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When a footballer cannot continue, the referee manages the stoppage and the player’s exit; the coach decides whether to use an available replacement under that competition’s rules. A suspected concussion is different: the player must be removed for medical assessment, and a quick check on the touchline is not proof that they are safe to return.
What happens on the pitch when a player is injured?
If a player is only slightly injured, the referee may allow play to continue until the ball is out of play. For a serious injury, the referee stops play and ensures the player is removed from the field, subject to the exceptions in Law 5. The referee controls the stoppage; medical staff assess the player, and the coach decides whether to make an available substitution.
Treatment and return to the field are governed by the Laws of the Game. In general, an injured player may re-enter only after play has restarted. See IFAB Law 5: The Referee.
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- The team informs the referee of the proposed substitution.
- The outgoing player leaves the field. Under the 2026/27 IFAB changes, a substituted player must leave within ten seconds of the substitution board being displayed or the referee giving the signal.
- During a stoppage, the substitute enters at halfway after the outgoing player has left and once the referee signals permission.
- The substitution is complete when the substitute enters. The replaced player then takes no further part, except where return substitutions are permitted.
These are the general steps in IFAB Law 3: The Players. The ten-second exit requirement is a 2026/27 change; check whether and how the relevant competition has implemented it.
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How many substitutions are allowed?
There is no single number that applies to every match. IFAB permits national associations, confederations and FIFA to allow up to five substitutes in official competitions, with conditions and limits on substitution opportunities governed by Law 3 and the competition’s rules. Check the rules for the specific league or tournament rather than assuming that every team has the same allowance. See IFAB Law 3.
What changes under the 2026/27 injury rules?
Under IFAB’s 2026/27 changes, a player who receives an on-field injury assessment, or whose injury causes play to be stopped, must leave the field and remain off it for one minute of running time after play restarts. This is distinct from the ten-second exit timing for a substituted player: the one-minute period concerns a player who has received the specified injury assessment or whose injury caused the stoppage, not every substitution.
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These are IFAB changes, and their adoption or implementation may depend on the competition. For the current wording, see the IFAB Laws of the Game and the relevant competition rules.
What happens if a player might have a concussion?
Suspected concussion calls for immediate removal from play and medical assessment. FIFA describes FOCUS as an on-pitch tool for clinicians to identify a player who needs formal concussion assessment; it is not a reason to treat a brief sideline check as a diagnosis. FIFA advises that an on-pitch medical assessment follow its Emergency Care Manual, and that a life- or limb-threatening injury takes priority. Its public guidance says a person with symptoms should see a doctor as soon as possible and within 24 hours, with return to play following medical advice. See FIFA concussion guidance and the FIFA Concussion Awareness Campaign.
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Symptoms may not be obvious immediately. FIFA says they can take up to 72 hours to appear. Its listed signs include headache or pressure, nausea or vomiting, balance problems, dizziness, visual disturbance, sensitivity to light or noise, memory problems, drowsiness, confusion and difficulty focusing. Warning signs requiring urgent attention include a worsening headache, repeated vomiting, seizure, weakness or numbness, and difficulty waking. These signs can help prompt recognition, but they do not diagnose concussion. See FIFA signs and symptoms.
When a competition permits a concussion substitution
IFAB’s additional permanent concussion substitution protocol applies only when the competition permits it. Under that protocol, a team may use a maximum of one concussion substitute, regardless of how many ordinary substitutes it has already used. The player with actual or suspected concussion cannot take any further part in the match, including a penalty shoot-out, and the opposing team is offered an additional substitute and substitution opportunity.
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A concussion substitution may follow an on-field or off-field assessment, or be made if concussion is suspected later—even if the player previously returned to the field. These rules do not apply automatically in every competition. Check the event’s regulations and the IFAB Law 3 concussion protocol.
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| Question | Ordinary substitution | Concussion substitution |
|---|---|---|
| Does it depend on competition rules? | Yes. The competition sets the available number and relevant limits. | Yes. The competition must permit the protocol. |
| Does it use an ordinary substitute? | Yes; it is subject to ordinary substitution limits and opportunities. | The protocol allows a maximum of one concussion substitute regardless of ordinary substitutions already used. |
| Can the outgoing player return? | Generally no, except where return substitutions are permitted. | No. The player cannot take further part, including in a penalty shoot-out. |
| Does the opposing team receive an additional option? | No additional option is specified for an ordinary substitution. | Yes. The opponent is offered an additional substitute and substitution opportunity. |
What does the coach decide when a player is forced off?
For an ordinary injury, the coach chooses whether to use a remaining substitution and which available player best fits the match. The decision may involve the replacement’s role, the team’s formation, the score and the match situation, as well as substitutions and opportunities remaining. Those are tactical considerations, not medical rules. An early exit alone does not establish the player’s diagnosis or recovery timeline.
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