Taylor Twellman is Right and Wrong on Concussions (LONG READ)

Trust me, I get where Taylor Twellman is coming from, I totally do… Hell, I have the CT-scans to prove it, but…

First a little history about me… according to the emergency room staff of the Washington Hospital Center, I almost died from a two concussions sustained in a 24 hour period during college.  One night I was hanging out in some friends’ dorm suite lounging against the wall, using one of their pillows, talking.  One of my friend’s wanted her pillow back so she pulled it straight up behind me…  The electrical outlets were not flush with the wall.  When the pillow was removed quickly without me being prepared the base of my skull slammed into the jetted outlet box.  My eyes dilated and I never lost consciousness so it was not really thought of as a big deal.

The next evening, I was back in their room where a bunch of us were watching a movie.  The girl who pulled the pillow was laying on her bed, I was laying on the floor on a red folding chair beds things next to her bed.  She dropped to remote between the wall and her bed which was a traditional steel-framed dorm provided one on rollers.   She pushed her bed away from the wall to retrieve the remote, the side of my head was exactly level with the steel frame.

From what I have been told, the metal frame slammed into the side of my head with force.  I do not remember it or the concussion tests or claiming that I did not want to go to the hospital but, “take me to McDonald. I just want McDonalds.”  I have no memory of it but have reconstructed parts of it from those that were there that night.  Apparently my eyes did not dilate, no idea if I answered the standard concussion questions correctly or if they were even asked.  Cannot tell you how I got to the hospital or got checked in at the ER.

The only thing I vaguely remember is walking up to what I still think is a pedestaled circular nurses’ station in the middle of the ER.  Now, I should note that I have been in that ER a lot and that nurses’ station has never existed there but it is what my mind continues to believe happened. I basically lost all track of time that night.  I have no concept to this day about how long it took to get to the ER, how long I was in the ER or how long I was there when I walked up to the nurses’ station.  I do not even have the slightest idea if anyone was there with me or not.

My memories are very hazy of the conversation with the nurse but I remember asking if she had something I could use to vomit in because I was horribly nauseated (I do not remember feeling anything even nauseated).  I remember saying that I understood it would be a while before I was seen so a bucket would be fine. It was public hospital in DC and they regularly treated gunshot wounds, knifings, and other level 1 trauma so waiting was expected.  Not sure that I was really cognitively able to understand that though and then the nurse asking why I was there..

No idea what I said but my next memory is very fleeting of me flying down the hallway on a gurney.  No idea how I got on the gurney or how long it was from talking to the nurse to being on the gurney.   I do not remember the gurney stopping or route it took or where we ended up.  Next I remember laying on a table (could have been the gurney, no idea) and something about CT-Scans.  I know in retrospect that I had CT-Scans of my head.  Yet, with a barrel of a shotgun to me chest, I would never be able to say definitively I underwent one.

Later I found out the CT-Scan showed two concussions in the two parts of my brain that I hit in those 24 or so hours.  I also found out that being nauseated with a concussion is VERY bad and is often a prelude to imminent death.  Good times… and that is why this is such a huge and under-respected injury.

It seems that I was there for hours and had several concussion exams… few tests have I ever failed miserably as the Glasgow Coma that night.  For the record, I also have no memory of the laying on the gurney, if I did,  for the next several hours or a drop of treatment I received that night.  I do not remember being cleared to go home or going back to my dorm.   I do not know if people watched me overnight (they did).  In short, I remember literally almost nothing about the experience and those memories I do have my not be accurate at all.

Hours of my life which were very dramatic are a complete blank to me.  It is a very odd sensation.  For a period of time after, I had headaches and other symptoms.  I understand what concussions can do to a person.. they can kill or at least really mess with your health and sense of reality.

My point in telling this is so you understand that I respect the work Taylor is doing to bring traumatic brain injury prevention in soccer to the forefront. It is very important work and he understands the costs concussions can have on a life more than most.   I simply disagree about his desired proposals.

That is simply an absurdly wrong approach.  It is a elitist, Bugatti Veyron yet simplistic and highly insufficient solution to a problem that is much more universally Ford Focus in breadth.

It is not that I think head injuries are not serious; of course, I do.  It is that I think this suggestion is absurd in practice.

I get why on the surface he thinks it would be a perfect solution.   He lives/played in a world of elite soccer but this problem spreads across all levels of the soccer pitch.  For example, under this plan where FIFA changes the law and there now must be an independent doctor on the sideline at every match, a few questions initially popped into my head:

    • Who picks the doctor?
    • Using what criteria?
    • Who pays for that doctor’s time?
    • Does the doctor have to be specialists in Traumatic Brain Injury (TBI)?  Board Certified?
    • What happens if independent doctor’s opinion differs from the team doctor’s opinion?
    • What happens if the doctor is late or called-up on an emergency, does the match just stop?
    • Would they have to be certified as TBI experts by FIFA? Controlling Confederation? The National Association?

These are a few of the basic questions for a proposed solution only covering the elite profession level at best potentially.  This approach is myopic at best.

Yes, I understand that part of this is him trying in vain to save his own career but in spearheading this issue, he needs to be a better leader for ALL those suffering.  That means thinking beyond what would have just saved his career.  He has to think and advocate for what will save other’s careers and lives.

I understand that I am basing this entire debate on a single tweet from Taylor (and hearing many of his televised comments on it).  I assumed there would be a more detailed explanation and/or much more formulated proposals on the website of his highly touted charity Think Taylor.

After searching the website top-to-bottom, I found very little information increasing concussion awareness,  what to do in the event a player sustains what may be a concussion, nothing on his proposals for change including any mention of an independent physician on the sidelines every game, but a lot of opportunities to donate though no information on how the collected funds are spent.   The same is true for its social media pages.  This tweet (and his others) and his televised discussions are all he’s provided.

The reality is concussions are a massive problem at all levels of soccer, especially at least in the US, for girls and women.  The Washington Post had an article last April, entitled, “Reducing the number of concussions in high school girls’ soccer is a daunting task  The lead girl profiled suffered 5 CONFIRMED concussion by the time she graduated high school.  YES FIVE.

This is where the main problem I have with Taylor’s approach is two-fold:

A) Schools, school districts, school conferences, AYSO, et al will never be able to get, let alone pay for an independent physicians trained in diagnosing TBI on the fly to be at every match conducted.  It is simply logically and logistically impossible. You have made it impossible for any group/school/team of players to play any organized matches.  Could it happen at a professional/elite level? maybe.. but even then finding physicians available and willing to work matches is a logistical nightmare.

B)  Secondly it removes responsibility from the coaches and the team’s leadership to take appropriate care of their players.  While watching the Final yesterday,  Chairman and Investor-Operator of the Columbus Crew Anthony Precourt tweeted this at the Kramer concussion incident.

I replied to his tweet with this simple question

Berhalter is of course his head coach, Greg Berhalter and I am still waiting for an answer.  If he, as the team’s owner/chairman of a professional team, does not demand automatic substitution for potential concussion standard of care then he has no place entering the discussion.  If he feels that it was wrong for Low and Kramer, how can it be correct for his own players?   I am very curious as what his position is on the topic when it is his own team’s championship on the line.

During the World Cup, FIFA came under tremendously harsh criticism for multiple players continuing to play in matches after being knocked out.  I honestly think that outrage is horribly misdirected.  Yes, absolutely, FIFA has a major role to solving the issue.  I disagree though that change must come down via edict from them.

The option to have an independent physician is clearly not sustainable from an organizational and financial standpoint for the vast majority of matches played.  This is a problem universe to soccer (and most other sports) at ALL ages, not just the super elite level.   More than that, it is highly insufficient to provide protections to players.

If this plan, or the similar plan requiring mandatory substitutions of players in match, becomes law how quickly does opposing players stop kicking shins or trying to stomp legs to get an advantage and start bashing heads?  This mandatory order simply puts a Vegas worthy neon bullseye on players’ heads.  If you want the opposing team’s best player out of the game, bash his head… It is a much more dangerous way then simply sweeping the leg a la The Karate Kid.  This is one of the unintentional negative consequence of these good-hearted proposals.

Secondarily, removing a team’s leadership and medical professionals in the decision-making, never solves the problem.  The revolution needs to happen in within the club structure first and foremost.   This is is the systemic change needed.

Having an independent physician 0n the sidelines for matches would only offer a player 90 minutes of protection maximum, which is a very small portion of the time players are at risk for head injuries.  Every practice offers many, many chances for a player to sustain a concussion.  What is is it roughly 6 to 1 per week on average, practices to matches? Who protects the players at all those?

If you do not first educate and change each team’s internal mindset, then players will continue to be in danger.  This is also where the FIFA, the Confederations, National Associates, state associations, and those issuing coaching licenses must lead.  Concussion reduction and proper aftercare must be a fully integrated part of the coaching curriculum. It is where they are ALL failing.

According to the US Soccer Federation, a class, “E,” coaching license is the most basic a coach can get.  It is the license class that teaches the youngest/most inexperienced players.   In USSF License E Guidebook, concussions are only covered in a single pre-course assignment (as far as I can tell), not covered at all in a three day course or listed in their “TEAM MANAGEMENT “TOP 10” SAFETY GUIDELINES.   Here is the full course curriculum which is HIGHLY detailed but lacks any focus on player safety an this is where for that course you have to find reference to concussion, not mention if you actually must complete it and there is no formal grading of it.  It does not seem to gain much more coverage the higher up the coaching ladder you move…

This is the crux of the problem…  if coaches are not trained concussion awareness is important, they will not treat it as important.  Changing the way we educate coaches is the ONLY way, change comes.

The proposals, like Taylor’s and others, that attempt to remove team selection from the coach will backfire.  It will but, what it will not do is protect players.   They won’t be protected in training or playing matches after sustaining concussion in training.  If there is an announced automatic policy in place to force players out of matches with TBI, those players heads become primary targets.  I am not saying they should play with head injuries, of course.. simply that giving extra incentive to intentionally cause TBI’S to remove a player is not the answer either.

Educating coaches concussion awareness and proper handling means teaching coaches that concussions and TBI are the same as any other match ending injury.    Placing them on par with other physical injuries elevates them to “reality” in coaches’ eyes.  At present, they are not a big deal now..  think about this…

It must be on the team’s board, owners, directors, presidents, or whatever group/person oversees the coach to demand that team’s medical professionals make those decisions and get coaches are in full agreement.  It is Precourt’s  responsibility, first and foremost, to institute those requirements and procedures in within the structure of the team.  It cannot be imposed from outside. 

Joachim Low didn’t hesitate to sub Sami Khadira for a hamstring injury because to Low that was a, “real,” injury that negatively impacts his team’s performance.  Christoph Kramer’s concussion was not viewed as probably negatively impacting Germany’s chances until it was possibly too late for Kramer.   Low and the like need to be reeducated.

What is worse is all the kids and their coaches watching Kramer, Pereira, Mascherano and the rest of the players who play through concussions, not think it is cool.. or manly… or required.  Low at the opportunity to  do much more than simply win a World Cup, but the chance to save many lives and careers.  He did it only when forced to do it.  That is not good enough… that is where change must occur.

Let’s hope Low didn’t end Kramer’s career …  Kramer is on record as not remembering  much of the World Cup Final.. dude, been there; I feel ya..