Jan Vertonghen injury: Head-injury experts demand protocol changes after Tottenham defender suffers heavy knock

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Leading head-injury experts have called for an overhaul of football’s concussion protocols following the treatment of Tottenham defender Jan Vertonghen on Tuesday.

Mauricio Pochettino and the club insist they followed the correct procedure after the Belgian defender suffered a serious head injury in the Champions League semi-final first-leg defeat to Ajax, leaving him bloodied and briefly unable to walk.

The 32-year-old clashed heads with team-mate Toby Alderweireld as the pair competed for a ball with Ajax goalkeeper Andre Onana and was treated on the pitch for around five minutes by Spurs’s medical staff, led by team doctor Christopher Hughes. After changing his blood-spattered shorts and shirt and following a check by referee Antonio Mateu Lahoz, Vertonghen returned to the pitch but lasted just 40 seconds. His right leg appeared to buckle and he was retching as he was helped down the tunnel by two members of Tottenham’s medical staff.

The club said Vertonghen had passed all concussion tests on the pitch and after the game and insisted no pressure was applied on him to continue. The defender, who watched the remainder of the match from the dressing room, said he was “fine” as he left the stadium with the rest of the squad, but he was set for further tests this morning, with the club not ruling out a concussion.

However, Dr Andrew Murray, one of the authors of the Scottish government’s concussion guidelines and former team doctor at SPL club Hearts, called for three major changes to the game’s concussion protocols: the introduction of independent doctors, concussion substitutes and video replays for pitchside medical staff.

According to UEFA’s current protocol, “in the event of a suspected concussion, the referee stops the game for up to three minutes, to allow the injured player to be assessed by the team doctor. A player will only be allowed to continue playing on specific confirmation by the team doctor to the referee of the player’s fitness to carry on”.

Dr Murray told Standard Sport new guidelines must be introduced to protect players and assist medics.

“Independent doctors supporting the matchday teams are able to make completely independent decisions,” he said. “If you’re part of the regular matchday teams and looking after that manager and players on a day-to-day basis, it can be really difficult to make a completely objective decision.

“Number two, medical staff should have access to a video feed. Referees have access to VAR, so why not medics pitchside, who could feed that information into the club’s medical team and help them make good decisions? And thirdly, having a blood or concussion substitution, so that issues can be looked at over a certain period of time and better decisions can be made.

“You would still get a great game of football but ensure there are processes that support player welfare better than the ones at present. Most of the other contact and collision sports, like rugby union and rugby league, have set protocols which are not foolproof but are proven to help and are making a difference with player welfare.

Feeling the effects: Jan Vertonghen is helped off the pitch last night
PA

“The bottom line is that if you think someone has suffered a concussion, do not return them to the game. That’s the fundamental thing: if in doubt, sit them out.”

Brain injury charity Headway also called for an urgent review into the current protocol, backing the introduction of concussion replacements and independent doctors.

Luke Griggs, spokesperson for Headway, said: “Concussion is notoriously difficult to diagnose. The symptoms may be hidden and require the individual to be honest about how they’re feeling, while they can also be delayed in their presentation.

“Assessing a player for three minutes — or even five, as was the case with Jan Vertonghen — does not allow for medical staff to make a reliable diagnosis, particularly when this is conducted on the pitch under the gaze of tens of thousands of fans eager for the game to resume.

“The pressure on club medical staff is enormous and unfair, particularly in such high-stakes games such as a Champions League semi-final.

“We believe the time has come for football to introduce temporary concussion substitutions that would allow for longer off-pitch assessments to be conducted. In addition, independent doctors with expertise in concussion and head injuries should make the ultimate decision as to whether or not a player is fit to continue.

“Not every head injury will result in a concussion, but allowing players to continue while showing clear signs of discomfort following a head injury is contrary to the ‘if in doubt, sit it out’ principle at the heart of all effective concussion protocols.”

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