Alex Freeman took a head-to-head collision during the USA’s 2026 FIFA World Cup group-stage match against Australia on June 19. He was briefly evaluated on the pitch, cleared to continue, and then scored his team’s second goal in a 2-0 victory.

What happened on the pitch

Freeman collided with Australia’s Paul Okon-Engstler during the match, a head-to-head contact that immediately raised concerns among viewers, commentators, and medical professionals watching the game. Medical staff conducted a brief evaluation on the field before determining he could return to play.

Under current FIFA regulations, team doctors are permitted to assess players for up to three minutes pitchside. There is no strict limit on ongoing evaluations while play continues, but the practical reality of a live World Cup match creates its own pressure.

The case against sideline assessments

Chris Nowinski, a neuroscience expert at the Boston University CTE Center, was among the most vocal critics of how the incident was handled. His argument is straightforward: on-field concussion assessments are fundamentally inadequate because they happen under time constraints, in a chaotic environment, and without the privacy needed for accurate evaluation.

Nowinski has argued that evaluations should take place off the pitch and last at least 10 minutes, advocating for the implementation of temporary concussion substitutes.

FIFA currently allows only one permanent concussion substitute per team during its competitions under IFAB (International Football Association Board) rules. That means if a team uses its concussion sub and another player later takes a knock to the head, the options narrow significantly.

FIFA’s defense and evolving protocols

FIFA has pushed back on the criticism, stating that medical staffs have every resource necessary for accurate assessments. The organization points to its independent concussion assessment teams stationed at World Cup matches and the availability of medical replay tablets, which allow doctors to review footage of the incident in real time.

FIFA has progressively enhanced its head injury protocols since 2022, and the organization has also highlighted its collaborations with the World Health Organization on brain injury research.

What this means going forward

For FIFA, the political dynamics are complicated. IFAB, which governs the laws of the game, must approve any changes to substitution rules. FIFA can advocate for changes but cannot unilaterally implement them. The current one-permanent-sub rule represents a compromise that satisfies almost nobody: too restrictive for player safety advocates, too disruptive for tactical purists who worry about teams gaming the system.

The temporary substitute model removes the competitive penalty for proper evaluation, which in turn removes the incentive to rush a player back onto the field. It also prevents teams from gaining a tactical advantage, since the substitution reverts if the player is cleared.