Over the last few seasons, the question of concussion in top-level football has become increasingly prominent. Time was that a bang on the head was something to be shaken off, but football has slowly been realising that head injuries, even where they don't appear immediately incapacitating, are a serious business.

Last season in England, questions were even asked in Parliament after an incident involving Tottenham's Hugo Lloris. Knocked cold by an onrushing Romelu Lukaku, Lloris nevertheless played the remaining twelve minutes of the game, an attitude that one prominent head injury charity described as "irresponsible and cavalier". And in the World Cup final, German youngster Christoph Kramer was eventually substituted after taking a blow to the head, then reportedly approaching the referee a few minutes later and asking "Is this the final?"



Tottenham's Hugo Lloris, Photo credit: Chris Brunskill / Getty Images

The tension at the heart of the debate has always been a question of priorities and authority. In another incident at the World Cup, Uruguayan defender Alvaro Pereira, who briefly lost consciousness following a clash with England's Raheem Sterling, angrily remonstrated with his own team doctor after the medic indicated that a substitution would be required. Eventually, the player got his way and finished the game. It's perfectly understandable that players might want to continue, since they're generally a competitive lot and they've just taken a blow to the head. It's perfectly understandable that managers might also want them to, on the basis that they picked them and so think they should be playing. But it's as stupid as it is dangerous.

This is why the Premier League — and you may want to sit down at this point — have taken an eminently sensible decision and decided to remove the power from the players and give it to the doctors. From the beginning of the forthcoming 2014/15 season, a player suffering a head injury must leave the pitch and it will be for the club's doctor — not the player; not the manager — to decide if they can return. A third "tunnel" doctor will also be provided by the home team, who will assist in monitoring for potential concussions and will also keep an eye on television replays.

Which is, unusually for a Premier League initiative, a remarkably sensible, swift and comprehensive set of steps. It remains to be seen quite how this plays out, of course, and one suspects that the sight of a doctor ordering a team's star player from the field may not play well with some fans, pundits, and members of the managerial staff. But as Gary O'Driscoll, Arsenal doctor and chairman of the Premier League club doctors' group, told the Telegraph: "We must overcome the idea that it is brave or heroic to play on and accept that this is an injury that cannot be run off."

This is the key. Because concussion doesn't come with exciting and obvious gouts of blood or snapped bones, there's been a tendency to assume that its effects are roughly akin to an impact injury: a moment or two of discomfort that can be lasted out. But it's becoming increasingly clear that the effects are serious, and range from momentary unconsciousness, confusion and memory loss — such as that suffered by Kramer — through to whiplash, debilitating headaches, and in the longer term the development of any number of emotional distresses and disorders linked to brain trauma. And all of the above can be exacerbated if the initial concussion is ignored.

As well as the specific, onfield steps, the Premier League are also implementing a number of broader, more strategic initiatives. A doctor will be appointed to undertake research and liaise with all 20 clubs, pulling together the independent information on their players. An FA-led awareness campaign will also be launched, targeting players and managers, and all Premier League players will have to undergo regular neurological assessments.

Slightly beyond the ambit of the Premier League, though not that of the FA, are some of the wider issues surrounding football and head trauma. Two recent deaths have drawn attention to the less obvious, but much more common impact of simply heading the ball. Former West Bromwich Albion player Jeff Astle died in 2002, and the coroner ruled that this was, in effect, a death by industrial injury; ie., the repeated heading of old, heavy, sodden leather balls. In 2014, the Justice for Jeff campaign was launched, after a promised FA investigation into the effects of heading the ball never materialised, and a separate campaign has called for legal restrictions on the amount of heading that is permitted for youth players and children.

This is, then, just a first step. In essence, there is no safe way to bang a head, and no footballer has ever got through a game without doing precisely that. The wider consequences are still under investigation. But by bringing in these protocols, the Premier League has acknowledged that as things stands, the managers are endangering the players and the players are endangering themselves. They have also acknowledged that the hyper-competitive, ultra-macho environment of top-flight professional is unlikely to lend itself to adequate self-policing. As such, they have taken what looks in theory to be decisive action to protect athletes not just from each other, but from themselves.