Concussion rules at the World Cup don’t protect players

It wasn’t long before the World Cup drew renewed attention to elite football’s troubling relationship with concussions.

In the eighth minute of England v Iran at the Khalifa International Stadium, Iran goalkeeper Alireza Beiranvand jumped off his line to intercept a cross and eventually collided face first with teammate Majid Hosseini. Both players fell to the ground in pain but it quickly became clear that Beirenvand had come off worse.

The Iran goalkeeper required lengthy medical treatment to stop a nosebleed and was checked for concussion on the pitch. Although Beiranvand appeared to show signs of disorientation and lay flat on his back for around four minutes, he was allowed to change his blood-stained shirt and try to continue – after Iranian captain Ehsan Hajsafi splashed water on his face. In the 17th minute, Beirenvand signaled to the Iran bench that he needed to be substituted and sank back to the ground.

Coach Carlos Queiroz revealed after the game that his goalkeeper had been taken to hospital with a broken nose and a “severe concussion” for a check-up, but offered no real explanation as to why he initially stayed on the pitch.

Alireza Beiranvand


Alireza Beiranvand after a headshot against England (Photo: Ulrik Pedersen/DeFodi Images via Getty Images)

The incident was branded a “complete disgrace” by Luke Griggs, interim chief executive of brain injury association Headway, underlining that football’s mechanism for treating concussions is far from perfect. Beiranvand was allowed to risk more head injuries, despite Qatar 2022 being the first World Cup where teams can make permanent concussion changes that don’t count towards their allotment of five changes.

A trial of permanent concussion substitutions was officially sanctioned by the International Football Association Board (IFAB) in December 2020 to address a key impediment to prioritizing player welfare: the fear of being placed at a strategic disadvantage in a game by losing a regular substitution. Major leagues and organizations then adopted the rule, including the Premier League, the English Football League and the Football Association.

At the World Cup, teams are allowed one permanent substitution for concussion in addition to their five standard substitutions per game. But while this frame represents a significant improvement over concussion treatment at previous World Cups, it still poses some major problems.

FIFA’s concussion rules state: “If signs or symptoms of brain damage are present, or a concussion is suspected when no signs or symptoms are present, the doctor/therapist should remove the player from the field of play for a more detailed examination (using a concussion replacement if available/required).

But unlike the NFL, where three independent neurotrauma consultants are assigned to each game and evaluate players suspected of having a concussion, the system allows FIFA to make the final decision on whether or not a player should leave the field, the team medical staff. In reality, the opinion of the coach and even the player concerned often plays a role. This is problematic considering few players will leave the field and coaches may be reluctant to lose key players for the remainder of a game.

In this regard, FIFA’s statement following the Beiranvand incident: “While the ultimate responsibility for the diagnosis and treatment of concussion lies with the team doctor in charge, FIFA expects all teams to act in the best interests of their players and their health.” – could be interpreted as naive.

Last month, the Professional Footballers’ Association (PFA) in England again asked IFAB and FIFA to authorize the introduction of temporary concussion substitutes, allowing affected players to be replaced on the pitch for a short period while they are being attended to by doctors be examined on the sidelines or in the dressing room.

The idea is that the option of a temporary move would reduce players’ reluctance to leave the field and encourage coaches to take them off, removing two key obstacles to prioritizing player welfare.

Following the Beiranvand incident, the PFA said: “We have seen a clear example on the biggest stage in the world of current concussion protocols not being used under the pressure of the game.”

Massive physical collisions aren’t as common as in the NFL or rugby, but football is the only major sport where the head is routinely used to manipulate the ball. In recent years, football’s awareness of concussion and the risk of brain injury has risen significantly, but many believe protective measures are still not up to par.

Yasser Al-Shahrani


Saudi Arabia’s Yasser Al-Shahrani lies on the ground after being hit to the head just before being carried off the stretcher and taken to hospital (Photo: Simon Stacpoole/Offside via Getty Images)

2017, the athlete Columnist and former England striker Alan Shearer presented a BBC documentary entitled ‘Dementia, Football and Me’ in which he explored the link between repetitive header play and an impaired ability to remember, think and make decisions related to day-to-day life Meeting activities examined.

Several players from England’s team that won the 1966 World Cup developed dementia, and former West Bromwich Albion striker Jeff Astle, known for his flying skills as a player, was diagnosed after his death aged 59 in 2002 discovered that he was suffering from chronic traumatic encephalopathy (CTE). a form of dementia associated with repeated blows to the head.

CTE will be awfully familiar to NFL fans. Earlier this year, the New York Times reported that it had been found in the brains of more than 320 former NFL players, and in 2015 the league had to compensate former players who suffered brain trauma with a $1 billion settlement plan .

No such compensation was given to affected footballers and their families, but in 2020 the PFA signaled a rethink by setting up a task force to study their response to dementia in football. Among those involved are Chris Sutton, Shearer’s former Blackburn Rovers strike partner, and Dawn Astle, Jeff’s daughter.

Sutton was among those who reacted most angrily to the handling of Beiranvand’s head injury: “The concussion in football is a disgrace,” he wrote on Twitter. “Where is the procedure if in doubt… I’ll say it again: the football authorities don’t care about their players.”

(Top Photo: David S. Bustamante/Soccrates via Getty Images)



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