Proposed USL head injury substitution rule has flaws that need to be addressed

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By Conor Gormally, co-founder of Concussion Alliance

A recent ESPN article on the United Soccer League (which encompasses the 2nd-4th tiers of American and Canadian soccer) details a “prospective rule change to the International Football Association Board (IFAB)...that would allow for a ‘head injury substitution.’” This proposed substitution is a temporary one that would allow another player onto the field while their teammate is assessed. The announcement of this proposal follows public criticism of the European soccer association’s handling of a concussion during the Champions League Semi-Final - the premier club soccer competition in Europe.

USL’s announcement signals an increased willingness to address concussions in sport. However, there are two troubling aspects of this proposal. Firstly, the USL plans to amend their proposal to include a decision cutoff time of around 10 minutes. There is ample evidence to suggest that a cutoff in this time frame would be insufficient for proper diagnosis. Often, players will be on the field for at least 1-2 minutes before reaching the sidelines for official concussion testing. Furthermore, the SCAT5 test, developed for sideline concussion diagnosis by medical professionals, states that “the SCAT5 cannot be performed correctly in less than 10 minutes.” Considering the possibility of a longer time spent on the field following a potential concussion, giving medical staff fewer than 15 minutes to make an appropriate diagnosis is potentially dangerous.

In addition to the previous issue, if the player is not deemed fit to return to play, the substitution becomes permanent and counts as one of the team’s three allowed during a game. If a team has already used all three substitutions, then they would be forced to continue the game with one fewer players. Professional soccer substitutions are usually used tactically during a game to adjust and, moreover, playing with even one fewer player is a significant detriment. These factors could serve to disincentivize players from cooperating during diagnosis due to the perceived detriment to the team, either by forcing a substitute to be used for their injury or leaving their team down a player for the remainder of the game. While it is cause for optimism that the USL has moved so swiftly following the attention on the Champions League, the proposal has non-trivial flaws that should be addressed, ideally before the rule is planned to be enforced for the start of the 2020 season.


Conor GormallyComment