All sports worldwide in recent years have started to take concussions and their impacts on players more seriously – and football is no exception.
This is from the grassroots level where heading a ball before a certain age is banned, right up to the professional leagues where we are beginning to see the implementation of concussions substitutions.
While the details vary between leagues, concussions substitutions allow teams to replace a player who is showing signs of suffering concussion without using one of their allocated substitutions.
It is designed to get teams to consider player welfare over the team as a whole, but does it work as planned?
MORE: World Cup 2022 injuries tracker
Are there concussions substitutions at the World Cup?
FIFA confirmed before the World Cup that concussion substitutions would be allowed at the 2022 World Cup – the first ever to have them in place.
There have long been calls for the competition to have concussion substitutions so that teams would not jeopardise the health of their players in the pursuit of winning a World Cup game.
The issue became prominent in football circles during the 2014 World Cup Final, when German midfielder Christoph Kramer sustained a head injury after failing to leave the field after receiving a knock to the head and exhibiting concussion symptoms. Referee Nicola Rizzoli revealed that Kramer came up to him during the match and asked him if he was in the World Cup Final, at which point Rizzoli informed the Germany team and replaced him.
The situation caused much debate and highlighted a need to take concussions more seriously and to have procedures in place to avoid these incidents occurring.
What is FIFA concussion protocol at World Cup?
FIFA's official concussion protocol dictates that: “If there are signs or symptoms of damage to the brain, or a concussive injury is suspected despite the absence of signs or symptoms, the doctor/therapist should remove the player from the pitch for a more detailed examination (using a concussion substitute if available/required).”
While this is a good theory in practice, as a directive to medical officials that forces them to take a safety first approach, there is still no requirements for any independent medical examiners to provide assessments as to whether players are fit to continue playing after a head knock.
Which leagues have concussion substitutions?
After the concussion substitution was first introduced by FIFA at the 2021 FIFA Club World Cup on a trial basis, many top leagues around the world officially adopted concussion substitutions as part of their rules.
The English Premier League, France's Ligue 1, and the MLS are all leagues that quickly adopted the concussion substitution in and around 2021.
The first instance of the concussion substitution being used in English football came on February 6, 2021 when West Ham's Issa Diop was substituted at half-time after receiving a head knock during a match. He continued to play initially, however after further assessment in the locker rooms he was deemed not fit to play and was replaced without havig one of West Ham's allocated subs taken away from them.
In the aftermath of this, the Professional Footballers' Association praised the concussion substitution rule as something that is of great benefit to players' long term health and safety while playing the game.
How many substitutions are teams allowed at the World Cup?
Not including the concussion substitution, teams are allowed to make five substitutions during a game at the 2022 World Cup at three separate intervals during a match. This is an increase from the three substitutions normally seen at a World Cup due to the continuing impacts of Covid-19.
In addition, in extra time games in the knockout rounds teams are also permitted to make one extra substitution, meaning that up to six substitutions could be made during a game if it goes to extra time.
The World Cup is moving in line with many major leagues around the world, which increased the amount of substitutes on the bench and also the amount of substitutions able to be made from three to five.
Iran's goalkeeper after clashing heads with his own defender, he tried to play on after being tended to by the medical team 😳 pic.twitter.com/uFyCDMXqrD
— ESPN FC (@ESPNFC) November 21, 2022
Iran goalkeeper head injury vs England
The issue of the concussion substitution made an immediate impact at the 2022 World Cup in England's 6-2 win over Iran.
In the first half, Iranian goalkeeper Alireza Beiranvand was involved in an awful collision with teammate Majid Hosseini, which left the keeper bloodied and bruised and also evidently disorientated, a sign of concussion.
However he was initially permitted to continue playing, though he then slumped to the floor after the game got back under way, forcing the team to replace him with substitute keeper Hossein Hosseini using the free concussion substitution. It was later revealed that Beiranvand suffered a broke nose and a severe concussion in the incident
In the aftermath of this incident, many pundits and fans slammed FIFA and the Iranian team for initially clearing Beiranvand to continue playing despite his physical state and evident symptoms of concussio.
Luke Griggs of brain injury charity Headway said: "It is an utter disgrace that the Iran keeper Alireza Beiranvand was allowed to stay on the pitch. It was irrelevant that he came off a minute later, he shouldn’t have stayed on for a second, let alone a minute. He was clearly distressed and unfit to continue."
Many believe there are still loopholes that allow for teams to coerce or allow players to continue playing even if they are showing evidence of concussion.
