Digital editor Richard Hook highlights the importance of the Premier League's new concussion ruling and argues why it needs to be extended to cover contact sports at all levels:
While the backs of this weekend's papers were full of transfer talk and the start of the new Football League season, arguably one of the most important footballing stories of any season may have slipped under people's radars.
For the coming season the Premier League has introduced new rules on how to deal with head injuries; a player suffering a head injury must now leave the pitch and the club doctor must decide if a player is capable of continuing, rather than the current system which sees non-medical members of team management make the decision.
Despite the potential long-term damage to mental health that mild traumatic brain injury can cause being widely accepted – see various studies on www.tbi-impact.org/ - at the recent World Cup finals we saw two players ushered back on to the field minutes after appearing to lose consciousness.
More worryingly, Argentina's Javier Mascherano was largely applauded for his 'courage' in continuing to play in the semi-final. While the effects of a concussive injury usually have immediate onset, are short lived and resolve spontaneously, other the signs may not be immediately appreciable, and neurological impairment can develop in the minutes or hours following injury.
Complex pathophysiological processes
As Elena Becker-Barosso suggested in a recent editorial for The Lancet Neurology journal with such complex pathophysiological processes in play decisions on whether a player can continue or not should not be made "by those with a vested interest" or those without a neurological background.
The full extent of the effects of allowing a player to continue playing was highlighted in a recent lawsuit led by Adrian Arrington, an ex-American football player at Eastern Illinois University, against the National Collegiate Athletic Association (NCAA). In the course of proceedings, which led to the NCAA establishing a £41.3 million medical fund for head trauma, Arrington revealed that he had endured five concussions during his time at Eastern Illinois, some so severe he could not recognise his parents afterwards leading to memory loss, seizures and debilitating depression.
With examples such as this of the risk involved in continuing to play with a possible concussion, hopefully the plaudits given to Mascherano will be replaced by those for the Premier League's decision to draw up a new 7-point concussion plan as follows:
1) A player suffering a head injury must now leave the pitch.
2) Team managers or coaching staff will no longer decide if a player continues to play and the final decision will be with the club doctor.
3) Home teams in the Premier League must now have a third "tunnel" doctor on match-days to support the work of the doctors for both sides.
4) The "tunnel" doctor will serve as an extra pair of eyes to spot potential concussions and watch TV replays to see the severity of incidents.
5) The FA, in conjunction with the Football League, Professional Footballers’ Association and League Managers Association, is to launch a campaign aimed at making players and managers at all levels aware of the dangers of head injuries.
6) The Premier League is to employ its own doctor to conduct research and liaise with all 20 club doctors in the league on key medical matters.
7) All Premier League players are to undergo baseline neurological assessments as part of their annual medical check-up to help doctors measure their recovery time if they suffer a concussion.
Training for on-pitch diagnosis at all levels
However, for myself and many other observers point 5 is the key aspect of these rules and one which should be expanded on. While it is great to know that Premier League players will be 'covered' by specialist medical professionals in instances of possible concussion, what about the hundreds of thousands of people who play the game from parks to the semi-professional and lower league ranks?
In particular, schools and youth clubs should be provided with the necessary funding to have staff involved receive training in using on-pitch diagnostic questionnaires as there are potential cumulative effects of repeated concussions, particularly in young athletes, which could lead to progressive degenerative diseases such as chronic traumatic encephalopathy.
One potential solution is a quick reference App, developed by the American Academy of Neurology, which identifies the symptoms of concussion, but the validity of this has yet to be tested in practice.
Therefore, it remains in the hands of non-experts to make the important calls over many head collisions. But hopefully the site of high-profile players receiving on-pitch diagnoses and being withdraw in situations of risk will lead to a culture where playing with concussion isn't applauded and those making the decisions err more towards safety.
As Luke Griggs, a spokesman for brain injury charity Headway, told the BBC: "It's an important step forward in the protection of footballers. Concussion is an evolving injury with symptoms that may take time to manifest, and if you don't get it properly assessed, it may be too late.
"It's key these guidelines are enforced at all levels, especially at grass roots. It's vitally important that we lose this culture where it's brave and courageous to play on."
To find out more about the risks of concussion in sport visit: www.tbi-impact.org/