Head Injuries in Sport

Despite backing from various high-profile organisations such as The Premier League, the Football Association and FIFPRO (the world players’ union), the International Football Association Board (IFAB) have decided, at their recent Annual Business Meeting, against a trial of temporary concussion substitutes in the sport.

A ‘concussion’ is a type of traumatic brain injury caused by a blow to the head or by a hit to the body that causes the brain to shake back and forth inside the skull, causing damage. Whilst their effects can often be mild and cause no long-term damage to the brain, concussions can cause temporary disruption to brain function that can last for weeks. If repeated head injuries are sustained, this can lead to various irreversible neurological impairments, including early onset dementia, CTE (chronic traumatic encephalopathy), post-concussion syndrome, epilepsy, Parkinson's disease and motor neurone disease.

As the governing bodies in charge of rulemaking in ‘The Beautiful Game’, IFAB and FIFA owe a duty of care to keep participants safe from undue harm as far as is reasonably possible. This is particularly relevant when it comes to head injuries. In recent years we have seen personal injury litigation brought against governing bodies in other sports, such as the NFL in American Football and the RFU, WRU and World Rugby in Rugby Union, due to their failure to advise players of the risks of head injury and failure to ensure that the rules of the game kept them safe from harm.

Under the current rules in professional football, two permanent concussion substitutes are allowed per game. When a potential concussion injury has occurred, the team’s medical staff are brought onto the pitch to undertake an assessment. The player is then either cleared to carry on or taken off the pitch and replaced by a substitute for the remainder of the game. Under the new proposals, the player would be removed from the field for 10 to 15 minutes for the medical assessment to take place in a private environment such as a changing room, with a substitute replacing the player for that assessment period. Once the assessment is complete, the player would either be allowed back onto the field, or, if they have displayed symptoms of concussion, the substitution would become permanent for the remainder of the game.

The issue with the current response in football to concussion-based injuries was highlighted during the Qatar World Cup in 2022, with a number of high-profile incidents emphasising the lack of understanding of the seriousness of the issue. For example, in England’s Group B opener in Qatar, Iranian goalkeeper Alireza Beiranvand was substituted off 10 minutes after a clash of heads with his own defender. Beiranvand had tried to continue playing after the incident but ultimately left the pitch on a stretcher and had to be replaced. The general attitude to concussion injuries in professional football sadly appears to remain ‘play on and see how it goes’.

In a statement following their Annual Business Meeting on 18 January 2023, IFAB said:

“The Board discussed applications received from certain leagues regarding the introduction of a trial with temporary substitutions for actual or suspected concussion, but no consensus was reached. The topic remains under active review, as does the agreement to introduce measures to improve the application of the protocols drawn up for permanent concussion substitutions. The Board indefinitely extended the trial with permanent concussion substitutions.”

Whilst this statement does indicate that further consideration may be given in the future, it is disappointing to see how far football continues to lag behind other sports in its consideration of the dangers of concussion and head injury. We can only hope that these rules are amended in the near future to promote safety and security in the modern game.

For more information in relation to the devastating impact that head injuries in professional sport can have, you can listen to our podcast, The Legal Lounge from Alexander Spanner and Dawn Humphries linked here: Podcast - Head Injuries in Professional Sport