Bundesliga: New measures to treat head injuries

"Place one foot behind the other so that they are touching, put your hands on your hips and close your eyes. Now keep your balance for 20 seconds." These are some of the new instructions that Bundesliga players will be following this season.

Preseason fitness and performance checks are of course nothing new. This season, however, club doctors will be paying particularly close attention to head injuries, with professional footballers in Germany being required by the German Football League (DFL) to undergo "baseline screening" in accordance with "SCAT 5" — the fifth edition of the "Sport Concussion Assessment Tool."

In addition to balance tests, SCAT also includes a comprehensive evaluation of other cognitive abilities such as memory retention, reaction speed and spatial awareness. It's a time-consuming exercise – the evaluation cannot be performed correctly in less than ten minutes – but enables doctors to diagnose serious injury more accurately.

"This is a step in the right direction," said Daniela Golz of the Society for Sports Neuropsychology (GNP) in Hennef, near the western German city of Bonn. "Nevertheless, we would still recommend an evaluation which goes even further than that which has been agreed." Only then, she says, can injury and recovery be thoroughly evaluated.

DFL takes action

Football is one of many sports that pose a risk of concussion, according to Katrin Hemschemeier, a researcher for the Federal Institute of Sports Science at the University of Paderborn. "In the Bundesliga, we see such injuries almost on a weekly basis," she contends.

Indeed, in the recent Bundesliga playoff at the end of May, head injuries to Stuttgart defenders Holger Badstuber and Ozan Kabak made headlines, as did a knockout blow to Christian Mathenia a couple of months earlier. Despite being temporarily unconscious, the Nuremberg goalkeeper continued playing.

Last November, Noah Sarenren Bazee, then of Hannover, was allowed back onto the pitch after a violent collision with Borussia Mönchengladbach's Matthias Ginter, only for the winger to sink to the ground with dizziness and nausea soon after. Later, he was diagnosed with a severe concussion.

"That is extremely serious," said Werner Krutsch, a doctor with the Bavarian Football Association (BFV), "but the DFL has taken the right action."

Other experts have also unanimously welcomed the new screenings, the results of which can also be stored in a database to enable diagnosis of longer-term effects, as Krutsch points out.

UEFA demands rule change

In the short term, however, deciding whether a player can continue or not is not easy, especially on the side of the pitch during a match. "Baseline screening is not suited to sideline tests," said Daniela Golz.

"You only have three minutes which you need to use for basic tests," adds Krutsch. That is, according to him, too little for a proper diagnosis, making the player's own experience and knowledge more important.

In order to make it easier for team doctors to do their work, UEFA has this year suggested changes to the lawmakers at FIFA. Now, in addition to the three-minute-break for head injuries, it could become standard international practice that doctors are given time to view slow-motion replays of collisions on tablets. The procedure is also established in the Bundesliga and in the Premier League.

"It's a huge advantage to be able to see what exactly has caused an injury," explains Katrin Hemschemeier, adding, from her own experience, that "it's difficult to see from a distance on the sideline."

Also conceivable, although not yet part of the discussion, would be the idea of temporary substitutions and the deployment of neutral doctors.

Further tests being developed

The main benefits of the new screenings come into play after a game when a concussion, or worse, has been diagnosed. Then, the data gathered during the initial screening allows for a more accurate diagnosis, closely monitored recovery and a carefully timed return to action.

"Professional leagues in the United States such as the NFL, NHL and NBA are the examples to follow," says Hemschemeier. "There, as well as baseline screenings, protocols and a series of tests, have also been developed specially for each sport to determine whether a 'return to play' is possible or not. That's a point we also need to reach."

Additional tests to make diagnoses quicker, more accurate and more sport-specific are still in development. Some will even have performance and training benefits, making them more likely to gain acceptance among coaches and players.