How do concussion substitutions work at WC2026?

The IFAB approved permanent concussion substitutions in 2021 after pressure from medical bodies and the PFA. Under the rule, any player who shows signs of a possible concussion can be permanently substituted, and the substitution does NOT count against the team's 5 normal subs (or 6 with the extra-time slot).

Each team has up to 2 concussion subs per match. They're available at any stoppage — during regulation, extra time, or even between extra time periods. The opposition team is automatically also granted an equivalent substitution to keep things balanced, even if they don't have a concussed player.

Decision-making: the team doctor has sole authority. If they decide a player needs to come off for assessment, the player CANNOT return to the field even if later cleared — to avoid the temptation to send a borderline-injured player back on. This is the so-called 'temporary substitute' debate IFAB has been having for years — currently rejected in favour of permanent subs only.

Coaches at WC2026 keep a designated concussion-replacement player in mind throughout each match. Goalkeeper concussions are particularly disruptive — the regulation that each squad must include 3 GKs in their 26 stems partly from this risk.