Robin Koch’s head injury in Leeds United’s 2-4 home defeat to Manchester United on Sunday has reopened the debate on how serious football is about head injuries. The Professional Footballers’ Association, the union for all registered players in England and Wales, has said Premier League is “failing to prioritise player safety”. And that wasn’t the harshest comment on the issue.
“Football is doing barely enough and is just trying to avoid criticism rather than solve the problem,” said Judith Gates, co-founder of Head For Change, a charitable organisation in England increasing awareness on neurodegenerative disease due to playing professional football or rugby and help those suffering from it. Gates’ husband Bill, a former central defender with Middlesbrough (1961-73), has dementia, a condition that has affected elite footballers including 1966 World Cup winners Jack Charlton and Nobby Stiles and Dennis Law. In 2020, Gates asked for dementia to be considered an industrial disease, a fall out of excessive heading of the football.
A study led by the University of Glasgow last August revealed that chances of footballers having dementia is up to five times more than normal people with defenders being at the highest risk. The study also said traumatic brain injury can happen due to excessive heading. Yet, according to Gates, “there is no evidence of a systematic analysis based on a comprehensive overview of the dangers of heading.”
With Koch, Gates said in an interview to HT on e-mail on Tuesday, “the guidance, ‘if in doubt, sit them out’ was not followed.” The Leeds United defender and Manchester United’s midfielder Scott McTominay had a clash of heads in the 12th minute which led to a cut and after being bandaged, Koch resumed. Leeds have said they followed all concussion protocols and Koch said he returned to help the team. But in the 31st minute, he asked to be replaced and was seen making his way out gingerly helped by the Leeds’ medical staff.
“Whether someone who has just received a blow to the head is able to ascertain their fitness to return is highly questionable,” said Gates. “The issue of ‘second impact syndrome’ is not sufficiently acknowledged. If a player returns to play too quickly after a first concussion and receives another blow to the head, even a minor one, the consequences could be extremely serious. SIS can even result in death. So, players should always be fully recovered before they return to play.”
That is why, like PFA, Gates is pitching for temporary substitutes. Because it buys time. “The more time the medical staff have to assess the severity of the injury without the pressure of making a permanent substitution, the more likely a responsible decision will be made,” she said.
Head injuries are common in football, think Raul Jimenez, Petr Cech in Premier League and Amey Ranawade in the Indian Super League. In the last Africa Cup of Nations, Senegal’s Sadio Mane stayed on the pitch — and scored —after a collision with Cape Verde goalkeeper Vozinha. Germany’s Christoph Kramer had a concussion in the 2014 World Cup final after colliding with Argentina’s Ezequiel Garay but played on for 14 minutes even though he had asked referee Nicola Rizzoli whether this was the final. Later, Kramer said he didn’t know how he made it to the change room after being replaced.
Yet in 2017, a report by doctors from Canada found that in the Brazil World Cup, players weren’t always assessed on the sidelines— as per Fifa guidelines— after head injuries and if they were, it was only briefly. Published by the Journal of the American Medical Association, the report listed 81 head collisions with 67 players showing signs of concussion. But 16% of those players were not assessed and 63% got on-field assessment, the report said.
Football’s moved from that with head injuries now needing immediate stopping of the game and as part of a trial, some competitions including Premier League allow, after medical assessment, up to two concussion substitutes per team in a game. But the International Football Association Board (IFAB), which makes the rules in the sport, have not yet deemed it necessary to have temporary substitutes in case of head injuries. According to a report by the PA news agency on Tuesday, it won’t happen soon either. The agency quoted an IFAB spokesperson as saying: “The concussion trials will indeed be part of the discussions at our upcoming AGM (on March 3). However, at this stage, changes to the protocols are not foreseen.”