Barcelona, Spain
Thursday 29th May 2014

Following on from my meetings in Paris, I flew down to Barcelona & switching sports to soccer, spent a day watching training at FC Barcelona. Accompanied by both a player (Brett Crompton) & a coach (Mikel Touzón) I worked with in Thailand, we spent time with the U19 (recently victorious in the domestic league & U19 UEFA Champions League) & the B teams.

We were made extremely welcome & as well as being granted access to watch the training sessions, we were able to discuss various aspects of the sessions & training ethos with the U19 head coach, Jordi Vinyal.

As usual, my travels give me a good chance to catch up on the latest literature being published & this week, the mass media came to the fore, with concussion & the debates surrounding the long-term effects of cumulative sub-concussive events continuing to hog the sports medicine headlines in the national & international press.

The usual suspects of rugby & American football remain in the spot light, whilst this week soccer joined the rather crowded courtroom.

Away from the expert opinions, research & sports writing sensations, the one article that caught my attention, along with many of those with whom I worked in rugby, was an autobiographical piece by Shontayne Hape, ghost written by Steve Deane, entitled “My Battle with Concussion”.

Shortly after the broadcast of Toulouse player, Florian Fritz, being subjected to appalling pressure by coach, Guy Noves, to return to the field of play following a significant concussive event (click below to view the video), the former international rugby league & union player has talked about his experiences pursuing a career in the sporting codes.

Robinson, G. (2014). Toulouse condemned after player allowed to play on following severe head knock. Sydney Morning Herald.

Hape played professional rugby league for the Warriors & Bradford in addition to representing the Kiwis, before switching codes to rugby union in 2011 to play for London Irish and later for Montpellier in the French Top 14, whilst earning international honours with England.

The library of head injuries he catalogues may not be that unusual, however, the widespread attitude of disregard, denial & ignorance that is portrayed by medical staff, coaching staff & players alike goes someway to illustrate the mountain we have to climb in educating the sporting world about the seriousness of head injuries.

If you are involved in contact sports at whatever level, in whatever role, you must read this article.

Deane, S. (2014). My battle with concussion. The New Zealand Herald.

Meanwhile, the truce agreed by the NFL & the players’ union in response to the concussion debate, seems to have deflected the accusations of medical negligence & cover-ups to the widespread use of anti-inflammatories & pain medication.

Several former players have filed a lawsuit in northern California, alleging that NFL teams regularly administered pain relief medication to mask the effects of severe injuries. They claim the medications were issued to the players in attempts to speed up recovery with an aim to get them back on the playing field as quickly as possible. However, the former players are claiming that this has now lead to further health issues after their playing careers have some to an end.

Chiari, M. (2014). NFL Sued by Former Players who Allege Illegal Use of Painkillers to Mask Injury. BleacherReport.

The lawsuit brings several points to the fore, the first of which being, whether the medical professionals involved were acting in the best interests of the players whose health they were charged to protect, or in the best interests of the team that paid them their wages.

Such conflicts of interest are not unusual & are difficult to protect against when many medical professionals find themselves in pressured, sporting situations for which they have received no formal training.

Where does a doctor, sports physiotherapist or athletic trainer get taught how to deal with the pressure applied by coaches, organisations, in addition to the players themselves to get that athlete back on the field of play as quickly as possible after sustaining an injury? They don’t…they normally pick it up as they go along & it takes a strong character to stand their ground, the consequences of which can result in losing your job. I know, I’ve been there & stood my ground, fully aware that my contract was on the line.

Is it fair to suggest that a medical professional employed by a team, operating in the sports environment can make a decision, which adequately weighs up the short term gains against the long-term indications? In my opinion it is paramount that they do, whilst informing the player of the information they drew on to form that decision. That’s what they are paid for.

Yet, the second question, is whether or not the NFL players were properly informed about the drugs they were being administered. This leads to the subsequent debate as to whether or not the environment that prevailed in their workplace (ie. the locker rooms & training rooms of NFL teams) actually meant they felt compelled to consent to the treatments that were being proposed.


Caplan, A.L. & Igel, L.H. (2014). Ex-NFL players' Lawsuit Over Use of Painkillers: Who is Ultimately Responsible?

Meanwhile, the debate regarding the long-term effects of heading footballs became the latest concern to the health & wellbeing of retired sports stars.

I remember this being debated during my time working for the Football Association between 2002 & 2004. One of the consultant neurosurgeons was keen to conduct a study to establish whether there were any health risks linked to this part of the game.

A few months ago, Glaswegian neuropathologist, Dr. Willy Stewart, publicly suggested that repetitive sub-concussive events may have lead to the findings of chronic traumatic encephalopathy (CTE) in a former rugby player. This week, he related the death of former England soccer international, Jeff Astles, to chronic traumatic encephalopathy caused by repetitive heading of heavy leather footballs throughout his career.

BBC (2014). Jeff Astle: West Brom legend "killed by boxing brain condition". BBC Online.

Opinions amongst the leading experts in CTE are far from uniform & there are those in the field that point to the lack of evidence relating to causative factors, in addition to the voicing of concern that speculation is being drawn on the back of, what are effectively, a couple of case studies.

As the debate surrounding CTE in former NFL & rugby players rages on, it seems plausible that more questions will now be asked in relation to the risks of heading footballs.

Reading through all the week's sports medicine news, intended for digest by the general public, one fact springs to the fore: education is paramount & in the past it seems that sports governing bodies haven't been as cognisant of this fact as perhaps they should.

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