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Headway signs open letter to IFAB Main Image

Headway signs open letter to IFAB

Mon 13 Jun 2022

The UK's leading brain injury charity Headway has signed an open letter to Football's law-makers to introduce temporary concussion substitutions in football.

Open Letter: Call for IFAB to introduce temporary concussion substitutions in Football.

Concussion in football is of increasing concern to athletes, their families, and the public, along with researchers, physicians, and other medical professionals.

A concussion is a brain injury. The global medical community agrees that when an athlete has a concussion, they should be immediately withdrawn from competition to prevent further harm.

The global medical community also agrees that an athlete suspected of having a concussion should also be removed immediately and, if a medical professional is available, clinically evaluated for concussion - without compromise. 

Evaluating a concussion during competition is difficult. Few concussions cause immediate and unambiguous signs like loss of consciousness. In situations where a concussion diagnosis is not certain, current best practice is for an athlete to go through a multimodal assessment with a medical professional off the field, and for the athlete to be held out from competition if a brain injury cannot be ruled out.

In football today, medical professionals are forced to evaluate athletes on the field, and they face strict time limits, often as few as three minutes, that prevent the medical professional from conducting a comprehensive clinical evaluation. These arbitrary rules put the athlete’s life at risk. Returning to play with a concussion can and has led to sudden death through Second Impact Syndrome. 

Permitting a temporary concussion substitution in football would allow medical professionals to conduct more comprehensive assessments. and send an important signal to every person in the game to treat head injuries with the necessary care. If temporary concussion substitutions were allowed, these concussion evaluations would not be time-pressured and could be conducted off the field in a quiet and controlled environment, which would allow medical professionals to use their years of training to make the best decision for the athlete. More accurate concussion diagnoses are in the best interest of a player’s long-term brain health.

We need to be giving medical professionals the time, space, and resources to do their jobs and protect the brains, and lives, of athletes.

Therefore, we call upon IFAB to immediately implement concussion substitutions in the laws of the game for Association Football for leagues whereby suitable medical coverage and independent oversight allows concussion assessments to be administered.

Kindest regards,

Dr Adam J White
Executive Director, Concussion Legacy Foundation UK
Senior Lecturer, Oxford Brookes University

Dawn Astle
Co-Founder, The Jeff Astle Foundation

Dr Robert Cantu
Co-Founder and Medical Director, Concussion Legacy Foundation
Medical Director and Director of Clinical Research, Cantu Concussion Center, Emerson Hospital
Clinical Professor of Neurology, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine

Dr Christopher Nowinski
Co-Founder and CEO, Concussion Legacy Foundation

Tim Fleiszer
Executive Director, Concussion Legacy Foundation Canada

Rachel Walden
Trustee, The Jeff Astle Foundation and Daughter of Rod Taylor

Chris Byrant MP
Member of Parliament for Rhondda

Gordon Stringer
Parent of Rowan Stringer
Advocate & Director, Concussion Legacy Foundation Canada

Professor Allyson Pollock
Professor, Newcastle University

Dr Ken Quarrie

Dr Alan Pearce
Associate Professor, La Trobe University

Nathan Howarth
Director of Development and Operations, Concussion Legacy Foundation UK

James Drake
Founder, The Drake Foundation

Dr Hilda Hayo
Chief Executive & Chief Admiral Nurse, Dementia UK

Dr Michael J Grey
Reader, University of East Anglia
Trustee, United Kingdom Acquired Brain Injury Forum

Chloe Hayward
Executive Director, United Kingdom Acquired Brain Injury Forum

Peter McCabe
CEO, Headway

Dr Thor Stein MD, PhD
Associate Professor of Pathology, Boston University CTE Centre

Professor Robert A. Stern, Ph.D.
Director of Clinical Research & Professor of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston University

John Mousinho
Chairman, Professional Footballers Association
Professional Football Player, Oxford United

Professor Adam M. Finkel, Sc.D., CIH

Dr Michael L Alosco, PhD
Associate Professor & Lead Scientist, Boston University CTE Center

Professor Helen Dawes
Professor, University of Exeter

Professor Hana Burianová
Professor of Neuroscience, Bournemouth University

Nicholas Civetta
Chairman, United States Rugby Players Association

Dr Rory Magrath
Associate Professor, Solent University

Dr Chris Szedlak
Lecturer, Hartpury University

Dr Melanie Lang
Reader of Safeguarding and Child Protection in Sport, Edge Hill University

Dr Howard Thomas Hurst
Senior Lecturer in Sport and Nutritional Sciences, University of Central Lancashire

Dr Jonathan Attwood
Academic Clinical Fellow in Neurology, University of Oxford

Dr Jack Hardwicke
Lecturer, University of Northampton

Dr Karen Hind
Associate Professor, Durham University

Andy Ellis
Professional Rugby Union Player

Dr Matt Smith
Senior Lecturer, University of Winchester

Dr John Batten
Senior Fellow, University of Winchester

Professor Eric Anderson MA, MA, PhD, CPsychol, FAcSS
Professor Sport, Health and Wellbeing, University of Winchester

Stephen Blain Elliotts
Former Professional Football Player

Eamonn Rogers
Former Professional Football Player

Andy Tysoe
Chair, Dementia Transformation Board and PFA Coordinator

Dr Joe Piggin
Senior Lecturer, Loughborough University

Keith R McIntosh
Sporting Memories

Dr Keith Parry
Deputy Head of Department, Bournemouth University
Director of Education Programmes, Concussion Legacy Foundation UK

Christine Gilliver
Wife of Former Professional Football Player

Dr Michelle Miller
Reader, University of Warwick

Dr Jo Batey
University of Winchester

Dr Kathleen Bachynski, PhD, MPH
Assistant Professor of Public Health, Muhlenberg College

Dr Katie Liston
Senior Lecturer, Ulster University

Hana Walker-Brown
Author & Creative Director, Broccoli Productions

Mrs Jean Hague
Wife & Full-time Carer for Former Professional Football Player

Dr Alex Fenton
Head of Centre for Professional and Economic Development, University of Chester

Penny Watson
Campaigner & Independent Consultant
Wife to Former Professional Football Player

Dr Stephen T. Casper PhD
Medical Historian


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Headway - the brain injury association is registered with the Charity Commission for England and Wales (Charity no. 1025852) and the Office of the Scottish Regulator (Charity no. SC 039992). Headway is a company limited by guarantee, registered in England no. 2346893.

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