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IFAB should reverse its decision on temporary concussion substitutes: César Azpilicueta’s injury proves why

In the 73rd minute of Chelsea’s bitterly disappointing defeat to Southampton, César Azpilicueta leaps to head the ball away from his team’s penalty area. Simultaneously, Southampton striker Sekou Mara attempts a bicycle kick. In the process, he catches Azpilicueta on the side of his head and the Chelsea defender collapses in a heap on the floor.

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After 10 minutes of club doctors treating the Spaniard with oxygen, he was eventually removed from the field of play via a stretcher.

Rewind back to the 19th January, the international football association board (IFAB) met at Wembley to discuss the possibility of a trial period of temporary concussion substitutions. But surprisingly, they rejected the idea.

After this incident on the weekend, are IFAB regretting that decision?

Who are IFAB?

IFAB comprises the four British football associations (England, Scotland, Wales and Northern Ireland) along with FIFA, which is responsible for developing and preserving the game’s laws.

The fact that only four football associations, along with FIFA who have four votes themselves, decide the rules for every country is a complete lack of representation of the so called ‘global game’.

Luke Griggs, chief executive of the charity Headway, said to Sky News it was ‘hard to fathom the flawed logic’ behind the decision.

Mark Bullingham, the Football Association chief executive, who was in the meeting, said ‘there were very strong and different views in the room, and we didn’t reach a consensus.’

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Bullingham, who has come out and supported the idea, also conceded there was now no chance of a trial taking place next season in the Premier League. The focus instead would be on implementing a permanent concussion substitution protocol.

The focus of IFAB board members, Patrick Nelson (IFA), Ian Maxwell (SFA), Noel Mooney (FAW) and Fatama Samoura (FIFA) along with Bullingham seemed to be on other agendas. In the same meeting, an agreement was struck on the referee’s ability to communicate his decision after VAR reviews. Surely, the health of elite players should be a higher priority than creating a better spectacle for fans?

Lack of concussion statistics at an elite level

What supports this theory is the frightening lack of concussion statistics at an elite level.

According to the drake foundation, which focuses on the short and long-term effects of head injuries in sports, no official statistics on concussion rates are released in professional English football.

Compare this to the RFU. Their website has a document highlighting the most common injuries during matches and training. Much clearer and more concise information like this, allows stakeholders the ability to address areas of concern.

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The FA’s motto for concussion guidelines is ‘if in doubt, sit them out’. With the rejection of concussion substitutes, this motto now seems lazy and almost as if they’ve put the slogan out just to tick a box to look like they are actively pushing for more stringent concussion guidelines. In turn, it sends mixed messages to club doctors and players alike. Do they really care?

The importance of temporary concussion substitutes

One person who was surprised by the decision making of IFAB around temporary concussion substitutes is Nathan Howarth, the development and operations manager at Concussion Legacy Foundation UK (CLF).

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Howarth spoke to the Sports Gazette to say ‘We had attended a session a few weeks prior to the proposals to go in with various different people around the room, the FA, PFA, and PL and we were really quite surprised that there was an outright no. We kind of expected that it might wait until a later date to have those discussions but to have the outright no was particularly difficult and problematic.’

He says, ‘We’re putting doctors under pressure by saying that they have a two to three minute window on pitch side to make these decisions on, which is actually really inappropriate for most clinicians.

In no other setting are we asking people to make such a judgment call. I understand some positions that people have had, and we suspect that it’s around the optics around the other end of the game. But I think what we’ve done by not having temporary substitutes is devaluing the seriousness of concussion.’

How long does it take?

Concussion substitutes have been a hot topic of discussion for several years.

Back in 2021, the Premier League agreed to trial IFAB’s additional permanent concussion substitutes. If a player was suspected of having a concussion, one club doctor would enter the field of play to make an assessment. Whilst another doctor on the bench would review video footage of the incident.

Although this action was a small step in the right direction, there has been a lack of action to follow it up.

When asked why it’s taken so long for discussions and action around temporary concussion substitutes, in comparison to other sports, Howarth responds calmly, ‘I think the difference in different sports is the nature of their play.’

He elaborates further by saying, ‘the concussion rate in rugby is significantly higher and the optics are so much more prevalent. With exception of the most recent World Cup where we saw three or four high profile examples in quick succession and particularly everyone thinks about the Iranian goalkeeper.

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We’ve also got the example from Wales vs England game (at the World Cup). Those moments are becoming increasing because of the attention that has been drawn to it.

There seems to be different journey’s that sports culturally take along this concession recognition path. By no means does rugby get it right. I think they are ahead of the curve. But, I will say that football is going on an accelerated journey.

The recognition and the positions that organisations are taking is much better than some we’ve seen in rugby. Most stakeholders are supportive of temporary concussion subs and are looking at how we best utilise this across different contexts shows the commitment football now has.’

Thankfully, since Azpilicueta’s injury, he has since released a statement via Twitter to let the world know he is ok.

But, this should be a stark warning to IFAB that they should reverse that decision quickly.


  • George Yates

    Sitting in the best seat in the house. Looking forward to covering a wide variety of sports for the Sports Gazette.