The protocol is unambiguous. The Consensus Statement on Concussions in Sport, as drawn up during the fourth International Conference on Concussion in Sport in Zurich a year ago and published in the British Journalism of Sports Medicine, says it very clearly. “A player with [a] diagnosed concussion should not be allowed to return to play on the day of injury.” It’s there, in black and white, under “On-field or Sideline Evaluation of Acute Concussion.”
Yet this edict, which is also written into the English Football Association’s regulations, was brazenly disregarded deep into Sunday’s 0-0 draw between Everton and Tottenham Hotspur at Goodison Park where Toffees striker Romelu Lukaku’s knee accidentally caught the head of Spurs goalkeeper Hugo Lloris as they both tried to get to a ball played between them. Lloris was out cold before his head had even had a chance to smack sickeningly into the turf.
Plainly, there was but one thing to do, something apparent to anybody enlightened on this subject. But that’s not what was done. Rather than take off Lloris, who looked heavily dazed, and bring on a substitute, he walked some distance to the sideline, seemed to change his mind and turned back to stay in the game. He disregarded his teammates’ pleas to put his wellbeing before the outcome of the game. And appallingly, Tottenham staff allowed Lloris to return and play out the game.
The handling of his injury -- and a concussion is officially classified as a traumatic brain injury, for the doubters out there -- was both misguided and misinformed.
On Monday, Spurs put out a statement declaring that Lloris had undergone a CT scan which showed no damage had been found. The thing is, as we’ve known stateside for two or three decades, CT scans are fairly well useless in diagnosing concussions. All they can pick up on is swelling and bleeding on the brain. And the presence of neither is necessary for a concussion to have taken place. There is no fool-proof diagnostic tool to discern whether a concussion occurred or not, that’s why time off is prescribed. Yet Spurs insist that the on-field medical staff was “totally satisfied that he was fit to continue playing.”
This simply can’t be said with any certainty, unless you go by the archaic science and medicine the Spurs staff evidently still employs.
Worse still, Spurs head coach Andre Villas-Boas praised Lloris for staying in the game, declaring that it had demonstrated “great character” -- even though he knew the goalkeeper couldn’t remember what had happened to him -- and that a late save preserving the point served to prove that he’d been right to leave his goalkeeper on the pitch.
The lack of understanding from not only the coaching staff but the medical staff in particular is stupefying. “It’s been blatantly obvious to me that in 2013, with the resources out there in the English Premier League and Europe in general, that there’s a complete ignorance,” says Taylor Twellman, a former Major League Soccer and United States national team striker whose repeated concussions ended his career at 30 and continue to give him daily headaches some four years on.
“Romelu Lukaku was completely knocked out earlier this year and he continued to play,” says Twellman. “Robert Huth was completely knocked out – he played. It is so obvious that the moment Lukaku’s knee hits [Lloris] in the head, he’s out.”
Leaving the game on account of a concussion, let alone sitting out the following one, is unheard of in the English game. While the Premier League has gained in polish and sophistication in the last two decades, its bedrock rah-rah spirit remains. While the American public looked on aghast as Lloris returned to the game, largely on account of the concussion awareness raised here by American football, the predominant narrative surrounding the incident over in England was one of praise for the player. What heart he had.
“For four years, since I’ve been dealing with it and speaking about it and started a foundation, you’d be amazed by how many tell me, ‘Well, it’s just a United States thing, it’s not a European thing. We don’t have concussions in England,’” says Twellman, whose THINK Taylor foundation aims to raise awareness. “And I laugh. I absolutely laugh.”
That isn’t to say that there isn’t anyone fighting the good fight in Great Britain.
Jiri Dvorak, FIFA’s chief medical officer, stated that “the player should have been substituted.”
He wasn’t alone. “We are hugely concerned that a professional football club should take such an irresponsible and cavalier attitude to a player’s health,” said Headway, an English charity trying to inform the public about concussions, through a spokesman. “A physio or doctor treating a player on pitch simply cannot accurately gauge the severity of the damage caused to the player's brain in such a setting.”
FIFPro, the worldwide player association put out a statement saying it was “alarmed.” The Professional Footballers’ Association demanded that from now on all concussed players be automatically substituted.
But in spite of this groundswell of criticism, the task of changing public perception is a steep one. By and large, people in the United Kingdom understand that concussions can give you dizziness, nausea, blurry vision and savage and unrelenting headaches. But the longer-term and lesser-known effects, like Chronic Traumatic Encephalopathy and exponentially increased chances of early-onset dementia and Parkinson’s, are far more serious.
That’s why England’s National Institute for Health and Care Excellence advises to refrain from contact sports for at least three weeks following a concussion. Not, as in the case of Lloris, and indeed Lukaku and Huth and countless others, a matter of minutes.
“What people don’t realize is it’s not the concussion,” says Twellman. “It’s what you do when you get one. Scientists have shown to us what that means, there’s a Second Impact Syndrome that’s fatal.” Suffer a second concussion before you’ve recovered from the first, in other words, and you could die from it.
“What happens if that [late] save didn’t hit him [in the body], but it hit him right in the head and then his career is over,” says Twellman. “Villas-Boas wants to tell me it was a good decision because of an 88th-minute save? You like that decision now? They don’t get it. They’re either ignorant to it or they think it doesn’t exist. It’s so barbaric to me, it’s beyond me.”
Unlike a knee or ankle, there’s no surgery that will fix your brain. “It’s the one injury that takes away your life,” says Twellman.
But until some case studies emerge, attitudes aren’t like to alter across the pond. There must be at least as many soccer players whose careers were ended as the half dozen we saw in the United States over the last decade. The professional game is much bigger there, after all, and the science and medicine less advanced.
Alecko Eskandarian was the top MLS draft pick in 2003 and one of its most promising players then. By 2010 his career was over. He’d suffered his first concussion in his maiden professional game, gotten several more in the subsequent years and still battles the effects every day. Eskandarian hasn’t watched the Lloris collision. He couldn’t stand it.
But he too has been outspoken stateside, understanding the stakes. “It has to be a combined effort from former players speaking out about the topic like some of us have done here in the States, to coaches recognizing the importance of it, to trainers and medical staff making sure that everyone knows the repercussions of putting yourself back on the field and being susceptible to being hit again,” he says.
This is what Britain lacks: poster boys. “In my experience, it takes something really tragic to happen for everyone to raise their eyebrows and realize what’s going on,” Eskandarian says. “It wasn’t until NFL players were putting shotguns to their chests and killing themselves and asking for their brains to be preserved that people really started to talk about it.”
If the English don’t grow aware of the problem and take unswerving measures, they’ll have their own cautionary tales soon enough.
