FOOTBALL ASSOCIATION OF IRELAND
SUBMISSION TO THE JOINT COMMITTEE ON HEALTH AND CHILDREN
Thursday 2nd October 2014
INTRODUCTION
Concussion is a brain injury and in its simplest form can be described as a disturbance of
brain function.
Concussion may be caused by either a direct blow to the head, face, neck or elsewhere on
the body with an impulsive force transmitted to the head.
Concussion typically results in the rapid onset of short-lived impairment of neurological
function that resolves spontaneously. However, in some cases, the clinical picture may
evolve over a number of minutes to hours.
Concussion results in a graded set of clinical symptoms that may or may not involve a
loss of consciousness.
The majority (80-90%) of concussions resolve in a short (7-10 day) period, although the
recovery time may be longer in children and adolescents.
All contact sports have a finite risk of concussion injury.
The most important aspect of the medical management of concussion, once
diagnosed, is the timing of the return to play decision.
There have been four International Concussion Consensus Conferences held since 2001,
starting in Vienna, and subsequently 2004 in Prague, 2008 and 2012 in Zurich. FIFA, our
world governing body, along with the International Ice Hockey Federation and the
International Olympic Committee were the initial signatories to the conferences and
subsequent consensus statements.
The 4th concussion consensus conference in Zurich (2012) further developed a number of
sideline tools for use by medical professionals: SCAT 3 (sport concussion assessment tool),
Child SCAT 3 (for ages 5-12 years) and the Pocket Concussion Recognition Tool for nonmedical people.
Fig. 1. Pocket Concussion Recognition Tool – Source FAI.ie
CLINCAL PRESENTATION
Concussion is a clinical diagnosis and presents with a collection of symptoms and signs, for
example:
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Headache
Dizziness
Confusion
Memory loss
Slowed reaction times
Loss of consciousness
Insomnia
If an athlete sustains a concussion or is suspected of sustaining a concussion they should
be removed safely from the field of play and they should not be allowed to return to play on
the day of the injury.
The final decision regarding a definitive diagnosis of concussion and/or the time frame for a
return to training/playing is a medical decision based on clinical judgement.
It should be recognised that the appearance of symptoms or cognitive deficit may be
delayed for several hours following a concussive episode. Concussion should be seen as
an evolving injury in the suspected acute presentation.
It is worth noting that conventional neuroimaging (CT/MRI) is typically normal in concussive
injury.
MANAGEMENT
The cornerstone of concussion management is physical and cognitive rest until the acute
symptoms resolve and then a graded programme of exertion prior to medical clearance and
return to play.
The graded return to play should go through the following stages, no activity, light aerobic
exercise, sport-specific exercise, non-contact training drills, full contact practice, and return
to play. Progress through each step is contingent on the athlete being asymptomatic as they
move along the stages.
It is worth restating that NO return to play should be allowed on the day of a
concussive injury.
In the child or adolescent it is recommended that no return to sport or activity should occur
before the child/adolescent has returned to school successfully.
CONCUSSION AND FOOTBALL
Concussion is a relatively uncommon injury in football.
The most recent study available on the subject comes from the Clinical Journal of Sports
Medicine 2013.
 26 Professional European Teams involving 1,401 players
 Run between 2001 and 2010
 Measures Head and Neck Injury Rate per 1000 hours of exposure
 Head and neck injuries – 0.17 head and neck injuries per 1000 hours
 2.2% of all injuries
 In the study a 25 player squad would suffer an average of 1.1 head and neck injury
per season.
 Concussions - 0.06 concussions per 1000 hours
 In the study a 25 player squad would suffer an average of 0.4 concussions per
season.
 Match v Training / 20:1 Ratio
For the FIFA World Cup in 2006, a deliberate elbow was sanctioned with a “straight red”
card resulting in a three match ban. When compared to the 2002 World Cup there were
fewer head and neck injuries (13 v 25) and fewer concussions (1 v 4) in the 2006 World
Cup. Adherence to the rules by players and strict enforcement of the rules by referees may
be an important aspect in the prevention of head injuries and subsequent concussions.
THE FOOTBALL ASSOCIATION OF IRELAND
The FAI considers all aspects of player health and safety to be of the utmost importance.
The FAI first published guidelines on concussion in January 2010. The most recent copy of
summary guidelines approved by the FAI Medical Committee is included at the end of this
submission.
Our International team doctors and chartered physiotherapists, at all levels from U15
Boys/U16 Girls through to the senior teams, attend an annual medical seminar which
includes the management of on-field emergencies, including the assessment, diagnosis and
management of concussion injury/suspected concussion injury. This course has been
running since 2006.
Our League of Ireland team doctors and physiotherapists are now required, under the club
licensing agreement, to attend an annual medical seminar which includes the management
of on-field emergencies including the assessment, diagnosis and management of
concussion injury/suspected concussion injury.
Under League of Ireland club licencing regulations, team doctors and physiotherapists are
required in both the Premier and First Divisions. The presence of an ambulance and crew is
also required at matches.
The FAI has a detailed Child Welfare policy which specifies that the health, safety and
welfare of children is of paramount importance with each club having a designated Child
Welfare Officer. The policy also recommends that first aid should be available for all training
sessions and matches.
Referees at all levels abide by the FIFA Laws of the Game. The referee is empowered to
stop the match, if in his opinion, a player is seriously injured e.g. head injury, concussion,
broken leg and ensures that the player is removed from the field of play.
RECOMMENDATIONS
It is self-evident that prevention is better than cure. As noted previously there is a finite risk
in all sports, including football, of a player sustaining a concussive type injury.
Players have a significant role in the prevention of concussion by adherence to the rules of
the game.
Coaches likewise have a role in the prevention of concussion too. The style of play they
choose for their team may influence the likelihood of a player sustaining a concussive type
injury.
At the core of the prevention, recognition and management of concussion is education and
awareness.
Players, coaches, referees, teachers, parents, administrators, physiotherapists and doctors
can all benefit from information about concussion. All stakeholders, especially players,
coaches and team medics need to be reminded to think with their “heads” and not their
hearts when making decisions on the medical fitness of a player who is suspected of or has
sustained a concussion injury.
CONCLUSION
The Football Association of Ireland regards the health and safety of all players to be of the
utmost importance.
Concussion is not a common injury in football. However, when it occurs it is a very important
injury and requires recognition and appropriate management.
A lot of work has been done over the last number of years on this important player welfare
issue by the FAI.
The cornerstone of any further work in this area should be based on an on-going education
programme of all stakeholders.
Football Association of Ireland: Summary Concussion Guidelines
 Concussion can be defined as a brain injury that arises from trauma to the head,
neck or through an impulsive force to the head from elsewhere in the body.
 Concussion results in a disturbance of brain function and should be treated as a
serious and significant injury with potentially fatal consequences.
 ANY PLAYER WITH A CONCUSSION OR A SUSPECTED CONCUSSION
SHOULD BE REMOVED FROM THE FIELD OF PLAY IMMEDIATELY AND
SAFELY AND SHOULD NOT RETURN TO PLAY, TRAINING OR OTHER
PHYSICAL ACTIVITY ON THE SAME DAY
 A player does not need to lose consciousness to be concussed
 The onset of symptoms can occur over minutes but can be delayed for hours
 The common symptoms of concussion include headache, dizziness, memory loss,
disturbance of balance
 All coaches, parents, referees should familiarise themselves with the pocket
concussion recognition tool to assist in identifying concussion.
 All doctors, physiotherapists and paramedics should familiarise themselves with the
pocket concussion recognition tool and with SCAT 3 and Child- Scat 3 to assist in
identifying concussions
 Most concussions (80-90%) resolve over a 7-10 day period but may persist for
considerably longer
 It is very important to note that the symptoms of concussion in children and
adolescents can be prolonged and can in certain circumstances last for weeks or
months.
 Concussed players should not be left alone
 Concussed players should not drive, should not take alcohol and should be escorted
home
 Players who suffer a concussion should consult with their medical practitioner
before returning to play.
 The successful management of concussion is best achieved through physical and
mental rest.
 Medical clearance is necessary in all players who suffer a concussion before they
can return to play.
 There should be a graded return to training activity.
 Children and adolescents should not return to any activity until they have made a
successful return to school/college.
 Return to play guidelines follows a stepwise approach outlined below.
Stages:
1. No activity – symptom limited physical and cognitive rest. Recovery is the objective.
2. Light aerobic activity – walking, swimming, stationary bike. Increase in heart rate is
the objective.
3. Sport specific exercise – running drills. The objective is to add movements.
4. Non-contact drills – passing drills. The objective is to exercise, add coordination and
cognitive load.
5. Full contact practice – This should be medically cleared. The objective is to restore
confidence and assess functional skills by coaching staff.
6. Return to play.
Dr Alan Byrne
Medical Director
The Football Association of Ireland
ENDS
The presentation will be made to members of the committee by Dr Alan Byrne, Consultant
in Sports and Exercise Medicine, MB BAO BCh MRCPI MSc (Sports Medicine) FFSEM.
Alan Byrne graduated from the Royal College of Surgeons in 1985. He commenced in
General Practice in South Dublin in 1990. He has worked in Sports Medicine since 1993.
Dr Byrne completed a Masters in Sports and Exercise Medicine at UCD in 2000. He was the
team physician at Shelbourne F.C. from 1993-1999. He has been the team doctor and
consulting sports physician at Shamrock Rovers F.C. since 2000.
Dr Byrne has worked with several teams at the Football Association of Ireland since 1999.
He has been the Republic of Ireland Senior International Team Physician since 2003. He
worked for a brief period as the team physician in the English Premiership with Fulham F.C
in 2011.
Dr Byrne was the first appointed Medical Director of the Football Association of Ireland. He
has held that position since 2006. During that time he established several programmes,
including the International and League of Ireland player cardiac screening initiatives and
several medical coach education programmes.
Dr Byrne is a founding Fellow of the Faculty of Sports and Exercise Medicine. He was
elected to the Board of the Faculty of Sports and Exercise Medicine in 2011. He is on the
Specialist Register of Sports and Exercise medicine.