MLS pushes to pioneer temporary concussion substitutes in 2023

Elias Manoel of the New York Red Bulls undergoes a concussion protocol evaluation by the team medical staff on Oct. 15, 2022. (Photo by Ira L. Black - Corbis/Getty Images)
Elias Manoel of the New York Red Bulls undergoes a concussion protocol evaluation by the team medical staff on Oct. 15, 2022. (Photo by Ira L. Black - Corbis/Getty Images) (Ira L. Black - Corbis via Getty Images)

Major League Soccer could become the first professional soccer competition to allow temporary concussion substitutions, pending a potential vote by the sport’s global rule-making body next week.

The International Football Association Board, which determines and regulates the laws of the game, will meet Jan. 18 in London. On its agenda, according to two sources familiar with discussions, is the issue of temporary subs, which have been the subject of an escalating push by some leagues and players’ unions.

The global players’ union, FIFPRO, and the World Leagues Forum, an organization representing 45 top-flight men’s leagues spanning six continents, wrote to the IFAB last month to “urge” it to permit trials of temporary substitutions, which would allow doctors to more thoroughly assess players in cases of suspected concussion.

The IFAB and FIFA, soccer’s global governing body, previously resisted similar advocacy, but in recent months, the push has gained force. While many of those 45 leagues have not actively called for temporary subs, FIFPRO and the WLF wrote that MLS and the MLS Players Association “are ready to start [a temporary concussion subs] trial by the beginning of their upcoming season.”

The letter, which was obtained by Yahoo Sports, also stated that England’s Premier League and France’s Ligue 1 were ready to implement the change at the start of their 2023-24 seasons in August. (Premier League CEO Richard Masters and MLS commissioner Don Garber both sit on the WLF’s three-member management board.)

For now, soccer remains the world’s only prominent contact sport that does not, under any circumstance, allow a substituted player to reenter a match.

The debate over concussion subs

In late 2020, growing concerns related to brain injuries compelled the IFAB to permit permanent concussion substitutions — an extra sub, specifically for a player who has suffered a head injury, beyond the three or five already allotted. But this solution simply “hasn’t worked,” Adam White, the Concussion Legacy Foundation’s UK executive director, told Yahoo Sports last year. In most leagues and competitions, return-to-play decisions remain in the hands of team doctors, who often feel explicit or implicit pressure to send players back onto the field. There is often no independent oversight and no punishment when protocols aren’t followed.

The permanent substitutions “don't change the parameters for the decision-making substantially, in the moment,” Jonas Baer-Hoffmann, the secretary general of FIFPRO, said Wednesday on a video call.

Temporary subs, on the other hand, would ease the time pressure on in-game examinations because teams wouldn’t have to play 10-v-11 while an affected player is evaluated. Those players could escape from the chaos of a match to the quiet of a medical room while a teammate takes their place. The temporary subs would “allow healthcare professionals to conduct more comprehensive assessments,” a wide range of advocates wrote in a letter last year, “and send an important signal to every person in the game to treat head injuries with the necessary care.”

The IFAB and FIFA, in the past, have essentially argued that temporary subs are an imperfect solution; advocates acknowledge this but say it would be better than the status quo.

The IFAB also “takes the view that they should make rules that can be applicable throughout the pyramid of football, on every level,” Baer-Hoffmann said Wednesday. “To which we just respond, that is fine if they're not feasibly applicable on every level. That is OK, but that should not deprive you of having safer rules on those levels where it is possible to apply them — and clearly on the professional level, where you have licensing standards that require you to have medical personnel available, we think it is feasible to apply them.”

An LED board shows the suspected concussion message during a World Cup match between Argentina and Saudi Arabia on Nov. 22, 2022. (Photo by Catherine Ivill/Getty Images)
An LED board shows the suspected concussion message during a World Cup match between Argentina and Saudi Arabia on Nov. 22, 2022. (Photo by Catherine Ivill/Getty Images) (Catherine Ivill via Getty Images)

Besides, Baer-Hoffman argued, what the IFAB could codify is not a requirement. If it votes to approve temporary subs, individual leagues and competitions — such as MLS — would then be able to decide on their own whether to implement them. Each league would also need to determine specific protocols — for example, the length of the temporary sub and the deadline by which a team must decide to either replace the player permanently or send the player back into the game.

Currently, IFAB’s laws prohibit any sort of trial of a temporary substitution protocol.

“What we've been asking for,” Baer-Hoffmann said, “is not that all of football applies temporary concussion substitutions as of tomorrow, but that in countries where leagues and unions are finding agreements to do so and to trial them, they're basically not prevented from doing so.”

Baer-Hoffmann and Alexander Bielefeld, FIFPRO’s director of policy and strategic relations for men's football, clarified that many leagues are not yet ready or have no interest in doing so.

“There was no consensus view,” Bielefeld said. But, he said, compared to previous discussions about concussion policies, there has been “a substantial change in how leagues and unions have cooperated on that in the past months, and that has significantly changed the landscape.”

MLS’s concussion sub plans depend on IFAB politics

IFAB is governed jointly by FIFA and the four British football associations: the national governing bodies in England, Scotland, Northern Ireland and Wales. Leaders of those four federations reportedly plan to meet next week, prior to the annual IFAB business meeting, to craft a joint position on concussion substitutions. The English FA, the most powerful of the four, is a known proponent of temporary subs.

Complicating their decision-making process, though, is a quirk of IFAB governance: The British FAs could vote to approve a trial next week. FIFA could then, in theory, overrule them at IFAB’s annual general meeting in March.

At the business meeting — which typically takes place in the fall but was pushed back until after the 2022 World Cup — each of the five organizations that sit on the IFAB board gets one vote. And when they vote — often on business matters but occasionally on trials, such as trials of concussion subs — they need only a simple majority for approval.

At the AGM, however, each of the British FAs gets one vote, while FIFA gets four, and they need a three-fourths majority to ratify any new law.

One source, citing this quirk, suggested that the British FAs likely wouldn’t force through a vote next week if FIFA weren’t on board. In the past, FIFA has opposed temporary subs. FIFA spokespeople did not immediately respond to an email asking whether that stance has changed.

If there is no vote next week, there still could be one March 4 at the AGM — a week after the MLS season has started. On behalf of MLS, FIFPRO has pushed for a green light from IFAB before the 2023 season kicks off Feb. 26.

One source, however, said MLS would be willing to implement temporary concussion subs midseason — or whenever IFAB allows it to.