World Cup Incident Draws Criticism, Demands for Change

The world was abuzz this weekend about the World Cup, with all the scintillating match play and high stakes drama.

But some of the drama was not at all flattering to the game and the organizational body that manages it – FIFA.

When Uruguay defender Álvaro Pereira went down in a heap after taking a knee to the head, those of us who track the concussion issue fully expected him to be removed from the match with England and be questionable for future matches.

After all, Pereira said felt “like the lights went out,” a sure fire sign of a significant concussion. But minutes after lying motionless on the floor, the player jumped up and demanded that he be returned to the game. Astonishingly, he was.

Here’s the video of the incident:

The players union, FIFPro, was critical of the decision, urging FIFA “to conduct a thorough investigation into its own competition concussion protocol which failed to protect Uruguayan footballer Álvaro Pereira.”

Experts Weigh In

Some industry experts weighed in immediately.

“FIFA clearly has a problem on its hands,” Dr. Andrew Blecher (, of the Southern California Orthopedic Institute, told Concussion Policy and the Law. “As a sponsor and host of the Zurich International Consensus Conference on Concussion they are acutely aware of what the current accepted guidelines are for evaluating a potentially concussed athlete.Andrew_Blecher

“Such mismanagement of a clearly concussed player on the worldwide stage for all to see sends the wrong message to all soccer players and organizations around the world.  The ‘Do as I say and Not as I Do’ attitude that has also been adopted by the NFL cannot continue.  For FIFA to comply with its own recommendations there will need to be rule changes to allow for substitutions so that players who suffer any head trauma can be properly evaluated.  The evaluations must also be performed by independent trained specialists in head trauma and concussion that are free from the conflict of interest that so commonly goes along with being a team physician.  Until these changes are made the ‘Beautiful Game’ will continue to be scarred by the mismanagement of head trauma.”

Dr. Michael J. Perrotti, a concussion expert with 30 years of experience in practice of forensic neuropsychology and clinical psychology, echoed the point about having an independent concussion expert on the sideline.

“This is why the NFLPA wanted its own doctors on the sideline,” he told Concussion Policy and the Law. “Team doctors would send them back in.”

michael-j-perrotti-phdOne of the problems “is there is NO standardized return to play protocol in FIFA. At least football has the SLAM criteria for return to play. What concerns me is the so-called second injury, physiological changes in the brain AFTER the concussion. What if he had had a micro bleed? This was very negligent of FIFA. Lax policies like this place players at great risk!”

Dr. Perrotti ( added that FIFA has an opportunity to get it right.

“FIFA has no return to play criteria to prevent a concussed, unstable player from re- entering the game.  Now is the time to institute this — neuropsychological assessment as the NFL has and comparison of baseline neuropsych functioning scores. More restrictions, such as these, need to be in place to protect the players.”

FIFPRO’s Statement

Meanwhile, FIFPro issued the following statement:

“Football is awash with incidents in which players suffer potentially concussive blows to the head and stay on the pitch. In Pereira’s case, he demanded to play on, overruling advice from Uruguay’s team physician for him to be immediately substituted.

“FIFPro understands that in certain moments, faced by the pressures of such an important international stage, many players would react in this way.

“There are times, however, when the players also require greater protection against the prospect of making any rash decisions. He must be subjected to further evaluation and follow-up procedures that help determine if and when he can return to training.

“The World Cup must set the standard for player health and safety to educate the international football community.

“Medical evidence shows that a person faces the risk of very serious brain injury, or worse, if he or she suffers a severe head trauma from a concussive blow.

“Furthermore, FIFPro states any sideline concussion assessment must not be conducted solely by a national team physician.

“In order to ensure real independence, FIFPro’s involvement, as the international authority representing the interests of the players, would ensure they are insulated at all times.”

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