Results must never come at expense of players' health

TOTTENHAM Hotspur's manager Andres Villas-Boas made a terrible decision. He put Hugo Lloris' sanity, maybe even his life, at risk when he allowed his goalkeeper back onto the pitch at Everton.

The Portuguese told the BBC minutes after the final whistle that he knew that his custodian had been knocked unconscious when his head collided with the knee of Romelu Lukaku.

"Hugo doesn't remember it," Villas-Boas said, "so he lost consciousness."

After a long delay, the goalkeeper was roused, but the Spurs doctor and physiotherapist, together with the team captain Michael Dawson, all demonstrably tried to convince him that he should accept being substituted.

The experienced American 'keeper Brad Friedel was gloved up and ready for action. But Lloris pleaded to go back on, and Villas-Boas let him.

Worse, or certainly as poor in perception, the coach was still digging himself deeper into the mire of controversy four days later.

"The call belongs to me," Villas-Boas had said on Sunday when asked who decided the groggy goalie should play on.

"The person Hugo is," the Portuguese insisted, "he seemed assertive and determined to continue, and showed great character and personality."

The contradiction was alarming.

If Lloris was incapable of remembering the impact, how could he have been in fit mind to show great character and personality?

He was being macho. But the line between a hardy player and a foolhardy one is sometimes too blurred to sense, let alone to trust.

You would have thought that anyone in charge of such situations would at least be aware that for 40 years, maybe longer, brain specialists have warned that concussion is invisible to the eye.

Not one neurological expert I have discussed this with would have made that call on the field. Every doctor, from Fifa's advisers to people who have devoted their careers to studying the effects of concussion, would have taken Lloris out, and put him in hospital for observation.

Brain damage is insidious. A tiny bleed might be difficult to detect on a scanner. It can develop deadly consequences days after a heavy blow to the skull.

No doctor, in any sport, could call it or exclude it.

Yet Villas-Boas stands "absolutely" by the decision taken on the touchline.

Foolish, foolish man.

Professor Jiri Dvorak and Dr Michel D'Hooghe, the senior medical advisers to Fifa, have a simple guideline: If in doubt, they say, take the player out.

In every other contact sport, the medical experts say the same.

Even in boxing, the only so-called sport in which the object is to knock the other fellow out (that is, damaging the brain), any fighter who is concussed is kept out of the ring unless or until specialists are satisfied the brain is not at risk of secondary impact.

Secondary might be terminal.

Listening to Villas-Boas' insistence on Wednesday that "all the checks were according to the book" makes me fearful for any player in his charge.

They are no checks that could rule out brain damage on the field. Fifa should not pussyfoot around with recommendations; it should not allow the coach, or anyone else, to send a concussed player back into the fray.

The recommendation to remove a player should be a cast-iron rule.

We cannot say for certain that Villas-Boas over-ruled the doctor and physio. But it looked that way. They looked fearful when they saw Lloris face down on the turf, eyes wide open, body dreadfully still.

Dr Shaabaz Mughal and "head" physiotherapist Geoff Scott had good reason to be anxious. Less than two years ago, they had raced onto the pitch at White Hart Lane to help Bolton's doctor and physio, and a heart surgeon who appeared out of the crowd, to resuscitate Fabrice Muamba whose heart went into cardiac arrest.

Even in that, Villas-Boas was wrong to claim on Wednesday that "a great doctor and a great physio saved the life of Muamba".

They helped. They did not, alone, save Muamba. The incidents are not comparable: Muamba had a heart attack, the medics who revived him had a defibrillator to shock his heart, but it took hours in hospital to "save" him and weeks of intensive care to ensure he could have a life - albeit not a sporting one.

If Villas-Boas wants to cite precedence, he might be interested in something that occurred long before he arrived at Tottenham. In 1994, Juergen Klinsmann, making his Spurs' debut at Sheffield Wednesday, was knocked cold in a clash of heads with Des Walker.

The doctor who spent three frightening minutes trying to bring the German round took him to hospital. Dr Patrick Keating then strongly recommended that Klinsmann should undergo intense tests by a neurologist - a brain specialist - before he resumed training or playing . At a subsequent industrial tribunal, Dr Keating accused Tottenham of undermining him.

"I was constructively dismissed," he claimed, "because I was not prepared to bend the rules and compromise the health of players." He suggested that the relationship between doctor and the then-chairman Alan Sugar and manager Osvaldo Ardiles deteriorated from that moment.

The club wanted their star striker back on the field, the doctor recommended thorough, inevitably lengthy, neurological tests before he resumed.

Almost 20 years on, Tottenham's coach insists that he made the right call and he resents implication that he and his goalie took any risk.

Maybe both the 'keeper and his coach got away with it this time. But adrenaline and bravado conditioned their action. The only way to prevent a recurrence is to mandate that the moment a player loses consciousness, he is removed from harm's way.

stsports@sph.com.sg