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Soccer: Concussions at World Cup put head injuries in focus

Major League Soccer is on the cutting edge of concussion protocol; will others follow?



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Who determines the severity of a concussion minutes after the a brain is jarred inside the skull? Once that question has an answer, who decides it’s ethical to give the green light to return to action?

Roalstad was the Medical Director for the U.S. Ski & Snowboard Association and helped the International Ski Federation (FIS) implement mandatory concussion guidelines for managing head injuries. Since furthering her studies of concussions with Think Head First, the awareness raised about the the injury has helped hike the number of those seeking advice and treatment.

At a glance

A closer look

The recent FIFA World Cup in Brazil drew rave reviews for its record-breaking number of goals, tantalizing finishes and routs during the knockout stage. But something marred the tournament: Several players appeared to suffer head injuries — most likely concussions — and were allowed to continue playing. FIFA has a “Pocket Concussion Recognition Tool” on it website “to help identify concussion in children, youth and adults.” A notable section under “memory function” is as follows: “Any athlete with a suspected concussion should be IMMEDIATELY REMOVED FROM PLAY, and should not be returned to activity until they are assessed medically. Athletes with a suspected concussion should not be left alone and should not drive a motor vehicle.” However, it’s unclear whether this is FIFA’s standard protocol. Do team trainers have enough time to evaluate players with head injuries during a game? If not, how long would it take to properly diagnose a suspected concussion?

Notable World Cup head injuries

» Uruguay’s Alvaro Pereira suffers head injury in World Cup group stage match against England on June 19.

» Argentina’s Javier Mascherano suffers head injury in World Cup semifinal against Netherlands on July 9.

» Germany’s Christoph Kramer knocked out of World Cup final against Argentina on July 13.

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As for the ideal length of time for a legitimate concussion test — no matter the venue — Roalstad said trainers and those examining must be willing to throw the flag.

"You sit them out and they’re out for the rest of that day," she said. "It gives you time to evaluate properly. Many times symptoms do not show themselves until several hours later. There’s a lot of adrenaline with competition. They think they’re in tact, able to execute certain things."

Wingert provided a player’s perspective and used Mascherano’s moment as an example.

"If I was Mascherano, would I have kept playing? Probably," Wingert said. "You’re in a semifinal of a World Cup … it is sad in a way that we highlight people that play through it as the hero and being a tough dude, because it’s really tricky. It’s not easy to see 10 years and 20 years down the line."

As for giving independent examiners full control to make the controversial call?

"I don’t know how I feel about saying it’s always up to the doctor or up to the ref," Wingert said. "It’s tough. I’ll tell you right now, Mascherano would have absolutely flipped if somebody would have told him you have to come out."

Wingert said in hindsight, each time he wanted to continue on, it wouldn’t have been worth the end result.

Roalstad, like many who are educated on concussions in soccer, said it is vital to have someone free of either team on the field to properly make the decision.


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"People get caught up heat of the moment and forget their protocols," she said. "I think an independent person, firm on protocol, is necessary. If there’s any thought that this kid or athlete might have had a head injury, pull them out quietly evaluate appropriately. It’s just impossible to do on the sideline and it’s not worth it."

What the future holds

The symptoms Twellman deals with daily fluctuate. He said he hasn’t properly worked out in six years. He can’t. There are days when a headache will rule and command what transpires until it slips away. There are days when he can’t get out of bed, but those days have dwindled since he changed his diet among other things.

"My life has changed because of concussions," he said.

He’s seen the other effects first hand. His former neighbor, Junior Seau, took his own life in May 2012 after playing in the NFL for 20 years. It was later revealed that the former star suffered from Chronic Traumatic Encephalopathy also known as CTE.

"We’re starting to see new rules in sports, new rules in returning to play after these injuries thanks to literal education and awareness," Twellman said, "but ultimately what we need to get rid of are athletes like myself."

The idea of bigger, faster, stronger has been fingered by some as a reason why more people are paying attention to concussions — and some think a direct correlation is there.

"There’s absolutely no doubt [concussions] happened at a high rate before and they’re at the same right now," Lagerwey said, "I suspect a lot of it is awareness and reporting of the injury."

Numbers will be crunched and analyzed in countries all over the world as more is made of what transpired this summer in Brazil. As ugly as it might have been, it may have been a necessary to showcase the seriousness of head injuries in soccer. After Kramer needed two people to help him off inside the Maracana, Twellman turned to former superstars Michael Ballack and Ruud van Nistelrooy inside the studio as sort of a point. He said they immediately knew something needed to change.

"This has been going on a lot longer than the 2014 World Cup," Twellman said. "It’s just that no one else has been listening."

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