Major League Soccer will participate in FIFA’s concussion substitute pilot program from the 2021 season, in continuation of its role as a leader in prioritizing player safety, the league announced Monday.

The program allows for up to two substitutions per team during a match to replace players suffering from a concussion or a suspected concussion, regardless of the number of substitutions already used.

A concussion task force comprised of sporting and medical leaders from MLS, NWSL, U.S. Soccer, the USL and NISA, have worked collaboratively to implement the initiative and have been approved by The IFAB and FIFA to participate in the trial.

Summary of Concussion Substitutes Protocol

In 2021, MLS will continue to allow a maximum of five substitutions in a maximum of three opportunities throughout the match. These will be known as "normal" substitutions. Any substitutions made during halftime (or between regulation and extra time or between the two halves of extra time in playoffs) will not be counted towards one of the three opportunities.

Above and beyond the five "normal" substitutions in three opportunities, each team will be permitted to make up to an additional two "concussion substitutions" when there is a suspected/possible concussion.

These two "concussion substitutions" are permitted regardless of how many "normal" substitutions or opportunities have already been used.

A "concussion substitution" may be made:

  • immediately after a concussion occurs or is suspected;
  • after an on-field assessment, and/or after an off-field assessment; or
  • at any other time when a concussion occurs or is suspected (including when a player has previously been assessed and has returned to the field of play).

When a "concussion substitute" is used, the opposing team then has the option to use an "additional" substitute and an additional substitution opportunity for any reason which may or may not be used at the same time as the opposing team’s "concussion substitution".

A team’s "additional" substitute can only be used after the team has used all its "normal" substitutes or "normal" substitution opportunities.

At the "additional" substitution opportunity, only the "additional" substitute may enter the game. If the team has used all its "normal" substitution opportunities but has not used all five of its "normal" substitutes, the team is not permitted to use any remaining "normal" substitutes at the same time as the "additional" substitution opportunity.

If the two teams make a "normal" or an "additional" substitution at the same stoppage, both teams will be charged an opportunity.

If a team makes a "normal" or an "additional" substitution at the same stoppage where a "concussion substitution" is being made, that team will be charged an opportunity.

Once a team has used all its "normal" substitution opportunities, it cannot use a "concussion substitution" opportunity to make a "normal" substitution.

The Process

The match officials are not part of the team’s decision-making process as to whether a player should be substituted or not, nor whether a player should be replaced by a "normal" substitute or a "concussion substitute".

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Pink pass used by the team making a "concussion substitution"
Pink pass used by the team making a "concussion substitution"

Medical professionals in the facility, including team athletic trainers, team doctors and the Venue Medical Director, will continue to follow policies and protocols established by the MLS Concussion Committee for on-field and off-field assessment and management.

MLS will also continue to utilize the medical spotter program through which trained professionals monitor the match broadcast to identify potential head injuries and possible concussions. Those medical spotters are able to quickly provide video to the Venue Medical Director at the fourth officials table to assist in assessing head injuries and possible concussions.

If a team decides to make a "concussion substitution", the 4th official is informed by using a pink substitution pass. The 4th official will inform the referee and the VAR/AVAR that the substitution being made is a "concussion substitution."

The opposing team is informed by the 4th official that it now has the option of using an "additional" substitute and an additional substitution opportunity and will be given a blue substitution pass.

Blue “additional substitution" pass awarded to the opponent of a team making a concussion substitution
Blue “additional substitution" pass awarded to the opponent of a team making a concussion substitution

The IFAB has set an initial 20-month trial period to test the concussion substitutes initiative in competitions around the world through Aug. 31, 2022. During its Annual General Meeting in March 2022, The IFAB will decide whether to extend the trial period or whether to make a decision on implementing concussion substitutes into the laws of the game.

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