Is MLS better at treating concussions than the EPL?

A month ago, the Colorado Rapids' injured Captain Pablo Mastroeni, was on the sidelines at practice. He was juggling a ball, while wearing what looked like rugby gear on his head. As we all know here at Burgundy Wave, Pablo has been injured for nearly a year now, as he recovers from multiple concussions, the first suffered last October against Real Salt Lake.

At the beginning of this woeful season Pablo suffered another concussion against Columbus. He then played in the next game and has not seen the pitch since. In an interview with the Denver Post earlier this year, Mastroeni indicated that he is approaching his recovery with caution.

"It's silly to look into the future, because no one knows what the future holds, how I'll feel, so I'm just taking it one day at a time," Mastroeni told the Denver Post. "There's no pill you can take, it's all wait and see."

In recent years concussions have leapt to the forefront in conversations on sports related injuries. According to the American Association of Neurological Surgeons, 446,788 people visited emergency rooms around the country in 2009 due to sports related concussions (and that's only the people who sought out treatment! Think of how many more untreated concussions there have been). Soccer accounted for 24,184 of these concussions. While this ranks fourth out of the five major sports in the US, it is still troubling, especially after what we have seen happen to Pablo.

A recent study in the British Journal of Sports Medicine looked at how well teams in the English football leagues are adhering to internationally accepted guidelines for treatment of concussions. These researchers, from the University of London sent questionnaires to the medical directors of each team asking about their practices surrounding head injuries.

The results of this survey were disappointing, as most teams in the English football system failed to assess their players before and after a concussion. Many teams were still using outdated guidelines. For example, it is recommended that all players go through pre-season cognitive tests to to figure out their "normal" cognitive performance. After a blow to the head, these same tests are expected to be done with players and only 42% of the teams surveyed completed the post-concussion tests.

Most likely as a result of major lawsuits against the league about the mistreatment of concussions, Major League Soccer has been striving to be the leader in concussion treatment in the world of soccer. This season MLS has added a neuropsychologist to every team who specializes in concussion identification and treatment.

In MLS, players who have suffered a blow to the head must be evaluated and treated using three separate tests. They must pass all these tests and be symptom free before being allowed to return to the field during a game or practice. We all know how seriously Pablo has been taking these recommendations.

Despite these procedures, MLS can still do more to protect players who may have suffered a concussion instead of only identifying and treating them better. The substitution rules of soccer do not protect players very well if they have a concussion. If all three substitutes have already been used by the coach and one suffers a concussion the team is suddenly forced to play a man down the rest of the game, even when the player who suffered the concussion may look fine and insist on returning to the field. If a player does return to play after a concussion they are much more likely to make the concussion worse and have more persistent symptoms than if they stayed out of the game.


I propose that MLS should introduce a new concussion specific substitution rule, where if a team has used all their substitutions and a player suffers a concussion they may be allowed to replace that player. This determination would of course have to be made by an independent party, most likely a physician associated with the referee's team.

Now, I understand that the soccer ‘purists' will hate this suggestion, but as the world changes so must our sports, as both the NFL and NCAA have demonstrated in recent years as they change their rules to better protect the players. But to make our sports safer and protect our players changes like this must happen. The MLS seems to be far ahead of the EPL and English leagues in concussion treatment, but there's still a long way to go!

What do you all think? Are concussions in soccer a big problem that needs to be addressed more, as we have seen from the injury to Pablo, or are things fine as they are?