English football clubs should be well aware of the CIS guidelines concerning concussion. It was a surprise to find that the international advice was not being followed. In the United States, concussion seems to be taken much more seriously. Since these are guidelines advocated by FIFA, it really should be the case that football clubs around the world are adhering to their recommendations.
Dr Jo Price
A survey has revealed that most English football clubs do not follow international concussion guidelines concerning player safety. Despite the fact that the Consensus in Sport (CIS) guidelines were developed to ensure that footballers are safe to return to play, there is no requirement for club doctors to use the available assessment tools or to demonstrate expertise in concussion management.
The guidelines stipulate that players should be thoroughly tested for symptoms of concussion and should undergo cognitive assessment before the start of the football season. Those deemed to be concussed should return to the field gradually, and only once they are free of all concussive symptoms. However, the authors of a report published online in the British Journal of Sports Medicine
, point out that whilst there is guidance in the form of the SCAT2 assessment tool, it is not being adequately disseminated to club doctors by the English Football Association (FA).
At the beginning of the 2009/10 English football season, Dr Jo Price from the Centre for Sports and Exercise Medicine at Queen Mary, University of London, developed and distributed questionnaires to all 92 clubs in the English Football League. 39 per cent of clubs returned these questionnaires with similar levels of response across all four leagues.
The results revealed that 28 per cent of football clubs had not heard of the CIS guidelines. Less than half of Premiership respondents routinely carried out cognitive assessment before the start of the season, although they conducted significantly more assessments than clubs in other leagues. Only one in 10 clubs carried out concussion symptom scores and just half of teams who were
aware of the guidelines used tests to measure both cognitive assessment and symptoms following a concussion.
I spoke to Dr Price to find out why she thought that the majority of English football clubs are failing to follow the international concussion guidelines. As Dr Price explained, she was initially surprised by the lack of adherence demonstrated by some teams.
"English football clubs should be well aware of the CIS guidelines concerning concussion," she explained. "It was a surprise to find that the international advice was not being followed. In the United States, concussion seems to be taken much more seriously. Since these are guidelines advocated by FIFA, it really should be the case that football clubs around the world are adhering to their recommendations."
I asked Dr Price whether she thought that the situation might have improved during the three years since her questionnaires were returned.
"As far as I am aware, there haven’t been any specific recommendations made advising club doctors to follow these guidelines since that time," she replied. "I think that the situation is unlikely to have changed."
In Dr Price’s opinion, the lack of adherence is due to a combination of time pressures and a lack of awareness.
"If the FA made it a requirement to follow the CIS guidelines on concussion, I think that clubs would find the time to implement the recommendations. It is a very simple, paper-based test that can be carried out along with all of the other tests that are conducted. It wouldn’t be very difficult for clubs to integrate this test within their current assessment procedures."
I ended our conversation by asking Dr Price how else clubs might be encouraged to take the possibility of concussive injury more seriously.
"Well it’s a difficult issue because there is actually no evidence to suggest that playing football with concussion, or with symptoms of concussion, causes any long-term damage," she explained. "I think that this is one of the reasons why clubs are reluctant to put much money or time into concussion. However, these are internationally recommended guidelines so clubs really should be persuaded to take them on board. I think that English football teams should also receive guidance from the FA. It would help if each club was sent a copy of the assessment tool at the start of the season. Creating awareness is really important.
"It will be interesting to see how the FA and the English clubs react to the report," continued Dr Price. "Hopefully, the FA will make a statement and become a bit more proactive by changing their recommendations. It would be worth reassessing the situation once this has happened."