Premier League doctors raise concern over manager influence in concussion cases

The Premier League’s leading doctors feel a growing concern that managers are putting players’ health at risk by appointing their own medical staff and creating conflicts of interest.

It was discussed recently at the top-flight doctors’ biannual meeting, and one medical professional who was there has told i that unhealthily close relationships between managers and doctors is increasing. They believe this puts players in jeopardy when important medical decisions are needed to be made during intense, high-pressure matches.

One particularly uncomfortable position doctors face is when a player has taken a blow to the head and is potentially concussed – an issue which arose on Tuesday night in Tottenham Hotspur’s Champions League semi-final first leg against Ajax. Defender Jan Vertonghen was assessed for concussion after falling to the grass covered in blood but was deemed fit to return after five minutes – only to leave the field less than a minute later barely able to stand.

New legislation dicussed

While there is no suggestion that such a relationship exists between Tottenham Hotspur manager Mauricio Pochettino and Tottenham’s medical team, doctors across the top flight want new legislation introduced to regulate the appointment of medical staff so that a professional independence is maintained and to ensure players’ health is put first in all decisions.

The point was raised at their most recent meeting during the last international break in March, near the Premier League’s offices in London, when the 20 lead club doctors or heads of medicine came together, alongside medical heads from clubs who have recently been relegated from the Premier League and are still receiving parachute payments.

As a consequence, the issue is set to be raised with the Premier League’s Medical Working Group – a body set up in 2013 to look at medical rules and policies in the game.

The MWG consists of two doctors from the Big Six clubs, two from the rest of the Premier League, two club lawyers, two chief executives and the Premier League’s director of football, Richard Garlick. If they can be convinced that the increasing closeness of doctors to club managers is putting players in danger, they can introduce regulations to stop it.

Concussion substitutions

The prospect of introducing a 10-minute “concussion substitute” – similar to rugby union, whereby a replacement can be made temporarily, for 10 minutes, while a player is assessed for concussion – was also on the agenda, although it remains divisive among medical professionals. Doctors use the Maddocks Score – five questions to ascertain short- and long-term memory – to identify concussion, but some believe assessment of balance is more important.

Currently, rules dictate that a decision on a player’s fitness to continue must be made within three minutes. Some doctors believe that concussion can be identified within one minute, but many others believe that 10 is far safer, as concussion can take time to develop after impact.

Making the ‘wrong call’

Another Premier League medical team member told i on Wednesday that it can be hard to justify to a manager if they make the wrong call and prematurely force a player to leave the field, a pressure that particularly increases later in the game if all three substitutions have been made, so their removal would leave the team a man down.

Vertonghen was said to have passed all the concussion checks on Tuesday night but had further brain scans yesterday to ascertain if he had delayed concussion.

After the game, Spurs manager Mauricio Pochettino said of the decision to send Vertonghen back on: “I was not involved. That was the doctor’s decision. I think it’s so important that the rules and the protocols are there. Our medical staff followed the protocol.”

Brain injury charity Headway also called for the introduction of temporary concussion substitutes. “It is hugely disappointing that we are once again talking about concussion rather than the game itself,” charity spokesman Luke Griggs said.

“Concussion is notoriously difficult to diagnose. The symptoms may be hidden and require the individual to be honest about how they’re feeling, while they can also be delayed in their presentation.

“Assessing a player for three minutes – or even five, as was the case with Jan Vertonghen – does not allow for medical staff to make a reliable diagnosis, particularly when this is conducted on the pitch under the gaze of tens of thousands of fans eager for the game to resume.”