Several championships, including Ligue 1, have proposed experimenting with temporary replacements, as in rugby, while a player who has suffered a head impact can be examined in the locker room, but the IFAB, which regulates laws of the game, refuses it.
He is back in the group. Twelve days after his concussion in an aerial duel against Reims, Samuel Umtiti was authorized to return to the field and could play with Losc in the derby against Lens, Sunday October 8. Stunned at the time, he was not taken off the field and returned to play before feeling unwell in the locker room at half-time, proof of a failure in the management of his concussion. While football rules only allow doctors three minutes to carry out fieldside tests, specialists are calling for them to be changed to bring them closer to those of rugby.
“Yes, football is behind in the treatment of concussions”, immediately admits Vincent Gouttebarge, a former professional footballer who studied medicine before becoming head of the medical service of the International Federation of Professional Footballers’ Associations (Fifpro). With a significantly lower incidence in football, around one concussion every 50 matches, compared to one concussion in every other match in rugby, this problem “was put a little less often on the work agenda”concedes the man who himself suffered two poorly identified concussions during his football career.
“For around 10-15 years, it is mainly rugby which has been at the forefront of this problem. For a very short time, around five years, football has been in tune, after the publication of an article very important scientific on this subject in a prestigious medical journal, in 2019. A study on a Scottish team proved that former players had increased risks of developing neurological diseases”adds Doctor Alexis Demas, neurologist and referring doctor with the French Football Federation for concussions.
A necessary awareness which did not solve the problem. “This delay was striking during the 2022 World Cup. There were several scenes of terrible concussions and the referee did not even stop the gamecontinues Doctor Alexis Demas. During the Saudi Arabia-England match, there was enormous contact between the Saudi goalkeeper and one of his defenders, the defender collapsed, remained unconscious on the ground and the game continued, without the referee blowing his whistle. I was watching the match live and I was shocked.”.
A strict protocol and doctors who could be helped by video
In France, and according to the rules of the IFAB (International Football Association Board), which determines the laws of the game, the FFF and the LFP (Professional Football League) have set up a process for the management of concussions which provides for the intervention of the team doctor for three minutes on the field. The trainer then asks questions to the player who has just suffered a head impact, such as: What is the date? What’s the score ? What is the name of such a teammate?… “If he has difficulty responding, then these are signs of brain dysfunction, which requires that the player be put to rest, in a safe place. He must then leave the field, be replaced, and once in a calm environment, like the locker room, we deepen the medical examination”explains Alexis Demas.
Had Samuel Umtiti answered these questions correctly? Damien Monnot, the Losc doctor, did not wish to answer questions from franceinfo:sport, citing medical confidentiality. Looking at the video of the shock, Alexis Demas believes that the concussion was immediately visible: “There was a scene of chaos, of the player losing consciousness. Quite quickly, as a caregiver, we said to ourselves that it was a fairly serious concussion since his arms were like a puppet when he fell. , which is a sign of atony”. Emmanuel Orhant, the medical director of the FFF, was able to speak with Damien Monnot, and defends him. “He told me that if he had seen the footage, he would have released Umtiti immediately, but there was no one there to watch the footage while he did the field testshe explains. It is up to the clubs to set up a tablet system, on the bench, it is authorized to watch these shock videos. There may also be someone in the stands watching the video and transmitting the information to the doctor via earpiece.”.
Once the concussion is detected, article 588 of the LFP regulations provides “that an expert examination be carried out within 72 hours following the concussion by an expert neurologist” and that one “new and final consultation by the expert neurologist must be carried out before the resumption of competition”. A recovery that occurs “in 90% of cases, approximately two weeks after the concussion”according to Alexis Demas. “In the event of non-compliance with these provisions, the club may be sanctioned by the competitions commission with a fine of up to €20,000”, adds the regulation. This is particularly what the Reims club risks, being sued by its goalkeeper Florent Duparchy, victim of two concussions in August 2022 and March 2023 for “endangering the lives of others”. He was not referred to a neurologist after the first, returned to training with symptoms, before suffering a second concussion, then playing with the reserve team the next day.
Championships ready to test temporary replacements
With only three minutes to carry out the tests on the sidelines, compared to 12 minutes in the locker room in rugby, the football concussion protocol may seem light. “The protocols are not comparable, particularly in relation to the different nature of the neck musculature of a rugby player, and in relation to the nature of the game, with more anticipation of tackles and impacts. Against Namibia, Antoine Dupont, for example, suffered a concussion, but was not stunned“, explains Alexis Demas. However, specialists still ask that the football protocol be extended to come closer to that of rugby.
“Studies say that it takes at least 10 to 15 minutes to notice an early progression of the concussion. So three minutes is ridiculousjudge Vincent Gouttebarge. Fifpro (the international players union) has been asking for changes to the laws of the game for quite some time. Very recently, three championships, Major League Soccer (UNITED STATES), the Premier League (England) and Ligue 1 (France) proposed to the IFAB to be a testing ground to make temporary replacements, while the player who had suffered a concussion could be examined in the locker room. But the IFAB has always been against this development. As long as the laws of the game are not changed, we will once again be subject to these kinds of errors from doctors on the field.”. Since 2021, the IFAB still authorizes an additional replacement to replace a player removed for a suspected concussion.
Still work on awareness
While waiting for a possible modification of the rules, the work of the authorities focuses on raising awareness among players, who sometimes refuse to go out when they suffer a head impact, or react badly when one of their teammates suffers one. “The concussion creates cognitive and emotional dysfunction in the player’s brain. At that point he has no functional capacity to judge whether he is fit to return to the field. So he is the last person to listen to make the decision to release it or not”, affirms Vincent Gouttebarge. On the other hand, “we must educate the players around him, so that they eventually encourage him to come out and encourage the work of the medical staff”, he continues. Obviously not sufficiently aware of this subject, Samuel Umtiti’s teammates had placed him in a lateral safety position before the arrival of the Losc doctor, which is not recommended to avoid damage to the spine and neck.
This awareness raising is now mandatory for players of the French national teams. “In all the selections, there is training carried out by the doctor on concussions. I did it myself to the players of the France team before the World Cup this year. Then in the clubs, it “It’s the doctor’s responsibility, and I’m not going to nitpick who does or doesn’t do it. If there’s ever a problem, they’ll take responsibility for it.”, says the doctor. Every Monday, after a day of the championship, Emmanuel Orhant also watches the videos as soon as a match delegate reports a head injury. He then sends a message to the doctor to validate or not the concussion. Last season, 23 cases of concussion were reported in Ligue 1 and Ligue 2.