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New York City FC defender Anton Tinnerholm out with concussion

The Venue Medical Director approved the re-entry of Tinnerholm and Servania after going through the in-game MLS protocol.

Anton Tinnerholm (left) is out for home match versus Atlanta United and uncertain for game at New England (Noah K. Murray-USA TODAY Sports)

New York City FC’s Anton Tinnerholm, who collided with Brandon Servania of FC Dallas on an air ball challenge in Sunday’s 1-1 draw in Frisco, Texas has been placed in Major League Soccer’s concussion protocol and is out of Wednesday’s match versus Atlanta United.

Tinnerholm suffered the concussion 20 minutes into the match with City in front, 1-0. The Swedish national had assisted on a Valentin Castellanos goal just 39 seconds into the match. It was Tinnerholm’s career-high eighth assist of the season.

Tinnerholm and Servania were prone and struggling outside the NYCFC penalty area before walking gingerly with assistance to the sideline after a lengthy delay. Soon thereafter, they were simultaneously beckoned into the game by referee Ismael Elfath. The fourth official had received verbal permission from the Venue Medical Director (VMD), who deemed the players fit for re-entry.

A short time later, both players voluntarily took a seat on the grass at Toyota Stadium presuming symptoms of a concussion.

Three years ago, MLS added the VMD – a neutral doctor – for every league match. The VMD is the only person that can clear a player to re-enter a game after a concussion is suspected. The team athletic trainers, who are familiar with the character traits of the players, can share their opinion and have the option to insist a player be removed.

Although not a written mandate, athletic trainers have three minutes to make an assessment after entering the field of play to treat the player who has experienced a head injury.

The VMD cleared the return of Tinnerholm and Servania during Sunday’s match after going through the in-game MLS protocol, which starts by determining whether a player lost consciousness followed by a balance test, a memory test (past and present) and the SCAT 5 – a standardized concussion screening for use by medical professionals.

Medical spotters are also required at each MLS match to evaluate the visual cues that an athlete might be struggling. 

The VMD reasoned that a heart rate increase while competing may have delayed the symptoms. A rule permitting a free substitution to allow for a more thorough examination to determine the feasibility of an athlete’s return to competition could help avoid the chance of a hasty return. The law has been discussed at the MLS and FIFA levels without resolution.

On Sunday, Tony Rocha replaced Tinnerholm, while Paxton Pomykal took Servania’s spot in the FC Dallas midfield.  Servania also is going through concussion protocol.

Following Tinnerholm’s departure, the match turned in favor of the home side and Dallas eventually leveled to earn an important point in their battle for a playoff spot in the Western Conference.

“My feeling is when we missed Anton, we lost the control in that moment,” NYCFC coach Dome Torrent said. “Anton played really well against Dallas.”

New York City is on top of the Eastern Conference table, four points clear of second place Atlanta. A mid-week triumph for NYCFC would halt the Five Stripes’ bid to win a second consecutive conference title, while a City win plus a tie or loss for the Philadelphia Union at San Jose on Wednesday would clinch NYCFC’s first Eastern Conference championship.

Tinnerholm’s status for Sunday’s match at New England is uncertain.

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