Temporary sub for head injuries?

[Joneth]

http://http://www.bbc.co.uk/sport/0/football/29403220

 

During Saturday's game there was a 5 minute delay for a head injury to QPR's Sandro.

 

It's a question I've often thought about, when a player takes a knock that requires looking at, is it fair that either the game is delayed or the team has to play on with 10 men for a bit until they make the decision to make a substitute (or otherwise). In Rugby you have the 'blood sub' system seems the fair thing to do.

 

With the rule about substitutions for head injuries being in the hands of the team doctor, surely the manager should be able to field a temporary sub whilst they assess the player properly? Obviously on Saturday it worked out in our favour (although Sandro is utter dross), but does old S*ggychops actually for once have a point here, or is he just finding excuses as usual?

[Redslo]

Something like this for head injuries would be a good idea. The rule would have to be drafted carefully to avoid abuse. There should also be a minimum time the player must be off to ensure that he gets a full concussion evaluation and is not rushed back onto the field.

[andoru]

The theory seems sound, but it could be open to abuse. If you're a 'big' club with an impact sub worth tens of millions of pounds sitting on the bench, someone could fake or exaggerate a knock to enable that player to come on for ten minutes. Imagine, for example, you're leading Man Utd 1-0 and they've used all three subs with ten minutes to go. Then Luke Shaw goes down clutching his head. Because of the 'blood sub' rule, they can bring on Falcao to see out the game, and he grabs the equalizer. Unless it was a like for like replacement (i.e. another left back for Shaw), it wouldn't be very fair. Teams could completely change their shape and tactics.

[Saint_clark]

The theory seems sound, but it could be open to abuse. If you're a 'big' club with an impact sub worth tens of millions of pounds sitting on the bench, someone could fake or exaggerate a knock to enable that player to come on for ten minutes. Imagine, for example, you're leading Man Utd 1-0 and they've used all three subs with ten minutes to go. Then Luke Shaw goes down clutching his head. Because of the 'blood sub' rule, they can bring on Falcao to see out the game, and he grabs the equalizer. Unless it was a like for like replacement (i.e. another left back for Shaw), it wouldn't be very fair. Teams could completely change their shape and tactics.

 

That's my worry too. Perhaps when naming a team sheet clubs should have to list who would replace who in the event of such an injury? So it's pre-determined?

[angelman]

I think FIFA said the game could be stopped for 3 minutes and I suspect that is what happened (although it felt like longer). I sort of agree with Saggy, but I would almost take it further. Not only have the "blood sub", but if it was clear that someone was concussed, then you could sub him without breaking into your allocation of 3. I realise that this could be abused, but if both team doctors and the ref agreed then it might work. One would hope that team doctors good be impartial in this but it might be asking too much. If that happened, then there would be less reason to endanger a player by keeping him on the pitch.

 

As for the delay on Saturday, we were all over the before it, but after, we were a little more reserved.

[Whitey Grandad]

Three subs out of seven is enough, surely?

[sadoldgit]

Why just head injuries? Why not any potential serious injuries? Really, how often does it happen?

[Redslo]

Why just head injuries? Why not any potential serious injuries? Really, how often does it happen?

 

Because there is a real problem with players with concussions continuing to play and risking their life or future mental health. There is no real problem with players with broken legs continuing to play.

[Pancake]

There is no real problem with players with broken legs continuing to play.

"Run it off ffs"

"But Dad, there's a bone sticking out of my shin"

"Man up!"

[sotonist]

The theory seems sound, but it could be open to abuse. If you're a 'big' club with an impact sub worth tens of millions of pounds sitting on the bench, someone could fake or exaggerate a knock to enable that player to come on for ten minutes. Imagine, for example, you're leading Man Utd 1-0 and they've used all three subs with ten minutes to go. Then Luke Shaw goes down clutching his head. Because of the 'blood sub' rule, they can bring on Falcao to see out the game, and he grabs the equalizer. Unless it was a like for like replacement (i.e. another left back for Shaw), it wouldn't be very fair. Teams could completely change their shape and tactics.

 

let the opposition manager choose who comes on

[KelvinsRightGlove]

On the abuse of this, one thing I thought when reading the article was penalties.

 

A unscrupulous coach may instruct their GK to stay down after any challenge, in case a penalty is given away. This may allow for situations akin to Holland in the WC where a 'specialist' penalty GK is subbed in for the spot kick, and then goes off after.

 

Unlikely? Yes. But, I wouldn't put it past somebody like Mourinho, who will do anything to gain an advantage (no blame on him, it's his job to get results and he is very good at doing this).

 

Edit, maybe even get to the point of specialist kick takers doing the same also. People coming on to take free-kicks/corners/penalties then sodding off again after the act.

[andoru]

On the abuse of this, one thing I thought when reading the article was penalties.

 

A unscrupulous coach may instruct their GK to stay down after any challenge, in case a penalty is given away. This may allow for situations akin to Holland in the WC where a 'specialist' penalty GK is subbed in for the spot kick, and then goes off after.

 

Unlikely? Yes. But, I wouldn't put it past somebody like Mourinho, who will do anything to gain an advantage (no blame on him, it's his job to get results and he is very good at doing this).

 

Edit, maybe even get to the point of specialist kick takers doing the same also. People coming on to take free-kicks/corners/penalties then sodding off again after the act.

 

Another good example. Just leave it as it is. No need to complicate matters. If it happens, it happens. Sometimes you've used all three subs and a player gets injured. Nothing you can do but play on with ten men. It's part of the game. And let's face it, how often is a team likely to face this concussion situation anyway? Once a season at most I'd say. Less even.

[KelvinsRightGlove]

Another good example. Just leave it as it is. No need to complicate matters. If it happens, it happens. Sometimes you've used all three subs and a player gets injured. Nothing you can do but play on with ten men. It's part of the game. And let's face it, how often is a team likely to face this concussion situation anyway? Once a season at most I'd say. Less even.

 

This is pretty much my take on it. If you get an injury and you've used your subs, you make do. Should be the same for head injuries.

 

As far as I understand it, there is no time limit for an injured player to return to the pitch if they are receiving treatment (may be incorrect on that of course), so if this happens after all three subs have been made the player could in theory take a few minutes on the side and if he feels ok and is given the green-light by the doctor should be able to return to the game.

 

Obviously, this wouldn't have been a big help to 'Arry on Saturday. But, it was early on and he could still make his subs. Injuries and knocks are part of the game, and it's one of the reasons why you have subs.

 

FWIW I think giving the decision to doctors in the case of head injuries is the right thing to do. I know it's a contact sport, but allowing players that have just taken a massive blow to the head to decide whether they are ok to play on seems silly. The case that sticks out was Lloris last season when he took a a knee to the head (Lukaku was it?) and was clearly not all there.

[Barry the Badger]

The main problem has been that the team's physio is the one who assesses the player for concussion. Clearly that physio will be feeling some pressure to let the player continue.

 

There just needs to be somebody impartial trained to recognize concussion and take that decision out of the clubs hands.

[sadoldgit]

Because there is a real problem with players with concussions continuing to play and risking their life or future mental health. There is no real problem with players with broken legs continuing to play.

 

I wouldn't want to play on with a broken leg!!!

[CanadaSaint]

Much of the focus of this discussion concerns the potential for cheating that would develop if any special sub rules were implemented to cover head injuries, and I completely understand that. It's a very valid concern.

 

However, that's placing the interests of the club and the sport ahead of the interests of the players, which is exactly what the NFL and NHL are accused of doing over here in North America. The stuff coming out is frightening. Autopsies have revealed horrendous brain atrophies that have accumulated over the course of a career and that have eventually resulted in the early death (sometimes by suicide) of former players. Needless to say, with the US being such a litigious society, sports leagues and owners are facing the prospect of huge lawsuits. Even if the leagues and owners weren't that concerned about player wellbeing (part of the accusation package), the lawsuits certainly got their attention.

 

I would suggest that this phenomenon will "jump the pond" and turn up in Europe at some point, and it's not just about injuries like Sandro's on Saturday. While football doesn't involve as many of the "head hits" seen in the NFL and NHL, it does involve frequent heading. The studies suggest that the physical consequences of even this kind of non-major head impact can build over time with similar results. The advent of the lighter ball will have helped to reduce the problem but not completely removed it. (As an aside, I can't help but wonder what would have been found in John McGrath's post mortem if this had been an issue in the UK at the time of his death, at the age of just sixty; he was a frequent header of the ball at a time when it weighed a ton on wet days, and damage was inevitable.)

 

I suggest that we should all take the same attitude to this issue in football as we would to safety in the workplace, because it's exactly the same issue. It's a "not why we can't but how we can" issue.

[Twiggy]

The difference is with rugby is that the players are infact like for like replacements - as mentioned about. And they have to occur, if briefly, to allow the game to continue and to stop endangering others. As if, for example, a forward as injured and had to go off briefly for stitches - but he was heavily involved in the lifting in the line out say - they would have to bring in a player who is also trained - to avoid potentially dangerous injury to players.

 

I saw it once watching London Irish - where a player went off in the blood replacement - and his replacement was sin binned for 10 minutes. Now this player in question was the bloke at the back of the line out - who holds up the player being lifted at the lower back. As he was off someone who wasnt used to having that responsibility took over - the bloke lifted fell over backwards and damaged his back.

 

But I digress - I don't think it would be a good idea in football. Unless - as suggested - its a like for like or you have a prenamed substitute for the player submitted before with the team sheet.

[Big Bad Bob]

The main problem has been that the team's physio is the one who assesses the player for concussion. Clearly that physio will be feeling some pressure to let the player continue.

 

There just needs to be somebody impartial trained to recognize concussion and take that decision out of the clubs hands.

 

Already covered by the regs :-

 

[TABLE=class: data-table, width: 464]

[TR]

[TD=class: left first]Home teams in the Premier League must now have a third "tunnel" doctor on match-days to support the work of the doctors for both sides.

[/TD]

[/TR]

[TR=class: row2]

[TD=class: left first]The "tunnel" doctor will serve as an extra pair of eyes to spot potential concussions and watch TV replays to see the severity of incidents.

[/TD]

[/TR]

[/TABLE]

[KelvinsRightGlove]

Much of the focus of this discussion concerns the potential for cheating that would develop if any special sub rules were implemented to cover head injuries, and I completely understand that. It's a very valid concern.

 

However, that's placing the interests of the club and the sport ahead of the interests of the players, which is exactly what the NFL and NHL are accused of doing over here in North America. The stuff coming out is frightening. Autopsies have revealed horrendous brain atrophies that have accumulated over the course of a career and that have eventually resulted in the early death (sometimes by suicide) of former players. Needless to say, with the US being such a litigious society, sports leagues and owners are facing the prospect of huge lawsuits. Even if the leagues and owners weren't that concerned about player wellbeing (part of the accusation package), the lawsuits certainly got their attention.

 

I would suggest that this phenomenon will "jump the pond" and turn up in Europe at some point, and it's not just about injuries like Sandro's on Saturday. While football doesn't involve as many of the "head hits" seen in the NFL and NHL, it does involve frequent heading. The studies suggest that the physical consequences of even this kind of non-major head impact can build over time with similar results. The advent of the lighter ball will have helped to reduce the problem but not completely removed it. (As an aside, I can't help but wonder what would have been found in John McGrath's post mortem if this had been an issue in the UK at the time of his death, at the age of just sixty; he was a frequent header of the ball at a time when it weighed a ton on wet days, and damage was inevitable.)

 

I suggest that we should all take the same attitude to this issue in football as we would to safety in the workplace, because it's exactly the same issue. It's a "not why we can't but how we can" issue.

 

I think you make some interesting points. I agree with what someone said above, head injuries should be judged by an impartial doctor. If they say the player is unfit to continue, then they don't. No ifs, no buts. If the team has subs left, they can use one they do. If not they make do, same as any other injury.

 

The heading issue I find interesting. I really think serious discussion needs to be had around banning heading from the game at junior level. I know a lot of people won't like that, but at that age and that stage of their development it can't be good for them long term. Heck, it might even get teams trying to lay the ball on the floor at junior level - which can't be a bad things.

 

As I've said before, yes it is a contact sport, and I wouldn't want the game completely sanitised. But, at the same time, serious consideration does need to be given to the long term health and well-being of all the players.

[st alex]

I think it's a stupid idea. Everyone gets three subs anyway. They're there to be used.

 

Redknapp has no idea whether Sandro was ok to continue in the second half or not. Head injuries are not always obvious and the player went off as a precaution as much as anything. The same with any other injury, you often take a player off if he's had any sort of knock to avoid making it worse.

 

He sounds like a Tory/UKIP politician. It's an ill thought out policy as a knee jerk reaction to a complete non-issue. If you read the article, then the head injuries expert who actually knows what he's talking about rightly advises against it.

[SarniaSaint]

Leave things as they are. Can't help feeling that this is part of redknapps excuse for losing

[andoru]

Much of the focus of this discussion concerns the potential for cheating that would develop if any special sub rules were implemented to cover head injuries, and I completely understand that. It's a very valid concern.

 

However, that's placing the interests of the club and the sport ahead of the interests of the players, which is exactly what the NFL and NHL are accused of doing over here in North America. The stuff coming out is frightening. Autopsies have revealed horrendous brain atrophies that have accumulated over the course of a career and that have eventually resulted in the early death (sometimes by suicide) of former players. Needless to say, with the US being such a litigious society, sports leagues and owners are facing the prospect of huge lawsuits. Even if the leagues and owners weren't that concerned about player wellbeing (part of the accusation package), the lawsuits certainly got their attention.

 

I would suggest that this phenomenon will "jump the pond" and turn up in Europe at some point, and it's not just about injuries like Sandro's on Saturday. While football doesn't involve as many of the "head hits" seen in the NFL and NHL, it does involve frequent heading. The studies suggest that the physical consequences of even this kind of non-major head impact can build over time with similar results. The advent of the lighter ball will have helped to reduce the problem but not completely removed it. (As an aside, I can't help but wonder what would have been found in John McGrath's post mortem if this had been an issue in the UK at the time of his death, at the age of just sixty; he was a frequent header of the ball at a time when it weighed a ton on wet days, and damage was inevitable.)

 

I suggest that we should all take the same attitude to this issue in football as we would to safety in the workplace, because it's exactly the same issue. It's a "not why we can't but how we can" issue.

 

Hard to disagree with any of that, but then I wasn't anyway really. I'm not suggesting we take head injuries less seriously, just that teams shouldn't get an extra substitute for it. If a player has a head injury, a team should have to use one of their three regular subs, or play on with ten men. Just as with all other injuries. Sometimes teams lose their star players for months at a time to injury. It's just hard luck, and hard luck is and always will be part of the game.

[Dark Munster]

One substitution rule I'd like changed is not have goalkeepers part of the quota of 3, provided the sub GK comes on for an injury. That would avoid the Blackstock fiasco, where I think 2 of our 3 used subs were also for injuries.

[Redslo]

The problem is that even with the new and improved head injury rules this year, we still have players returning to play only to go off later with concussions. Shane Long, for example, in the Newcastle game. I think part of the problem is that there is too much pressure to rush the assessment on the side line. A temporary replacement would allow a full and proper assessment to occur. This is not happening in all cases right now. I have discussed this on my blog several times.

 

http://redsloscf.blogspot.com/2014/08/concussions-and-brain-injuries-in_8.html

 

http://redsloscf.blogspot.com/2014/08/concussion-update.html

 

http://redsloscf.blogspot.com/2014/09/concussion-update-part-3.html

 

http://redsloscf.blogspot.com/2014/09/concussion-update-part4.html

 

Simply telling teams to use one of their three substitutions is not working. If you are concerned about tactical misuse of the temporary subs maybe the referee should simply declare a head injury and that would require an automatic temporary sub for ten minutes at the end of which the player had to be returned to play or permanently replaced.

[CanadaSaint]

Hard to disagree with any of that, but then I wasn't anyway really. I'm not suggesting we take head injuries less seriously, just that teams shouldn't get an extra substitute for it. If a player has a head injury, a team should have to use one of their three regular subs, or play on with ten men. Just as with all other injuries. Sometimes teams lose their star players for months at a time to injury. It's just hard luck, and hard luck is and always will be part of the game.

 

I think we're probably on the same page.

 

Football (thankfully) lacks the thing that makes the problem (now that they're fully aware of it) easier to address in the NFL and NHL - unlimited substitutions; it's much easier to take a player out of the game for assessment in those leagues.

 

Here's an article on the NHL's concussion protocol:

 

http://www.nhl.com/ice/news.htm?id=556289

 

Even though Redslo's suggestion has some merit, I also tend to favour leaving things pretty much as they are in football, but with a rider. The rider reflects the fact that we shouldn't completely trust the clubs to always act appropriately in deciding whether to let a player with a head injury stay on - not so much because I doubt their motives but more because a quick, on-pitch analysis by the club's medical staff is no longer enough. That's where the independent doctor comes in, but then fans will need to get used to a couple of things; the doctor will always do what s/he should do - take the time to reach a proper diagnosis, and err on the side of caution. So the decision is taken out of the hands of the manager, who then has a choice - play with ten men until the doctor makes a decision or make the substitution right away (if he still has one). In the case of Loris last year, who IMO should never have stayed on the pitch, Spurs would have had to use their substitute keeper.

[Redslo]

I think we're probably on the same page.

 

Football (thankfully) lacks the thing that makes the problem (now that they're fully aware of it) easier to address in the NFL and NHL - unlimited substitutions; it's much easier to take a player out of the game for assessment in those leagues.

 

Here's an article on the NHL's concussion protocol:

 

http://www.nhl.com/ice/news.htm?id=556289

 

Even though Redslo's suggestion has some merit, I also tend to favour leaving things pretty much as they are in football, but with a rider. The rider reflects the fact that we shouldn't completely trust the clubs to always act appropriately in deciding whether to let a player with a head injury stay on - not so much because I doubt their motives but more because a quick, on-pitch analysis by the club's medical staff is no longer enough. That's where the independent doctor comes in, but then fans will need to get used to a couple of things; the doctor will always do what s/he should do - take the time to reach a proper diagnosis, and err on the side of caution. So the decision is taken out of the hands of the manager, who then has a choice - play with ten men until the doctor makes a decision or make the substitution right away (if he still has one). In the case of Loris last year, who IMO should never have stayed on the pitch, Spurs would have had to use their substitute keeper.

 

That seems like a better protocol that the new English football one. On the other hand, I don't know what you can do about people who show no symptoms (or hide them) for several days. They are just as much at risk of the dangerous effects of a second concussion, but there is no way to spot them.

 

From my perspective the primary problem with the current English football protocol is that people with qualifying symptoms that should trigger a full evaluation (in a quiet place according to the NHL) are being evaluated at the touch line and put back into the game after seconds or minutes.

Edited 30 September, 2014 by Redslo

[Whitey Grandad]

One substitution rule I'd like changed is not have goalkeepers part of the quota of 3, provided the sub GK comes on for an injury. That would avoid the Blackstock fiasco, where I think 2 of our 3 used subs were also for injuries.

 

I'm old enough to remember when there were no such thing as substitutes, and when they were introduced it was only one and he could only replace an injured player. Three substitutes are plenty, all the team need to do is keep one in reserve until the last few minutes. If they decide to use all three then they run the risk of a further injury leaving them short.