The English Premier League concussion protocol is designed to protect players who suffer head injuries during matches. Under the rules for the 2026–27 Premier League season, players suspected of having a concussion must undergo a medical assessment, and clubs are permitted to make an additional permanent concussion substitution.
But what happens when a Premier League player suffers a head injury? Can they return to the match, and how long must they remain sidelined?
Here is everything you need to know about the Premier League’s concussion rules, substitution procedures and return-to-play requirements.
What Is the Premier League Concussion Protocol?
The Premier League concussion protocol establishes procedures for identifying, evaluating and managing potential concussions during matches.
When a player suffers a head injury, the referee can stop play to allow medical personnel to assess the situation.
If a concussion is suspected, the player must be removed from the match and cannot return that day.
The protocol follows guidelines established by the Premier League and the International Football Association Board (IFAB), football’s lawmaking body.
How Does the Premier League Concussion Protocol Work?
When a player suffers a suspected concussion during a Premier League match, the following procedures apply:
- Immediate stoppage: The referee can stop the match to allow medical personnel to examine the injured player.
- Medical assessment: Team doctors evaluate the player for concussion symptoms, including dizziness, confusion, headaches, memory problems and balance difficulties.
- Concussion decision: If medical personnel suspect a concussion, the player must leave the match permanently.
- Additional substitution: The club can use a permanent concussion substitution without losing one of its five regular substitutions.
- Opposition substitution: The opposing team receives the option of making an additional substitution.
- Return-to-play assessment: The injured player must complete the appropriate recovery and medical clearance process before returning to football activities.
The primary objective is to prevent players from continuing to compete while potentially suffering from a brain injury.
How Many Concussion Substitutions Are Allowed in the Premier League?
Under the Premier League’s concussion substitution rules, each team is permitted one additional permanent concussion substitution per match.
This substitution does not count toward the team’s five regular substitutions.
For example, if Arsenal has already used all five regular substitutions and a player suffers a suspected concussion, the club can still replace that player using its concussion substitution.
When one team uses a concussion substitution, the opposing team is also granted the opportunity to make an additional substitution for any reason.
This provision is intended to maintain competitive balance.
Can a Premier League Player Return After a Concussion?
No. A Premier League player who is diagnosed with or suspected of having a concussion must be permanently removed from the match.
The player cannot return later in the game, even if symptoms appear to improve.
However, a player who undergoes a head injury assessment and is medically determined not to have a suspected concussion may be allowed to continue playing.
Medical personnel are responsible for making this assessment, and players must continue to be monitored for symptoms.
How Long Is a Premier League Player Out With a Concussion?
There is no universal number of Premier League matches that a player must miss following a concussion.
The recovery period depends on several factors, including:
- The severity and persistence of concussion symptoms.
- The player’s medical history.
- Results of neurological and clinical assessments.
- Completion of a graduated return-to-training process.
- Final medical clearance.
Some players may recover relatively quickly, while others require a longer period before returning to competitive football.
A player must not return simply because an important Premier League or European competition match is approaching.
What Is the One-Minute Rule for Injured Premier League Players?
The Premier League also has rules governing how long players must remain off the pitch following certain injury assessments.
During the 2026–27 season, players who receive treatment or assessment on the field are generally required to remain off the pitch for at least one minute, subject to exceptions.
This rule is separate from the concussion protocol.
If a player is suspected of having a concussion, the player cannot return to the match regardless of how much time has passed.
Does the Premier League Allow Temporary Concussion Substitutions?
No. The Premier League uses permanent concussion substitutions rather than temporary replacements.
A temporary concussion substitution would allow a team to replace an injured player while medical personnel conduct a more detailed assessment away from the pitch.
If the player were subsequently cleared, they could potentially return to the match.
The Professional Footballers’ Association (PFA) has advocated introducing temporary concussion substitutions, arguing that additional assessment time could improve player safety.
However, permanent concussion substitutions remain the system used in the Premier League.
Who Decides Whether a Premier League Player Has a Concussion?
Club medical personnel, including team doctors, are responsible for assessing suspected concussions and determining whether a player can safely continue.
Referees can stop matches when they identify potentially serious head injuries, but the medical assessment is conducted by qualified medical staff.
A player’s desire to continue playing does not override a medical decision to remove them because of a suspected concussion.
Premier League Concussion Protocol: Frequently Asked Questions
Can a team make six substitutions because of a concussion?
Yes. A Premier League team can make five regular substitutions plus one additional permanent concussion substitution when the relevant conditions are met.
Does a concussion substitution count as a regular substitution?
No. A concussion substitution is separate from the five regular substitutions allowed during a Premier League match.
Can a player return after passing a concussion assessment?
A player may continue if medical personnel determine that a concussion is not suspected. However, once a player is removed through a permanent concussion substitution, they cannot return to that match.
Does a player automatically miss the next Premier League match after a concussion?
Not necessarily. There is no universal fixed match suspension for concussion. The player’s eligibility to return depends on the required medical recovery and clearance process.
Can a goalkeeper be replaced because of a concussion?
Yes. Goalkeepers are covered by the same concussion substitution rules as outfield players.
Why doesn’t the Premier League use temporary concussion substitutions?
The Premier League follows the permanent concussion substitution framework approved by IFAB. Temporary substitutions have been debated, with supporters arguing they could provide medical teams with more time to assess head injuries.
Final Thoughts
The Premier League concussion protocol for the 2026–27 season prioritizes player safety by requiring the removal of players with suspected concussions and providing clubs with an additional permanent substitution.
Although the rules allow medical personnel to assess players following head injuries, anyone suspected of suffering a concussion must leave the match and cannot return that day.
With growing attention on head injuries and long-term brain health in professional football, concussion management remains an important part of player safety throughout the Premier League season.