If you’ve been following the World Cup at all, you may have noticed that among the blood, sweat and tears were a myriad of player injuries. But behind all the pulled muscles and broken noses lies a much darker side to many of our favorite pastimes: concussions. Perhaps the most jaw-dropping event of the World Cup thus far occurred in the game between Uruguay and England when Uruguay’s midfielder Alvaro Pereira fell unresponsive on the field after taking a knee to the head. It was clear that Pereira was unconscious when his teammates and trainers were trying to slap him awake as he lay on his back. And if all of this weren’t enough, when the team’s physician tried to signal for a substitution to take Pereira off the field, Pereira had come-to enough to become outraged and insisted he be allowed to finish the game. In doing so, he became part of an evolving discussion about the way his sport handles head injuries, in a time when their effects are changing the way other sports are played.

The Centers for Disease Control and Prevention define a concussion as “a type of traumatic brain injury caused by a bump, blow or jolt to the head that can change the way the brain normally works” and can result from a blow to the head or body that causes the brain to move quickly back and forth within the skull. Symptoms of a concussion may begin immediately, and can last for days, weeks or longer. Symptoms include headaches, dizziness, nausea, vomiting, malaise, difficulty with memory and concentration, and sleep disturbances. Although concussions are deemed a “mild” head injury, in rare cases a severe blow to the head can have more serious consequences. Those who suffer a head injury who have a constant, worsening headache, weakness, poor coordination, repeated vomiting or slurred speech are urged to seek immediate medical attention. It is also important to know that once an individual suffers a concussion their risk of a second is greatly increased, especially if the first has not fully healed.

Second impact syndrome (SIS) is a rare condition in which a second concussion occurs before the first one has properly healed and can cause rapid and severe brain swelling that may be fatal. The second blow may occur minutes, days or weeks after the initial concussion, and even the mildest grade of concussion can lead to SIS. Experts advise that those athletes who have suffered a concussion and still complain of symptoms be prevented from returning to a game. Return-to-play guidelines have been established in many sports, and recommend that an athlete not return to play until they are symptom free during rest and exercise. The American Academy of Neurology recommends that younger athletes be prohibited from returning to play for at least a week after an initial concussion. This is why it was especially shocking when Uruguay’s Pereira was allowed to return to play not only in the England game, but then played soon after versus Italy, where he was again struck in the back of the head by another player in a near-collision.

Soccer is not the only sport that has come under harsh scrutiny about how it handles head injuries in players. We’re all familiar with the head injuries in American football, and the changes that teams have had to make on a local, college and national level to protect the players. It’s no secret that some of the sports best players are now suffering from advanced dementia, and even committing suicide after facing severe mental health disorders as a result of numerous head injuries during their days of play. The National Football League is busy trying to figure out how to make the sport safer, while holding tight to the speed, power and violence that makes it so appealing to the fans. These same fears trickle down to the college and youth level, as parents question whether to allow their children to participate in a sport that could potentially cause long term damage.

No matter the sport, concussions and other more serious head injuries that result from sports are a growing concern, and a topic that needs to be taken very seriously by players, coaches, parents, and the public. These sports are often glorified for their sometimes violent plays, but we must remember that the injuries sustained may be more severe than they look. So play smart, and remember that winning the game is not worth the price of permanent damage.

Resources: • http://www.cdc.gov/concussion/index.html • http://www.nytimes.com/2014/06/21/sports/worldcup/uruguayan-player-debate-over-head-injuries.html?_r=0 • http://en.wikipedia.org/wiki/Second-impact_syndrome • http://www.brainandspinalcord.org/traumatic-brain-injury-types/second-impact-syndrome/index.html%20

Photo: Uruguay’s  midfielder Alvaro Pereira fell unresponsive on the field after taking a knee to the head.