Villas-Boas should be ashamed for not taking Lloris off
It is time that concussion in football begins to be taken seriously - whether or not players insist they are okay to play on
Monty Python perfectly captured the foolhardy, chivalrous and brash macho ego with The Black Knight's immortal phrase: "Tis but a scratch". We saw this type of boneheaded gallantry last Saturday when Spurs keeper Hugo Lloris, who was knocked unconscious for several seconds after a nasty collision with the knee of Everton forward Romelu Lukaku, insisted on playing on.
This was against specific expert medical advice at the time, and against Fifa's general guidelines on concussion. Tottenham Hotspur manager Andre Villas-Boas was the ultimate decision maker, not the medical doctor or the match referee.
"The medical department was giving me signs that the player couldn't carry on because he couldn't remember where he was," said Villas-Boas. "Hugo still doesn't remember the impact but he was quite focused and quite determined to continue. When you see this kind of assertiveness from the player it means that he is able to carry on. It was my call to delay the substitution, you have to make a decision in situations like this. From my knowledge of football he seemed OK to continue."
Villas-Boas is sending out the message that as long as someone has the mental fortitude and obstinate willpower they can continue playing soccer. Despite the fact that there might be internal bleeding or a fracture present, determined players can carry on providing they say something impressively courageous and manly like: "I've had worse … It's just a flesh wound".
Referees are at odds with this because their main consideration is safety. EPL referee Kevin Friend was concerned about Lloris and appeared to suggest he be substituted. Furthermore, the Spurs medical team, along with captain Michael Dawson, wanted Lloris to be replaced. But Villas-Boas rejected medical opinion and common sense and allowed his first-choice keeper to complete the remaining 12 minutes of the match, plus nine minutes of stoppage time.
With Lloris subsequently making an important save and completing the match without further incident, Villas-Boas clearly felt vindicated. It is interesting that no one has publicly condoned Villas-Boas for his decision. Plenty others have condemned the 36-year-old Spurs boss for being irresponsible and ignorant toward the health and safety of his player.
"[Lloris] should have been substituted. It's a 99 per cent probability that losing consciousness in such an event will result in concussion," said Fifa's chief medical officer Professor Jiri Dvorak.
"We are hugely concerned that a professional football club should take such an irresponsible and cavalier attitude to a player's health," said Luke Griggs, spokesman for brain injury charity Headway.
EPL doctors at all 20 top-flight clubs hold meetings two or three times a season to discuss health issues in the game and they will assess whether amendments to the rules are needed. One rule states that in the event of a head injury, a player may only return if given the all-clear by a club doctor after pitchside assessment. The other recommends that if a concussed player is substituted, he should not make any appearance for five days afterwards.
Villas-Boas did not break any rules. His crime was that he made an error of judgement when, with no medical training, he overruled advice from his medical staff.
There is a further rule that effectively limits what referees can do about players who should be substituted off. When a player resolutely refuses to be substituted, that is his prerogative. A referee cannot force him off and the match has to continue providing there are no safety concerns.
But surely, in cases similar to Lloris' concussion, referees should be privy to what medical staff have recommended. Typically, we never see medical doctors inform referees about their views on the safety of an injured player. But referees are clearly informed about safety concerns in other areas, such as by security experts and police chiefs regarding potential crowd trouble. Had referee Friend been aware of the medical advice that recommended Lloris to be substituted, he might have taken a more proactive role. Perhaps even going so far as threatening to abandon the match due to safety concerns over one player, which would make the manager reconsider substituting the player. However for referees, this is a grey area in the laws.
The problem is, each club pays for its own medical doctor and therefore the doctor may feel pressured into supporting his or her employer. This was alluded to by Dr Peter Brukner, a medical doctor who was previously head of sports medicine and sports science at Liverpool FC.
"We have had senior, experienced medical staff sacked by club managers because they would not toe the line and compromise their medical opinions to suit the manager's needs," said Brukner. "Medical staff should not be appointed or removed on the whim of the manager but should be appointed and reviewed objectively as in any other area of work. Clubs must support their doctor when he stands up to the manager in matters relating to the health of players."
Brukner was talking about the lack of respect for experts, such as medical personnel, within the Premier League. Villas-Boas, in appearing to have dismissed sound medical advice from his medical staff, is an example of those who go beyond their remit and expertise. It is a common syndrome in soccer and demonstrates a lack of respect to the real experts who are there to do their jobs. Managers and players are not trained medical doctors and therefore have no business assessing and usurping medical decisions. Similarly, managers and players are not trained referees and also have no business assessing and usurping refereeing decisions.
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