McKenzie’s head injury: The doctor’s account

Photo: Courtesy of USL

Understanding an event depends on where you sit and what you see.

The television camera at Goodman Stadium for Bethlehem Steel FC’s matches sits at midfield halfway up the empty East side stands, directly across from all live seats available to observers.

On Sunday, June 5, I was sitting in a camera-high, west side seat when Bethlehem left back Mark McKenzie took a clearance to the head and then went down immediately, an apparent drop from playing to prone. For alarmed observers on the fan side of the field, the player’s own head blocked a clear detailed view. As McKenzie’s teammates surrounded him and medical staff rushed onto the field to treat him, many observers views’ — including my own — were obscured by the gathering.

Later, we never saw, let alone heard, the instruction to McKenzie of, “Take a knee.” Those observing live get one bite at the apple, referees and spectators alike.

Faisal Al-Amin’s view

Dr. Faisal Al-Amin, Bethlehem’s team doctor and a former soccer player for Canada’s Carleton University, saw differently from the sideline. He saw both the ball’s angle of strike and point of contact with the head, he told PSP in a telephone interview. All those who have responsibility for in-game player safety know the criticality of direct event observation. Dr. Al-Amin and the Steel’s trainer Yaseen Khan both had it.

They hurried to address the player’s needs, launching the system to diagnose blows to the head. They assessed headache, neck pain, balance, memory, and cognitive function. “Where does it hurt?” Al-Amin recalled asking McKenzie. “Do you feel pressure? What’s your name? What happened? Where are you? What have you been doing?” The player answered perfectly.

They also questioned aggressively for concussion symptoms such as dizziness, light-headedness, and unsure balance — “aggressively because 17-year-olds are more vulnerable than fully matured adults,” Al-Amin said. Such symptoms often delay their appearance. For the soccer player turned physician who questioned a proud, competitive athlete making his first professional start, first assurance did not suffice. The questions were repeated insistently as the McKenzie recovered, arose, and made his way to the sidelines. He only complained of contact-sided facial numbness.

As we all saw, the player was waved back on. Already, Bethlehem head coach Brendan Burke had been advised to prepare to send in a substitute to replace McKenzie.

“These are my players, and I know them well,” Al-Amin told PSP.

As Bethlehem staff continued to observe the teenager closely, McKenzie began running slower, triggering Dr. Al-Amin’s decision.

“Take a knee,” McKenzie was told, an instruction all coaches have given to prevent medically foolish bravery.

The player went from standing through kneeling to flat in one continuous motion, with no discernable pause. The player subsequently came back to his knees, raising an arm.

The bench-encouraged ref saw, ran, and waved. Trainer and doctor again hustled, raised up their player, and, never removing his waist-supporting arm, Dr. Al-Amin angled him toward the sidelines and then briskly to the locker room.

The follow-up

Once in the locker room, the questions resumed, Al-Amin said. For the first time the player said he was experiencing dizziness, triggering the neuro checks described above.

Once any concussion symptom shows up, neuro-check protocol begins. It repeats every 20 minutes until “symptoms free” occurs. By the end of the rain-delayed game, it did. After a final, different assessment, focus shifted to recovery.

In Chester, the player retook a computer test, Al-Amin said. He first took it during preseason, establishing a baseline for this assessment. The retest showed no change, and continued thus for the next few days.

For soccer, controlled exercise must produce no symptoms for four days before the candidate may resume play. Team procedures follow these rules. Coach Burke said on Wednesday the player had practiced, but not fully.

Mark McKenzie traveled to Charlotte and subbed on for Derrick Jones after the 90th minute. Steel fans — and others — breathed a sigh of relief.


  1. These are scary events. I have coached as well, many years, for youth teams. I have never had a player that actually told the truth about how badly they felt. This includes my own daughter, who was fifteen when it happened to her. Good for Dr. Al-Amin, and thank God that we are paying more attention to these issues.

    • Dan Walsh says:

      I think often a player doesn’t know how he really feels. I once got knocked out on a basketball court going after a loose ball, got back up, ran up and down the court at least once, and was taken off because I couldn’t remember who was on my team. Another time, I got fouled on a basketball court, bounced my head off the floor, got back up to keep playing, and subsequently lost 20 pounds over the next week from throwing up and not being able to eat due to post-concussion effects.

      In my experience, you just don’t know right away. It’s only after suffering probably a half dozen concussions that now I can figure out when I’ve probably picked up another one.

      And yes, I’ve taken a few too many hits to the head over the years. It explains everything about my columns, I’m sure. 😉

  2. Buccistick says:

    Tim, thank you for following up on — and fleshing out — McKenzie’s saga.
    Soccer may be the beautiful game, but life is the original team sport.

  3. Maybe some kind of injury-substitution rule could be helpful by taking away the temptation to keep an injured player in the game.
    I believe someone mentioned this on the original article, and it seems like a good idea to me.

    I’m glad the kid is ok.

  4. Kudos to Philly Soccer Page for following up on this! Just want to say as a practicing Athletic Trainer (ATC)… concussions, while we are trained very well and are on the forefront of signs, symptoms and special tests to help us, are a struggle to diagnose during in game situations. There are countless times where as an ATC you see a mechanism of injury, head hits the ground, head to head and when checking the player, he/she is perfectly fine, pass all the tests answer all the questions and then they come in the next day complaining of a headache or other signs and symptoms. It certainly helps when you know your athletes. Concussions vary so much from person to person it is difficult to put one or even a few tests to make them standard which is why examination for a concussion is/should be a 5 – 10 minute process. One of the easiest test is physical exertion. There is so much more to be said about concussions in sports currently and how ATC and team physicians go about treating and diagnosing them so I will leave it at this; Soccer is one of the worst sports for establishing in game concussion protocols. If you pull a player off, your team goes a man/woman down or possibly loses a substitution, it creates a terrible environment for proper concussion testing to be put into place. Soccer needs a “concussion sub”, one designated player that can come on and off if a player needs to be tested for a concussion. Obviously that solution is not a fool proof by any means but I think it would help change the environment and help medical professionals intervene when necessary.

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