On June 15, in the first round of the 2018 World Cup, Morocco's Nordin Amrabat sustained a concussion.
His dazed appearance was obvious to anyone watching. After being taken to the hospital for neuroimaging and a 24-hour medical watch, he was sidelined for four more days. Then, against FIFA guidelines and the team doctor, he played a full match against Portugal, declaring, "I am my own doctor."
He was not fully recovered, but in that moment, he valued World Cup playing time over brain health; and for that, his coach called him a "warrior." After Morocco fell to Portugal 1-0, Amrabat admitted he could remember nothing of the match where he sustained the concussion, nor the 4-5 hours that followed.
FIFA's concussion management system (or lack thereof) has been scrutinized for years, so after the 2014 World Cup, when the federation drew criticism for the handling of several concussion-related issues, they decided to follow the NFL, MLB and NHL by rolling out their own concussion guideline protocols. However, as the number of cases similar to Amrabat's accumulate, it's clear that the presence of guidelines alone is not enough.
FIFPro, the World Players' Union for soccer players, has loudly criticized FIFA and the individual teams' handling of concussions. Until the concussion protocols are better enforced, it's imperative that athletes and coaches are educated enough to take brain health into their own hands.
With that, here are three things to keep in mind when it comes to concussions in the sport of soccer.
1. You can't shake off a concussion
As with any injury, a concussion needs time to heal. In the Morocco vs. Iran match, we witnessed an abysmal display of "medical treatment" after Amrabat collided with another player. He was pulled from the pitch, then his coaches/trainers sprayed water on his face, slapped him and applied an ice pack to his head. That is not how concussions should be treated. A concussion is not an injury you can walk off or "rub some dirt on." The brain has sustained a transient insult, which caused neuronal dysfunction. This usually takes 7-10 days (at a minimum) to return to baseline.
Although recent research has found that performing very light aerobic activity with minimal head movement shortly after sustaining a concussion could help accelerate recovery, competing in a soccer match is a far cry from that sort of activity. Continuing to play immediately after sustaining a concussion puts you at greater risk of severe brain trauma and will likely cause longer recovery time. A 2016 study published in the journal Pediatrics found that teen athletes who continued to play in a game or practice after sustaining a concussion took twice as long to recover from symptoms than those who immediately removed themselves from action (44 days versus 22 days, on average).
2. Look out for your teammates
Anyone who's had a concussion will tell you that it caused them to feel "out of it" in some type of way.
Unfortunately, since brain function is temporarily impaired, it's difficult for a concussed athlete to articulate how they feel. Sometimes, they don't even realize that something is off, partly since the phrases "seeing stars" or "getting your bell rung" are common in the sports world.
As a teammate, it's your responsibility to support the other athletes on your team. If you notice that someone is displaying concussion symptoms after a hit (e.g., complaining of dizziness or lethargy, having a hard time focusing, behaving unusually, etc.), inform your coach/athletic trainer. If your teammate does indeed have a concussion and either continues to play or returns to sport too quickly, he or she may be putting themselves at risk for neurological impairments down the road.
3. Follow return-to-play guidelines
Immediately after a concussion, your biggest priority may be to get back in the game. Unfortunately, if you have a concussion and re-enter the game prematurely, you're not only putting yourself at risk for another hit, but you're also decreasing your team's chances of success. Studies have shown that reduced cognitive function (e.g., slower reaction time) and impaired balance increase your risk of sustaining another injury. Earlier this year, Liverpool's goalie, Loris Karius, sustained a concussion in the 48th minute of the Champions League final. He continued to play, however, and committed two costly errors which effectively lost his team the match.
Governing bodies establish concussion protocols, but they don't necessarily have the ability to enforce them. FIFA's return-to-play guidelines technically require a six-day suspension following a concussion, but that duration is rarely met. Ultimately, the decision to allow an athlete back in the game occurs at the team level. It's on the coach, the athletic trainer, the team doctor and/or the player.
So, take responsibility for your brain health and the success of your team. When in doubt, sit it out. It's better to miss one game than an entire season.
Photo Credit: Peter Kovalev/Getty Images
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