SAO PAULO, Brazil — Earlier this week, FIFA staged a special news conference to address medical issues at the World Cup. A dais of experts detailed a variety of pressing health concerns: player cardiac arrests, fan safety, care for volunteers, communicable diseases. It wasn’t until nearly an hour passed and reporters were allowed to ask questions that anyone mentioned the one topic the international soccer world seems all too eager to ignore: head injuries.
Even when the question about concussions was finally posed, there wasn’t much in the way of self-reflection from the sport’s largest governing body.
“We have done everything to manage the concussions accordingly,” announced Jiri Dvorak, FIFA’s chief medical officer.
While head injuries have become a buzz topic in American sports, many feel it’s not nearly a high enough priority for FIFA and the international soccer community. Protocols are vague and inconsistent. Players have returned to games quickly after suffering injuries. And sidelines lack independent observers with any sort of authority.
“It’s barbaric. The way FIFA has turned an eye to head injuries, it’s 1950s-ish,” said ESPN analyst Taylor Twellman, the former University of Maryland and MLS star whose career was cut short due to concussions. “It’s just mind-boggling. . . . FIFA acts like it doesn’t exist.”
On Tuesday in Natal, Uruguay took the pitch and midfielder Alvaro Pereira was again in the starting lineup. Pereira took a nasty knee to the head in the first half — his second in as many matches — but somehow rose to his feet this time. Four days earlier he was knocked out cold in a game against England.
“It was like the lights went out a little bit,” he explained after the England game.
When Pereira finally came to, he was visibly impaired but was able to overrule team officials and re-enter the game. FIFPro, the worldwide players’ union, immediately asked FIFA to investigate, urging it to ramp up its concussion protocols.
For their part, FIFA officials say Pereira was examined but a concussion was not diagnosed. Regardless, FIFA says the ultimate responsibility lies with the club.
“We can only recommend,” Dvorak said, “and even if we suspect, we cannot overrule the decision of the team physician.”
“The ultimate responsibility must always remain in the hands of the team doctor,” said Michel D’Hooghe, chair of FIFA’s medical committee.
Dvorak said FIFA has specialists on hand at World Cup games, but it’s the teams’ responsibility to utilize them. “If we are not asked, we are not going to overrule the decision,” he said.
Some have lobbied for FIFA to allow teams to use temporary substitutes while a player is tested for a concussion on the sideline. FIFA has resisted, and D’Hooghe points to logistical complications. “Suddenly 10 minutes cooling down then coming up again without warming up, I can assure you’ll have more muscle lesions,” he said.
With FIFA watching from a safe distance, every World Cup team seems to handle head injuries in its own way. For example, after the Netherlands’ Bruno Martins Indi left a game against Australia last week, he was sent to a hospital overnight for evaluation and held out of the Dutch team’s next match.
“I’m making baby steps forward. . . . I’m taking step by step,” he said earlier this week. “Yesterday I was allowed to jog for a bit, so I have to wait and see when I can play again.”
In North America, where litigation and media attention have highlighted concussion risks in a variety of sports, MLS established new practices in 2011 requiring its players to undergo baseline testing before each season. When a suspected head injury occurs, that player cannot return to the pitch until he’s been examined by a specialist, and if a concussion is diagnosed, that player must remain symptom-free for at least 24 hours before he can begin to work his way back onto the field.
While MLS has made strides in recent years, similar to the NFL, it had to be nudged toward change. A handful of star players, such as Twellman and former D.C. United star Alecko Eskandarian, have had promising careers cut short by head injuries. And former United player Bryan Namoff has a $12 million civil suit pending in D.C. Superior Court, claiming United was “negligent in its management, care and treatment” of a 2009 head injury suffered at RFK Stadium.
While Eskandarian, who is now an assistant coach with the New York Cosmos of the North American Soccer League, says soccer in the United States still has “plenty of holes in our system,” he says attitudes are markedly different elsewhere.
“Some of it’s based on lack of medical knowledge. Sometimes in other countries it’s the toughness factor where maybe guys don’t want to admit suffering from the symptoms. And in other places, nothing tragic has happened yet,” Eskandarian said.
Concussion research is still largely in nascent stages, and the spotlight has shined the brightest on American football. Soccer officials, meanwhile still don’t understand the full impact of headers or nasty midair collisons.
Earlier this year, researchers found their first confirmed case of chronic traumatic encephalopathy (CTE) in a soccer player. Patrick Grange played college soccer at Illinois-Chicago and New Mexico. In 2012, he died at age 29 from a degenerative motor-neuron disease. After his death, Grange’s brain was studied at Boston University’s CTE center and researchers found signs of the degenerative neurological disorder.
While players such as Twellman and Eskandarian say they’re still living with the effects of soccer-related concussions, there hasn’t been research that fully illuminates the toll head injuries take later in life. In April, FIFPro released a study called “Mental Illness in Professional Football” that surveyed 180 active professional soccer players. One in four players reported feeling anxiety or depression. The study went on to survey retired players — average age was 36 — and 40 percent reported signs of anxiety or depression. The study didn’t make any correlations with head trauma and mental illness.
Twellman, whose MLS career was cut short in 2010, founded the ThinkTaylor Foundation, hoping to spur more awareness and discussion about concussions in soccer. Before flying to Brazil this month, he took part in a concussion summit at the White House that included President Obama.
Twellman, 34, notes that more children play soccer than most other organized activities, yet he’s watched other youth sports make important safety adjustments — hockey leagues limiting the amount of checking, baseball coaches monitoring pitch counts — and wonders when soccer will follow suit.
“It’s like we’re in a society where we’re more worried about a shoulder than a head,” he said. “I don’t want people to quit sports. We just need to evolve. . . . I think everyone’s a little scared of what head injuries means to the sport and how do you address it.”
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