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Home » Football » Concussion Substitute in Football: Meaning, Rules, and How It Works

Concussion Substitute in Football: Meaning, Rules, and How It Works

Football / By /
Arsenal's Brazilian defender David Luiz (L) and Wolverhampton Wanderers' Mexican striker Raul Jimenez lay injured and coach made Concussion Substitute.
(Credit: Getty Images)

What is a Concussion Substitute?  

The concussion substitute meaning refers to a special type of substitution in football that allows a team to permanently replace a player who has suffered an actual or suspected concussion. This substitution is made outside the normal limit of substitutions, ensuring the player’s safety without penalizing the team numerically.  

IFAB officially introduced this protocol to put player welfare above tactical concerns. Unlike regular substitutions, a concussion substitution is about medical protection, not strategy.

Why were concussion substitutes introduced?  

Football’s governing body, the International Football Association Board (IFAB), introduced concussion substitute protocols to prioritize player welfare. The rule ensures that any player with a potential head injury is removed from the match to avoid further risk. Teams are not forced to play with fewer players due to medical precautions, maintaining fairness in the game.  

How serious is a concussion injury?

A concussion is a very serious injury because it is a mild traumatic brain injury (TBI). While often called “mild,” this refers to it not being life-threatening in most cases, not that the effects are minor. It disrupts the brain’s normal functioning, which can have significant short and long-term consequences.

Think of the brain like a soft, delicate organ floating in protective fluid inside your hard skull. A concussion occurs when a blow to the head or body causes the brain to shake or twist rapidly inside the skull. This sudden movement can stretch and damage brain cells and create chemical changes that make the brain work improperly.

Concussion Substitute Rules  

The concussion substitute rules are designed to be straightforward and protective. Here are the key points:  

1. Number of Substitutes: Each team can use up to one concussion substitute per match. In some trials, such as in the Premier League during the 2020/21 season, teams were allowed two concussion substitutes per match.  

2. No Impact on Normal Substitutes: A concussion substitution does not count toward the regular substitution limit. For example, even if a team has already used all its permitted substitutes, it can still make a concussion substitution.  

3. Opponent’s Right to an Additional Substitute: When a team uses a concussion substitute, the opposing team is granted the option to make one additional substitution for any reason. It ensures that neither team gains an unfair advantage.  

4. Permanent Removal: The replaced player is not allowed to return to the field under any circumstances, including penalty shoot-outs.  

5. Medical Assessment: Team doctors have sufficient time to assess the player on the field. A tunnel doctor may also review video footage to assist in diagnosis.  

How Does the Concussion Substitute Process Work?  

The process is designed for clarity and safety:  

AspectRule 
PurposeTo permanently replace a player with an actual or suspected concussion without penalizing the team’s substitution count.
Subs Allowed1 per match (Some trials allowed 2, but the permanent IFAB law is 1).
Counts toward normal subs?No. It is made independently of the regular substitution limit.
Opponent’s RightThe opposing team is granted the option to make one additional substitute (for any reason) to maintain competitive fairness.
Player’s StatusPermanently removed. The player cannot return to the field of play or participate in a penalty shootout.
Step 1: IncidentPlay is stopped by the referee after a player sustains a head injury or shows signs of concussion.
Step 2: AssessmentTeam medical staff enters the field to assess the player. A neutral “tunnel doctor” may review video footage to assist.
Step 3: DecisionIf a concussion is confirmed or suspected, the team informs the referee of the intention to use a concussion substitute.
Step 4: NotificationThe opposing team is notified of their right to an additional substitute, which can be used immediately or later.
Post-MatchThe concussed player must undergo a formal medical assessment. A report is filed with the league before their return.

1. Incident Occurrence:  

  • If a player sustains a head injury or shows signs of concussion, the referee may stop the game.  

2. Medical Evaluation:  

  • The team’s medical staff enters the field to assess the player.  
  • A tunnel doctor may review video evidence simultaneously.  

3. Substitution Decision:  

  • If concussion symptoms are clear or video evidence confirms suspicion, the team can opt for a concussion substitute.  
  • The team informs the referee or fourth official, often using a distinctly colored card (e.g., green or pink) to signify the type of substitution.  

4. Opponent’s Additional Substitute:  

  • The opposing team is notified of their option to make one additional substitution, which can be used immediately or later in the match.  

5. Post-Match Protocol:  

  • The concussed player undergoes a formal medical assessment after the match.  
  • Clubs must submit a report to the league within seven days of the player’s return to training or play.  

Role of Match Officials  

Match officials, including the referee and fourth official, play a supportive but non-decisive role:  

  • They do not determine whether a player is concussed.  
  • They ensure that the substitution procedure is followed correctly.  
  • They may delay the restart of play to allow for a safe and thorough assessment.  

Case Examples

  • In November 2020, Raúl Jiménez of Wolverhampton Wanderers suffered a severe head injury in a collision with David Luiz. At that time, concussion substitutions were not in place, sparking a strong debate. The incident accelerated the push for trials in England.
  • In the Women’s Super League, several early concussion substitutions highlighted how the protocol protects athletes from being pressured into continuing.

Global Implementation and Trials  

The concussion substitute rule was trialed in multiple leagues, including the English Premier League, Major League Soccer (MLS), and the Women’s Super League, before being officially incorporated into the Laws of the Game in March 2024.

Although some leagues and player unions advocated for temporary concussion substitutions (where a player could return after assessment), the permanent substitution model was adopted to prioritize caution and player safety.  

Last Words

The introduction of the concussion substitute is a crucial advancement in modern football. It clearly demonstrates the sport’s evolving commitment to player welfare above all else. The concussion substitute meaning is rooted in protection—ensuring that no athlete is ever pressured to play on with a potential brain injury.

The concussion substitute rules are designed to be both fair and effective. They safeguard the health of the player while maintaining the competitive balance of the match by granting an additional substitution to the opponents. This protocol ensures that a team does not gain an unfair numerical advantage from a serious medical incident.

As this rule continues to be implemented globally, it sends a powerful message: safety must always come first. The concussion substitute is more than just a rule change; it is a fundamental part of football’s future, ensuring the game is safer for everyone who plays it.

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