The World Cup Final and More


Maracana Stadium, site of the 2014 final….and site of more medical controversy?

At last. we have reached the final game of the 2014 FIFA World Cup.  Who will be crowned the victor, Argentina or Germany?  We will soon find out.

There has been plenty to write about and talk about in this tournament, which began back on June 12 at Arena Corinthians in Sao Paulo.  On the sport medicine front, we have seen issues ranging from Neymar’s fractured vertebra to the concussion seen ’round the world:  Uruguay’s Alvaro Pereira and his return to the pitch immediately after his injury were the focus of our post a few weeks back.

I haven’t yet had the chance to discuss with you all the incident which occurred in the semi-final between Argentina and the Netherlands, involving Javier Mascherano.  Since he’ll be playing for Argentina in today’s final, I thought it high time to discuss his injury and the further implications such events have for sports medicine clinicians covering sports around the world.

Like many of you I was watching the semi-final live.  [Full disclosure:  I was rooting for Argentina (I still am….hoping for a triumph of faith over reason in today’s final!)].  For those who were watching you will remember, that Mascherano went down toward the end of the game after colliding with an opponent’s head while the two were attempting to head the ball.  The medical staff worked on him for several minutes.  While this was going on, my son correctly worried that should he not be able to return to the pitch, Argentina would have to play a man down, as they had already used their limit of three substitutions for the match.

Like a lot of sports medicine folks watching, I was surprised to see Mascherano make it back to the pitch; it seemed clear that he had possibly suffered a concussion, and should probably have been removed.  The field-side decision-making was roundly criticized subsequently.  The player himself went on to perform a possibly game-saving tackle on Arjen Robbens after returning to the field.

The complexity of decision-making in these settings is immense.  I re-posted a blog post from our Executive Editor Chris Hughes in the wake of the Perreira incident exploring precisely this issue of same-day return-to-play clearance.  The most immediate consequence of proceeding with what was arguably the correct medical call would have been to consign Argentina to playing a man down the rest of the match.  It’s not difficult to start imagining parallel renderings of what ‘might have been’ for the Netherlands had Argentina finished the match a man down……without Mascherano on the field, who is there to block Robbens’ shot?

All of us clinicians who manage sideline medical care face such decisions.  Regarding concussions, the information is readily available, albeit still up for debate!  You can go to our pages to access the 2012 Zurich Consensus Statement on Concussion in Sport, which argues against same-day return to play and argues for “Sufficient time for assessment and (that) adequate facilities should be provided for the appropriate medical assessment both on and off the field for all injured athletes” (my itals).  You can go to our freely available ‘Concussion Collection,’ which contains some of the research published in our pages on this rapidly evolving field.  You can even listen to our Podcast, with Canadian authors Drs. Oliver Leslie and Neil Craton, who provide a powerful critique of the Zurich statement. Read more of this post

Ramadan and the World Cup

The Islamic holy month of Ramadan begins today and will affect athletes and sporting fans around the globe until the fast is broken with the feast of Eid al-Fitr on July 28.

The World Cup may be like a religion, and is currently affecting the lives of many…..but throughout the next month Ramadan will have possibly the bigger impact on over a billion people on the planet.


Hassan Yabda, one of the players on the Algerian national team.

How, for instance, will the fast affect Algerian athletes who play their World Cup knock out match against Germany in two days?  How will it affect, for that matter, the millions of the faithful, Algerian fans who will be watching?

We revisit a blog post from last year, and an excellent study published in our pages on this very issue:  Does Ramadan Affect the Risk of Injury in Professional Football?

How topical:  The World Cup, the very pinnacle of professional soccer–it’s happening!  Ramadan–it has begun!

Good luck to the teams playing in the knock-out stages of the World Cup, and Ramadan Mubarak!

Clinical Journal of Sport Medicine Blog

Crescent_Moon_(2558144570) The Crescent Moon rising at sunset, marking the start of the month of Ramadan

The month of Ramadan begins tomorrow, July 9, and lasts until August 7.  As many of this blog’s readers will know, observant Muslims will fast from dawn until sunset:  no food, no liquids… sports drinks or power bars.  The questions of ‘carb loading’ or ‘gluten free’, (‘should i drink some chocolate milk after my workout?‘) can all be put on the table until the evening.  The diet is one of pure abstinence, morning until night.

Muslim athletes are not unique in observing a fast: Catholic Christians will consume much less than usual if observing the prescribed tenets of Lent on Ash Wednesday and Good Friday, and Jewish athletes will go a full 25 hours consuming nothing on Yom Kippur:  friends have told me they will be loath to brush their teeth or even shower, lest…

View original post 936 more words

What’s a World Cup without controversy?

Uruguay 4 - Chile 0

Uruguay’s Alvaro Pereira

Followers of this blog will know I have just returned from Quebec City, where I spent a fabulous four days catching up with professional colleagues from around the world at the 2014 FIMS sports medicine conference.  The event was hosted by the Canadian Academy of Sports and Exercise Medicine (CASEM), who conjointly held their annual meeting with FIMS.

Followers of the vastly bigger event known as the World Cup will know during this same period, there was the medical (mis)decision seen around the world involving Uruguay’s Alvaro Pereira:  knocked unconscious, and subsequently allowed to return to the pitch.

In truth, I got to see the event live, along with hundreds of millions of other people on the planet.  On a break in between conference sessions, I was in my hotel room. I had the television on while working on the laptop, when I noticed the downed Pereira.  My initial glimpse of his limp body was first out of context, which is to say I didn’t see the hit live, and I had yet to see the replay; my initial reaction was to fear the worst, as Pereira’s entirely limp body had me concerned he had suffered a cardiac event.

Quickly, though, I got to see the replay–the knee to the head–and it all made sense to me.

What followed, in some ways, made no sense.

Like the others in the viewing universe, I saw Pereira attended to by his medical staff.   As he got to the sideline he started to vigorously protest the intended substitution; and, of course as you all know, Pereira eventually made his way back to the pitch……

And at that moment I saw the twitter universe explode.

At the very least, the 2012 Zurich Consensus Statement on Concussion in Sport was being honored in the breach rather than the observance.

Just a smattering of the tweets: Read more of this post

The Safety of Artificial Turf vs. Grass as a Sport Playing Surface

Mo soccer

Safety aside, soccer and a muddy, grass field: a boy’s idea of heaven!

The World Cup has arrived, at last, and brought with it already the first controversy of the tournament: did Fred flop?
But in the world of football/soccer, there is another, older controversy: turf vs. grass. We revisit this issue by looking at a previous blog post (it is very difficult to write while watching Mexico vs. Cameroon!).
Turf vs. grass: which is safer? Take a read, and let us know what you think.

Clinical Journal of Sport Medicine Blog

I was interviewed last week for a newspaper article which looked at the debate over a local school’s intention to transform a grass playing surface to artifical turf.

Among the controversies in sports medicine, the turf vs. grass wars are not the loudest nor the meanest, but they have been among the most persistent ever since 1966, when the Houston Astros first introduced a synthetic turf playing surface in the Astrodome, and dubbed it Astroturf.

Picture_of_Reliant_Astrodome Reliant Astrodome

The history of the Astrodome makes for interesting reading:  of note, the original intention was for the surface to be natural grass, and the makers of the dome had installed traslucent skylights to allow for grass to grow on the indoor surface.  Alas, not enough light made it to the playing surface, the grass died, and Astroturf was born.

The progress of science and technology have seen Astroturf give way to…

View original post 1,378 more words

%d bloggers like this: