The World Football Cup is the world’s largest sporting event, the Olympics aside. It has a huge worldwide audience and anything that happens during the event on television has an instantaneous and magnified impact.
So when the impact is a knee of an English player hitting Uruguay’s Alvaro Pereira’s head (watch the video here), leaving him unconscious on the pitch, fearing the worst, it is in everyone’s home live on television, or on screens in every pub on the planet.
What happens next is a real disgrace. When the concussed Uruguayian gets back up, his team doctor is signalling for the necessary substitution. The player has suffered a severe concussion, is not behaving normally, and must be taken out of the game, all World Cup and all. Alvaro Pereira angrily pushes the doc back and DECIDES to go back to the game, and actually does! Catch this tweet with the embedded video of the sequence (by Gabriele Chiocchio).
Alvaro Pereira didn’t take very long to recover some analytic capacity, as today he publicly apologized for his gesture towards the team doc, saying that the doc is the one who should make the call, his goal being the health of the athlete. This is too late, of course. The damage has been done, not to the team doctor, who was making the right call, but to all the millions of viewers who got the message that an obviously concussed player has the right to show his determination and courage to return to play in spite of the dangerous injury and medical advice, and widely accepted guidelines for concussion management. The kids, coaches, parents and fans get this message sent to them: A concussed player can successfully immediately return to play and help his team win at the highest level. It is utterly wrong and this cannot be accepted. Some sports have installed concussion sideline rules (Rugby Union), which come with their own problems and exceptions (see George Smith’s concussion in this rugby game), but reviewing incidents has recently led to slight modification of the rule (see this post), in the hope of avoiding further “misunderstandings”.
Luckily, today FIFA has announced that they have initiated an investigation in the Pereira Concussion. Maybe this decision is the result of the little “nudge” by the International Players’ Union (FIFPro), who called for the investigation on the failure to protect a player’s health. The union is also “seeking urgent talks and immediate assurances that FIFA can guarantee the safety of the players, which must be priority number one, for the remainder of this tournament and beyond”.
This is not the first time soccer is in the midst of the RTP decision debate. In November 2013, Tottenham Hotspurs goalkeeper, Hugo Lloris, was knocked unconscious, another obvious serious concussion. He was cleared to return to play by….the coach, André Villas-Boas, who later claimed that the call was ultimatel his to make, the team medical staff only there to assist him in the decision. This sparked an important debate, relayed by sports science and medicine professionals of the highest caliber, see post by @PeterBrukner, a world leading sports medicine practitioner, on the British Journal of Sports Medicine (BJSM) blog. In that post, he reminds readers of the widely accepted RTP protocols after concussion, which looks like this (each step is a day, not a minute!):
We can only hope that the ultimate result of this commission will be to delegate the return-to-play (RTP) decision to the team doc, and potentially to outside neutral observers, if that is required. The RTP decision should be the result of a clearly defined process, in order to reach appropriate decisions to protect the players on the pitch.
Alvaro Pereira apologized, but he also said the following, leaving a bitter taste to the apology:
“It was a moment of madness…I’ve apologized to the doctor because I know it’s his job to look after the players,” Pereira said.
I went back on dizzy but, in the heat of the moment, with a hot head, you don’t think properly.”
“Still, it was a time to help the team and to get a result. And the most important thing is that we got the result.”
As a sports medicine practitioner I can only state that I do not agree. The most important thing is and should always remain the safety of the players.