Morocco’s Nordin Amrabat spent last Friday night in a hospital. He was, quite clearly, concussed. Hours earlier, he had staggered off a St. Petersburg field after a clash with an Iranian opponent. He would later say he remembered none of his World Cup debut.
“Five, six hours – gone. Totally gone,” Amrabat said of that sliver of his memory. “When you think about it, it is a little bit scary.”
When he was finally discharged from the hospital, he was, understandably and necessarily, ruled out for his team’s second game against Portugal. Morocco’s team doctor, surely basing the decision on FIFA’s concussion protocol and loads of legitimate medical research, said Amrabat wouldn’t even train for a week. There was zero chance he could fully recover from the concussion in time for Wednesday’s game. Or at least there was zero chance doctors could be 100 percent sure he had recovered.
And yet there Amrabat was, in Morocco’s starting lineup on Wednesday. He had supposedly been cleared to play. And he did.
Which is absolute hogwash. It’s irresponsible. It’s dangerous. But neither FIFA nor its members care.
“This is yet another alarming example of a player being put in harm’s way,” FIFPro, the global soccer players’ association, said in a statement. “Amrabat returned to action too soon according to medical guidelines. Four years on from the debacle of the last World Cup, where several players did not receive adequate care, [soccer] has not made sufficient progress in concussion management.”
Morocco’s mishandling of Amrabat’s concussion
Morocco’s team doctors are either clueless, powerless, or both.
They began their treatment of Amrabat’s concussion with an ice pack, and by hurriedly slapping him in the face as a teammate sprayed him with water:
I’m no doctor but I feel confident that you’re not supposed to handle a potential concussion by smacking a player in the face and squirting him with water pic.twitter.com/pPOhlWDwCT
— Kevin Dillon (@ByKevinDillon) June 15, 2018
Meanwhile, Amrabat could barely walk or stand up straight without support. He was clearly not right. The severity of his immediate symptoms meant not even Morocco could rationalize keeping him on the field. So he was subbed off. Hours later, he was in the hospital.
Five days later, he played with a protective helmet on. Which is ridiculous. Protective helmets can soften blows, but can’t prevent concussions. And Amrabat ripped off the helmet during the first half anyway. He played the rest of the match without it.
So Amrabat might have been susceptible to second-impact syndrome – a second concussion before full recovery from the first. It can be fatal.
Morocco manager Herve Renard was asked after the game about the decision to play Amrabat — to put him at risk – and his answer was insufficient. “Because he’s a warrior and wanted to play,” Renard said. “I’m not a doctor. It is the medical team’s decision.”
But apparently it wasn’t the medical team’s decision – which is precisely the problem. Amrabat said it was his. Six days, he acknowledged, “is the official time to recover, for your safety. I decided to make it shorter. I felt good. … I am my own doctor.”
Everybody that allowed Amrabat to be his “own doctor” is at fault here. That includes Renard and the Morocco medical staff. It also includes FIFA, whose chief medical officer re-directed blame, but who is anything but blameless.
FIFA’s concussion protocol
FIFA’s website lays out a six-step return-to-play process that players and teams must adhere to – or should adhere to, not must; because FIFA has never been serious about enforcing it. The guidelines implicitly stipulate that a player cannot return to game action within five days of the injury (emphasis ours):
No activity, complete rest. Once the athlete is asymptomatic, they proceed to level two. The athlete spends, at the minimum, one day at each stage.
Light aerobic exercise such as walking or stationary cycling, no resistance training. Performing step two without symptoms allows the athlete to proceed to level three. If symptoms return, the athlete moves back one stage then continues.
Sport specific training (e.g. skating in hockey, running in football), progressive addition of resistance training at steps three or four. Performing step three without symptoms allows the athlete to proceed to level four.
Non-contact training drills. Performing step four without symptoms allows the athlete to proceed to level five.
Full contact training after medical clearance. Performing step five without symptoms allows the athlete to proceed to level six.
Even if Amrabat was suddenly symptom-free on Saturday after leaving the hospital — highly unlikely — he couldn’t have been cleared to play Wednesday. That is, if Morocco followed FIFA’s rules. But nobody follows FIFA’s rules, because FIFA doesn’t really care about its supposed rules. Instead, it puts players’ lives at risk.
FIFA’s concussion negligence
FIFA refuses to address soccer’s concussion problem even as the problem becomes more and more evident, and even as criticism mounts. A study of the 2014 World Cup found that, of 81 players who suffered head collisions, 67 exhibited two or more signs of a concussion. Of the 67, all but three returned to the game.
One of them was Germany’s Christoph Kramer, who later stumbled out of the World Cup final in a daze. He eventually admitted to not remembering any of the game.
The real problem here goes beyond FIFA. Proper assessment of head injuries takes several minutes – roughly 10, according to some experts. A soccer team, though, can’t afford to play 10-on-11 for 10 minutes, so its doctors rush a player back onto the field, often in 1-3 minutes, without proper testing, and often with symptoms.
The issue is that FIFA – and every single pro league – hasn’t done anything to fix this. There have been calls for rule changes to allow for temporary substitutions, or for a fourth substitution reserved for concussed players. Alternatively, FIFA could hire its own doctors to carry out pitchside assessments and decide whether a player needs to be substituted. It could eventually outlaw – or partially outlaw – headers, as U.S. Soccer has done at youth levels.
At the very least, FIFA needs to do more than it’s doing right now, which is barely anything. It says it has put final return-to-play decisions in the hands of team physicians, and says doctors have access to video replays to help diagnose concussions. But when teams don’t follow this protocol, FIFA turns a blind eye. It has nothing in place to prevent coaching staffs from pressuring team doctors to clear players. It has nothing in place to prevent an Amrabat situation.
Soccer, as a sport, is still living in the dark ages when it comes to brain injuries. So many people in power ignore short-term and long-term risks similar to the ones plaguing American football. These people are going to be responsible for ruining thousands of lives. Soccer’s various governing bodies are likely going to eventually be on the hook for millions of dollars as a result of lawsuits.
And yet no matter how much the problem intensifies, FIFA and others continue to disregard it.
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