Tottenham Hotspur suffered a significant blow in the first half of their Champions League semi-final with Ajax in north London, as Jan Vertonghen was forced off through injury.
The Belgium international was left with a bloody nose and in a daze after clashing heads with defensive partner Toby Alderweireld and was withdrawn after it became clear he could not continue.
Referee Antonio Miguel Mateu went to the touchline to check if Vertonghen was able to continue and it initially appeared he could play on, though it quickly became clear that was not the case as he shakily left the field moments later.
Spurs will now have concerns about Vertonghen’s fitness ahead of the second leg in Amsterdam next week and plenty of questions have been raised about how head injuries are dealt with, so we’ve gathered some of the details below.
These Spurs fans are calling for a change in the rules as Jan Vertonghen suffers head injury
What are the rules?
In the Premier League, any player who suffers a head injury must leave the field and be assessed by the medical staff, who then decide whether the player can continue - not the manager or the coaches.
The Champions League appears to have a similar approach as the referee was picture speaking to the club doctor before Vertonghen attempted to continue and seemed to be content with the response that the bench provided.
What happens with a head injury?
If a player is believed to have lost consciousness, the player must be removed from the field of play and is not permitted to return. In those situations, it is usually obvious when it occurs so there is little room for confusion.
'Am I seeing things?' - Spurs fans notice two former players in attendance against Ajax
If a player has not lost consciousness, the medical team will ask a series of basic questions to gauge if a concussion has been sustained - as one of the clearest signs of this injury is short-term memory loss.
What questions are asked?
The series of basic questions includes the match in play and any other recent fixtures, with the players then earning a ‘score’ based on their responses - which is used to work out if a problem has occurred. Some of the questions include:
- What venue are we at?
- Which half of the game is it?
- Who scored last in this match?
- Who did you play in your last game?
- Did your team win the last match?
Mauricio Pochettino explains the reasons behind Moussa Sissoko and Fernando Llorente decisions
How long does it take to return from a head injury?
In English football, the Football Association and Premier League have set out clear ‘fit to play’ guidelines which dictate that an individual cannot play within six days of a suspected or confirmed concussion.
The recovery works on a step-by-step basis, advancing every 24 hours, but this could take longer. The stages are as follows; no physical activity, light aerobic exercise, sport specific exercise, non-contact training drills, full contact training, return to play.
How serious is concussion?
Concussion can be extremely serious, with the Headway Brain Injury Association saying:
'Gutted he's only on the bench' - Mixed emotions from Spurs fans as Moussa Sissoko returns
"If you continue to play after you've had a concussion and you suffer a secondary knock, that secondary knock can significantly exacerbate the damage to the brain and cause real problems.
"One of the issues we have with concussion is it tends to be an evolving injury, where the signs and symptoms may take some time to present themselves.
"You could be playing on without necessarily showing any of those signs, especially the more visible ones, such as loss of balance or vomiting or loss of consciousness. Only in around 10 per cent of concussions is there a loss of consciousness. Looking out for that one key indicator is not a sensible way to go.
"It's very important to protect someone while their brain is recovering from that initial, minor traumatic brain injury, to sit it out, rest and recover before going back into the field of play."
For all your latest Tottenham Hotspur news, opinion, analysis and transfer gossip, click here
Keep up to date with the latest Tottenham Hotspur news, features and exclusives from football.london via our free WhatsApp service .
Text NEWS to 07776197989 and then add the number to your phone contacts book as spurs dot london (case sensitive, with spaces) to receive daily updates and breaking news from Alasdair Gold and the team on Spurs.
Your phone number won't be shared with any other members of the group. Click here for more information on the service.
