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Josh Williams’ concussion leads to questions about MLS protocol

Williams was never checked by medical staff for a concussion during the final minutes of the game, but diagnosed immediately after.

Jul 13, 2019; Orlando, FL, USA; Orlando City SC midfielder Cam Lindley (15) gets a red card on Columbus Crew SC defender Josh Williams (3) during the second half at Exploria Stadium. (Kim Klement/USA TODAY Sports)

COLUMBUS, Ohio — When the Columbus Crew faced Orlando City last week, the team suffered more than just the 1-0 loss on the field. Centerbacks Gaston Sauro and Josh Williams were both injured in the match, the latter due to an elbow to the head from Orlando striker Dom Dwyer.

Williams sustained a concussion during the stoppage-time play and Dwyer received a red card. However, Williams was never checked for a concussion by medical staff during the game and he stayed involved in active play for the remaining few minutes, playing high up into the box as the Crew attempted to tie the game.

He was diagnosed immediately following the match, which led to questions about Major League Soccer’s concussion protocol and why Williams continued to play.

There is some confusion about concussion protocol because it is not a publicly available document. A league spokesperson said a written protocol is only distributed to teams and venue medical directors. 

There are multiple processes in place to identify a possible concussion, and they worked properly in Williams’ case, according to the league.

There is a “medical spotter” assigned to each match, whose job it is to flag potential head injuries or other serious injuries. The spotter then makes a clip of the incident and alerts the venue medical director, who will stop play for trainers to evaluate the player.

The medical spotter for this match did follow that process after Williams went down, according to the league, but the match had already ended so the venue medical director tested Williams for concussion in the locker room.

Before serious injuries are flagged and sent to the venue medical director, trainers can only enter the field if beckoned on by the center official. The referee for this game, Dave Gantar, never waved the trainers onto the field, according to a Crew spokesman. If the training staff wants to evaluate a player but is not waved on, they can go directly to the venue medical director, who will alert the fourth official to get the trainers onto the field.

“Within 30 seconds, Williams is back on his feet. You see the player talk to [the official] face to face, eye to eye,” PRO general manager Howard Webb said. “Williams was showing no signs of requiring attention at that point. We provide training to the officials for signs of concussion. Those signs were not evident in Williams, who was asked by Dave if he needed to see the doctor. Therefore, he was allowed to continue in the game.”

Webb provided video to confirm Gantar talked to Williams for about seven seconds before play resumed. The Crew’s training staff also appears to be waiting on the sideline ready if waved on.


“If any of those signs were evident or the referee felt like there was doubt in his mind that he needed to be examined, then the doctor would’ve come in,” Webb continued. “Not every hit to the head or face results in the doctor coming in. You also have the safety net of the spotters sending things to the venue medical director.”

In the immediate aftermath of the hit to Williams’ head, officials were working to deescalate the situation. Dwyer was taking his time leaving the playing field, which resulted in Crew players surrounding and pushing him. The officials intervened to try and prevent further escalation. 

“The referee in this case was accurate in his assessment of what happened with violent conduct. He was quickly surrounded by eight, nine, 10 players by both teams. The foremost concern for us as referees is to protect the players and protect the image of the game, in that order. …We always err on the side of safety or caution.” 

The violent nature of the red card is similar to incidents that have received additional game suspensions in the past.

MLS rules say the Disciplinary Committee “will automatically review any incident in which a player cannot continue to play in the match due to an injury through contact with an opponent. If the player returns to the field of play after contact with the opponent for any amount of time, the automatic review shall be nullified.” 

Williams never left the field, so the automatic review was not triggered. However the league said the play is being looked at by the MLS Disciplinary Committee.

“The MLS Disciplinary Committee does regularly meet and review plays where a red card has been issued,” a league spokesman said. “Ensuring player safety is a key mission of the Disciplinary Committee.”




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