The image froze the blood of his teammates, as well as his opponents and the (TV) spectators. Unconscious for several minutes on the Reims pitch last Saturday, after being violently hit by the Champenois Amadou Koné and before being hospitalized, Lille’s Angel Gomes is doing much better today.
But this (fortunately) rare event on the pitches of L1, six months after the serious head trauma of the Bordeaux player Alberth Elis in L2, has revived the problem of concussions. In recent years, the subject has been much more pressing in rugby, which can be explained quite simply by the frequency of incidents.
“For Ligue 1 and Ligue 2 clubs, or roughly 800 European Cup, championship and French Cup matches, we had a total of 14 concussions reported,” explains Emmanuel Orhant, medical director of the FFF, citing figures from the past season. “In football, a concussion occurs every 55 matches, in rugby, one every two matches.”
During a L1 match, in the event of a head collision, the doctor, usually the doctor from the injured player’s team, has three minutes to intervene with him, examine his condition and ask him a few basic questions, such as the date and the score. If the test is negative, the player is taken off, as an additional replacement, in addition to the five changes allowed by the regulations.
Two independent experts to avoid pressure
Then start a six-step protocol defined by the FFFaccompanied by two examinations by a “concussion expert” approved by the Federation (there are 18 throughout France), within 72 hours after the shock and then before the competition resumes. “This is to avoid the club doctor, who may find himself under pressure from the player or the coach, being the only one to make the decision,” continues Dr. Orhant. On average, over the last two seasons, the player resumed on the fourteenth day after the concussion.”
There are sometimes holes in the racket, like when Samuel Umtiti, during a Lille – Reims in September 2023, seemed to successfully pass the test, before feeling unwell at half-time and need to be replaced.
“What has been put in place works well in France, judges David Terrier, vice-president of the UNFP, the professional players’ union. But what would be good, and we have campaigned for this at the FIFPRO level [l’association internationale des footballeurs pro]it would be to be able to make temporary replacements, on the rugby model [12 minutes hors du terrain]. The doctor could take the time to check the player’s condition, without pressure from other players or the coach.”
However, the IFAB, the body that guarantees the laws of the game at a global level, does not want to hear about this reform. Nor does Emmanuel Orhant, for that matter.
” “It’s not the same vision at all. In rugby it’s: “there is a suspicion of concussion, I test the player before possibly bringing him back on the field.” In our country, the doctor has three minutes. If he is sure that the player has nothing, he continues. Otherwise, from the moment there is a doubt, he goes out. It’s black or white.” »
Another reason for disagreement between the head of the UNFP and Dr. Orhant: the awareness of French players. “I’m coming back from Manchester and for the PFA [le syndicat des footballeurs britanniques]”It’s a big issue,” says David Terrier. “Players are asking for more protection against concussions.”
Varane, the electroshock
The former defender of Metz, Nice and Ajaccio does not see the same phenomenon on this side of the Channel. “Having held meetings with players, they ask questions,” replies Dr. Orhant. “All national teams have an annual meeting to explain what a concussion is. In the Poles (hopefuls), it is also the case. In the clubs, the doctors also pass on information.”
Raphaël Varane also provided information in April, in a highly influential interview published in The Team. The 2018 world champion admitted to having played despite symptoms of concussion during two of the important matches: France-Germany (0-1, quarter-final of the 2014 World Cup) and Manchester City – Real Madrid (2-1, round of 16 second leg of the Champions League in August 2020). The French defender, out of the game, had also been guilty of both Cityzens goals.
“This interview served as a wake-up call,” says Philippe Malafosse, the Hérault doctor who took care of Varane after his concussions. “But we’re going to have to give booster shots. We mustn’t let the soufflé die down.” Previously, in France, only Florent Duparchy had played the role of whistleblower, despite himself, last September. The young goalkeeper, now retired at just 23, had filed a complaint against an unknown person “for endangering the lives of others” by considering that the Reims club had not properly treated his concussions.
But because of his aura, Varane’s voice obviously carried more. “As footballers used to playing at the highest level, we are used to pain, we are a bit like soldiers, tough against pain, symbols of physical strength, but these are symptoms that are quite invisible,” observed the now Como (Serie A) player in The Team.
A helmet for concussion management
Dr. Malafosse, who is more specialized in rugby on the MHR side, conducted a study for one year until June 2023 at the Georges-Pompidou hospital in Paris on a series of 50 concussions (mainly rugby players, but also a few footballers). He relies in particular on a virtual reality headset to treat patients.
“That’s how we got Varane back on his feet,” says the practitioner. “It’s a piece of equipment that analyses eye movements during certain exercises. Our eyes move constantly, at an even higher speed in a top athlete, who will analyse a situation very quickly, position themselves, anticipate. In the event of a concussion, this analysis can take twice as long. He can then be badly positioned, like Varane against Manchester City.”
“A player who has had a concussion, even if he has followed the return to play protocol, should carry out this type of test to find out if he has recovered his visio-cognitive abilities,” continues the doctor, whose initiative does not necessarily convince Dr Orhant, who is equally doubtful when he hears talk of a limitation in heading, particularly among young footballers.
England upholds U11 heading ban
Raphaël Varane is campaigning for this measure, applied in England after a test period this season for the under-9s, before being extended to the under-10s and then to the under-11s over the next two years.
“No scientific study to date says that there is a link between heading and neurodegenerative diseases,” the federal doctor says. “It’s a shortcut made with four studies, two Scottish, one Swedish and one French that I led, which show that when you are a professional football player, you are five times more likely to have a neurodegenerative disease than the average person. But who tells you that it’s because of heading?”
Dr Orhan is involved in new work on the subject, led in Strasbourg by Professor Stéphane Kremer, with MRI and memory tests. They involve 31 former professional players (including David Terrier), who had not suffered any concussion but had played a lot with their heads, and about the same number of high-level athletes not exposed to cranial impacts. The first results of this study are expected in the coming months.
In the UK, the issue of concussion has already moved from the lab to the courtroom. For more than two years, 17 former British footballers or their families have been waging a legal battle against their sport’s authorities. The authorities are accused of failing to adequately protect the former players, including 1966 world champion Nobby Stiles, who suffered from dementia and died in 2020.