Spurs claim Lloris WAS fit to continue after Everton KO, despite FIFA's top doc insisting AVB should have subbed the keeper (who had a '99% chance' of concussion)

By Jack Gaughan, Laurie Whitwell, Dominic King and Martyn Ziegler, Press Association

PUBLISHED: 12:16 EST, 3 November 2013 | UPDATED: 09:43 EST, 4 November 2013

 

Tottenham Hotspur have announced that Hugo Lloris showed no signs of concussion during and after Sunday's game against Everton, even though FIFA's chief medical officer said there was a '99 per cent probability' of the brain injury.

Andre Villas-Boas revealed after the game that he went against medical guidelines to keep the goalkeeper on the pitch after the collision with Romelu Lukaku's knee, however Spurs confirmed on their website that Lloris was given the all-clear by all parties to continue. Head of Medical Services Wayne Diesel said: 'Once the relevant tests and assessments were carried out we were totally satisfied that he was fit to continue playing.'

The French international underwent a CT scan on Sunday evening and was allowed to travel back to London, but Professor Jiri Dvorak said FIFA's guidelines state that if there is any doubt about concussion then the player should be removed from the field of play.

 VIDEO  Scroll down to see Villas-Boas defend his decision to keep Lloris on the pitch

All smiles: Andre Villas-Boas says he went against medical advice to keep Hugo Lloris on the pitch after concussion

All smiles: Andre Villas-Boas chose to keep Hugo Lloris on the pitch after the keeper was struck in the head following a collision with Romelu Lukaku

Out cold: Hugo Lloris was accidentally clobbered in the head by Romelu Lukaku's knee

Out cold: FIFA's chief medical officer said there was a '99 per cent probability' that Lloris was concussed

Urgent: Lukaku immediately asked the medics on the touchline for help

Urgent: Lukaku immediately asked the medics on the touchline for help

Advice: Andre Villas-Boas revealed after the 0-0 draw that medics had advised that Lloris should be taken off

Down but not out: But Wayne Diesel and his medical team decided that Lloris was fine to continue

CONCUSSION CAMPAIGN

The Mail on Sunday recently launched a concussion campaign with a five-point guide for the rugby authorities to take note of.  

Click here to read an emotive interview with former England captain Lewis Moody, who says he used to treat concussion as a joke.

Dvorak insisted the solution should have been obvious given the fact that even the opposing player got injured from the contact.

He said: 'The player should have been substituted. The fact the other player needed ice on his knee means it's obvious the blow was extensive.

'It's a 99 per cent probability that losing consciousness in such an event will result in concussion.

Villas-Boas said he got the nod from Lloris stating he wanted to continue.

'Hugo still doesn't remember the impact but he was quite focused and quite determined to continue,' he told Sky Sports.

But Dvorak added that the player's view should not be taken into account in such situations.

He said: 'When he has been knocked unconscious, the player himself may not see the reality.

'I do not know the details but I know that the Premier League doctors are extremely good and I can imagine that the doctor may have recommended he be replaced.

'We have a slogan: if there is any doubt, keep the player out.'

Difficulties: Villas-Boas admitted that Lloris couldn't remember how he was hit on the head Difficulties: Villas-Boas admitted that Lloris couldn't remember how he was hit on the head

Hugo Lloris

Lloris had lay motionless for a number of seconds and Villas-Boas said, after the game: 'The medical department was giving me signs that the player couldn't carry on because he couldn't remember where he was.

'When you see this kind of assertiveness from the player it means that he is able to carry on.

'It was my call to delay the substitution, you have to make a decision in situations like this.

'From my knowledge of football he seemed OK to continue.'

Premier League doctors will discuss the rules governing head injuries to players at their next general meeting after the incident.

Medics at all 20 top-flight clubs get round the table to discuss health issues in the game two or three times a season and they will look to assess whether laws need tightening.

There are already two points in the Premier League rulebook addressing concussion but currently they allow for discretion from doctors and managers at the time of the incident.

One rule states that in the occurrence of a head injury a player can only return if given the all-clear by a club doctor after pitch-side assessment, while the other echoes FA guidance that the player in question should not appear again for five days afterwards. That was the rule cited by Arsene Wenger when Matthieu Flamini missed Arsenal's Champions League match with Borussia Dortmund following a collision in a game against Norwich.

But this leaves a grey area for what is allowed by football's governing bodies in the immediate aftermath of a head injury.

Former QPR and Leeds manager Neil Warnock believes the Portuguese boss was wrong to make the call, claiming the risk could have been fatal.

'Andre Villas-Boas was wrong,” he told talkSPORT. 'I think in this particular case it should have been taken out of his hands.

'The doctor should have insisted that he come off. There are more important things than football. It’s more important that they make sure he’s all right, rather than having a catastrophe.

'If anything had happened to him and he gets an accidental knock on the brain, you do not know what the consequences are.

'We talking about life and death here, it’s not double vision, this is a serious knock. You can’t mess about [with things like that].'

No chance of leaving: The French goalkeeper insisted that he would carry on playing

No chance of leaving: The French goalkeeper insisted that he would carry on playing

Lloris

THE FIVE-DAY RULE

It is not often a footballer sustains concussion, so methods on how best to approach keeping them safe in the coming days have mostly come from the NFL.

A Zurich Consensus Statement in 2012 published a six stage rehabilitation process, with each stage (from walking, to ice skating, to simply passing skills) due to take a day, before finally taking part in full practice again.

Leading football medic Mark Leather was also critical of Villas-Boas, saying: 'The guidelines are that players shouldn't be allowed to carry on and instead be monitored. It's a risk for managers to take medical decisions on that matter and the more serious the injury the bigger the risk.

'The consequences can be drastic, fatal even. You don't really know about internal bleeding for a period of time.'

Villas-Boas countered: 'I made the call to keep him on the pitch because of the signs he was giving.

'When you see this kind of assertiveness from the player it means that he is able to carry on. He was determined to continue and looked concentrated, driven and focused enough for me not to make the call to replace him. The saves he made after the incident proved that right.'

Lloris was knocked out in the 78th minute and after lengthy treatment appeared to be heading off, with Brad Friedel ready to replace him. Referee Kevin Friend also appeared to suggest a substitution would be the best thing to do.

However, the France keeper began to struggle with members of the medical team guiding him to the touchline and indicated he was fit enough to stay on, leading to Villas-Boas giving the signal to let him have his way.

'Hugo still doesn't recall everything about the incident,' said Villas-Boas. 'The medical department were giving me signs that the player couldn't carry on because he couldn't remember where he was.

'It was a very difficult moment for us and I am happy he is well.'

But brain injury charity Headway have also condemned the manager's actions.

'We are hugely concerned that a professional football club should take such an irresponsible and cavalier attitude to a player's health,' said Luke Griggs, spokesperson for Headway.

'When a player - or any individual - suffers a blow to the head that is severe enough for them to lose consciousness, it is vital they urgently seek appropriate medical attention. A physio or doctor treating a player on pitch simply cannot accurately gauge the severity of the damage caused to the player's brain in such a setting as there may be delayed presentation of symptoms.

'By continuing to play, the player may have caused greater damage to his brain. He should have been removed from the game immediately and taken to hospital for thorough tests and observation.'

Lloris

Nasty: Stephen Hunt collided with Petr Cech and the chelsea goalkeeper has needed protective headgear ever since

Nasty: Stephen Hunt collided with Petr Cech and the chelsea goalkeeper has needed protective headgear ever since

Worrying: Robert Snodgrass was knocked out for eight minutes at Manchester United in midweek

Worrying: Robert Snodgrass was knocked out for eight minutes at Manchester United in midweek

EVERTON 0 TOTTENHAM 0

Click here to read Ian Ladyman's report from Goodison Park. 

And Leather, Bolton Wanderers' head of sport development and a former head physio at Liverpool, added that the full effects of concussion often only come to light in the hours following an incident, and can prove extremely serious.

He said 'I recall an incident in amateur football when a 16-year-old suffered a clash of heads and went home feeling unwell.

'Later he had a brain haemorrhage that resulted in a long stay in hospital.

'It seemed innocuous but there was a slow bleed in his brain and he had symptoms similar to a stroke. These kinds of occurrence are not common but equally not rare enough to be disregarded.

'Sometimes you get away with it. If you have an insistent player it is very difficult but I would do my damnedest to get them off and into dressing room to be assessed by a neuro specialist - you can't do that on the pitch.'

The collision brought back memories of Petr Cech's clash with Reading's Stephen Hunt in 2006. The Chelsea goalkeeper has had to wear protective headgear ever since.

'It was a dreadful situation, you can remember the impact of a knee going against the goalkeeper's head,' Villas-Boas said.

'It happened unfortunately for Petr Cech a couple of seasons ago, so it's good that the players went to him and fortunately it is nothing serious.'

Irritated: Everton boss Roberto Martinez felt Lukaku's booking was unjust

Irritated: Everton boss Roberto Martinez felt Lukaku's booking was unjust

Norwich's Robert Snodgrass also found himself concussed in the midweek Capital One Cup match against Manchester United in midweek and spent time in hospital. The Scotland international wasn't risked by Chris Hughton for the Canaries' demoralising 7-0 defeat against Manchester City.

Everton boss Roberto Martinez was relieved Lloris did not appear seriously injured but was irritated that Friend booked Lukaku for his involvement.

'We were glad to see Lloris back on his feet,' Martinez said.

'It was a strong incident, nothing malicious, two brave players fighting for the ball.

'Romelu did nothing wrong and he picked up a strong knock on his thigh and he had to come off as a consequence.

'I was really disappointed to see Romelu punished with a yellow card in what was an honest challenge, both players trying to get the ball.'

 

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Interesting that FIFA have thought fit to involve themselves in all this. One hopes that they remember what they've said today when the World Cup takes place in Qatar, as heatstroke is one of the major causes of concussion.

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Fred, Cheshire. Nothing like showing your ignorance! With head injuries your confused, most of the time you don't know you have one. Jog on princess I'm sure you've got some wet paint to watch.

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All you people moaning get a life. He's a grown man and can make his own mind up. Because you all phone in sick a dozen times a year, does not mean every one does.

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AVB said he overruled the medical staff because he knew Lloris was okay due to 'footballing experience'. So why are the NHS blowing taxpayers' money on CT scanners, doctors, nurses, neurosurgeons and suchlike when men with 'footballing knowledge' can evidently see inside brains? Should just give doctors a Rothman's Football Annual each and save money on fancy training and equipment.

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... concussion is a brain injury ... very very poor decision by spurs medical staff to let lloris continue on.

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Some of the comments on here are just absurd. The player wanted to play on and the Spurs medical staff know EXACTLY what they're doing (just ask Fabrice Muamba). Is there nothing in football which doesn't get blown out of all proportion these days?

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I think AVB is taking the fall for this. He was the first person to get Friedel ready and Lloris and the medical staff were on the other side of the pitch. Lloris forced the staff to let him play on, whether they approved it or not, and AVB didn't know the whole story until the end of the match. Then he took the blame in the press conference to take any possible heat off Lloris and the medical staff.

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Happens often in rugby, without all the fuss. - KB1982, Chelmsford, UK, 04/11/2013 18:43 Actually in rugby (league and union) if you have clash of heads that means you are even just dazed (never mind knocked out!) it is MANDATORY to be removed from field and a Dr has to test you!

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AVB needs to go if for no other reason than that he doesn't have the respect and control of his players. He may claim now that it was his decision to keep Hugo on, but watching the match live, it was clear AVB wanted to make the sub but Lloris refused to go. Instead of asserting his authority and taking him out, he let the player dictate the decision. No way that would have happened if Harry was still in charge or at teams managed by Sir Alex, Wenger or Mourinho.

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You wouldn't be one of those goonies would you..

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Who the hell are you ..........

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I am a Spurs fan and also a rugby youth coach. As much as I didn't want to throw away the point at Everton as a coach we have a duty of care towards our players and AVB was, and is wrong. Of course the competitive nature of a player knowing if they leave the field will have a 10 day compulsory rest period will insist they are ok and want to play on. But the risk involved is too great and as a coach a decision outside of the sport must take president. I love my spurs, I actually think AVB is a good coach and fits in well with a modern Tottenham. But it was Townsend last week and Loris this week. AVB grow up and respect the position your in. I for one as a coach and as a human being could not sleep act night knowing I put the result in front of my player.

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