International Players Union Calls For Investigation Into World Cup Concussion


Uruguay's Alvara Pereira lays on the field after suffering an apparent concussion Thursday at the World Cup. He later returned to the match.

Uruguay's Alvara Pereira lays on the field after suffering an apparent concussion Thursday at the World Cup. He later returned to the match.

Uruguay’s Alvara Pereira lays on the field after suffering an apparent concussion Thursday at the World Cup. He later returned to the match.


The International Federation of Professional Footballers is calling on international soccer’s governing body to investigate its concussion protocols and return to play standards to provide better protections to soccer players at the World Cup and otherwise, the union announced in a statement Friday.

The call for an investigation comes after Uruguayan defender Alvaro Pereira returned to play despite suffering an apparent concussion on the field Thursday evening. Pereira appeared to lose consciousness after taking a knee to the head while attempting a slide tackle during Uruguay’s World Cup group stage match with England. He was briefly taken off the field, but he shook off a doctor’s motions for a substitute or further evaluation and returned to the field. Afterward, Pereira said he was dizzy and that he waved off the doctor in “a moment of madness.”

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Pereira’s concussion was at least the second high-profile incident that appeared to go without a concussion evaluation, as American forward Clint Dempsey returned to play Sunday against Ghana after taking a kick to the face that broke his nose. It was never confirmed whether Dempsey suffered a concussion.

FIFPro, as the international union is known, called on FIFA “to conduct a thorough investigation into its own competition concussion protocol which failed to protect Uruguayan footballer Alvaro Pereira.” The union is also “seeking urgent talks and immediate assurances that FIFA can guarantee the safety of the players, which must be priority number one, for the remainder of this tournament and beyond,” the statement posted on its web site Friday morning says.

FIFA has protocols for evaluating concussions, though it is unclear whether there were full evaluations performed on Dempsey or Pereira. FIFPro will consider calling for changes to that policy that would take evaluations out of the hands of team doctors. “In the absence of” FIFA’s immediate assurances of safety, the statement said, “FIFPro is considering alternative solutions such as independent medical practitioners appointed by FIFPro for all future FIFA competitions.”

The union also suggested altering soccer’s substitution rules to allow for a temporary substitute while a player is evaluated for a concussion. The current substitution rules, which allow for only three substitutions in any match and no return to play for any player who is removed from the match, have been seen as a barrier to proper concussion evaluation and diagnosis during matches, especially those as important as World Cup tilts.

As Foreign Policy’s Mike Goodman wrote after Dempsey’s injury, soccer, particularly at the international and major club level, has not shown much willingness to deal with concussions, even as (at least anecdotal) evidence mounts that the injuries could pose a serious problem in the sport. Doctors diagnosed the first case of chronic traumatic encephalopathy (CTE), the brain disease thought to be related to concussions that has been found in dozens of former football players, in a soccer player earlier this year, and fears of concussions have mounted at the youth level. In the United States, concussion rates are relatively high in youth soccer, especially in the girls’ game, which ranks behind only football and ice hockey for concussion incidence rates according to injury tracking data.

As in other sports, more research needs to be done about the prevalence of concussions in soccer and their causes, and that remains true at both in the youth game and at the professional level, where players often return to matches after suffering concussions with little or no evaluation or monitoring and leagues have been slow to implement basic standards. Soccer, FIFPro said in its statement, “is awash with incidents in which players suffer potentially concussive blows to the head and stay on the pitch.”

In Pereira’s case, the union said it “will be monitoring the health of Pereira over the course of today. He must be subjected to further evaluation and follow-up procedures that help determine if and when he can return to training.”