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Professional football’s focus on concussion and player welfare is continuing to develop. The latest in a number of initiatives has been announced by the Spanish footballing authorities in collaboration with FIFPRO and European Leagues.

Dr Javier Barrerahe of Real Sociedad has developed a concussion training course for the medical staff of the 42 professional Spanish clubs. The emphasis however is not just on the medical teams. The objective is for the dissemination of the information to players and other club staff. The hope is that everyone can then play a role in detecting and protecting players who may be suffering from concussion promoting FIFPRO’s Recognise, Report, Remove messaging.

This new approach attempts to build collaboration within the ranks of professional clubs. In conjunction with Dr Barrerahe’s work, LaLiga is underlining the important role that players and coaches can have in helping to protect themselves as well as their teammates and opponents.

The key elements set out in Dr Barrerahe’s concussion training are:-

  1. How to detect a concussion
  2. Players with a concussion should be removed from the pitch and not allowed to return
  3. Players should be given sufficient time to recover

Combining these elements gives players a significantly better prognosis as we’ve seen the number of recurring concussions or persistent symptoms is a lot lower under these circumstances. If players are allowed to continue or they return to action too soon then, as Dr Barrerahe explains to his colleagues on the course, evidence suggests the incidences of persistent symptoms or recurring concussions is much higher.

"... it’s important for the players to be aware and involved. The players can say to their teammates ‘you should go off because your health is more important than the match’. I think this is part of the challenge, to inform the players and to ensure they’re able to identify such a situation, prioritising the health of their teammates"

Geni Martínez

Director of the Association of Spanish Footballers Health Department

A presentation has been shared with clubs, which combines the expertise of Dr Barrerahe and the medical team from FIFPRO, using video clips to highlight examples of the six main signs of a possible concussion, These are described as:-

  1. lying motionless
  2. motor incoordination
  3. tonic posturing
  4. no protective action or flopping
  5. a blank or vacant look
  6. impact seizure

An emphasis on player education and enabling them to become part of the solution is an innovative strategy. A reluctance amongst players to disclose symptoms remains an issue for medical staff when attempting to diagnose and subsequently treat concussion. Creating a culture of supporting one another, via greater education and a focus on health rather than just football performance can hopefully be established.

As Geni Martínez, the director of the Association of Spanish Footballers (AFE) Health Department, said: “From AFE’s point of view, it’s important for the players to be aware and involved. The players can say to their teammates ‘you should go off because your health is more important than the match’. I think this is part of the challenge, to inform the players and to ensure they’re able to identify such a situation, prioritising the health of their teammates.”

This new approach in Spain is a welcome step forward for football. Concussion education and involving players will hopefully move detection and care forward. It is not just in Spain however, where players may benefit from this new initiative. FIFPRO who collaborated with the team in Spain is seeking to develop a standardised protocol for concussion in football. It’s important to note that concussion affects players in very different ways based on a host of factors that are still to be fully understood. Therefore whilst standardised protocols do offer a step forward, it remains imperative that each player's management and treatment is based on their individual needs.

New technology will help make both standardised protocols and individualised treatment easier for clubs and players. Unlike in rugby and other sports where mouthguards use offers the potential to monitor and track impacts, football simply doesn’t have that culture.

Therefore different solutions are required. HITIQ is at the forefront of concussion management technology. This includes virtual reality systems, video analysis, machine learning and the basis for AI to play a role in keeping players safe. One of the most comprehensive app-based monitoring platforms, CSX is already available as part of the HITIQ suite of products. The system is used across a number of elite clubs and can be easily integrated into medical programmes. It has been used to help with diagnosis, symptom tracking and return to training/play treatment strategies.

The incidence of concussion during football remains much lower than that seen across other contact sports. The need to prioritise player welfare is no less important though. New initiatives such as that being rolled out across Spanish professional football are therefore to be welcomed. If they prove to be successful, by changing the culture towards concussion amongst players, further adoption into FIFPRO’s protocols and across more football leagues will be a logical next step.

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