Don’t Let the Heart Rule the Head

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Head injuries are an inevitable consequence of contact sports, be it the unintentional clash of heads eager to be the first to the ball or a more sinister rage driven coming together. At the World Cup in Brazil however, there were several instances where such clashes were deemed far more trivial than they should have been.

Head injuries account for almost 700,000 hospital attendees in the UK each year and roughly 20% of these require admission for monitoring. NICE recommends that a patient requires referral to an emergency department if there is any loss of consciousness even if the patient is fully alert at the time of the initial assessment. Yet, on at least two occasions in Brazil, where the best medical guidance and evidence based practice should be employed, players were permitted to return to the game after seemingly losing consciousness.

The impact of brain injuries, especially repeated ones, has only recently had a light shed upon it. In American football, chronic traumatic encephalopathy (CTE) has recently entered the vernacular as a potential disorder that all players may be at risk of. It is similar to “Punch-drunk Syndrome” observed in boxers in the 1970s and often referred to as dementia pugilistica (DP). Recent research in rugby players has revealed similar neuroimaging findings to those seen in CTE and DP with cumulative changes to central structures and signs of diffuse axonal injury consistent with repeated traumatic incidents. Footballers are no doubt exempt from this risks when they too experience head injuries but the trend seems to be for players to return to the field of play – defensible in a sporting sense but reprehensible in a medical one.

The Lancet Neurology believes that an assessment of a player should be performed by an independent medical practitioner rather than a coach or medic with “a vested interest”. Patients, because that is what these players are in horse circumstances, require an assessment that does not compromise their health but, by releasing players such as Alvaro Pereira and, briefly, Christoph Kramer, back onto the pitch could have had, or may still have, lasting consequences.

Nobody wants to be seen as a villain, let alone on the grandest of stages at a worldwide spectacle, but that should not compromise a sense of duty to doing something what is the most medically sound option. Kramer eventually did leave the pitch in the final propped up by his teammates and coaching staff but Pereira returned for Uruguay against England as did Argentina’s Javier Mascherano when he also seemingly lost consciousness in the semi final against the Netherlands.

While FIFA need to do as much as they can to minimise the occurrence of head injuries, there also needs to be responsible medical treatment at the pitch side that isn’t influenced by the occasion itself. No player wishes to leave a game prematurely but no human, athlete or not, would want to increase their risk of suffering from dementia. They say that you should play sport having left everything you could have given on the pitch – should they really have to leave their neurological health there too?

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