On Hugo Lloris, Romelu Lukaku, and English soccer's head injury negligence

Hugo Lloris refused to come out of the game against Everton despite the efforts of the club's medical staff and teammate Michael Dawson. (Chris Brunskill/Getty

Hugo Lloris refused to come out of the game against Everton despite the efforts of the club's medical staff and teammate Michael Dawson. (Chris Brunskill/Getty Images)

In the second half of today's scoreless draw between Tottenham and Everton, Spurs goalkeeper Hugo Lloris came out to collect a through ball as striker Romelu Lukaku gave chase. It's the kind of play you see countless times in soccer -- two players moving at speed toward one another, the striker withdraws, goalkeeper collects the ball, and usually everyone gets away unscathed.

Not this time. This time, this happened:

In an accidental clash, Lukaku's knee slammed into the side of Lloris's head, leaving the French goalkeeper sprawled on the ground. Spurs sent out their medical staff, who almost immediately called for a stretcher. Clearly, Lloris had suffered a head injury of some sort. Manager Andre Villas-Boas called on backup custodian Brad Friedel to step in, and the American waited patiently at the sideline to come in and help preserve a shutout.

He wouldn't get the chance. Lloris adamantly rebuffed the suggestions of the medical staff and teammate Michael Dawson that he should come out of the game. Still looking woozy and wobbly on his feet, the goalkeeper would begin to walk off the field, only to reverse his steps in persistent atttempts to convince the doctors. They seemed generally flummoxed at the whole situation. In the end, they capitulated. Lloris stayed on for the remainder of the game, despite his inability to remember its most painful moment (video here).

"He doesn't remember [the collision] so he lost consciousness," Villas-Boas admitted to the BBC after the game. "It was a big knock but he looked composed and ready to continue."

Then Villas-Boas said something that exposed a larger issue: The EPL's neglectful handling of head injuries.

"The call always belongs to me," he said. "Hugo seemed assertive and determined to continue and showed great character and personality. We decided to keep him on based on that."

Villas-Boas is many things, but a medical doctor is not one of them. Every professional player wants to play. If they didn't, they probably wouldn't be pros in the first place. But that doesn't mean they always should, and it certainly doesn't mean that they're the ones that get to make the call. That Villas-Boas is in that position with enough authority to reward such foolish and self-destructive actions from his players should tell you all you need to know about the state of head injury protocol in the world's most-watched domestic soccer league.

If you think this is an isolated example, you're wrong. In fact, you need only look as far as Lukaku -- Lloris' accidental assailant. The big striker was on the receiving end of a target="_blank">skull-on-skull collision with Joey O'Brien as he scored Everton's winner against West Ham United just over a month ago. The incident left Lukaku sprawled on the ground, but afterward he was let back on to the field. The Belgian claimed in a post-match interview that he didn't even remember scoring the goal. The response from the interviewer was not one of concern, but of bemusement. Humor, even. Watch:

A few weeks before Lukaku, Stoke City defender Robert Huth was target="_blank">knocked unconscious against Manchester City by Alvaro Negredo's knee. The first person offering treatment at his side was not a club doctor or an independent medical professional. It was Stoke teammate Jonathan Walters, who apparently knew enough about head injuries to spot this one from far away, sprint to the goalmouth, muscle the surrounding crowd of players out of the way, and turn Huth on his side so the defender wouldn't swallow his tongue.

Amazingly, Huth returned to the game after regaining consciousness, supposedly because Stoke was out of substitutions at the time. He was named to premierleague.com's official team of the week, and earned praise from pundits everywhere for his decision to stay in. They used words like "toughness" and "bravery."

Any NFL fans in the house? Does this sound familiar?

From an American perspective, instances such as these (and the many, many others around the world I'm leaving out) seem to indicate appalling lack of oversight. That's because that's exactly what is going on.

In response to John Terry's shocking head injury in the 2007 League Cup Final ( target="_blank">Here's video, in case you forgot or never saw it in the first place. Don't watch if you're squeamish), the British Journal of Sports Medicine distributed a survey to all 92 teams in the English Football League, including every Premiership team. Summaries of the findings from this survey are available here, and the full report can be purchased here, but the short version is this: Around half of Premier League clubs or less follow the internationally agreed-upon protocol for dealing with head injuries. The same ratio of Premiership clubs fail to administer pre-season neuropsychological tests that can help determine the likelihood of sustaining a concussion and identify symptoms well ahead of time.

That report was published online in August of 2012, five years after Terry's horrific incident. Yet as of today, the only instance of the term "head injury" showing up in the 2013-2014 Premier League Handbook is the following, rule O.9:

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.

Those 54 words are the beginning and the end of the EPL's head injury protocol. To compare: Major League Soccer has a nine-man committee formed specifically to enforce its policies, which include neuropsychological testing and the installation of team physicians as the ultimate authority on whether or not a player should play -- not head coaches/managers, and certainly not the players themselves.

American fans following the NFL's battle with head injuries, their aftereffects, and its policy on their treatment know the stakes. But just because the sport is different doesn't mean head injuries can be any less detrimental. Former New England Revolution striker, current ESPN commentator, and head injury awareness crusader Taylor Twellman said as much in an interview with the LA Times last year:

"Any other injury doesn't take your life away. This takes your life away," Twellman says over an iced coffee at an Arizona shopping mall. "You get a knee [injury] … you still can go to the movies. You still can play video games. You still can remember things.

"This brain injury of concussions takes your life away. We've got to stop it."

The policies of any sport, at its highest level, have a way of filtering down to the lowest. A developing goalkeeper that hopes to one day fill Lloris' shoes could witness the impact of Lukaku's knee, see the winning argument to stay on the field, and hear Villas-Boas' praise of the saves his goalkeeper made to keep the scores level at zero in the aftermath. In doing so, that player could mistake the Tottenham medical staff's foolishness for Lloris' toughness, praise from his coach for medical clearance, and devalue their own health as a result. And then this whole thing starts over again.