MLS, NWSL, USL all join FIFA’s concussion pilot program

Concussion-related injuries have long been a thorny issue in soccer, especially given the limited number of substitutions allowed per FIFA regulations. With only three substitutions allowed per game prior to the Covid-19 pandemic, a suspected concussion was often overlooked or brushed aside after a cursory examination. But given the evolving science on head injuries, leagues are taking the issue more seriously.

And now, the major North American soccer leagues are joining a new initiative which hopes to mitigate cases where a team may feel the need look past a potential concussion-related injury.

Starting in 2021, Major League Soccer (MLS), the National Women’s Soccer League (NWSL), the United Soccer League (USL) and National Independent Soccer Association (NISA) will join FIFA’s pilot program, which will allow for additional substitutions due to suspected head injuries that occur during play.

A concussion task force comprised of sporting and medical leaders from MLS, NWSL, U.S. Soccer, the USL, and NISA, worked together create and implement the initiative, which was approved by The IFAB and FIFA.

Starting this season, MLS teams will be allowed to make up to two concussion substitutes during a match to replace players suffering from a concussion or a suspected concussion, whether a team has substitutions remaining or not.

According to a release from the league, MLS teams will have the following three types of substitutions available each game, which could theoretically allow a team as many as nine in a match:

• Normal Substitutes: A continuation from 2020, each club has five normal substitutes available to make over three separate opportunities. throughout an MLS match. Any substitutions made during halftime, or between regulation and extra time, or between the two halves of extra time in the postseason will not count as one of the three opportunities.
• Concussion Substitutes: Each team will be permitted to make up to two concussion substitutions only during instances of suspected concussions. A concussion substitution can be made immediately after a concussion occurs or is suspected, after an on-field assessment, and/or off-field assessment, or at any other time when a concussion occurs or is suspected. This includes when a player has previously been assessed and has returned to the field of play.
• Additional Substitutes : If a team uses a concussion substitution, the opposing team will receive an additional substitution that will be available to use only after all five of its normal substitutions have been made. If a team makes a second concussion substitution, the opponent receives another additional substitution opportunity.

A “concussion substitution” may be made:

• immediately after a concussion occurs or is suspected;
• after an on-field assessment, and/or after an off-field assessment; or
• at any other time when a concussion occurs or is suspected (including when a player has previously been assessed and has returned to the field of play).

According to the release, each club’s technical staff will be responsible for designating the substitution type by providing the Fourth Official with the appropriate color substitution card: white for a normal substitution, pink for a concussion substitute, and blue for an additional substitute.

Referees remain in charge of the decision to stop play if they suspect a head injury. However, they will not determine whether a player should be replaced, nor decide what type of “substitution” should be used.

The potential benefits of the program are apparent, in that it will relieve teams of the pressure of leaving concussed players in the game for fear of playing down a man for significant periods of time. It will also allow those players to get immediate and thorough treatment, potentially speeding up recovery time.

The pilot program has initial trial period of 20 months, concluding on Aug. 31, 2022. However, IFAB has the opportunity to extend the trial period at its Annual General Meeting in March 2022.