Ross Tucker Profile picture
Jun 5, 2018 15 tweets 5 min read Twitter logo Read on Twitter
This is, for many reasons, a fascinating story. It’s the trigger for discussions ranging from medical/duty of care failure to legal/policy issues. According to US doctors, #Karius is #concussed in this incident, shortly before the 1st of his huge errors. Brief thoughts follow...
First, a too-common reaction is “What a lame excuse, he’s clearly not concussed”, because it doesn’t look like they expect it to. And, hey, you all know I value sound skepticism! But the thing about concussion is that only about 50% of them show present with any of these signs:
So…that leaves about 50% that DON'T obviously look like concussion - no loss of consciousness, no ataxia, no dizziness, no confusion etc. Heck, some only present as symptomatic after matches are completed! So dismissing it based on what you saw on video, probably not ideal
So it’s a shame that it has quickly degenerated into parochially motivated dismissals of concussion as an excuse. I think a far bigger and more important issue that gets lost in the ‘war’ is that there is currently limited mechanism by which these SUSPECTED cases are identified
In other words, if around half of cases are not obvious, then what will allow cases potentially like this one to be picked up?There are clear potential performance implications, plus there are the health/welfare reasons to say “We need to be able to act on these cases in games"
The answer is that unless that medical team are given the luxury of space and time, it’s very, very unlikely that suspected concussions are ever going to be acted on. This lesson has been clearly learned in other sports. You must drive awareness & policy to buy these ‘luxuries’.
IMO,this means allowing temporary substitutions to remove a player with a suspected head injury for assessment, away from the field, in ample time. This would lower the barriers to identification, & you’d have fewer cases like this, picked up 5 days later & triggering controversy
People argue that footballers fake injury all the time, so you’d have a conveyor belt of temporary subs! Yes, but maybe a forced 10 min temporary substitution is a disincentive to faking it. Where there’s a will, there’s a way, I believe. This temp system works in other sports
Bottom line - we don’t know whether #Karius was affected by that elbow to the head. We don’t know the clinical development. But I do know that it sure would be good if suspected head injuries could be managed at the time, for the good of welfare, and, possibly, performance. No?
For football/soccer followers, just as a matter of comparison, rugby has a head injury assessment protocol that allows a ten-min temporary substitution for a player to leave the field for assessment when there is a suspected concussion, as indicated by the following criteria:
A player then undergoes a battery of tests - this is important - concussion does NOT present one way only, so the screen is multi-modal - measures cognitive state, symptoms, balance, recall. And while not perfect, it has meant a lot of players who used to play on are now removed
Final point - having worked in rugby for a few years on concussion (and that’s a disclaimer for previous, btw), I would just say that the reaction of football fans to this #karius #concussion report is extremely disheartening. The concussion awareness thing is a mountain to climb
This is true in all sports, of course, just noticeable today. The place we need to get to is where players will remove themselves when they know their brain health is not quite right. Some attitudes I’ve seen today suggest that’s a long way off! Still, all awareness is valuable!
And yes, folks, I know this is a theoretical goal - it’s never going to happen in these massive, career-defining matches (I work in the field, I get it). This is why policy matters even more. I say this because I’m trying to make a point about “concussion management utopia”.
That utopia is a place where head injury is recognized as real, where players DO sometimes stand themselves down (it’s happened in international matches, yes. not big finals, granted), & where awareness is so high that concussion is not a cue for accusation & counter-accusation

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More from @Scienceofsport

Oct 8, 2018
OK, this may seem really lateral, but bear with me. Here’s a solid study showing that an intensive education intervention in 9-10 year olds does not help prevent obesity & overweight: thelancet.com/journals/lanch… This made me think about anti-doping education, so here’s a short thread
“Education” is often held up as a powerful and effective tool for anti-doping, despite pretty thin evidence that it does anything. If I’m cynical, an over-reliance on education seems to often replace the obligation to test as the thought of most effective deterrent.
That Lancet study in children suggests that even a really focused campaign, that achieves good engagement, doesn’t change behavior, at least in that group. And OK, they’re 9-10 year olds, you could say they’re too young to be ‘consciously impacted’ by it.
Read 10 tweets
Jul 13, 2018
The IAAF’s research on testosterone & performance has significant data errors & problems. We (@RogerPielkeJr, @boyeerik & I) have reanalysed some of the events, finding errors that may affect its conclusions and so call for it to be retracted. Story here: nytimes.com/2018/07/12/spo…
To elaborate briefly - in early May, we wrote to BJSM to request the performance data used by the IAAF in the study. This after noticing some strange statistical implications of their reported results, and wondering about methods to exclude duplicates: blogs.bmj.com/bjsm/2018/05/1…
What we were asking for, basically, is which of the performances that are publicly available in results archives had been included, and which excluded? After some back and forth, and lengthy process, we got sent some of the events in early July.
Read 14 tweets
Jun 21, 2018
So…#russia have run the furthest of any team at this year’s #WorldCup18 triggering the inevitable discussion about the suspicion that would already have existed, given many suspicions. I wanted to share a few thoughts on this, so here’s a short thread...
First, whether or not there is doping in football is an unnecessary question. I don’t even understand why people discuss this as a “are they, aren’t they question”. This is as true of Russia as pretty much every team.
Second, had you asked for a prediction of distance run statistics to confirm that Russia were still guilty of systematic doping, you’d have come up with those numbers! However, that may also be circular, a form of confirmation bias. So there is nuance in that data I’d love to see
Read 9 tweets
Jun 20, 2018
Every time a footballer collapses in agony, and forces the game to be stopped, there should be a mandatory 5 min assessment period. The game goes on, no temporary substitution. Make sure that poor diddums is OK, and disincentivize the behavior that characterizes football.
I applaud many of you for realizing the possibility of second order consequences on this. I’d expect nothing less. Thanks for those who have raised them. I had (believe it or not) thought through these possible downsides, and I don’t believe they are insurmountable challenges.
The possibility of cynical fouls to eliminate valuable players for 5 min is an obvious one. I’d say that committing deliberate fouls just severe enough to force a guy off for 5min is asking a bit much. There’s also a disincentive for this which outweighs pros of “maybe” doing it
Read 7 tweets
Jun 2, 2018
Next time a voice in your head says “But he/she hasn’t tested positive. Show me evidence”, remember Jama Aden - IAAF followed & observed his group for 30 months, then a hotel raid discovered syringes with EPO & anabolic steroids. Not one of his athletes failed a test in that time
Now Aden is facing 4.5 years in jail for providing 8 types of substances to his athletes, from EPO to corticoids: cat.elpais.com/cat/2018/06/01…

So even a 30 month spotlight, a raid, & focused testing caught 0%. So yeah, you can have your “never failed a test”. I’ll take sense.
Sense might also suggest that a hugely prolific coach of multiple Olympic & World medalists is not just holding a stopwatch & calling out times for Mo Farah, who denied even knowing him until multiple pictures emerged of them in camps & socially. But…”never failed a test”.
Read 4 tweets
May 8, 2018
In case you missed it - here’s my thread with some thoughts on the “Futility of urine salbutamol” paper that may form part of Sky’s intent to criticize the validity of the test. Also, one or two additional updates and thoughts below it.

I was re-reading the paper last night, & this section from its discussion really jumps out. It reads like a closing argument of a lawyer in a John Grisham novel. Given that the findings come from simulations using a “semi physiological” model based on dogs, it’s a little strong
Another important point - @DickinsonTimes has confirmed that this study was not funded by Sky/Froome, and is ‘independent’. The timing is terrific for Sky obviously, the quality less so. This research group has previous form though - remember the “EPO doesn’t work” study
Read 4 tweets

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