While Tottenham vs. Ajax was quite the entertaining match on Tuesday in the Champions League, it wasn't without a scary moment. Spurs defender Jan Vertonghen picked up a nasty, bloody head injury. The defender was checked out by the medical staff, and he was let back on the field before nearly collapsing. He was then substituted off. The incident has once again brought the topic of head injuries back on to soccer's main stage. While we hear about it so much in the National Football League and college football, it's a growing concern in soccer and usually occurs on 50-50 balls or set pieces. In the past we've seen plenty of collisions, like the one to Petr Cech which resulted in him having a fractured skull, hence why he has worn headgear for over the last decade. Cech nearly died as a result of the injury. The one to Vertonghen on Tuesday happened when he went up for a header and crashed heads with fellow defender Toby Alderweireld. Take a look. He obviously looks concussed, and he had to be helped off the field because it looked like his legs were giving in: But it turns out, according to the Evening Standard's Dan Kilpatrick, that the player actually passed all concussion tests after the match. Former U.S. men's national team player Taylor Twellman took to Twitter to give his stance. The 39-year-old has long been promoting the awareness of concussions, which ended his career early. Now, the fact that he was allowed to come back on to the field is a bit questionable. Many players think they could play through it, but any head injury can be potentially serious. Perhaps there needs to be modifications as to how the sport handles head injuries, but the image of Vertonghen stumbling to stay up is quite concerning. There have been various studies, like this one from the Institute of Medicine (US) Board on Neuroscience and Behavioral Health, that detail the concerns of simply repeatedly heading the ball, let alone the grave concerns for head-on-head collisions. While Vertonghen seems to be fine, and lucky for him, this is just another example of perhaps clubs needing to be more cautious when it comes to injuries and a reminder for the leaders to find a more efficient way to diagnose and treat these, no matter what a player says. You can watch the Champions League on fuboTV (Try for free).<doc-sep>A lot of people have been wondering how Jan Vertonghen is doing one day after he was forced off the pitch during last night’s Champions League semifinal loss to Ajax. Vertonghen bashed heads with teammate Toby Alderweireld, was attended to on the pitch bleeding profusely from the nose, was judged ok to return to action, but took himself off again after feeling woozy. Initial reports from football journalists after the match was that Vertonghen had passed all of his tests for a concussion and that he was feeling fine. A lot of skepticism has surrounded those reports. Today, Tottenham Hotspur put an official update out about Vertonghen on their website, and it comes across a touch defensive. Here’s part of the release. The Belgium defender was assessed on the pitch yesterday immediately after the incident with our medical team strictly following Football Association concussion guidelines. Following testing he was judged to be alert and answered all questions correctly and lucidly, deeming him fit to return to the field of play. All available video footage was relayed to our on-pitch medical team and they were able to confirm that he had suffered no loss of consciousness. Jan was immediately withdrawn as a result of the player informing medical staff that symptoms were developing suddenly and that he no longer felt stable standing up. Tests today have been clear and testing will continue for the next few days. Additionally, as is standard Club policy with certain injuries, we shall also be seeking independent advice and Jan is due to see a neurologist, who specialises in elite athletes, tomorrow. The player has reported no ill-effects today. — Tottenham Hotspur The club understandably got a lot of flack for letting Jan go back out onto the pitch, even though he initially passed all of the FA’s concussion protocols. This release seems to try to provide a thorough explanation of the medical staff’s actions last night and to justify its decision process as providing an update on Jan’s health. That’s fine — it’s something that the club should’ve done anyway. Also importantly, Jan himself (or his social media team at the very least) tweeted that he’s feeling better. Not the way I wanted the game to go last night. Feeling ok today. Thanks to both sets of fans for the positive messages #UCL #COYS pic.twitter.com/I9l4GaBznX — Jan Vertonghen (@JanVertonghen) May 1, 2019 I don’t think we need to rehash the argument over whether or not the concussion protocols in English football are adequate or not. We all have opinions about it. What seems pretty clear is that the club is taking Jan’s safety and health seriously and I can’t imagine that he’ll be cleared to play without full cooperation and the support of the Spurs medical staff. It certainly sounds like, as scary as his injury looked last night, it could’ve been a lot worse. That’s good news, at least.<doc-sep>Mauricio Pochettino defended his medical staff at Tottenham after the club’s 1-0 Champions League semi-final, first-leg defeat to Ajax was overshadowed by a sickening head injury to Jan Vertonghen which raised questions about concussion protocols. The Spurs centre-half was laid out in the 32nd minute following a free-kick into the Ajax box which saw him challenge with the Dutch team’s goalkeeper, André Onana, and his Spurs colleague Toby Alderweireld. Vertonghen’s nose was bloodied and he needed lengthy treatment, together with a full kit change, before he was given the all-clear by Spurs medics. The Spanish referee, Antonio Mateu Lahoz, demanded that Vertonghen be double-checked, which he was, and he was allowed to return but moments later he became unsteady on his feet and signalled that he had to come off. In distressing scenes, Vertonghen retched and half-collapsed before he was helped down the tunnel. By the time that Pochettino introduced the substitute, Moussa Sissoko, it was the 39th minute. Jan Vertonghen was withdrawn for Tottenham after clashing heads with teammate Toby Alderweireld. Photograph: Tom Jenkins/The Guardian Spurs said that the Belgian had passed all the on-field concussion tests, as per protocol – in other words, he had not suffered a concussion. He was later able to walk away from the stadium, briefly stopping to tell reporters he had not broken anything and there had been no concussion. Vertonghen said he had felt weak and briefly fainted. Quick Guide Follow Guardian sport on social media Show Twitter: follow us at @guardian_sport Facebook: like our football and sport pages Instagram: our favourite photos, films and stories YouTube: subscribe to our football and sport channels Photograph: Chesnot/Getty Images Europe Was this helpful? Thank you for your feedback. Pochettino said: “I was not involved. It was the doctor’s decision. It’s so important that the rules and the protocols are there and our medical staff followed the protocols. The referee asked and the action we needed to take was to take him out because he did not feel well. Now he is OK, now he is good. He was walking away [from the stadium], he was more relaxed. You need to keep eyes watching him and monitor him because it was a big knock but at the moment he is OK. “First of all, we must protect the player’s integrity [health]. Our medical staff followed the protocol and they decided it was possible to restart the game and possible for Jan to play again. But, of course, Jan started to feel unwell and we needed to change him. “Of course I was worried. That is normal because for me the most important is the health of the player. If they say to me ‘change’, I am not going to doubt that. In that type of situation, the medical staff are the bosses. Never am I going to question them.” Jan Vertonghen was assessed by Tottenham’s medical staff and had to change his bloodied shirt before taking the field again. Photograph: Tom Jenkins/The Guardian Spurs face a difficult task to turn the tie around in next Wednesday’s second-leg after they started slowly and fell behind to Donny van de Beek’s goal. Until Sissoko came on and Pochettino changed from his back-three system, his team were second best. They improved thereafter but they struggled to create many clear cut chances. “The team didn’t show the energy that we wanted to show,” the manager said. “Ajax showed more energy than us and the way we conceded the goal was so painful. We were so poor in this action. The Fiver: sign up and get our daily football email. “In the first half hour of the game we struggled because they showed more energy, they were more proactive than us. That was the key. With Sissoko on, we started to play better, with more energy. The second half was much, much better. “We pushed them to play deeper and we started to press in the way that we wanted to press. We started to play more and I think the second half gives us hope for the second-leg in Amsterdam. The tie is still open, although it’s going to be difficult.” The Spurs midfielder Christian Eriksen, a former Ajax player, added: “We were under-par and we didn’t play our best at all. In the first 20 minutes we were ball-watchers. We need to change it up a lot for the next game. We made them look a lot better. They are a good side but we helped them along the way. It was our fault. “At the start the system didn’t matter. The change gave us a different way to press, to play more direct. But we were still far from where we know we can be. No one wanted to play the first half we did. Everyone knew we didn’t compete. We were better in the second half. “We can’t keep talking about injured players. In a semi-final it doesn’t matter who plays. We have to step up. We’re lucky they hit the post [in the second half] and, hopefully, we can turns things around in Amsterdam.”<doc-sep>FIFPro wants stakeholders to explore the possibility of allowing a temporary substitute to accommodate 10-minute head injury assessments. Tottenham's Jan Vertonghen suffered a head injury during Tuesday's Champions League defeat to Ajax, but was allowed to return to the field before it became clear he could not continue. FIFPro, the worldwide representative for professional footballers, has now called for an independent doctor to assist the club doctor and assess whether a player with a head injury should be allowed to return to the pitch. The tool used to assess concussions is not effective when used in just three minutes, the length of time UEFA allows for players to undergo assessment. 1:15 Tottenham manager Mauricio Pochettino says Spurs’ medical staff followed concussion protocols after Jan Vertonghen suffered a head injury against Ajax Dr Vincent Gouttebarge, FIFPro's chief medical officer, called this time limit "ridiculous" and explained why the need for temporary substitutions is so pressing. "The problem is you need at least 10 minutes to apply properly this assessment tool and in football the medical team is given only three minutes to complete it," Dr Gouttebarge told Sky Sports News. "This is a ridiculous measure with regard to the 10 minutes needed to thoroughly apply the tool and the protocol available. "We know from a scientific point of view that the first set of questions in the tool in isolation, as they are used in football, are not valid to identify concussion. Image: Vertonghen was helped off the pitch "With regard to yesterday's event, we have to be cautious of blaming the medical team for every concussion because it is not easy. "We need to facilitate the medical team in this exercise. The three minutes given to the medical team to make an on-field assessment of the concussion is just ridiculous. "FIFPro has been very clear. We need to educate not only the players, but also the technical and medical staff properly." FIFPro has been working on improving concussion management since Hugo Lloris was injured in a 0-0 draw with Everton at Goodison Park in November 2013. That incident led the FA to change its procedure, meaning team doctors could overrule managers who wanted their player to return to the field. 1:15 Tottenham manager Mauricio Pochettino says Spurs’ medical staff followed concussion protocols after Jan Vertonghen suffered a head injury against Ajax Tottenham manager Mauricio Pochettino had to put his arm round Vertonghen during Tuesday's game and support the defender before the Belgian was carried away after appearing to retch by the touchline. Tottenham's decision to allow Vertonghen to attempt to continue playing had been taken after club doctors "followed concussion protocols", according to Pochettino. Peter McCabe, chief executive of brain injury charity Headway also called for an independent doctor to take stressful decision-making powers away from club staff. "You need to have timeouts without disadvantaging the team and the other thing we think is really important is that there should be an independent doctor involved in the decision-making process because the pressure on club staff with a huge game of that magnitude is intense," McCabe told Sky Sports News. "We think that having somebody independent of the club, whose job it is to focus entirely on the health and wellbeing of the player would be really important and those simple measures would make a big difference." 1:44 Consultant neurosurgeon Mr Peter Hamlyn explains signs of concussion and the procedure for safely dealing with footballers when head injuries occur Mr Peter Hamlyn, a consultant neurosurgeon and expert in sports medicine, said many concussions are difficult to identify quickly, saying that Vertonghen could well have appeared fine initially. "Sometimes it's obvious, somebody has lost consciousness," Mr Hamlyn told Sky Sports News. "There are then many, many concussions, indeed most, where there isn't a loss of consciousness. "The signs can be anything from a player not behaving appropriately, perhaps running in the wrong direction, to performing very slowly. "When they come off the pitch, the questions you ask them are about orientation - do they know who they are, what they are, what they're doing, which stadium we're in, what the score is? "Whether you go back on has to be partly up to the player and partly up to the officials. "Most of the time the players do want to go back on, even if it's not in their best interests. "Vertonghen could have passed the screening protocol, went back on and the symptoms became more apparent as he exercised."<doc-sep>
Tottenham Hotspur have delivered a positive update on Jan Vertonghen after his head injury in the Champions League semi-final first leg against Ajax. The experienced defender collided with Toby Alderweireld, banging his face into the back of his fellow Belgian's head. After the blood was stemmed from a cut on his nose, Vertonghen passed all the concussion tests the medical staff carried out on him. The referee took some more convincing but Vertonghen was eventually let back on the pitch only to come off seconds later, looking like he was going to be sick and his legs appeared to buckle beneath him before he was caught by manager Mauricio Pochettino and helped down the tunnel. He passed all the post-match concussion tests and had more on Wednesday. The club released a statement on Wednesday which read: "Jan Vertonghen has undergone further assessment today after sustaining a head injury in last night's Champions League semi-final first leg against Ajax. He also suffered a small cut to his nose that was bleeding heavily. "The Belgium defender was assessed on the pitch yesterday immediately after the incident with our medical team strictly following Football Association concussion guidelines. "Following testing he was judged to be alert and answered all questions correctly and lucidly, deeming him fit to return to the field of play. "All available video footage was relayed to our on-pitch medical team and they were able to confirm that he had suffered no loss of consciousness. "Jan was immediately withdrawn as a result of the player informing medical staff that symptoms were developing suddenly and that he no longer felt stable standing up. "Tests today have been clear and testing will continue for the next few days. Additionally, as is standard club policy with certain injuries, we shall also be seeking independent advice and Jan is due to see a neurologist, who specialises in elite athletes, tomorrow. The player has reported no ill-effects today." Pochettino had explained after the game that when it came to the player's health he let the doctors make all the decisions. "I was not involved. That was the doctor’s decision. I think it’s so important that the rules and the protocols are there," he said. "Our medical staff followed the protocol. I was never involved. The decision was the doctor’s. The referee asked, and the action we needed to take him out because he did not feel well. "Now is he okay, now is good. He was walking away, was more relaxed. I hope it is not a big issue. "You need to keep eyes watching him and monitor him because it was a big knock but. At the moment he is okay." 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.