Permanent Concussion Substitutes in Football: What the IFAB Protocol Changes

Football’s Laws of the Game now allow competitions to use an additional permanent concussion substitute. The International Football Association Board approved the measure at its annual meeting on 2 March 2024, and it entered the Laws for the 2024/25 edition.

The word “allow” matters. The protocol is an option for competitions, not an automatic rule in every match worldwide. Players, coaches, medical staff, and referees need to know whether the competition has adopted it before play begins.

What the substitution does

If a player has an actual or suspected concussion, the team may remove that player permanently. The change does not count against the team’s normal number of permitted substitutions or substitution opportunities. The player who leaves cannot return to the match.

The protocol permits the substitution immediately, after an on-field or off-field assessment, or later if symptoms emerge after a player has initially continued. That flexibility reflects the fact that concussion signs can evolve and may not be obvious at the moment of impact.

The one-substitute limit

Each team may use a maximum of one additional permanent concussion substitute during a match. It can be used even if the team has already exhausted its normal substitutions.

Where the named substitutes and normal permitted substitutes are the same number, the protocol can allow a previously substituted player to act as the concussion substitute. The precise match administration remains governed by the Laws and competition rules.

Why the opponent gains an extra option

When one team uses a concussion substitute, the opposing team receives the option of one additional substitute and an additional substitution opportunity for any reason. The balancing measure is intended to reduce a tactical disadvantage that could otherwise discourage a team from making a medically cautious decision.

The opponent’s option can be used at the same time or later, subject to the protocol. It does not turn the original medical substitution into a normal tactical change.

Permanent and temporary models are different

Under the approved IFAB protocol, the affected player leaves permanently. Some sports use temporary concussion substitutions while an assessment occurs. Football’s lawmaking process trialled different approaches and selected a single permanent model for this provision.

Supporters of the permanent approach argue that it prioritizes removal from play and avoids a rushed decision to return. Critics have debated whether a temporary replacement could give clinicians more assessment time. The current law should be described accurately while that medical and policy discussion continues.

The rule does not diagnose concussion

A substitution protocol creates space for a safety decision; it does not replace clinical assessment. Match officials do not make a medical diagnosis. Team clinicians and competition medical systems need training, recognition tools, emergency procedures, and a conservative return-to-play pathway.

“Suspected” is deliberately important. Requiring certainty before removal would defeat the protective purpose when concussion can be difficult to identify quickly.

Implementation determines effectiveness

Competition organizers should publish the rule, brief teams and referees, define the signal and paperwork, and collect consistent data. Players must be protected from pressure to hide symptoms, especially in decisive matches.

Youth and grassroots football present additional challenges because medical personnel may not be present. Clear emergency guidance, coach education, and a rule that an affected player does not return that day are essential safeguards within the relevant local medical framework.

What this means

The protocol removes a tactical reason to keep a potentially concussed player on the field: the team does not lose a normal substitution, and the opponent receives a balancing option. That is a meaningful structural change.

Its success cannot be measured only by the number of substitutions. The goal is earlier recognition, safer removal, appropriate medical care, and no premature return. The law creates permission; competition culture and medical practice must turn it into protection.