Dr. Don Kirkendall

I won’t defend the National Football League. For years, they denied any problems with head injury while seemingly aware that a problem did indeed exist. But give them credit, they are directly facing the problem. The EPL should consider following the NFL’s lead

Three contrasting situations between Nov 3-10 caught my eye:

• Tottenham vs. Everton. Spurs keeper Hugo Lloris comes out to narrow the angle on Everton striker Romelu Lukaku and is struck on his temple by Lukaku’s knee. Lloris goes down and is motionless for some seconds. He slowly gets up and is helped to the sidelines.

Spurs manager, Andre Villas-Boas huddled with medical personnel evaluating Lloris. Back-up Brad Friedel gets up and prepares to enter the match. But after some sideline questioning, Lloris re-enters the match.

However, later he was not cleared for the next game. How’s that? In five minutes, he was OK’d to stay in, but ‘upon further review’ after the match, he was held out for their next match?

• The following week: Man United vs. Arsenal. The Arsenal keeper Wojciech Szczesny collides heads with United’s Phil Jones and lays still for a brief time before getting up and, after ‘treatment’ by the physio, continues playing.

Not much later, Man U captain and central defender, Nemanja Vidic, collides with his own keeper, David de Gea. Visibly shaken and bloody, Vidic is removed from the game, leaves for the locker room and eventually to a hospital for observation.

• Same day, Carolina Panthers vs. San Francisco. Two ’49ers, Vernon Davis and Eric Reid, leave the game for concussion evaluation. This was Reid’s second concussion this season, having been injured in Week Two. When Davis headed for the training room, the commentators remark, “He’ll go through the NFL-mandated concussion tests and if he fails any part, he’s done for the day.”

After the Lloris injury, FIFA’s Chief Medical Officer, Jiri Dvorak, was critical of Tottenham’s handling of the injury. The English brain injury charity Headway said the club had an “irresponsible and cavalier attitude” by allowing an obviously concussed player to continue. I hope we are all aware that a second injury to an already concussed brain can be fatal.

In the post-match press conference, AVB, as he’s known, said, “it was a big knock, but he looked composed and ready to continue” because Lloris “seemed assertive and determined to continue and showed great character and personality.” Wow, that’s sound medical evidence.

FIFA’s Dvorak stated unequivocally that, “it’s a 99% probability that losing consciousness . . . will result in a concussion” and added, “When a player has been knocked unconscious, the player himself may not see the reality.”

How good will his decision-making be during the run of play if he’s making decisions like that? More importantly, another head impact could be fatal.

What Dvorak’s last comment means is that the player’s desire to play is not a part of the decision-making process. Ever!

In the crush of competitive pressure, under the gaze of thousands of spectators and millions on television (or even in a rec league match), the last person to decide on continuing to play is the injured player. But, AVB (and a substantial fraction of UK commentators in the following days) lauded Lloris for being tough and soldiering on.

Two things about these incidents were interesting to me. First, the NFL now has a league-wide policy and evaluation procedure. When a player has sustained a head injury, a rigid evaluation process, consistent across all teams, is initiated.

And I can guarantee you that one of the questions asked of the player certainly is not, “Do you want to keep playing today?” Of course, the player will say he’s fine. Unless the player is out cold when asked, they almost always want to get back in the game.

Second, cross the Atlantic to a different sport for three highly visible and scary head injuries. A sideline decision by medical staff, coach, and player results in an obviously concussed player staying in.

Fast-forward one week to ManU v Arsenal. Two obviously serious head injuries. Szczesny stayed in, Vidic quietly left the field. What this shows is the lack of a league-wide policy regarding head injury – each team has its own policy and at Old Trafford, the two extremes were on display. ManU subbed, Arsenal didn’t. In one week, the EPL experienced three big-time head injuries and two were handled poorly.

Now, some might say that the U.S. is far too touchy when it comes to getting one’s “bell rung.” Heck, there is even an old medical diagnosis from the 1960’s on the books called a footballer’s migraine. I mean, the English invented the game, right? They must be the most knowledgeable.

Sorry boys and girls. With all that is being learned about the long-term outcomes of head injuries, who could agree with how Tottenham and Arsenal handled injuries? Yet we sit and applaud a player’s warrior mentality, and hey, they are getting well paid to take the risk.

Author: dr.don.kirkendall@gmail.com

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