Arguments over concussion protocol are an ongoing headache for football

The Guardian

March 3, 2024

Three years of trials have led to permanent concussion substitutes being added next year but not everyone in the game agrees

From next season the use of permanent concussion substitutes is to be added to the laws of football. The culmination of three years of trials in the men’s game, the decision is a “very important step”, according to Fifa’s general secretary “ad interim” Mattias Grafström, one based “on data and also medical advice”. It’s fair to say not everyone in football agrees.

For the Premier League, players’ unions PFA and FifPro, and a number of national associations, the decision taken by football’s lawmaking body, the International Football Association Board (Ifab), during its AGM at the weekend was a rebuff. All welcomed the addition of the new law, but had wanted further action – namely a trial of temporary concussion substitutes.

This method of dealing with suspected concussions, removing a player from the pitch for 15 minutes while they are assessed (and removing them permanently from the match if there is concern), is the one they believe most likely to be effective at the elite level of the game. Letters were written to Ifab before the meeting urging them to take up the trials. For at least the third time in the past two years, that request was declined.

Gianni Infantino, the Fifa president, was in town for the AGM. He did not attend the post-meeting press conference, instead taking in a Scottish Premiership match between St Mirren and Aberdeen. But the night before he had made some impromptu remarks on the topic. “We will not introduce temporary concussion subs, because we care about the health of the players,” he said.

“If you want to care about the health of the player, then the player [goes] out and another player comes in, and that’s the end of it. All the rest is not protecting the heads of players, just making some PR announcements.”

At the least, Infantino’s remarks were an undiplomatic way of addressing a serious issue on which there are sincerely held differences of opinion. The private response of those seemingly accused of preferring PR over player health bordered on the incandescent. After the dust has settled a familiar question remained unanswered, meanwhile: is football taking concussion seriously enough?

For a decision based on data, Ifab says it struggled to establish the facts of its permanent concussion substitute trials. “It’s been difficult to gather data on it, and that’s been part of the challenge of the trial,” said Ian Maxwell, the chief executive of the Scottish Football Association, who sits on the Ifab board.

Furthermore, the cumulative figures – with approximately 650 concussion substitutes used across 317 competitions over three seasons – does not suggest the most vigilant approach to the trial. Academic studies of the men’s 2016 European Championship and 2018 World Cup found that potential concussive events occurred at a rate of more than one a match. The trial results suggest such instances occurring less than once a season (it should be noted, though, that trial competitions vary in length with the Community Shield being one of the 317).

If there is a question over how effectively the trials were applied, there’s also doubt over how many competitions will apply the protocol now it is law. The introduction of permanent concussion substitutes will not be mandatory but instead down to competition organisers, with Grafström comparing the process to the decision over whether to have five substitutes in a match or three. “As the Ifab body we set out the options for the competition organisers but then it’s up to them to apply it or not,” he said.

There is an argument for permanent concussion substitutes; that it is the most direct way of reducing risk. “If in doubt, sit them out” is a mantra on which everyone agrees and removing a player permanently eliminates the possibility of an assessment producing a false negative result and a player being sent back on to the pitch at risk of further injury. On the other hand, temporary substitutes guarantee the minimum recommended time for conducting a concussion assessment and they remove players and doctors from the glare of coaches and fans and the possible incentive to keep playing on.

“Even amongst medics there are differences of opinion, with some leading on the permanent model and saying in theory that is safer because even at the point of an assessment they are removed permanently”, says Mark Bullingham, chief executive of the English Football Association and another of the home nations executives who share half of the voting rights on the Ifab board. “The argument in favour of temporary is whether that is really working.”

While there are arguments for and against both kinds of substitute protocol, only one has been trialled, while the other has been dismissed as a stunt by the head of Fifa. It gives the sense that politics, rather than concern for player safety, is at work. Reminiscent of the debacle over rainbow armbands in Qatar, or the blue card which was also nixed after a personal intervention from Infantino, there seems to be a trend of ideas which originate from outside the president’s office being dispatched with extreme prejudice. As long as this situation endures, football is not doing all it can to limit concussion.

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