potentially fatal, injury by continuing to play was not identified until several days later. Trautmann was a German living and working in austere post-war Britain, adding to the mystique surrounding the story.
Bravery and selfless commitment to a cause are human qualities that we understandably admire. This admiration has, though, contributed significantly to a failure to identify the dangers of head injuries in sufficient time. Together with an ignorance of the significant risks associated with brain trauma, it has also created an inertia within certain sports, including football, which persisted for over 50 years following the Trautmann Cup Final.
For most of that period, a culture of passive acceptance of concussive injuries and their consequences existed amongst players, managers, coaches, medical staff , owners and governing bodies alike.
Increased awareness
As recently as November 2013, the Tottenham Hotspur goalkeeper, Hugo Lloris, was allowed to continue playing after sustaining a head injury following a collision with an opposing striker. Lloris
appeared to lose consciousness – although the club subsequently disputed this. He was attended by the club doctor and club physiotherapist on the pitch.
As Lloris was being led to the touchline he resisted and said that he wanted to carry on. Tottenham’s coach at the time, Andre Villas Boas, directed Lloris to return to his goal and to continue. The
Everton striker with whom he had collided had to be replaced as a result of the injury to his knee, which he sustained when it made contact with the head of Lloris.
Lloris was lauded as a hero but controversy soon ensued over the decision to allow him to continue to play, demonstrating at least an increased awareness of the risks associated with concussion. Although Tottenham claimed that tests carried out after the match showed that he had been fit to continue playing, FIFA’s chief medical officer was insistent that Lloris should have been withdrawn. Robust statements, critical of the decision to allow a player to continue playing after losing consciousness were also issued by the head injury charity, Headway, among others.
Setting out new rules
New guidelines and rules were introduced by the FA for the 2014/15 season for the management of concussion and head injuries in football. They followed a review by its medical committee, which was undertaken in 2013.
The key features of the guide include a requirement for all players to undergo pre-season baseline cognitive training to detect any risk that may exist through previous injury. The guide has also
radically changed pitch-side medical assistance. Always erring on the side of caution, players must be removed from the field of play and not be allowed to return, even if there is only a suspected
period of loss of consciousness. Where there is no doctor, players must be sent to A&E immediately, and never left alone or allowed to drive home.
In addition, neuropsychological testing should be carried out every 48 hours after the injury until return to play, and show a gradual return to baseline. Clinical assessment should be made
daily, with a minimum return to play period of six days.
Where there has been a head injury, but no loss of consciousness, an on-field or touchline assessment will take place using the Pocket Concussion Recognition Tool which should be a
standard item of any pitch-side medical kit.
FA Premier League Rules were also amended for the 2014/15 season to establish that the decision of the team doctor is final when assessing whether a player who has sustained a head injury
is, or is not, fit to continue playing or training.
Those developments drew on the recommendations that were made in Zurich at the fourth International Conference on Concussion in Sport in 2012, and published in 2013. A panel
of neurological experts defined concussion as “a complex pathophysiological process affecting the brain, induced by biomechanical forces.”
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