Commentary: AVB merely highlighting there's much work to be done

Antiquated attitudes show concussion concerns continue, in England of all places

Comments made by the Tottenham manager Andre Villas-Boas on Wednesday are the reason why the English game, and maybe even the European game (AVB is Portuguese), is charting a very dangerous course with its stance on head injuries.

To those unfamiliar with the incident, I’ll bring you up to speed. In the 77th minute of their Barclays Premier League match at Everton on Sunday, Tottenham goalkeeper Hugo Lloris raced from his goal to try to intercept a pass, only to be caught on the side of the head by the knee of the on-rushing man-mountain Romelu Lukaku.

Lloris briefly lost consciousness, but after being tended to by doctors and telling them he was okay, the 26-year-old Frenchman was allowed to continue.

Cue amazement on this side of the pond, and a steady wave of criticism in Britain and beyond. Dr. Jiri Dvorak – the chief medical officer with world governing body FIFA – insisted that Lloris ought to have been substituted, in accordance with FIFA guidelines … and therein lies part of the problem.

No rules are in place for head injuries, only guidelines, which too few adhere to in the English game.

Tottenham are in the firing line on this occasion, but other English clubs are equally clueless when it comes to concussion. It’s making headlines in the UK because the topic of how sport deals with concussion is very much in the spotlight.

Dr. Brian O’Driscoll is a former medical adviser to the International Rugby Board. He resigned his position recently due to the introduction of the Pitch Side Concussion Assessment (PSCA), stating: 'Rugby is trivializing concussion'.

And so too is soccer.

Villas-Boas refused to back down on Wednesday when talking to the media. In fact, he suggested: "I stand by the decision I took and I stand by the decision made by my medical staff. They did everything by the book."

In a sense, he has a point by stating ‘they did everything by the book’, because if what we witnessed at the weekend is anything to go by, then the 'book' on how to deal with head injuries in English soccer would be made of parchment, and the out-dated, antiquated guidelines written by quill.

AVB wasn’t finished. He hit out at those he felt were seeking publicity over the incident, and also defended his medical team, which only two years earlier had saved the life of Bolton midfielder Fabrice Muamba after he suffered cardiac arrest on the field.

Fair point, Mr Villas-Boas, were it not for this. That medical team would not have been in place, or have the expert know-how, neither would there have been protocol and procedures had it not been for the tragic death of former Cameroon international Marc-Vivien Foe.

He collapsed, unchallenged, in the middle of the 2003 FIFA Confederations Cup semifinal – from sudden cardiac arrest. As a result of that, the sport implemented better safeguards and stricter procedures. Don’t allow a preventable death or long-term suffering be the trigger for change. Just listen to the experts.

In August 2012 doctors published a report in the British Journal of Sports Medicine which outlined major flaws in the way English professional soccer teams deal with concussion.

According to the Consensus in Sport (CIS) guidelines, each team must assess their players before the start of each season. A cognitive score is filed, and that is then used as a starting point for if any head injury occurs during the season.

Staggeringly, less than half of the Barclays Premier League clubs had bothered to make preseason cognitive assessments for their players.

More than a quarter of the 92 professional soccer clubs in England were not even up to date on the latest CIS guidelines.

Just 21% routinely record an approved preseason cognitive score.

A third used outdated fixed periods of abstinence following a concussion.

As many as 42% failed to complete a recommended postconcussion assessment.

And more than half, 55.6%, did not routinely follow the CIS guidelines.

The findings make for chilling reading and, although this report was published over a year ago, it seems little has changed.

It’s akin to describing a rose to a blind man. They just don’t see it.

What I’m hearing is that ‘NFL and NHL have concussion. It’s not a major issue in soccer’.

Nonsense. Call it arrogance, call it ignorance but this is going to end one of three ways:

  1. A player will sue the English Football Association for failing in its duty of care.
  2. A player will die as a result of second-impact syndrome (a second concussion before symptoms from an earlier one have subsided).
  3. The soccer authorities in England will remove their well protected craniums from the sand and lay down strict rules on the treatment of head injuries.

I’m hoping it’s the latter, and I’m hoping it’s of their own volition – and not as a reaction to either 1 or 2.

As a way of giving a Colorado Rapids perspective, I interviewed midfielder Dillon Powers on Wednesday (below), almost a month to the day since his 2013 season ended prematurely due to concussion.