Concussion protocols in English football explained

Medical practices in the world of football have come a long way since a wet sponge was treated as a universal cure. Now there is a cold spray.

But the world’s most popular game consistently comes under fire for its relatively reductive approach to dealing with concussion injuries compared to other contact sports, with rugby union often upheld as significantly superior.

IFAB, the governing body which decides football’s laws, have been urged to reconsider their rejection of the Premier League’s proposed changes to the current structures.

With calls for changes in the air, here’s everything you need to know about the current concussion protocols in English football.

Pledgeball’s Katie Cross & Canaries Trust’s Sarah Greaves join Shebahn Aherne to have football’s climate conversation about the success of Green Football Weekend. If you can’t see this embed, click here to listen to the podcast!

According to the Centres for Disease Control and Prevention (CDC): “A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.”

Across a 90-minute match, players repeatedly find themselves in situations where head injuries, including concussions, can occur. In the Premier League last season, there were 11,717 aerial duels contested (per FBref).

Concussion symptoms can include, but are not limited to: “headache or ‘pressure’ in head; nausea or vomiting; balance problems or dizziness, or double or blurry vision; bothered by light or noise; feeling sluggish, hazy, foggy, or groggy; confusion, or concentration or memory problems”.

The English Football Association‘s concussion guidelines opens with the decree: “Footballers who sustain a suspected concussion, either during training or in a game, should immediately be removed from the pitch and not allowed to return until the appropriate treatment has been administered.”

Essentially, precaution should be prioritised, as alluded to by the slogan the FA have adopted: “If in doubt, sit them out.” If there is confirmation that an individual lost consciousness during the match, “the player must be removed from the field of play, and not be allowed to return.”

Players undergo neuro-psychological testing at the start of each season to act as a baseline for comparison if they are suspected of suffering any head trauma. If a player already has a history of two or more “documented concussive episodes” then they are required to undergo a more thorough inspection.

Referees are instructed only to stop play if “a player is seriously injured or receives a head injury”.

The biggest change to the concussion protocol in recent years comes in the form of concussion substitutes.

In February 2021, IFAB approved a joint appeal from the FA and the Premier League for the trial of permanent concussion substitutes. The scheme has continued since with each team allowed to make a maximum of two changes for players that either show clear symptoms of concussion or there is clear video evidence of a concussion.

Once a player is substituted off under these protocols, they are not allowed to return to the field of play but the opposition team is granted another substitute so that neither side is at a numerical disadvantage by prioritising player welfare.

The Premier League, backed by MLS and Ligue 1, appealed to IFAB in December to trial temporary concussion substitutions. The proposal suggested that a player suspected of a concussion be removed from the pitch and replaced by a teammate. The individual in question could then be inspected for a short period in the quiet of a dressing room before deciding whether they will be allowed to return, giving the medical team more time to make an informed diagnosis without reducing one side to ten players.

IFAB rejected the appeal in January but have been urged to reconsider by the world players’ union FIFPRO when it gathers at its annual general meeting on Saturday, 4 March.

The revamped concussion protocols, headlined by permanent concussion substitutions, were introduced “following extensive consultation with medical experts and National Associations to find ways to improve management of possible neurological head injuries in football matches” according to the Premier League.

Calls for temporary concussion substitutes have been made by England’s players union, the PFA, which argues that “the current rules…are not providing adequate protection for players”.

Head of the PFA’s dedicated Brain Health department, Dr Adam White stated: “Put simply, the current laws of the game are jeopardising player health and safety.

“Permanent substitutions do not allow medical teams to assess a player with a potentially serious brain injury in an appropriate environment. The rules, as they are, create an extremely challenging situation and offer no support to medical personnel.”