AVB in Lloris KO storm as Spurs boss slated for allowing stricken goalkeeper to play on

The Mail on Sunday recently launched a concussion campaign with a five-point guide for the rugby authorities to take note of.  

Click here to read an emotive interview with former England captain Lewis Moody, who says he used to treat concussion as a joke.

Andre Villas-Boas admitted that it was purely his decision to keep Hugo Lloris on the pitch after he was knocked out during the goalless draw at Everton.
The Tottenham goalkeeper accidentally felt the full force of Romelu Lukaku's knee as the pair clashed when chasing a ball into the away box. Spurs' medical staff, along with captain Michael Dawson, urged Villas-Boas to take his man off. 

Both Lloris and Villas-Boas were advised that he should be substituted after being knocked out cold, but the manager insisted that his No 1 was capable of continuing - going against expert advice.
 VIDEO  Scroll down to see Villas-Boas defend his decision to keep Lloris on the pitch

All smiles: Andre Villas-Boas says he went against medical advice to keep Hugo Lloris on the pitch after concussion

Out cold: Hugo Lloris was accidentally clobbered in the head by Romelu Lukaku's knee

Urgent: Lukaku immediately asked the medics on the touchline for help

Advice: Andre Villas-Boas revealed after the 0-0 draw that medics had advised that Lloris should be taken off

WHAT FIFA SAY

FIFA have clear rulings on the issue. 'If concussion is suspected, a player should be immediately removed from play and urgently assessed medically,' their guidelines read. 
But each nation have their own protocols and do not have to follow the example set by football's world governing body.

Lloris had lay motionless for a number of seconds and Villas-Boas told Sky Sports: 'The medical department was giving me signs that the player couldn't carry on because he couldn't remember where he was.
'That is the situation right now. Hugo still doesn't remember the impact but he was quite focused and quite determined to continue.
'When you see this kind of assertiveness from the player it means that he is able to carry on.
'It was my call to delay the substitution, you have to make a decision in situations like this.
'From my knowledge of football he seemed OK to continue.'
But Villas-Boas was accused of risking his goalkeeper's safety by overruling medical staff, who recommended that Lloris should be substituted.
Leading football medic Mark Leather said: 'The guidelines are that players shouldn't be allowed to carry on and instead be monitored. It's a risk for managers to take medical decisions on that matter and the more serious the injury the bigger the risk.

Villas Boas: Hugo Lloris recovered well from Lukaku knock out

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No chance of leaving: The French goalkeeper insisted that he would carry on playing

Difficulties: Villas-Boas admitted that Lloris couldn't remember how he was hit on the head

THE FIVE-DAY RULE

It is not often a footballer sustains concussion, so methods on how best to approach keeping them safe in the coming days have mostly come from the NFL.
A Zurich Consensus Statement in 2012 published a six stage rehabilitation process, with each stage (from walking, to ice skating, to simply passing skills) due to take a day, before finally taking part in full practice again.
Wenger won't risk Flamini because of the doctor's guidance not to risk a further concussion by playing him again on Tuesday night.

'The consequences can be drastic, fatal even. You don't really know about internal bleeding for a period of time.'
Villas-Boas countered: 'I made the call to keep him on the pitch because of the signs he was giving.
'When you see this kind of assertiveness from the player it means that he is able to carry on. He was determined to continue and looked concentrated, driven and focused enough for me not to make the call to replace him. The saves he made after the incident proved that right.'
Lloris was knocked out in the 78th minute and after lengthy treatment appeared to be heading off, with Brad Friedel ready to replace him. Referee Kevin Friend also appeared to suggest a substitution would be the best thing to do.
However, the France international began to struggle with members of the medical team guiding him to the touchline and indicated he was fit enough to stay on, leading to Villas-Boas giving the signal to let him have his way.
'Hugo still doesn't recall everything about the incident,' said Villas-Boas. 'The medical department were giving me signs that the player couldn't carry on because he couldn't remember where he was.
'It was a very difficult moment for us and I am happy he is well.'
But Mark Leather, Bolton Wanderers' head of sport development and a former head physio at Liverpool, said the full effects of concussion often only come to light in the hours following an incident, and can prove extremely serious.
He said 'I recall an incident in amateur football when a 16-year-old suffered a clash of heads and went home feeling unwell.
'Later he had a brain haemorrhage that resulted in a long stay in hospital.
'It seemed innocuous but there was a slow bleed in his brain and he had symptoms similar to a stroke. These kinds of occurrence are not common but equally not rare enough to be disregarded.
'Sometimes you get away with it. If you have an insistent player it is very difficult but I would do my damnedest to get them off and into dressing room to be assessed by a neuro specialist - you can't do that on the pitch.'

Nasty: Stephen Hunt collided with Petr Cech and the chelsea goalkeeper has needed protective headgear ever since

Worrying: Robert Snodgrass was knocked out for eight minutes at Manchester United in midweek

EVERTON 0 TOTTENHAM 0

Click here to read Ian Ladyman's report from Goodison Park. 

The collision brought back memories of Petr Cech's clash with Reading's Stephen Hunt in 2006. The Chelsea goalkeeper has had to wear protective headgear ever since.
'It was a dreadful situation, you can remember the impact of a knee going against the goalkeeper's head,' Villas-Boas said.
'It happened unfortunately for Petr Cech a couple of seasons ago, so it's good that the players went to him and fortunately it is nothing serious.'
Mathieu Flamini suffered a similar knock in Arsenal's win at Crystal Palace last month and was ruled out of their Champions League defeat to Borussia Dortmund because of the 'five-day rule'.
'Flamini is doing well, he has practised normally but we will not play him,' Wenger said.
'There is a five-day rule which we will respect, not to take any chance. It was concussion and the doctor advised us not to play him.'
Norwich's Robert Snodgrass also found himself concussed in the midweek Capital One Cup match against Manchester United in midweek and spent time in hospital. The Scotland international wasn't risked by Chris Hughton for the Canaries' demoralising 7-0 defeat against Manchester City.
Everton boss Roberto Martinez was relieved Lloris did not appear seriously injured but was irritated that referee Kevin Friend booked Lukaku for his involvement.
'We were glad to see Lloris back on his feet,' Martinez said.
'It was a strong incident, nothing malicious, two brave players fighting for the ball.
'Romelu did nothing wrong and he picked up a strong knock on his thigh and he had to come off as a consequence.
'I was really disappointed to see Romelu punished with a yellow card in what was an honest challenge, both players trying to get the ball.'

Irritated: Everton boss Roberto Martinez felt Lukaku's booking was unjust