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Soccer needs to fix the substitution rule for head injuries

A simple change would significantly improve player health with only marginal effects on game play. It’s time to make the change.

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Soccer: CONCACAF Women’s Olympic Qualifying-Panama at USA Thomas Shea-USA TODAY Sports

In the second game of the CONCACAF Olympic qualifying tournament, Panama faced the United States. It was always going to be a tough game for them, but things were made worse when their best player, the young goalkeeper Yenith Bailey was forced to leave the game in the 33rd minute. The cause of her removal: a head-to-head clash with US forward Jessica McDonald roughly twenty minutes earlier.

It has now been confirmed that the clash fractured Bailey’s zygomatic arch (cheek bone). That means she played for twenty minutes with a fractured face.

Why was Bailey allowed to continue? Teams are supposed to be intensely concerned with head injuries, given the increasingly devastating clarity about the dangers of repeated head trauma. But ‘supposed’ is often far from reality, as it was in this case. Bailey herself obviously wanted to continue, and Panama certainly did not want to lose their best player, or burn a precious substitute ten minutes into the match.

But this is precisely the problem. Players always want to continue. The mentality that makes them world-class athletes also makes them terrible judges of their long-term interests. They will give everything, even well beyond what the body can actually handle, in the effort to win. And teams are usually willing to go along with them, giving into motivated reasoning which says the player can’t really be hurt if they want to continue.

The only solution is to take these decisions out of the hands of parties with strong vested interests. When it comes to head injuries, the final decisions should be in the hands of medical professionals, not players or teams.

Such a rule comes with problems, though. A thorough medical check takes time. Either that means wasting 10-20 minutes of game time waiting for the result, or treating all head injuries as mandatory substitutions. The former is never going to happen for practical reasons. The latter imposes a serious cost on teams, who might lose a player that is actually perfectly capable of continuing, and waste a substitution in the process.

A simple solution: mandatory temporary substitutions

But there’s actually an easy fix. Head injuries should require mandatory substitutions, but these should not count toward the team’s limit of three substitutions. Further, the substitution should be reversible if the player receives an affirmative okay from a neutral medical officer.

The hard-and-fast treatment of substitutions as final is a longstanding principle of association football, but carving out this limited exception would not meaningfully harm the game. Head injuries are genuinely different, given the heightened potential for irreversible consequences. We should not be forcing teams and players into the cost-benefit calculation of whether to risk lifelong brain trauma to fight for the three points.

When put in those terms, the choice seems obvious. But in the heat of the moment, interested parties often don’t make the right call. By making that decision less consequential for the game, and turning it over to third parties, player safety will be enhanced with minimal disruption to the game.

Rugby has a temporary substitution rule, and it has been implemented with minor fuss. Several proposals are already floating around to implement a version in soccer, with multiple organizations—from USL to UEFA—having requested the change. According to a report from the Telegraph, “FIFpro, the global players’ union, Uefa and Premier League doctors are also now backing concussion substitutes.” These parties hope to see a decision from the International Football Association Board by this spring.

However, even these proposed rules don’t go far enough. They set a limit of ten minutes, and convert the substitution to a normal one (thus counting toward the limit) if the player cannot return. These preserve the ‘tactical’ decision-making aspect of concussion substitutions, which continues the practice of balancing need against urgency.

Protect the players now. Before it’s too late

Yenith Bailey was ‘lucky’ to only suffer a face fracture. That she attempted to play through it for twenty minutes proves her resilience and determination. But it also proves that the laws of the game are broken. Players should not be permitted to place themselves in this sort of danger. That is true for everyone, but feels particularly poignant when you consider that Bailey is just eighteen years old, with a full life and career ahead of her.

The risks of not protecting players are too high. Especially when a new study suggests that young women have a uniquely high risk of long-term brain injury from concussions. This is an area where former US national team stars like Brianna Scurry, Michelle Akers, and Brandi Chastain have taken the lead in advocating for change.

The rule-makers should follow their lead and implement an aggressive change in policy. A small amount of disruption today is worth protecting future generations from significant harm.