Football is by far the most popular sport in Scotland. It dominates the back pages in every paper and is often a way of escaping the grind of working life for a couple of hours at the weekend.

Despite the mass amount of attention it gets, there is growing concerns about player well-being. Football is a contact sport and it’s borderline impossible for a player to escape getting hurt in some sort of way while playing the game. Despite this, when they do suffer injury, questions will be asked about how effectively medical staff deal with the injured player.

One of the main areas of concern is the treatment of head injuries, particularly concussions. In the UK there were 348,453 admissions to hospital with acquired brain injuries between 2016-17 according brain injury charity Headway. That’s 531 hospital admission per 100,000 people in the UK.

Just this season alone on the professional football pitches of Scotland, there have been numerous occasions where serious head injuries have occurred on the field of play. The most notable one is Aberdeen winger Gary Mackay-Steven’s injury in the League Cup final in November, which left the winger unconscious.

Even during the Champions League semi-final between Ajax and Tottenham, Jan Vertonghen was rushed back onto the park, despite visibly struggling with an earlier head knock. Questions have been asked about how he had been allowed to return so quickly. It’s brought up the question of whether medics and the concussion protocols fully protect players.

A real issue

Having worked with a football and ice hockey club in the past, Sports therapist David Jenkins from Sports Therapy Scotland has seen it all when it comes to injuries in sport.

He believes the way Scottish football deals with concussions is an issue, particularly in youth football, with managers and volunteers forcing players into returning quickly. He believes players across the board must be brought back gradually.

“I see head injuries in my clinic every couple of weeks. When I worked in sport it was possibly weekly. It’s a lot more common now,” Jenkins told NTOF.

“If they are deemed concussed it is three weeks before they can return to cardiovascular exercise, never mind returning to sport. There is a pressure on the medical team depending on the player and the game. That will determine how it’s reported and that’s a real problem. In professional sport are they trying to rush them off the park? No.

“They could develop secondary concussion syndrome. They need to be taken off, especially at youth football. If they have a head knock you take them off as they are only kids. People under the age of 18 are more susceptible to longer term injuries and concussions.

“We even see it at elite level not being managed correctly, never mind at youth level. That’s a big problem.”

Aberdeen’s way of working with concussion injuries

The man partly responsible for dealing with Aberdeen star Mackay-Steven’s League Cup final concussion was Adam Stokes. Stokes is Aberdeen’s head of medical and sports science. He is responsible for the health and well-being of the playing staff at the club.

He walked through the procedure his staff follow when dealing with concussions at the club and when they find it suitable to let a player return to play.

“If someone suffered a head injury, we always have to be extremely careful of the neck as well,” Stokes told NTOF.

“You often see much more skin sports medicine which is good when you watch and see someone with some kind of head injury. The first person to them will normally stabilise the neck which is important because a neck fracture can cause significant problems.

“Assuming that we’ve cleared the neck, the next problem when you’re dealing with a head injury essentially is to see if they are showing signs of a concussion. That doesn’t always correlate with a loss of consciousness.

“I think it’s in rarer cases that a player will lose consciousness from an impact. When I say that I essentially mean knocked out. That would mean an immediate removal from the pitch with absolutely no chance of going back on.

“It almost makes a decision easier. But in 80% of cases they don’t suffer a loss of consciousness so they can actually get even more difficult to deal with.”

If In Doubt Sit Them Out

The If In Doubt Sit Them Out protocols were updated in 2018, an update from the first ever protocols in 2015. It’s quite scary that it took this long for such protocols to be made up.

Stokes believes these protocols do their job effectively: “I think the protocols are good. I’m not sure that they need updated. I think it is more just getting buy in from everyone that will be the way forward.

“I do think the management of concussions in the last 15 to 20 years has taken significant improvements. That’s not to say it’s perfect, but I think it’s certainly moving in the right direction.”

Sports therapist Jenkins has contrasting views though, believing that all sports, not just football, have to look at their concussion protocols in some respect.

“I think they need to make amendments to the protocols, and at the ground level. The medical team only know if it has been reported in the correct manner. There are too many ifs and thats.

“If you need to ask concussion guideline questions, just take them off. Let the doctor make the decision about whether it is safe to return.”