 "'Lights went out,' but he kept playing")
The team doctor stepped away from his patient and motioned to the coaches on the far sideline. He rolled his hands one over the other, the signal that the stumbling player beside him, Uruguay midfielder Álvaro Pereira, would have to be substituted.
In many sports, Pereira’s day would have been over. Moments earlier, he had been flat on his back, unresponsive after taking a knee to the side of his head during a World Cup match against England on Thursday afternoon. A concussion was a serious possibility. At worst, his condition merited a full evaluation.
But even in his weakened state, Pereira was having none of it. Noticing the doctor’s hand signals through his groggy haze, Pereira angrily pulled those hands down, wagged his finger in the physician’s face and insisted he be allowed to remain in the game. When Pereira’s coaches went along, he returned after less than two minutes on the sideline and played the final half-hour of his team’s 2-1 victory in São Paulo.
In doing so he also plunged his sport into a new discussion about how it handles head injuries in an age when their effects are changing the way other sports are played.
The ESPN analyst Taylor Twellman said that he watched in horror as first Pereira’s teammates and then Uruguay’s trainers tried to slap him awake as he lay on his back. Twellman, whose repeated head injuries ended a promising career in 2010, called the shaking of an injured man by people who should have known better both “pathetic” and “barbaric”.
FIFPro, the world players union, accused FIFA of failing to protect Pereira, and it called for an investigation into why he was allowed to continue. It also called for new rules to guarantee the safety of players, even from themselves. “Football is awash with incidents in which players suffer potentially concussive blows to the head and stay on the pitch,” FIFPro said in a statement. “In Pereira’s case, he demanded to play on, overruling advice from Uruguay’s team physician for him to be immediately substituted.”
Uruguay later made three substitutions against England, but Pereira was not among them. Later he acknowledged that he felt “like the lights went out” when he sustained the blow.
FIFA officials said the decision to allow Pereira to continue lay solely with his team’s doctor, Alberto Pan, and that Pan had signed a statement in which he stated he had completed a full neurological examination of Pereira on the sideline and determined his condition to be “normal” before he allowed him to return. There was no explanation of Pan’s signal for a substitution before Pereira protested.
“I don’t think people realise you’re taking a life in your hands there,” Twellman said. “Second-impact syndrome can be fatal.”
FIFA’s chief medical officer, Jiri Dvorak, said that after the injury, a sideline medical team was called in to assist Pan, and that the local organising committee’s doctor and the site’s medical officer offered support. But, Dvorak said, “The team doctor and the coach decided finally that the player is allowed to play.”
Soccer, with its continuous play, its limits on substitutions and its traditions of toughness and bravery, has long struggled with the issue of head injuries. Because players who are removed from a game cannot return to it, coaches are often loath to pull them. Team doctors often defer to coaches and players, who wield far more power in the team dynamic. In World Cup matches, where the quadrennial stakes include national honour, the decision to pull a player from a close game can be even more difficult. But a FIFA spokesman still stressed that “the ultimate responsibility lies with the team’s medical officer.”
Pereira kept playing on Thursday. Afterward, Uruguay’s coach, Óscar Tabárez, heaped praise on his players, telling reporters: “We won because we were fighting. It was not to do with the training, but the persistence and will of my players.”
In many sports, Pereira’s day would have been over. Moments earlier, he had been flat on his back, unresponsive after taking a knee to the side of his head during a World Cup match against England on Thursday afternoon. A concussion was a serious possibility. At worst, his condition merited a full evaluation.
But even in his weakened state, Pereira was having none of it. Noticing the doctor’s hand signals through his groggy haze, Pereira angrily pulled those hands down, wagged his finger in the physician’s face and insisted he be allowed to remain in the game. When Pereira’s coaches went along, he returned after less than two minutes on the sideline and played the final half-hour of his team’s 2-1 victory in São Paulo.
In doing so he also plunged his sport into a new discussion about how it handles head injuries in an age when their effects are changing the way other sports are played.
The ESPN analyst Taylor Twellman said that he watched in horror as first Pereira’s teammates and then Uruguay’s trainers tried to slap him awake as he lay on his back. Twellman, whose repeated head injuries ended a promising career in 2010, called the shaking of an injured man by people who should have known better both “pathetic” and “barbaric”.
FIFPro, the world players union, accused FIFA of failing to protect Pereira, and it called for an investigation into why he was allowed to continue. It also called for new rules to guarantee the safety of players, even from themselves. “Football is awash with incidents in which players suffer potentially concussive blows to the head and stay on the pitch,” FIFPro said in a statement. “In Pereira’s case, he demanded to play on, overruling advice from Uruguay’s team physician for him to be immediately substituted.”
Uruguay later made three substitutions against England, but Pereira was not among them. Later he acknowledged that he felt “like the lights went out” when he sustained the blow.
FIFA officials said the decision to allow Pereira to continue lay solely with his team’s doctor, Alberto Pan, and that Pan had signed a statement in which he stated he had completed a full neurological examination of Pereira on the sideline and determined his condition to be “normal” before he allowed him to return. There was no explanation of Pan’s signal for a substitution before Pereira protested.
“I don’t think people realise you’re taking a life in your hands there,” Twellman said. “Second-impact syndrome can be fatal.”
FIFA’s chief medical officer, Jiri Dvorak, said that after the injury, a sideline medical team was called in to assist Pan, and that the local organising committee’s doctor and the site’s medical officer offered support. But, Dvorak said, “The team doctor and the coach decided finally that the player is allowed to play.”
Soccer, with its continuous play, its limits on substitutions and its traditions of toughness and bravery, has long struggled with the issue of head injuries. Because players who are removed from a game cannot return to it, coaches are often loath to pull them. Team doctors often defer to coaches and players, who wield far more power in the team dynamic. In World Cup matches, where the quadrennial stakes include national honour, the decision to pull a player from a close game can be even more difficult. But a FIFA spokesman still stressed that “the ultimate responsibility lies with the team’s medical officer.”
Pereira kept playing on Thursday. Afterward, Uruguay’s coach, Óscar Tabárez, heaped praise on his players, telling reporters: “We won because we were fighting. It was not to do with the training, but the persistence and will of my players.”
© 2014 The New York Times