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World Cup folly: Uruguay deserves a red card for concussion management

Uruguay Deserves A Red Card For Concussion Management: US Youth Sports Must Do Better

By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

• During the World Cup the Uruguay team allowed a player with an obvious concussion to continue playing in the same game, risking permanent injury to the player
• Youth Sports organizations in the US must take the lead and require proper concussion recognition for their coaches.
• Youth Sports organizations must provide clear and consistent rules for return to play; a qualified physician’s clearance should be mandatory

In a group stage game last week, Uruguay’s Alvaro Pereira sustained a concussion. To debate whether he did or did not have a concussion is ludicrous- it’s a concussion even by 1950s definitions. Take a look here, along with some commentary by Taylor Twellman.


There’s quite a bit of debate about what professional soccer must do to provide an appropriate way for medical personnel to evaluate a concussion (or any other potentially serious injury, for that matter). Rules in professional soccer essentially penalize a team for evaluating a player with an injury. And disturbingly in the Uruguay scenario the player and coaching staff were allowed to overrule the doctor, and the referees allowed the player back on.

Professional soccer has many questions to ask and answer about how they want to address the issue of on-field injury evaluation. And from their atrocious approach there are actually lessons that we can apply to youth sports in the United States. Let’s have a look.

Lessons For U.S. Youth Sports

The first take-away is that there must be a uniform process that strongly favors player safety. No more guessing about who’s in charge. No more inconsistent education for coaches. I’ve spoken to many high ranking decision makers in youth sports over the years and it’s interesting to listen to the pushback we get when discussing our available programs for in-game or in-practice injury recognition and management. Common statements are “we can’t afford this”, “our board won’t support this”, “we can do this ourselves”, “we can’t force our coaches to do any more than we are already making them do”, etc. etc. etc. The reality is that coaches do want the education and they expect that the service organizations to which they are paying fees to provide the education. Our youth sports leagues must take the lead and require the proper education and support to ensure uniform application of player safety rules. Leaving it to the discretion of local leagues or making it optional simply will not work.

The second lesson is specific to concussions. We can’t expect a concussed player to determine whether he/she is fit to play, and we can’t expect a coach without medical training to make a diagnosis of concussion. The coach must be educated enough to suspect a concussion, remove the player from play, and then let a qualified physician make the actual diagnosis.

And the final lesson is about return to play. When a youth sports coach decides to remove a player from play due to suspected injury the rules of the league, the club, and the referee need to stand behind the coach. The reality is that the coach can often be pressured by the player, the parents, or teammates to allow an injured player to play. The safest thing to do- especially in a problematic issue like concussion- is for the league to require written clearance from a physician to determine return to play.

We are making progress with player safety in U.S. youth sports but we can do better. It will be a big step forward when our youth sports organizations take a stand for uniform requirements favoring player safety.

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