Thread by @Scienceofsport

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