The 2014 World Cup in Brazil has wrapped up with a well-deserved fourth tournament win by “Die Nationalmannschaft” of Germany. This tournament was a fantastic football festival and one of the most exciting in decades. There were goals galore and breath-taking offensive and defensive plays in just about every game.

There were also far too many examples of the ridiculous way that concussion and probable concussion are handled in sport and in our society. I’ve written about this numerous times and in this blog quite recently in the context of ice hockey. I’m driven to write again on the topic after observing some absolutely stunning examples of poor concussion management at the World Cup.

It hasn’t necessarily been concussion at the Copacabana, but it’s been pretty close to that. The most recent example occurred in the final itself, contested between Germany and Argentina. During an accidental collision with Argentinian Ezequiel Garay, Germany’s Christoph Kramer received a hard shoulder directly to his head. Kramer went to ground immediately and when he eventually made his way unsteadily back to his feet he was clearly unwell and should have been withdrawn.

But, of course he was not and ran around for another dozen minutes or so until his deteriorating play eventually led to him being substituted. In North America, NFL and CFL football and NHL ice hockey have recently come a long, long way in terms of assessment and treatment of concussion. We have an awful long way to go, but at least awareness is rising and some actions are being taken.

The relative state of progressive action in other sports contrasts sharply with the shameful state of affairs found in football, fußball, fútbol, calcio, soccer, or whatever name you wish to attach to the sport administered globally by FIFA—the Fédération Internationale de Football Association. There were also several other high profile concussive incidents at this world cup and all were handled quite poorly. Dan Diamond at Forbes has written about this extensively.

To see this go on at the World Cup is a huge problem. You see, lots of people listen to, watch, and comment on the World Cup. It’s been reported that Facebook users had almost 300 million “social interactions” during the final itself and that number or more watched the game on television. So it’s a problem when many viewers see the kind of spectacle that occurred with Christoph Kramer’s head injury. Seeing him continue to play on despite his injury provides a tacit endorsement that this is safe behavior.

But it’s not and reams and reams of scientific and medical research demands we do better. The 2013 “American Medical Society for Sports Medicine position statement: concussion in sport” published in the British Journal of Sports Medicine underlines the problem. The authors suggest strongly that effective medical monitoring and evaluation of players must be implemented proactively. So far, this is often quite passive in many sports, as we saw in the 2014 World Cup.

In the words of Gabriele Marcoti at ESPN “FIFA must do better with concussions”. This has to change. Let’s start now.

© E. Paul Zehr (2014)

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