Sports are brutal. Just a few weeks ago, we all watched boxer Francisco Leal get knocked out, never to regain consciousness. People who watch football, hockey or lacrosse see broken bones, ripped ligaments, spinal injuries, and concussions on an almost weekly basis. These are viewed as gladiator sports, in which athletes attempt to destroy each other. Things like head injuries can't really be prevented; to combat them, these sports have mandated its athletes to dress the part, in pads and helmets, and the professional leagues have established protocols for what do once there is risk of a player suffering a concussion.

Perhaps because it's not seen as an American or a gladiator sport, soccer is often viewed as "soft." But it's a physical, often violent game, that can maim and even kill. Two years ago, Major League Soccer neurologist Dr. Ruben J. Echemendia discovered that men's soccer players are the fifth-most likely athletes in all of sports to sustain in-game concussions. Players are knocked out cold, concussed, or left on the ground with their skull in pieces. Some professional leagues, like England's Premier League, are more physical than others, and often, these devastating, life-changing injuries are the product of collisions. It's frighteningly common, as you can see in the below video of three Premier League players getting blown up within a week of each other.


The first incident took place on November 3, when Tottenham Hotspur traveled to Everton. Everton striker Romelu Lukaku was put through on goal with a long ball, and the only thing preventing a score was an onrushing goalkeeper, Hugo Lloris. They reached the ball almost simultaneously, and Lukaku's knee collided with Lloris' head with such force that Lukaku couldn't immediately stand, and needed medical attention. Lloris was temporarily knocked out, and later said he couldn't remember the incident. He stayed in the game.

The second and third highlights took place a week later, during the first half of the Manchester United-Arsenal match, just several minutes apart. United whipped in a corner kick, and United defender Phil Jones jumped with keeper Wojciech Szczesny for the aerial ball. They clashed heads. Szczesny crumpled to the ground, limp, and didn't even respond when a teammate gently slapped his face to wake him up. Paramedics arrived with a stretcher to remove him from the biggest match of the season to date. He shook them off, and stayed in.

Minutes later, Arsenal crossed a dangerous the ball into United's own box. Captain Nemanja Vidić backtracked, marking a Gunner, as keeper David de Gea rushed out to punch. de Gea jumped, and his thigh smashed into Vidić's face, who was immediately knocked out cold, and appeared to be asleep before he even reached the ground. Vidić, who only rose minutes later, mouth bloody, was removed from the game.


There are more examples. Just this year, we've seen Spurs' Andros Townsend, Arsenal's Mathieu Flamini, and Lukaku himself all on the receiving end of atrocious head collisions. Most famously, Chelsea keeper Petr Čech was nearly killed in a 2006 match. After challenging a long ball, much like Lloris, off the kickoff in a match against Reading, an opposing player's shin struck his head, fracturing his skull. He had to be stretchered off.

What's interesting about the video is that no one—not the commentators, not the referee, not the players—seems to have understood the gravity of the situation. They're stalling to see if he can play again. But Čech had a depressed fracture—a dent from blunt force—in his skull. Though he'd return months later, Čech would never be the same again. He still has to wear a helmet to protect part of his skull softened from the blow.

His replacement, Carlo Cudicini, was also knocked unconscious in the same match.

Surprisingly, Major League Soccer, which is flawed on so many levels, gets it. Maybe it's because of the sport's geographic proximity to the National Football League, which has been under fire for years concerning the effects of concussions. Maybe it's because the league has seen the careers of some of its own stars, like, Alecko Eskandarian and Taylor Twellman cut short from repeated head trauma. But in 2011, MLS decided to do something about it:

In the MLS, a player suspected of having a concussion in a game or practice must be removed immediately and evaluated. Team physicians are the ultimate authority.

Players are evaluated and treated using three testing protocols. Players must pass cognitive tests and be symptom-free before returning to the field, which could take days or months. The team doctor and team neuropsychologist must OK the return to competition.

"Once they're symptom-free both physically and cognitively, in other words they're saying that the feel fine, then our protocol is to evaluate them using neuropsychological testing to make sure that cognitively they are fine," Echemendia said. "Because very often the physical symptoms will resolve prior to the cognitive symptoms, and we really don't know that until we test them."

Players then start low-level aerobic activity and gradually build up their exertion to the level of competition.

What MLS did was take the decision out of the hands of the players. If one is even suspected of having a concussion, they're taken off, evaluated, and have to go through a multi-step process to see the pitch again. They have to meet with doctors and neuropsychologists. This is important because all of this takes time. Players are given the opportunity to heal from brain trauma, whether they want to or not.

Now compare that to this year's Premier League concussion protocol:

Any Player, whether engaged in a League Match, any other match or in training, who having sustained a head injury leaves the field of play, shall not be allowed to resume playing or training (as the case may be) until he has been examined by a medical practitioner and declared fit to do so.

The Premier League is saying that if a player is forced off the pitch, then they can't play again until a medical practitioner says they can. The term "medical practitioner" is murky, and says nothing about standard tests. But even more important, what does it take to force a player out of a game? In the above videos, three men appear to be knocked out cold. Two waved off team doctors, so they were never taken off the field, and continued to play. What's scary is that Lloris failed his concussion test a week later, and was scrapped late from the Spurs match against Newcastle. He still had symptoms.

But this is expected. After all, few athletes want to be removed from game due to injury, and most will play through if physically capable. Players will risk their health trying to be heroic. Hell, it is heroic. It's United, after all. It's Arsenal. It's Everton. And that's why it's imperative to take the decision out of their hands.

You'd think that the world's most popular league, which measures club values in the billions, would understand that its players are assets. It's vital that they protect those athletes, because that's who we're paying to see. Guys are getting knocked unconscious, and allowed to play on seconds or minutes later. Maybe this one, single time, it would help for the Premier League to take a lesson from its American counterpart.