Philly.com Sports Doc
Posted: Tuesday, July 15, 2014, 1:14
PMRIO DE JANEIRO, BRAZIL - JULY 13: Christoph Kramer of Germany receives treatment as referee Nicola Rizzoli looks on during the 2014 FIFA World Cup Brazil Final match between Germany and Argentina at Maracana on July 13, 2014 in Rio de Janeiro, Brazil. (Photo by Robert Cianflone/Getty Images)
Concussions in soccer are becoming more evident, as seen in the World Cup final. Germany’s Christoph Kramer was injured in a shoulder-to-head collision during the first half. He appeared concussed to the average viewer. Kramer even told the German newspaper Die Walt, “I can’t really remember much of the game.”
Germany’s medical staff evaluated Kramer on the sideline and returned him to the match. Approximately 15 minutes, later Kramer fell down on the field and was subsequently substituted.FIFA’s concussion management protocol is based on Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport, which is the gold standard for concussion management. The SCAT 3 and pocket SCAT 2 are the concussion tools used to evaluate athletes suspected of having a concussion. According to the consensus statement, if it is determined that the athlete has suffered a concussion, he is immediately removed from the game and may not play for a minimum of one week.
Did Kramer pass his sideline testing? Was the German staff not competent in assessing his concussion? Did they return him to play despite having a concussion?
From my observation, he had some obvious signs that would have raised serious concerns about a concussion. We will never know what truly occurred on the sideline, and these situations are becoming more common as seen in this World Cup like Gonzalo Higuaín in the final match, Javier Mascherano in the semi-finals and Álvaro Pereira in the group stages.
In any American sport, Kramer would have been removed from the game and a thorough concussion assessment would have been performed. The NFL even has independent concussion evaluators on each sideline to limit any bias from the team physician.
International soccer is behind American sports in the assessment and management of concussion. One problem is that they don’t take them as seriously as we do here in the U.S.
Having to play down a man during the evaluation and the limited number of subs is another big problem for concussion assessment and management in international soccer. If the quick sideline test – as performed in the U.S. – shows signs of a possible concussion, a more formal evaluation can take upwards of 10-15 minutes to perform, which means the team will have to play down a man until it’s completed.
Another issue is who is doing the assessment. As we’ve seen, the team physicians have been very liberal about letting a player return. There is talk in soccer circles about having an independent physician on the sidelines that has the final say, much like the NFL. Another option may be to allow a temporary sub until the concussion evaluation is completed.
Besides a cultural change, there will need to be some significant rule changes to allow appropriate and unbiased sideline concussion evaluations in international soccer. I just hope that these changes occur before it ends up in the courts as it did here with the NFL.
Philly.com Sports Doc
Justin Shaginaw MPT, ATC
RobertSenior, Sports Doc blog Editor
Posted: Wednesday, December 11, 2013
Friday’s World Cup 2014 draw was wildly panned by fans of the United States Men’s National Soccer Team (USMNT), as the team was selected into the foreboding “Group of Death” alongside Ghana, Portugal and Germany for June’s world championships in Brazil.
The matchups alone are enough to give fans apprehension—Ghana, the nation that’s eliminated the USMNT from the last two World Cups, alongside perennial powerhouse Germany and Portugal, who feature one of the world’s best in Cristiano Ronaldo. But the conditions in which the USMNT will play their games offers equal cause for concern.
Over the course of 12 days, the team will travel over 9,000 miles for their three games—more than any other World Cup squad. What’s more, the second of the three games—against Portugal—will be played in Manaus, in the heart of the Amazon rainforest.
Concerns about the conditions have already caused enough uproar to cause the game to moved from 3 p.m. to 6 p.m. local time—out of the worst heat of the day—but this game promises to provide the USMNT with their stiffest test, in terms of conditioning.
“It’s going to be difficult—for both teams,” says Justin Shaginaw, MPT, ATC, who’s worked extensively with the USMNT. He traveled to South Africa for World Cup 2010.
“Most of Portugal’s players are playing professionally in Europe. They’re not accustomed to that climate either. If they were to be playing against a South American country in that environment, the South American nation would have an advantage because of their familiarity with the climate.”
Shaginaw adds that people can’t focus on the environment in Manaus as the only challenge the team will face. “It may not be as hot as the jungles,” he admits, “but those other two aren’t exactly going to be mild, either
In terms of travel, Shaginaw says that the advantage in South Africa was the ability to set a home base, and drive to and from each game. That won’t be possible in Brazil, with games being played throughout the nation at points hundreds and even thousands of miles from one another.
It may sound funny, but at least with all the travel the players won’t be cooped up indoors all day. Shaginaw explains.
“There are pluses and minuses—in South Africa, we couldn’t leave the hotel without security detail—and my understanding is it’ll be pretty much the same in Brazil,” he adds. “In Europe, the players can kind of come and go—they can walk around town, have coffee… you can’t really do that in Brazil.”
The travel, he added, can be notoriously difficult on team staff members who are responsible for transporting about 10,000 pounds of gear to and from each game. “Warm-up gear, cleats, Gatorade, etc… shipping all that stuff back and forth can take a toll on you,” Shaginaw says. “But for the players? They might like the change in venue—a chance to get out of that same hotel you’ve been in for the last 20 days.”
In the end, while Shaginaw admits there’s a decided advantage for South American sides in this tournament, he adds that there’s reason for optimism for USMNT supporters. “If they can make it out of that group, they should have a good shot of going pretty far in the tournament,” he says. “All three of their opponents are strong teams, so if they can make it past that group, that’s evidence you’ve got a pretty strong team.”
World Cup 2014: The "dress rehearsal"06/27/2013
Philly.com Sports Doc
POSTED: Wednesday, June 26, 2013, 6:00 AM
Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
The 2013 FIFA Confederations Cup is underway. Group play is over and the semifinals are set: Brazil vs. Uruguay; Spain vs Italy. It’s a tune-up, a full dress rehearsal for the biggest event on the soccer world stage—the FIFA World Cup. Confederations Cup competition consists of eight teams: the champions of each of the six FIFA confederation championships (UEFA, CONMEBOL, CONCACAF, CAF, AFC, OFC), along with the FIFA World Cup winner and the host nation.
The teams play in the exact same venues where World Cup play will take place. The dry run gives teams a chance to make sure everything is ready and allows the host nation time to make adjustments when they are not. Players get a chance to check out the pitch and the volume of the crowds. Coaches get a sense of how the field will play and plan accordingly. Also, players get an idea of weather conditions, sun positioning, and altitude. All of these factors will play a major role next summer.
Also, this dry run allows a team’s staff members to get a chance to assess the amenities so they can bring what they need for the World Cup. In the United States, each professional sports league has specific rules and regulations regarding the locker rooms and athletic training rooms, supplies that the host team provides, and assistance for away teams. That’s not the case in international play.
Teams don’t really know what they will find and need to deal with in a stadium overseas. Commandeering the fire hose to fill up the cold tubs is fine as long as you don’t get caught. Among the other things the team will need to consider ahead of time: electrical supply for ball pumps and medical equipment. Will there be running water for showers? Is the water drinkable, or does the team need to bring in bottled water? Will the host nation supply simple amenities such as towels, soap, and toilet paper? It’s the biggest event in the sport and teams want to be totally prepared and make sure they’ve packed all they need from band-aids to Benadryl, Gatorade to gum. If the players might want it, the teams will bring it.
Just like you surf the web for the best hotel rooms, the teams check out possible accommodations in the host country while in town for Confederations Cup.
How are the rooms? The amenities? The safety? The food? What is the distance to and from the practice field and game stadiums? This base becomes the team’s home away from home for a month or more. The happier and more comfortable the players are with their accommodations, the more likely they are to perform well on the field. Simple things like a good internet connection can make all the difference when you are thousands of miles from home and looking for some creature comforts.
Confederations Cup also allows teams to size up the competition a year ahead of the big event. It’s one thing to play these teams in a friendly where only pride is on the line. It’s another to play them when there is a major international trophy at stake. Not only does this allow the team to scout the opponent but also lets the coaching staff see how individual teams stack up and what needs to be changed or worked on in the year ahead.
Confederations Cup also gives players a psychological edge going into the World Cup. They spend some time in the host country, play in the real venues, and know how the environmental conditions affect the game. Often, it’s the psychological and not the physical or tactical aspect that makes the difference between winning and losing.
While we’re waiting for this year’s Confederation Cup final, remember there will be another international tournament being played here in the United States in July. The winner of this summer’s Gold Cup qualifies for a playoff match against the 2015 Gold Cup winner for a spot in the 2017 Confederations Cup. So buy a ticket, grab your jersey, and support the United States as they are already looking ahead to the 2017 Confederations Cup in Russia and a chance to gain that valuable edge for the 2018 FIFA World Cup.
Justin Shaginaw, MPT, ATC, traveled with the United States Men’s National Team for the 2010 World Cup in South Africa.