World Cup focuses minds on concussion management

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RIO DE JANEIRO (AP) - Felled by an opponent’s knee to the head as they both chased the ball, a player is seemingly out cold on a World Cup pitch. The clock is ticking. Millions are watching. National honor, careers and sponsorship dollars are at stake.

Groggily, the player wakes up and argues furiously with his team doctor that he must play on. For anyone attuned to the dangers of concussions and head injuries, this is when alarm bells ring - just as they did when this scenario unfolded at the World Cup in Brazil.

As in American football, team doctors should be able to pull a player off the field and calmly determine whether the player can continue. But that’s not easy when the player himself is yelling he’s OK and the doctors know that every minute they take is another minute the team must survive without that player.

And once a player is substituted, he can’t return.

To give doctors more time, the world union for footballers is arguing that soccer’s rules - first codified 151 years ago in a London pub - should be revised so teams can temporarily replace players while they’re examined for possible concussion.

“It might take a medical practitioner at least 10-15 minutes to properly diagnose a possibly concussed player, and symptoms/signs can take longer than that to show,” FIFPro said in emailed responses to questions from The Associated Press.

“Teams and players should not be disadvantaged for upholding player health and safety, or encouraged to act in a way that compromises it.”

FIFA’s medical chief told the AP he doesn’t oppose the idea. Michel D’Hooghe also was critical of Uruguay’s management of a head injury to Alvaro Pereira in a match last week against England.

Pereira inadvertently got a knee to the temple. He later said the blow knocked him out and “was like the lights went out.” Team doctor Alberto Pan initially made hand signals for a substitution but then seemingly changed his mind after the clearly dizzy player furiously protested. The images provoked criticism from FIFPro, head injury specialists and others.

“I was also not happy with that situation. I must confess that,” said D’Hooghe, a member of the FIFA executive and chairman of its medical committee.

D’Hooghe said one possible risk with temporary substitutions could be that players’ muscles would cool while they’re examined and this would make them more prone to injuries if they then are put back in play.

However, D’Hooghe said FIFPro’s proposal “has also advantages. “

“It’s a discussion point for the future,” he said.

D’Hooghe also said FIFA should legislate procedures for managing suspected concussions. Currently, there are FIFA-approved guidelines team doctors can follow, but they’re not obliged to do so.

“I think we can make that step forward, from guideline to rule,” D’Hooghe said. . “And we will do that.”

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