Are the football concussion protocols a pyrrhic victory?

Posted: 08/02/2022

The case of Sadio Mané

53 minutes into the Senegal v Cape Verde round of 16 match in the Africa Cup of Nations, the talented Senegalese forward Sadio Mané, who plays his club football for Liverpool FC, was involved in a head-on-head collision with Cape Verde’s goalkeeper, Vozinha.  

BBC’s commentator, John Bennett, reported to those watching live that Vozinha could not walk straight, while Mané appeared to be ‘knocked out’. Vozinha received a red card and left the pitch on a stretcher before being taken to hospital. Mane was given the ‘all clear’ to return to play.

Just ten minutes later, after Mané scored the first goal of a 2-0 victory for Senegal to secure their position in the quarter final, he dropped to the ground holding his head. He was escorted off the pitch and taken to hospital for further investigations into the nature and extent of his head injury.

The concussion protocols

On 18 December 2020 the International Football Association Board (IFAB), as the law makers of the football world, published Circular no.21. This seminal document authorised any football competition to trial two protocols, which allow up to two permanent substitutions a match, where concussion is suspected. This is over and above the ordinary number of allowed substitutes if a medical doctor on the pitch suspects a concussion has occurred.

The protocols are to be implemented in conjunction with SCAT5 (Sport Concussion Assessment Tool) along with the medics’ clinical judgement to diagnose any suspected concussion. The IFAB states that the protocols aim to ensure that ‘where there is any suspicion about a player having been concussed, the player should be protected by being permanently removed from the match and to facilitate this, the player’s team should not suffer a numerical disadvantage as a result of prioritising the player’s welfare.’

The FA has succinctly coined this guidance as: ‘if in doubt sit them out.’

On Friday 8 January 2021, FIFA confirmed that it would be implementing Protocol A (up to one substitution), but the Confederation of African Football has not signed up to the protocol and both organisations are running the tournament.

What should have happened on the day of the incident?  

• Any athlete with suspected concussion (using SCAT5) should be removed from play, medically assessed and monitored for deterioration.
• No athlete diagnosed with suspected concussion should be returned to play on the day of injury.
• The player is substituted with another player permanently from the ‘concussion substitution’ allowance.

From the description of the injury, and Mané and Vozinha’s respective acute responses, rather than ‘if in doubt sit him out’, it appears that the approach taken for Mané was one of ‘keep him in play until he collapses on pitch holding his head.’

Although not part of the protocol per se, SCAT5 provides this guidance about a player’s return to play: ‘After a concussion, the athlete should have physical rest and relative cognitive rest for a few days to allow their symptoms to improve.’

Following this, SACT5 recommends a five-step programme to get the player back to normal play. Each step should not be attempted any less than 24 hours apart and, if there is any deterioration while exercising, the athlete should go back to the previous step.

As a bare minimum, this incident should have amounted to seven days out for Mané. Unsurprisingly, given the previous actions, he was cleared for the quarter final and played in the match against Equatorial Guinea, in which Senegal beat Equatorial Guinea 3-1.

What next?

The facts paint a worrying picture of the state of play in football, in which scoring goals appears to take priority over the prevention of brain injury for the players and, until the protocols are widely adopted throughout the football world, Circular no. 21 could be a pyrrhic victory.

Return to news headlines