FIFA Must Learn Lessons On Head Injuries From the NFL Lawsuit

4,500 former NFL players, many of whom had suffered with mental health or cognitive problems, sued the league over head injuries sustained whilst playing... Yet at the World Cup, this evidence was flagrantly ignored... any medic will tell you that Christoph Kramer should have been taken off immediately.

Last year, headlines were made when some 4,500 former NFL players, many of whom had suffered with mental health or cognitive problems, sued the league over head injuries sustained whilst playing. The NFL lawsuit was met with scepticism in some quarters. Surely the risk of injury is something that, as a professional, you accept and take responsibility for when signing up to play in the NFL; surely it should not come as a surprise that the risk of head injury comes with the territory when playing top-level American football.

However, such scepticism is a vast oversimplification. The brain is the most poorly understood organ in the human body, and in this regard assessing risks associated with head injuries is venturing into the unknown. This is particularly true of the long term ramifications. Yet to explain the justification for the NFL players' lawsuit, we need to delve a little deeper. The brain may be poorly understood, but it is also widely researched. Of course, in an area as complex as neurology, some medical research is transient; there will always be some level of unknown when it comes to long-term consequences of head injury. But in order for individuals to make an informed decision about the risks they are taking, they need to be made aware of the latest research, and the regulatory bodies involved in sports where there is a risk of head injury need to take this research seriously. The NFL players who brought the case claimed that not only had they been poorly informed, but actually willfully misled, by the NFL. For example, the NFL's own Mild Traumatic Brain Injury committee's representatives had repeatedly rejected evidence from a study of former NFL players that linked brain trauma to CTE, a progressive degenerative disease which can cause depression and cognitive problems.

And now, we see a similar failure on FIFA's part to take the research seriously. There is a growing body of evidence highlighting the dangers of concussion and the risks associated with playing on after a potentially concussive knock. Yet at the World Cup, this evidence was flagrantly ignored. That Christoph Kramer, blurry-eyed and dazed, played on for 15 minutes after being struck on the head in a collision during the World Cup Final (subsequently admitting that he did not remember the first half of the game) is illustrative of a complete failure by football's authorities to take the risks seriously: any medic will tell you that Kramer should have been taken off immediately.

Fundamentally, not many team managers would be willing to substitute a top player in a big game if they think they are able to play on, and it is certainly not in a team's interest to go down to 10 men whilst assessing a player's head injury (as would happen under football's current status quo). FIFA wants to see the biggest stars play the biggest games, and therefore added precautions with regards to concussion are not in their short term interests. Similarly, it was not in the NFL's interests at the time to acknowledge the research linking brain trauma to CTE. It is this conflict of interest that is the crux of the problem. But the tide is changing (due in no small part to the precedent set by the NFL lawsuit), and it is time to prioritise player safety above all else. It must be the responsibility of sport's governing bodies to make sure that the risk their players take with regards to their bodies, and in particular their brains, is an informed one, and to put in place the safeguards necessary to minimise these risks, even if in the short term it may not feed their own interests.

Across all sports, a longer term approach which encompasses raising awareness, taking precautions, and investing in research is required. A proportion of the money in the NFL settlement is to be set aside for education and research. Rugby Union is making similar commitments: not only will all players and coaches have to complete training in concussion before the start of this year's Premiership season, Scottish Rugby is currently running a major, and potentially ground-breaking, study into the long term effects of concussion. FIFA must learn lessons from the NFL lawsuit, and take responsibility to ensure that the risks professional footballers take are not only minimised but also taken with the most information possible at their disposal. Football urgently requires a protocol whereby a player with a potential concussion is independently assessed and prevented from playing on if they are deemed to be at risk, and this is where FIFA must start - but when it comes to taking head injuries seriously, it certainly isn't where they should stop.

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