Concussion substitutes: Football head injury rules a 'shambles', says expert

Football's new head injury substitute rules are a "shambles", says leading head injury expert Dr Willie Stewart.

Football's lawmakers approved a trial in December, which has now been adopted in the Premier League and FA Cup.

The new rule means permanent substitutions can be made if a player suffers a head injury, even if all replacements have already been used.

Stewart said football should follow rugby union's example where doctors are given more time to assess players.

Speaking at a Department of Culture, Media and Sport (DCMS) session on head injuries in sport, the consultant neuropathologist said it was safer to allowing temporary substitutes to replace players while this assessment was carried out.

Stewart was invited to the hearing, having conducted the Field (Football's Influence on Lifelong Health and Dementia Risk) study, which found that former professionals were three and a half times more likely to die of dementia than the general population.

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"Football has a habit of, when it is forced to develop, it develops something unique to other sports. What football has introduced is a shambles in 2021," he told MPs.

"Rugby has made great developments, and that should be the model for other sports.

"The poor medics have no more time, opportunity or tools to assess players with a complex brain injury. They haven't given them any more tools to do that."

The Football Association, which introduced head injury substitutes into the FA Cup in February, has echoed experts from world governing body Fifa and international rule makers Ifab who say using permanent head injury replacements is safer because concussions can often be delayed.

The meeting on Tuesday heard from several experts on how sports might improve their approach to head injuries and the long-term effects that might be caused by taking part in football, rugby and boxing.

It also discussed research funding, differences between elite-level and amateur sports, and the risks that might affect women more adversely than men.

Stewart called for more money for research into the long-term effects of head impacts in sports and said other countries should follow the lead of Scotland, where concussion guidelines have been standardised across all sports.

He also said rugby union had been "slow to change" its approach to head injuries compared with the NFL in the United States, although he praised the sport's monitoring of injuries. And he said the current level of one brain injury per match in English rugby, which had stayed at the same level for four of five years, was "totally unacceptable".

Dr Michael Grey, who is a conducting a study into the long-term effects of head injuries in football at the University of East Anglia, said government should push changes forward because governing bodies had been too "reactive'.

He said: "Government organisations need to lead the way; sports associations have been given their chance. We need to work with them, rather than them setting their own rules and own guidelines for each sport."

Grey also said he knew of head injury research projects commissioned by governing bodies that had not been made public, and said more independent research would help tackle the issue.

"They are not required to produce a report," he said. "Individual governing bodies make the call because it's their money."

Pete McCabe, chief executive of brain injury charity Headway, told the DCMS session his organisation had been "patronised" by governing bodies in the past on head injuries.

"For many years we have pushed football authorities on this and they haven't taken this seriously," he said. "Since being invited to this meeting, we have had many football authorities saying, 'why don't you come and talk to us?'"

"We need to undertake more research and that needs to happen sooner rather than later, and when research emerges, we need to take sensible decisions, whether that's looking at heading footballs or tackling and collisions in rugby."

McCabe also said Headway wanted a ban on boxing, because unlike other sports "there was no safe way to change the rules" and told the meeting that he was "appalled" by the BBC's decision to show boxing and cage fighting.

"There are occasions where I've wondered whether it's the British Broadcasting Corporation or the British Boxing Corporation because there does seem to be an excessive amount of coverage of such sports. Cage fighting blows my mind.

"I don't think there is much research on cage fighting, but the assumption must be that it is as dangerous to kick someone in the head as punching them in the head."

A BBC spokesperson said: "The BBC caters for all licence fee payers, with coverage across a whole range of sports."