18 July 2014

It's Time for FIFA to Stop Stumbling Through the Haze

Executive Editor Shane Nicholson says the world's governing body needs to lead from the front in dealing with concussion and other brain injuries.

Let's talk about head injuries in football, since at the end of the day this is still a football blog and not one about how to forge a proper corporate structure in a club.

We saw repeatedly in the past World Cup players who had taken obvious blows to the head that left them out of sorts and out of their minds. Multiple instances culminated with Germany's Christoph Kramer unaware that he was playing in the World Cup Final after suffering severe head trauma early in the match against Argentina and being allowed to stay on for nearly a quarter-hour at times seemingly stumbling aimlessly through a thick haze following an "assessment" that lasted less than 90 seconds. 

Kramer had, on camera, in view of the entire world, been unable to stay on his own feet after the initial hit and was clearly glassy eyed on the sideline as he waited to re-enter play. Like any athlete at his level playing in such a competition he talked his way back onto the pitch thanks to a medical staff unprepared and unwilling to make the difficult decision for him and his side to send him to the locker room. It was perhaps the most telling moment in FIFA's denial of the impact of head injuries in football. They simply do not see fit to shift around some of their vast piles of cash (including that $1 billion rainy day fund) to study the effects of repeated blows to the head on its talent and to bring in policies to ensure proper diagnosis and treatment of the resulting injuries.

While the onus ultimately falls on the governing body to implement universal best-practices in this regard, including a potential temporary substitution law to allow time for medical staff to properly evaluate the injured player, match officials and the team doctors and physios themselves need to in the meantime step up and stop allowing such incidents to occur. Officials have an obligation to the safety and integrity of the game they're in control of. Doctors and physios have an obligation to the safety and well-being of the players in their charge. Repeatedly, at all levels of football, these two integral components of the players' safety net have let them down.

It's not just at the World Cup, though seeing it unfold over and over on the sport's biggest stage has finally, hopefully, cast the spotlight on a very serious issue. And it's not just a case of the overtly apparent injuries we saw during the course of this past tournament being the only concern for the sport. Players for generations have suffered the long term effects associated with repeated blows to the head, many simply from a core part of football: your head is a contact point for the ball. While a header rarely results in a severe brain trauma event, repeated blows over the length of a season and career take their toll. Thanks mostly to the intense criticism of the NFL and NCAA's efforts to ignore and cover up the effects of such "minor" impacts, the specter of chronic traumatic encephalopathy (CTE) has become part of the sporting lexicon. Simply put, the small hits add up over time and their impact can be as debilitating as a single major injury such as the one Kramer suffered. 

It is arguable that such impacts are part of the game that cannot be avoided. However, American football now has programs teaching youths to avoid the minor head impacts associated with the game. Perhaps it's time for such measures to be taken in the youth levels of football as well, where these small trauma events have the greatest impact on players' growing brains. How many headers could be avoided by teaching better chest control techniques? How many uncontested balls in the middle of the pitch could be collected at the feet? It should be imperative that coaches teach young players to avoid using their head to attack the ball unless it is absolutely necessary.

An ongoing study at Purdue University in Indiana into CTE has recently uncovered that youth athletes who suffer these small repeated blows to the head show changes in brain patterns over the course of a season. How their brain processed and executed functions prior to a playing season is different from how it handles the same functions after. This is the same type of remapping you see in the brain following a traumatic event such as concussion or stroke.

Steps toward this can begin now with a simple directive from FIFA to coaching courses: Avoid headers, avoid the awful impact of CTE later in life. This challenge will be just as large and the reaction just as important to how they address the severe traumatic brain injuries like the repeated concussions we saw at the World Cup, not a single one of which saw the player thoroughly evaluated, all of which saw the players return immediately to the pitch based on telling their team doctors that they were okay to continue. 

Concussion simply cannot be evaluated in such a short time span, and the decision should never be in the hands of the player who has suffered the injury. By allowing the player to dictate how and when they will re-enter the game medical staffs are risking even further damage to the athlete's health, short and long term, as the period immediately following an injury is when the brain is at its most fragile state. Simply put, following an impact like the one Kramer suffered in the Final any further injury could result in irreversible brain damage, even from the slightest contact. It's like sending a player out after severely twisting his knee and not expecting him to suffer further damage over the course of the match. 

Of course one can see a knee swelling; the bruising and physical damage is apparent on sight. But the resulting swelling of brain trauma is not readily apparent, hidden from view under the skull. It is for this reason that concise universal procedures must become part of the laws of the game, from the highest levels of the sport down to U5 matches. Safety first in any suspected brain injury should be a no question proposition. If there is a chance an athlete has suffered a traumatic brain injury then time should be taken for a full evaluation, just as one would undergo for a suspected torn ACL or broken ankle.

FIFA must take the lead. Match officials must use better discretion to keep players safe. Coaches and medical staffs must put the health and well-being of the players higher on the priority list. Waiting to institute such changes is unacceptable. We've seen now, billions of us around the world, just what happens when concussion diagnosis is left in the hands of the athletes, a decision which should not be theirs under the best of circumstances let alone at a time when their brain is simply not functioning at its full capacity. Kramer was allowed to continue playing for 14 minutes at a time when another blow to the head could've left him in an intensive care unit for a lengthy period of time.

That cannot be allowed to happen again, anywhere in the game. It's time to accept that these injuries, while not completely preventable, should be treated far more seriously by everyone involved in the sport. It's not a matter of toughness, not a sign that players are softer now than in years past. It's a sign of a game reacting to knowledge that was not available in years past and using it to benefit the health of its players, measures which will ultimately improves the health of the sport as a whole.

There should be no time limit placed on how long it takes to evaluate and treat a player unable to stand on his own two feet following a blow to the head, but the time limit for FIFA to take the steps to ensure these injuries are treated with the same care and importance as a shattered lower leg has passed. The understanding of brain trauma and its effects is rapidly increasing seemingly every day; it's time FIFA kept up instead of stumbling aimlessly through the haze.