Concussion in football: Is it time to get ahead of the game?

Recently concussion in football has become a serious issue for debate, and with the UEFA EURO 2020, UEFA Women’s EURO 2022 and FIFA World Cup Qatar 2022 coming up it is likely to be in the spotlight once again.

Why is concussion a serious issue?

The latter has been in the media spotlight with the emotive stories of former England players Nobby Stiles and Jeff Astle, who died from a type of degenerative dementia known as Chronic Traumatic Encephalopathy (CTE), and Jack Charlton who died with dementia. This was believed to be caused by repeated impacts to the head when heading the ball during their careers.

Consequently, there are serious concerns over the risk of concussion, the impact on players’ health, and the management of concussion at all ages and levels of football. So, what is being done to manage the risk of concussion in football and is it enough?

Image copyright: Photo by Phil Noble — Pool/Getty Images.

Tributes outside Old Trafford for former Manchester United player, Nobby Stiles.

The Concussion in Sport Group

SRC has a rapid onset, may or may not involve loss of consciousness and results in a functional disturbance to the brain rather than structural injury. The CISG developed a consensus statement to guide practice for healthcare professionals at all levels of sport. This includes SRC management guidance for side-line evaluation, player removal and neuropsychological assessment, rest and rehabilitation, graduated return to sport, and risk prevention.

SRC Guidelines: if in doubt sit them out

It was reported by the media that during a Premier League match, Arsenal defender David Luiz played on until half time despite sustaining a head injury following a traumatic head clash with Wolves striker Raul Jimenez. This calls into question whether the protocols are working and suggests that team management and tactical decisions might be taking priority over the health of players.

Image copyright: David Price / Contributor/Getty Images.

David Luiz and Raul Jimenez — Jimenez was stretchered off following a clash of heads with Arsenal defender Luiz.

Trials for concussion substitutes

Image copyright: MICHAEL REGAN / contributor/Getty Images.

From Left to Right: Craig Dawson and Issa Diop of West Ham and Fred and Nemanja Matic of Manchester United in the match in which Diop clashed heads with Anthony Martial.

The head injury charity Headway has condemned the use of permanent substitutes because the doctor is still under huge pressure to make a rapid concussion assessment and critical decision to remove a player from the game. Headway has suggested that the use of temporary substitutes and a longer assessment time, such as the 12 minutes allowed for the Head Injury Assessment (HIA) in rugby, would enable a team doctor to make a better decision and protect the welfare of the players. It should also be noted that concussion substitutes are currently only ‘trials’, which may be a case of too little too late. It will be interesting to see how successful these trials are in the upcoming competitions and how concussion substitutions might be rolled out across the sport in the future.

A change to the heading guidance

The issue raises serious concerns for our youth players and their long-term health. In particular, female youth players have been found to have nearly double the risk of SRC. Following a recent field study, the Football Association has announced new heading guidance for youth training (under 18s) but only at grassroots level. This includes no heading during training for primary school children, a graduated approach to heading training for older children, and specified ball sizes for training and matches. This goes part of the way to reducing the risk but heading is still allowed in competitive matches where repeated blows to the head can still occur.

Image copyright free: Pixabay.

Arguably, football may be behind other sports in its approach to managing SRC but there are some signs of change in the right direction. Football could learn important lessons from the improvements made in other sports such as rugby. For example, the doctors are allowed a longer concussion assessment time, there are temporary substitutions, and the Rugby Football Union (RFU) has a comprehensive educational concussion awareness programme called HEADCASE. Perhaps football does need to raise its game, sooner rather than later.

Nigel Wright is a lecturer in Sport and Fitness at The Open University.

This article was previously published on OpenLearn on 18 May 2021 and can be viewed here.

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