FIFA Laws of the Game, rule change proposal:
Temporary substitution to allow proper evaluation of a player who has suffered
a possible concussion
Dr. Daniel Meeroff and Dr. J.C. Meeroff
A concussion is a very serious problem affecting many soccer players.
A concussion is a complex
pathophysiological process that affects the brain, typically induced by trauma
to the head and/or upper body (traumatic brain injury or TBI). It can be caused either by a direct blow to the head,
or an indirect blow to the body, causing internal biochemical changes in the
brain. In soccer, those changes usually resolve spontaneously with no consequences,
but in some cases they can lead to severe cerebral alterations resulting in
cognitive changes such as memory deficits, sleep disturbances and eventually in
some cases to severe conditions leading to permanent disability and even the death
of the affected athlete.
A major determinant in the prognosis of
concussion depends on the management of the initial impact. It is has been well
established that a second impact
immediately after the first impact (second impact syndrome or SIS) increases
exponentially the risk for severe complication and decreases the likelyhood of
fast recovery. SIS carries a 50% mortality rate and an almost 100% morbidity
rate.
In the US, repeated head trauma forced retirement of New England Revolution stra Taylor Twellman in 2010. Concusions also forced out DC United Bryan Namoff and Alecko Eskandarian, like Twellman a former league MVP. In 2012, Seatlle Sounders back up keeper Terry Boss retired because of complications from concussions
These are only a few examples of a
problem of great magnitude. In response to these facts, the MLS and the NASL
(the two professional men’s leagues in the US) have implemented a drastic
policy mandating that a player suspected of having a concussion in a game or
practice must be removed immediately and evaluated. In youth soccer in the US, the
policy is that a player who has suffered a trauma that can cause a concussion
must be substituted and prohibited to return to play in the game.
We propose to modify the current text of
FIFA’s Law Three-The number of players- to allow for proper examination and
management of a player who suffered a concussion during a match.
The proposed changes are as follows:
The injured player who demonstrates
signs of concussion must be mandatorily removed from the field of play and a
temporary substitution must be allowed (one substitution that will not count as
one of the maximum allowable substitutions according to the rules of the
competition) to permit the team to keep playing without disadvantage, while the
injured player is evaluated by a neuro-trauma expert physician unaffiliated
with the teams to determine if, the player can safely return to play. If he/she
can indeed return, the temporary substitution ends. He/she is back on the field
at the next stoppage of play, and the temporary substitute returns to the
bench. And the team is not charged with a substitution. The player who came in
as the temporary substitute in this case and was removed, may re-enter as an
official substitute at a later time. Contrarily, if the player is in no
condition to return to play, then the temporary substitution becomes official
and counts as one of the maximum allowed by the Laws of the Game.
Examples:
Blue #5 is involved in a collision and
exhibits signs of a concussion. Team medical personnel enter the field of play,
and the player is removed for further evaluation by the neutral neuro-trauma
expert. The Blue team is allowed to have #20 from the list of eligible
substitutes enter as a temporary substitute.
Situation 1: Blue #5 is determined to
have no concussion symptoms and is allowed to re-enter the game.
Then, Blue #20 is removed, and the team
is not charged with a substitution. Blue #20 is allowed to enter at a later
time as an official substitute if necessary and if the team has not used up its
maximum number of substitutions.
Situation 2: Blue #5 is determined to
have a significant concussion and is not allowed to re-enter.
Then, Blue #20 remains on the field and
becomes an official substitute. The team is charged with one substitution.
Situation 3: Blue #5 is determined to
have a significant concussion and is not allowed to re-enter. The team has
already used up its maximum number of substitutions before the time of the
injury occurred.
In these circumstances, Blue #20 is
removed from the field, and the team plays short.
The process recommended here is similar
to the one used in the American NFL, and it was suggested to be implemented in England
by the British media after the concussion suffered by Tottenham GK Hugo Lloris
in a match vs Everton last year. This idea of a temporary substitution has ample
support from players and sport physicians as well.
References:
Doolan A.D., Day D.D., Maerlender, A.C, Goforth M. and
Brolinson, P.G; A Review of Return to Play Issues and Sports-Related
Concussion. Ann Biomed Eng 2011
American College of Sports Medicine. Concussion (mild traumatic brain
injury) and the team physician: a consensus statement. Med. Sci. Sports Exerc.
2006: 38:395–399
Consensus statement on concussion in sports: The 4th
International Conference on Concussion in Sport held in Zurich, November 2012.
Br J Sport Med 2013: 250-258
