Why introducing temporary concussion replacements into football would be the right move

Dr. Adam White is the Chief of Brain Health at the Professional Footballers’ Association.

in world Cup Full of standout moments, there was one early in the tournament that grabbed more attention than most.

Iran guard Alireza Beiranvandin his team’s opening match with England, suffered a violent, high-speed clash of heads with one of his teammates. Sitting on the grass with his swollen, bleeding nose badly on his set, Beeranvand was treated for several minutes on the field by the medical staff. Even though he was in a state of extreme annoyance, he was allowed to continue.

The game had barely resumed before Beeranvand took matters into his own hands and signaled to the bench that he would need to be replaced (top photo). Taking to social media, the global TV audience had one question: How was this allowed to happen?

This event, along with a series of other high-profile head injuries and concussions on football’s biggest stage, has focused minds on the need to look again at how the game can best protect player safety.

The International Football Association Board (IFAB) is meeting for its annual business meeting in London today (Wednesday). IFAB, the body responsible for approving changes to the Laws of the Game, is made up of the football associations of England, Wales, Scotland and northern Ireland. FIFA Provides the final board member.

At that meeting, members will consider a request to allow trials of interim concussion replacements to begin. The app is supported by many of the leading leagues and players’ associations, including the Professional Footballers’ Association (PFA) and the Premier Leagueand their global organizations, the World Leagues Forum and FIFPRO.

The app reflects the view that more can be done across the game’s concussion protocols to protect players and support paramedics.

As the Players’ Association of England, the PFA has long campaigned for the introduction of temporary concussion replacements, whereby a player with suspected concussion could be taken off the field for examination and temporary replacement. If, after an off-field assessment, the medical staff feel the player is safe to return to the match, their team will have the option to send them back, with the temporary substitute out. After a previous series of concussions, the PFA wrote to the IFAB at the start of 2021 urging them to make this change.


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Under current protocols, if a player leaves the field for concussion assessment, the game continues, with either the player having to be replaced permanently and unable to return, or playing with his team at a disadvantage.

Aston Villa’s Emiliano Martinez was hit in the head in a match in October. He played after field checks before he was eventually taken on the move (Picture: Serena Taylor/Newcastle United via Getty Images)

The result of this approach is that concussion assessments are done on the field with play interrupted. Medical teams, managers and players are required to make decisions under time pressure as the game is suspended in front of packed stadiums and perhaps – as we have seen in Iran Against England – Huge TV audience watching at home.

The theory behind preferring permanent concussion alternatives is that it provides a more straightforward approach. The message is “if in doubt, leave them.”

This is absolutely true and should remain the basic principle of any player evaluation.

However, in pursuit of that goal, shouldn’t we give those involved in that decision all the tools they need to make that decision? This includes working to eliminate “game factors”, environmental challenges and human behaviors that may be at play at the moment, as best we can.


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The PFA believes that allowing players to be removed from the field for evaluation through a temporary concussion replacement system is an effective way to reduce those pressures. It is an approach that has already been adopted by other sports.

A concern sometimes raised about the introduction of temporary concussion replacements is that the necessary resources and structures, in terms of factors such as medical support and facilities, cannot be implemented across the game but only at the elite level.

There will, of course, be required for a pragmatic and sensible approach to how to effectively introduce new protocols at different levels of the game, taking into account available resources and facilities. But these things cannot be overcome. Ultimately, across the board, the game should adapt what it believes is best for player safety, not the other way around.

In a world where VAR and other gaming technologies are limited to just a few leagues and divisions, it’s also hard to argue that the inability to achieve uniformity across football should be enough to stop a change in its tracks. This is especially true in the case of player safety.

The momentum behind temporary concussion substitutions is now as strong as ever, with consensus from players’ associations and leagues. The football associations that make up the IFAB now have an opportunity to be proactive in addressing this.

Football’s unique global reach and influence means that it must take the lead in making player safety measures as effective as possible. She should not allow herself to be seen as being left behind.


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(Top photo: Katherine Ivel/Getty Images)

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