Christophe Simon / AFP / Getty Images

World Cup shows soccer cannot be complacent on concussion

NCAA’s $75M lawsuit settlement a reminder that head injuries can be costly in more ways than one

This week, as the U.S. soccer establishment counted the dollars coming in from big European teams playing friendlies across the country, officials might have also been keeping an eye on the dollars going out from another sport — and hopefully learned a valuable lesson.

On Tuesday the NCAA reached a $75 million settlement on a class action concussion lawsuit, which bound them to a new and far-reaching protocol for the assessment and treatment of concussions. The settlement will prevent the NCAA from becoming involved in the type of costly class actions in which the NFL has just reached tentative settlement with up to 5,000 of its former players.

The NFL legal battle’s ultimate (and still uncapped) costs could run to the billions inflicted and collateral damage on the game and governing body’s image. The NFL’s handling of the affair has possibly undermined its future position as undisputed No. 1 sport in the country.

When President Barack Obama told a New Yorker writer in January of this year, “I would not let my son play pro football,” he was arguably echoing the thoughts of many parents around the country who, with mounting alarm, watched the concussion debate and the attendant revelations about the NFL’s alleged suppression of players’ medical data. 

Concussion, an injury usually caused by an impact in which the brain is jarred or shaken to the point that the fluid surrounding the brain doesn’t cushion it effectively against the inside of the skull, can be difficult to diagnose and track, since its effects can range from immediate unconsciousness and visible disorientation to subtler symptoms. 

Properly diagnosed and with proper recovery time (which can take up to a few weeks), most such injuries can be overcome. But the larger issue around concussions in sport and most recently the NFL in particular involves not just addressing what causes concussions but also taking the proper medical precautions to ensure players are not exposed to the type of secondary impacts that can cause permanent damage and possibly even death. With the pressure to get back in action felt by players and even club medical staffers, the scales can be tilted toward unnecessary risk.

Yet as certain recent high-profile incidents have shown, any hopes soccer might have of benefiting from being perceived as a safer sport for young people to play has to be tempered by the reality that it, too, is a contact sport. 

One emblematic moment came during the sport’s marquee game, the World Cup final in July, when Christoph Kramer, the German defender who moments earlier had been dazed in a clash with Argentina player Ezequiel Garay, approached Italian referee Nicola Rizzoli and asked him, “Ref, is this the final?”

A concerned Rizzoli made him repeat the question, and then, seeing the player’s stunned response to his reply, communicated to Kramer’s teammate Bastian Schweinsteiger that the evidently concussed player needed to be subbed out, which he was, 14 minutes after the collision with Garay.

Kramer’s predicament was hardly an isolated incident. It was only the highest-profile of a number of head injuries during the World Cup, including a knee to the head for Gonzalo Higuaín from Germany goalkeeper Manuel Neuer in the same game. 

Javier Mascherano on the turf after a blow to the head in Argentina’s World Cup semifinal, July 9, 2014.
Christophe Simon / AFP / Getty Images

And in one much-discussed performance in the semifinals, Argentina’s Javier Mascherano took a similarly hard knock before going on to play the remainder of that match, in which he made a vital last-ditch intervention on the Netherlands’ Arjen Robben that kept his team in the tournament. Mascherano’s injury illustrates an insidious problem in the culture of the game, as he was widely lauded for his resilience in playing on — perhaps feted precisely for putting his health at risk.

American players were also affected at the tournament. Toward the end of their defeat by the Belgians in the round of 16, there was a telling moment when Jermaine Jones, the combative U.S. midfielder who had broken his nose in the previous game against Germany, caught a ball in the face and went down heavily.

In the commentary box, ESPN announcer Taylor Twellman seemed to wince in sympathy before pointing out that Jones had been tested for a concussion after the first incident. His co-commentator Ian Darke, perhaps thinking of the context of a vital World Cup game and a player whose reputation was built as a physical enforcer, instantly said there was “no way” Jones was coming off — in a similar vein to the admiration generated by Mascherano’s return to the field. Jones duly got to his feet and continued the game.

The normally garrulous Twellman said nothing as he did so. Speaking this week, Twellman was adamant that he had no judgment about Darke’s take on events, insisting that as part of a team, he and Darke are learning about these issues as they go and that in the heat of a game it was a natural response about an important player. 

Asked about the praise for Mascherano playing through his injury, though, Twellman was equally adamant, saying, “The player who returns to the field with a head injury doesn’t have any more heart than the player beside him. To think that is dangerously ignorant. Is it worth the risk of a secondary contact that can be fatal? Do we have to see a player die on the field before we get the message?” 

Too often, Twellman might argue, players’ desire to demonstrate their commitment to their team by returning to the field, even after a blow to the head, makes them the worst judges in those situations — and that’s without factoring in what may be their impaired judgment. 

Former player Taylor Twellman describes FIFA’s treatment of the concussion issue as ‘barbaric.’
Gail Oskin / Getty Images

Twellman speaks from bitter experience. A former MLS and national team player, he was forced out of the game at 30 by the effects of multiple concussions — injuries that he claims need not have prevented him from continuing as a player had they been handled properly at the time. Instead, he felt he was pushed back into playing too soon and ended up compounding the effects. He still suffers from debilitating headaches, vertigo and extreme sensitivity to light (even from cellphones) and can’t work out for fear of raising his heartbeat to a dangerous level. 

As well as his announcing work, which began before he officially retired, Twellman has channeled his energies into a foundation, Think Taylor, that as well as educational work has advocated for an agreed protocol for handling concussions — a protocol adopted by MLS in 2011. The protocol places a neuropsychologist with every team and institutes mandatory cognitive testing before players are allowed to return from head injuries. A dedicated nine-person league committee continues to review best practices. In this MLS is ahead of the game’s global governing body.

Twellman argues that it’s important to have an independent protocol in place that sometimes removes players from games for their own good. He and FIFPro, the international players’ union, advocate third-party medical examination on the field, independent of the team doctors, and he was unimpressed, if unsurprised, by FIFA’s treatment of the issue during the World Cup.

“‘Barbaric’ was one word I used. I mean FIFA actually had independent medical advisers at each game — but for heat. Are you kidding me? They should be seeing the same TV feeds we’re seeing and be in communication with the assistant referees to step in and examine a player and remove them if need be. We already stop the game for head injuries, but when have you ever seen a referee tell a player he can’t continue? And then you look at their protocols, which are from the ’80s or something, and it’s like, ‘You can’t operate a motor vehicle for 24 hours.’ It’s pathetic.”

For Twellman, it’s a stance that hasn’t always made him popular among his peers. After hearing a previous comment from him on the subject, the women’s world record goal scorer and U.S. player Abby Wambach was dismissive, saying, “There’s obviously some risks that you take playing anything or doing anything, and that’s what we all assume when we step on the pitch.”

To which he countered, “Yes, but when you step on that pitch, don’t you want to know the exact risks you’re taking? And are you in any position to assess the risks of playing on after a head injury?”

Twellman, a former New England Revolution forward, is deeply skeptical about the NFL’s commitment to anything more than figuring out a dollar amount that will make the issue go away. As he put it, “You just watch this year and see how many players have concussions that miraculously clear up within six days, in time for the next game. They say they’re addressing it, but …”

He is in no doubt about the deadly severity of the issue. For a time, he was a neighbor of Junior Seau, the former NFL player whose experience with head injuries led him to shoot himself in the heart so that his brain could be studied. Twellman too has said he will donate his brain to medical study after his death.

For now, though, Twellman, the grandson of an Major League Baseball union man, has found himself fighting for a cause of his own. “You’ll never eliminate concussions,” he said. In fact, I’ve no doubt the [reporting of] incidents of concussion will rise as we get better at recognizing them. But part of being an athlete is having a support group around you that is well-educated and well-informed.” Twellman doesn’t add, although he might, that part of being an athlete is knowing what game you are playing.

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