Alvaro Pereira Head Injury: Maybe FIFA Should Look To NFL 'Return-To-Play' Policy

As FIFA faces a backlash over its handling of Álvaro Pereira’s concussion on Thursday, it may want to take a cue from the NFL, another professional sports league that’s dealt with its fair share of criticism on the subject.

Pereira, a midfielder for Uruguay, took a knee to the head in the 61^st minute of his team’s World Cup match against England on Thursday in São Paulo. The blow was forceful enough that Pereira appeared to lose consciousness; he lay limply on the ground while team doctors attempted to rouse him.

Just two minutes later, Pereira reportedly overruled Uruguay’s medical staff and re-entered the match, despite the fact that he looked “punch-drunk” on the sideline. FIFPro, soccer’s international players union, released a statement on Friday, which called on FIFA to re-evaluate its protocols for the assessment and handling of head injuries during in-game action. In the statement, FIFPro said that FIFA “failed to protect” Pereira by allowing him to return to the pitch.

“The World Footballers’ Association is 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 read. “In the absence of that, FIFPro is considering alternative solutions such as independent medical practitioners appointed by FIFPro for all future FIFA competitions.

“Football is awash with incidents in which players suffer potentially concussive blows to the head and stay on the pitch,” FIFPro added. “In Pereira's case, he demanded to play on while overruling advice from Uruguay's team physician for him to be immediately substituted.”

FIFPro wants several alterations to the manner in which FIFA approaches in-game head injures: the introduction of a standardized concussion test (to be compared with data by each player before matches), an independent medical examiner to conduct the tests and the ability for teams to temporarily replace potentially concussed players without that substitution counting against the team’s limit of three subs per game.

The National Football League, an organization which has, inarguably, dealt with more concussion-related issues (and the subsequent legal fallout) than any other professional sports league on the planet, utilizes a similar in-game procedure. The “Return-To-Play” policy, enacted by NFL Commissioner Roger Goodell after intense public pressure, is designed to prevent a player who may be in a compromised medical state from further injury.

In essence, any NFL player who suffers a concussion during play isn't allowed to return to the field on the same day as his injury. Furthermore, that player shouldn't play again until they’ve passed a standardized neurological test and demonstrated medical readings equal to those measured prior to the injury.

“Once removed for the duration of a practice or game, the player should not be considered for return-to-football activities until he is fully asymptomatic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both his team physician(s) and the independent neurological consultant,” the policy reads.

Thus, the NFL’s “Return-To-Play” policy is nearly identical to that requested by FIFPro. Under the NFL’s policy, Pereira -- if he was indeed “punch-drunk” on the sideline -- would, in theory, never have been allowed to return to the match, much less overrule team physicians to do so.

This isn't to say that the NFL’s concussion policy is foolproof; players experienced at least 152 concussions during the 2013 season, a number that is likely much higher, given the inevitability of unreported head injuries. Furthermore, the league paid out a $765 million settlement in 2013 to ex-players who had suffered concussions. Some have even pointed out that in-game protocols don't function as well in real life as they do on paper.

Most importantly, Goodell still hasn’t adequately addressed how the league plans to prevent concussions before they occur in the first place. Still, at the very least, the NFL has actively attempted to improve the manner in which it deals with them.

Head injuries are incidental to any contact sport, particularly one in which players’ feet, knees and heads are launched into crowds of humanity like missiles. Still, until FIFA agrees to take concrete action to address the issue, situations like that experienced by Pereira on Thursday will remain all too common.