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Kevin Doyle’s Concussion-Induced Retirement Should Sound Alarms

MLS can, and must, do better.

MLS: Colorado Rapids at Portland Timbers Troy Wayrynen-USA TODAY Sports

Last week, Colorado Rapids striker Kevin Doyle retired from professional soccer, citing headaches and additional problems from multiple concussions sustained throughout his playing career, including two in this most recent MLS season. His last game was in a September game against the LA Galaxy, in which he went off with a head injury in the first half (which would later be diagnosed as a concussion).

To begin with I’d just like to congratulate Doyle on a wonderful career playing for the likes of Reading, Wolverhampton Wanderers, the Rapids, and the Irish national team.

Now then, the news of Doyle’s retirement is both concerning and heartening at the same time. It’s heartening because he recognized that something was very wrong with his body and, instead of endangering himself further, decided to hang up his boots in favor of his health. This somewhat mimics the story of Taylor Twellman, who also retired early due to complications from multiple concussions. The news is also concerning because it points to a much larger problem, both in MLS and in the sport of soccer as a whole — one that needs to be addressed better than it is currently.

Doyle’s injury against the Galaxy last month was handled as it should have been. It was recognized he had an injury, he was evaluated by the Rapids’ team doctor and medical staff, and the decision was made to substitute him. However, this isn’t always the case. In a May game between the Portland Timbers and Atlanta United, Atlanta defender Yamil Asad had a ball absolutely blasted into his face from close range. He instantly fell to the ground limply, making no attempt to lessen his fall on the way down. Obviously, this led many people to speculate that he was knocked unconscious, and he was evaluated by both the Atlanta medical staff and the Timbers team doctor, Jonathan Greenleaf.

The evaluation did not take particularly long and Asad was shortly allowed back onto the field, much to the distress of Dr. Greenleaf, who was seen enthusiastically talking to both the Atlanta medical staff and the fourth official after Asad returned to the field. After the game, when asked about the incident, referee Alan Kelly stated that the “Atlanta medical staff determined after a check that he was fit to play.” He also said that referees do not make medical decisions.

MLS: Atlanta United FC at Portland Timbers Jaime Valdez-USA TODAY Sports

There are a couple things wrong with this situation. The first is the way the evaluation was handled. MLS uses a concussion evaluation protocol called the Sport Concussion Assessment Tool, or SCAT. In Sports Neurology, An Issue of Neurologic Clinics by Dr. Tad Seifert, it is recommended that “Optimally, the SCAT should be administered in a quiet, distraction-free environment, such as a locker room.” This obviously didn’t happen. One can argue that it would be unreasonable to pull a player all the way back to the locker room, so the sideline will do in a pinch. That’s not the best argument, because if you’re actually concerned with the safety of your players then it shouldn’t matter, but I’m sure that’s what some people will say.

There’s something else, though. The SCAT is made up of four pages worth of testing and you can view a copy of it for yourself here. Are we really supposed to believe that the entirety of the test was administered in the three to four minutes before Asad returned to the field? Because I’ve administered that test more than once myself, and let me say that administering the SCAT that quickly just isn’t possible. And, if it is being done in that amount of time, then it isn’t being done correctly, and that’s a whole different can of worms.

MLS Deputy Comissioner Mark Abbott stated that medical personnel made the on-field call that Asad was okay to return to the field, and then additional evaluation was done later at halftime and after the game. This in itself is a problem; if there’s even the slightest suspicion of concussion then a player shouldn’t be returned to play, and additional evaluation shouldn’t be needed later just to check and make sure the three-minute once-over didn’t miss a potentially life-threatening injury.

The modus operandi shouldn’t be “wait until halftime and then do a more in-depth evaluation,” because if that player is concussed then sending them back out onto the field puts them at risk for something called Second Impact Syndrome (SIS). Basically, SIS is what happens when a second concussion is sustained before an individual has recovered from the first one, and can lead to rapid brain swelling, respiratory failure, shut down of the brain stem, and death.

The next thing to address is Alan Kelly’s comment about referees not making medical decisions. While this is true, it’s a problem. Yes, 99% of the time referees don’t have the medical knowledge necessary to make decisions on whether or not a player is fit enough to continue playing. But if a player is potentially knocked unconscious, and a qualified medical professional (in this case Dr. Greenleaf) is distressed with the idea of him going back in the game, then the referee should be able to mandate a substitution for that player. This is where MLS needs to continue taking steps to ensure that head injuries are treated with the caution and levity that they deserve, which is something the league has been fairly hit and miss on.

So, what happens when a team breaks MLS’ concussion protocol? Apparently, nothing whatsoever. Abbott also gave a spiel about how anyone who breaks MLS rules and protocol stands to be disciplined, sanctioned, and fined by the league. And yet, nothing really happened. I’d be willing to bet both my kidneys that proper protocol wasn’t followed in that situation but no investigation was forthcoming and fines or sanctions certainly didn’t materialize. I’ll echo what Twellman said after the incident occurred — until MLS actually enforces its rules when infractions occur, then actual progress won’t happen.

This isn’t the only instance where there have been questions about whether protocol has been followed. Kellyn Acosta and Matt Hedges this past May, Seth Sinovic in 2015, oh and also Twellman. He’s gone on the record saying that the New England Revolution ignored his concussions, including the one that would eventually end his career, with the team sending him back into play after he said, “I have a concussion.” Granted, the Twellman incident was in 2008, but it points to a culture in MLS where, while everyone says the right thing when talking about the C-injury, talking is where the action ends.

In the end, I applaud Doyle for taking what is happening to him seriously. At some point in our lives most of us have probably sprained an ankle in a coed or pickup game and said, “it’s cool, I can still go.” Maybe we finish the game and then play on it again the next day. But this isn’t an ankle, or a knee, or any other body part that can be replaced with surgery. We’re talking about the human brain, something that we can’t replace or, in most cases, repair. So I applaud Kevin Doyle for doing his best to take care of his. Maybe MLS and all 22 of its teams should stop being 70% talk and 30% walk, and make serious efforts to do the same.