Football fan and specialist brain injury lawyer Ipek Tugcu has become a leading analyst of the concussion in sport debate. Here, she discusses the crucial issue of player safety with NR Times.
Whether you’re a football fan or not, you’re likely to have seen that the sport has recently been in the headlines for all the wrong reasons.
The focus has been on how football has dealt with the increased risk of neurodegenerative disease suffered by professional players. The quick answer? Not well.
I initially became involved in this campaign as I was a football fan and also work as a brain injury lawyer, representing those harmed by medical negligence or an accident.
Attempting to change any sport is a sensitive matter. Now more than ever, fans rely on sports as a means of escape from their busy lives.
People invest a lot into their favourite team, and the idea that tradition could change often causes immediate uproar. So it’s important to look at the facts, and to understand what the issue is and how the sport could evolve, to allow it to safely continue.
So what is the issue?
While it may just be hitting the news now, none of this is new. For decades, campaigners have raised concerns about the increasing number of professional players diagnosed with neurodegenerative disease, namely dementia.
Of course, neurodegenerative disease can affect anyone, but a worrying correlation has been apparent in the sport.
One of those players affected was West Brom legend Jeff Astle, who died in 2002, aged 59. His death was due to chronic traumatic encephalopathy (CTE) – a progressive, degenerative brain disease usually suffered by athletes with a history of head injury, such as multiple concussions.
Sadly, his situation is not an anomaly, and a growing number of former footballers have been diagnosed with dementia, including Gordon McQueen, Sir Bobby Charlton and Nobby Stiles.
So what exactly are the risks?
In October 2019, a research study commission by the FA and PFA (the “FIELD” study – Football’s InfluencE on Lifelong health and Dementia risk) revealed that former professional footballers were 3.5 times more likely to suffer from neurodegenerative disease than the general public.
Within this, former footballers were 5 times more likely to develop dementia or Alzheimer’s and twice as likely to have Parkinson’s.
These statistics are alarming, and working in the field of brain injury – we know the widespread devastation that such conditions cause, not just to the individuals diagnosed but to their friends and family, their local community and the NHS, who are often left to pick up the pieces and care for them.
The reality is that brain injuries, by their nature, cause significant administrative and financial pressures on individuals and authorities caring for the patient. The sporting world needs to take on the burden of finding solutions to problems they have created, before the younger generation is put off sport for good.
So what is it about football that puts players at increased risk? Whilst the FIELD research study didn’t pinpoint the exact aspect, research tells us that:
- It’s nothing to do with the argument that ‘the balls back in the day were heavier than the current, modern ones’. This is an incorrect misconception which has been debunked. The old leather balls and the new synthetic ones both weigh around 15oz. Whilst the older balls were heavier when wet, this means they would also have been slower so would have had less of an impact when hitting a player’s head. As such, today’s players face the same risks as footballers from decades ago.
- Subconcussive hits may be the main culprit. People often focus on concussion in sport, but it’s easy to forget that even those blows to the head that don’t formally cause concussion (i.e. are subconcussive) will impact the brain. In respect of football, players suffer most of their subconcussive blows during training, when practising heading. This type of training can usually mean hours every week of repeated hits to the head. Multiply this by the likely duration of their career, and a bleak picture emerges of the extent of trauma suffered to the head.
Despite the above, the current rules in football have not changed.
Whilst injuries, including head injuries, are part and parcel of any sport, it doesn’t negate the fact that players should be protected from known risks. It’s reckless and not to anyone’s advantage to ignore the research.
There’s also the legal side to this. Professional footballers are employees merely doing their job and, as with anyone in this situation, their employer has a duty of care to take reasonable steps to protect them from foreseeable harm.
Ignoring known risks will only cause a headache for governing bodies in the future, making them vulnerable to legal claims against them for ignoring the known dangers and failing to establish and follow proper protocols. You only have to look to the NFL to see that this is not a far-fetched prediction.
So what’s the solution? Do we ban all forms of heading in football? What about the fact that footballers choose to play the sport, and with that comes an element of risk – do we just have to eliminate all potential injuries from the sport?
The truth is, the authenticity of football does not have to be compromised in order to protect a player’s health. There have been a number of proposed enforcements, however as a fan and campaigner, temporary football concussions has been one option which I hope could really make a difference.
As of 6th February 2021, the Premier League became the first in the world to introduce a trial for permanent concussion substitutes. So, what exactly does it mean – and how does it compare to the campaign for temporary concussion substitutes?
The current trial means that where a head injury has occurred, or is suspected, the injured player’s club can make a concussion substitution. This means:
- They can substitute that player, even if they have used up all their normal substitutions. The player will be removed from the pitch and sent for head injury assessment in a private room. The substitution is permanent – once the player is off the pitch, they cannot return to the match, even if the assessment finds that they are absolutely fine.
- To ensure a level playing-field, the opposing team is afforded an additional substitution at the same time too
- A team is allowed two concussion substitutes, per match
The intended aim is to put the player’s health at the forefront and ensure that this is the priority, over team tactics.
At the moment, there’s a fear that players aren’t being substituted for proper head injury assessments because the club is focussed on their match strategy. The trial hopes to encourage clubs to be reassured that they will not be at a disadvantage by having their player assessed for a potential head injury.
Temporary substitutions are similar, but crucially allow a footballer to return to play if they are deemed safe enough to do so. In this case, the player would be temporarily replaced by a teammate, but then would be able to resume play if they had the all clear.
The concern is that permanent substitutions don’t encourage players, or clubs, to proactively engage with the trial – because they know that starting this process will automatically rule that player out for the rest of the match, regardless of the outcome of their medical check.
So you’re left with a situation where the manager needs to make a quick decision on the spot as to whether they’re willing to lose that player for the remainder of the match.
Even for the most caring manager, this puts them in a position of choosing team tactics over player safety and we’re back to square one.
A perfect example of this happened in a recent FA Cup match, where West Ham’s Issa Diop suffered a nasty head collision. He played on, whilst clearly struggling, until finally being substituted at half time.
Of course, we don’t know why a decision was not made at the time of the injury to engage with the trial – but it makes you wonder whether not wanting to lose their player factored into the club’s decision and they decided to chance it to see if he could be safe to play on.
Temporary substitutions offer a win-win situation for clubs and footballers.
Teams can be reassured they won’t be at a tactical disadvantage, as the substitution could just be temporary, and players can be reassured that their health is made a priority and they can undergo a thorough head injury assessment privately.
Doctors will be well-versed in the mantra ‘if in doubt, sit them out’ – so the risk of putting a potentially injured player back on the pitch is minimal.
This continues to be an ever-evolving situation affecting footballers here and abroad. It will be interesting to see what permanent steps, if any, are taken by the Premier League and other leagues across the world.
Of course, the issue of brain injury mismanagement in sport isn’t just limited to football. It’s my hope that a balance can be achieved between protecting players, reassuring the new generation and still allowing fans to experience the thrill of the sport as they have always known it.
* Ipek Tugcu is a Senior Associate in the Adult Brain Injury team at Bolt Burdon Kemp and an avid Southampton fan. She is a well-known campaigner for brain injury in sport, particularly football, to be taken more seriously.
Twitter: @Ipek_Tugcu
