Athletic Trainer’s Perspective on World Cup Concussions

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Published:  July 22, 2014

Last week, John Hoover wrote yet another fantastic article, this one pertaining to the horrid concussion practices witnessed by millions during the World Cup soccer tournament. Since July 14th, John’s sentiments have been echoed by various writers and bloggers throughout the country. Another brief, but excellent piece, on this topic was published by Juliet Macur in the New York Times on July 15th. I encourage you to give these a quick read and some thought.

In a nutshell, the organization responsible for the World Cup (FIFA) has chosen to actively turn a blind eye to the issue of concussions during sanctioned matches. Just in case you missed it, during the course of the World Cup there were multiple times in which participants were obviously concussed (with the exception of Netherlands Martins Indi).  The concussed players were, more often than not, allowed to remain in the contest without any legitimate evaluation. Referees didn’t remove them, coaches didn’t remove them, the players didn’t remove themselves, and the medical staff didn’t remove them.   How, in 2014, in a professional environment are concussed players allowed to remain on the field?

As Macur points out, FIFA’s substitution rules dictate that each team has only three substitutions per game, and that once a player is out of the game, they must stay out. There is no allowance within this policy for head injuries, and because of the inflexibility…players stay on the field and continue playing rather than force their teams to play a man down. Obviously, a concussion impairs your ability to reason this out…”let’s see, should we play a man down so that I can get my head evaluated or should I stay on the field and risk death…. I think I’ll go with the death risk.”

From an athletic trainer’s perspective, the standard of care in the U.S. would include immediate removal from competition for evaluation, with the likelihood of re-entry into the contest unlikely. I can’t speak to the standard practices of the other professions involved from around the globe (physiotherapist, physician, etc)…but what I can say is that these practitioners were handcuffed by FIFA policies, coaching tactics, and the players refusal to remove themselves. Having an athletic trainer on the sidelines is critical for not only world cup matches, but also for youth events…and the policies of the host organization can’t take medical decisions out of the hands of medical professionals such as ATs. The role of the athletic trainer is to make medically based decisions, based on the health status of the athlete, not based on wins and losses or substitutions.

In addition to the life endangerment of participants, and the circumventing of the medical staff, the FIFA concussion problem prominently displayed on our screens will undoubtedly have a cultural carryover. An example (or lack thereof) has been set for younger players and youth coaches. There is absolutely nothing that we can do to reverse this poor example. No matter how many people pay attention to the concussion crisis by educating themselves with material such as this blog but there are literally tens of millions more who watched those concussed players continue to play in those world cup matches. Many of my friends’ children had drawn/been assigned a world cup team by their soccer organization to watch, follow, and cheer for.

There were millions of children and young adults watching their soccer heroes sustain concussions and continue playing, as if that’s what good players do. When these kids return to their own fields, Athletic Trainers must be available to these kids in order to handle concussive events the proper way. I hope that these kids never experience a concussive event and if they do, I hope that they have immediate access to an an athletic trainer that will not follow the World Cup examples orchestrated by FIFA.


(Editor’s Note: John Hoover, a sports columnist for the Tulsa World has been awarded, on multiple occasions, by state and national athletic training organizations for his excellent work on the need for appropriate medical coverage at all levels of sport in particular concussions)

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