PREMIER LEAGUE WANTS TO INTRODUCE RUGBY-STYLE CONCUSSION SUBSTITUTES
The Premier League is lobbying lawmakers to finally approve trials of rugby-style temporary concussion substitutions.
England’s top tier is among 28 competitions applying renewed pressure in a letter to the International Football Association Board (Ifab).
Premier League clubs are currently allowed to make one permanent concussion change per match which does not count against their usual substitution limits. However, critics argue that by forcing medics to make a decision on the pitch they are endangering players, as there could be a natural tendency to want to avoid removing a player if concussion is not certain.
The Premier League, which has been calling for temporary substitutes for years, is also submitting a formal request for a trial, with support from the EFL. Competition executives are understood to have told Ifab that medical and scientific evidence supports the need to revisit the law. The letter will be discussed at Ifab’s annual business meeting on Tuesday, it is hoped.
Temporary substitutes were previously opposed by Ifab in 2023. “While we note that a trial has not been dismissed, we remain convinced it should go ahead at the earliest possible opportunity in the interests of player welfare,” the league said at the time.
Brain injury charity Headway also criticised Ifab’s stance, insisting the current law places unnecessary pressure on players and club medics.
To mitigate concerns this time, the league is proposing that both teams would be allowed to make additional substitutions to ensure the law is not abused.
What is the current situation?
In recent years, Premier League teams have been permitted to make one concussion substitution which does not count against their usual substitution limits. However, the decision as to whether a player is suspected of having a concussion still has to be made on the pitch.
The Premier League, along with the Professional Footballers’ Association and FifPro, the global players’ union, want a temporary concussion substitute who could be brought on for 10 or 15 minutes while the potentially injured player is assessed in an off-field environment. That system is widely used in elite rugby union and league.
Medical and scientific evidence
Supporters of temporary subs point to research showing that between 27 per cent and 53 per cent of players diagnosed with a concussion are not immediately removed from play.
In rugby, that proportion has fallen from 58 per cent of players to eight per cent. In the NFL, less than two per cent of players diagnosed with concussion were returned to play.
In June 2023 the Concussion in Sport Group (CISG) “strongly advised” sports organisations to permit temporary subs.
Practical considerations
In 2023, the league was left disappointed as Ifab voted against trialling the system amid concerns it would cause an added layer of complication. Fifa president Gianni Infantino said at the time that the decision to reject a trial had been taken to prioritise players’ health and ensure “zero risk” in such scenarios.
The Premier League has promised to reduce any concerns by helping to assist with research. The league is understood to claim it has developed a regulatory framework to ensure temporary subs are not misused to gain a competitive advantage.
To mitigate concerns, both teams would be allowed to make additional substitutions to ensure the law is not abused.
An oversight group would also help review video footage to ensure there was “a legitimate basis for removing the player for an assessment”.
What’s next
The Premier League has offered to meet with Ifab to discuss a trial. Ifab could then progress the discussion of a trial at its annual general meeting – potentially with an approval for the league to start planning this year. If the request is rejected by Ifab, the Premier League would request detailed rationale on that decision.
Football can learn from rugby but process not foolproof
The first introduction of temporary substitutions for suspected concussions in rugby union came as a trial protocol in 2012. This forerunner to the current head injury assessment (HIA) was called “pitch-side concussion assessment” and allowed a player to leave the field for five minutes to be assessed and be replaced.
After a couple of seasons of refinement, the HIA was incorporated into the laws of the game in 2015, with the change legally allowing for temporary substitutions in elite adult rugby. Current regulations state that a player must be taken off for an HIA if they display a clear sign of concussion (e.g. loss of consciousness, or dazed or confused behaviour), in which case they are permanently removed from the match.
If a player experiences a head impact which has a potential for concussion and is identified by match officials, team medical staff, or independent match-day doctors – including via video review or instrumented mouthguard data – they must leave the field for an HIA. It is a multi-stage process. The first stage sees the player undergo a clinical evaluation including video review, objective measures and mouthguard data, with a fixed minimum assessment time of at least 10 minutes. There is a further assessment later in the day to check for symptoms and a third up to 48 hours after the event.
If concussion is diagnosed, players must complete an individualised return-to-play protocol – based on symptoms shown, a players’ history of concussions and their speed of recovery from any previous concussions, with most players not permitted to return to playing for at least 12 days.
The process is not foolproof for a number of reasons. There have been instances when mouthguards have picked up “collisions” which have been disputed by the player and forced a player to go for an assessment. The reliance on technology and camera footage/angles can lead to head impacts being missed or misreported. The cognitive tests can sometimes be passed by a player desperate to return to action.
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2026-01-18T19:00:45Z