That FIFA is a very conservative organisation is an undisputable fact. Over the years they have shown that they can be very slow to reform the game.

There are ‘Puritans’ in that organization who, if they had their way, will leave the game ‘untouched’. I must however admit that there have been some changes to the rules that FIFA painfully had to do because of the tremendous pressure brought on by all those interested in the game.

Probably the biggest change ever made was the acceptance of Goal Line Technology for the first time at a summer world cup. In the end proponents of the introduction of the technology were right in that it did not affect the flow of the game and very much reduced any controversy. I hope that very soon they will be bold enough to introduce video reviews of every penalty decision or red card issued.

These two events usually change the outcome of games and there is no reason to get it wrong when the technology is available to be at least 99 per cent sure of that decision.

Others will once again say that will leave to stoppages and slow the flow of the game. But truth is every penalty and red card stops the game and not to mention the time players spend arguing with the referee or fighting among themselves. In our day-to-day lives we have reduced the human error factor by employing computers and other sophisticated equipment, so why should a game be left to the ‘errors’ of one man in the middle whose decisions can affect millions.

Anyway I have digressed from my main topic for today but I had to stray into territories that are considered outside my field of expertise.

As a sports physician and like all others in any form of sports medicine practice our primary goal is towards the health of our athletes.

We are duty bound to protect them and be proactive in preventive measures, which includes presenting data and making cogent arguments for changes in the rules governing a sport.

In my humble opinion the rule in football that allows only three substitutes to be used does not make sense to me anymore. Why suit up twenty-three players to sit on the bench if you are going to use only three? I guess the big shots in FIFA can best answer that question and most likely the answer will be because of some old thinking.

This rule, as far as I am concerned impacts negatively on the health of the players and should be looked at. Every major sport has a rolling substitution in which all the players suited can be used as substitutes and you can bring a player on and off at any time for whatever reasons. Now let’s look at some of the situations in which a rule change will help.

Concussions are a common injury in football but am sure most people have never been exposed to it until this past world cup where we saw a flurry of concussions.

These are serious injuries and FIFA’s lack of a consensus on concussions was evident during the tournament. Most of us saw on television at least three serious head injuries, which was mismanaged and could have led to serious consequences.

The most appalling one was to see a player from Uruguay who was visibly concussed gesticulating with his coach and team doctor.

The player eventually was allowed back into the game. The next serious one was the German player who was allowed back into the game without proper assessment and was taken out again within a few minutes because he still looked groggy on the field.

To perform a complete assessment of player suspected to have a concussion takes a minimum of four minutes. Please note that a proper concussion test was not done on any of those players.

The dilemma of the coach then is should he play for the next four minutes with a man down and hope his star player will be cleared or substitute him immediately and bring on a sub. Now if he waits for four minutes and his player is not cleared then he has used one of his allowed substitutions that is unplanned and also put his team at risk of conceding in those four minutes because the team is down by a player.

If he makes the change immediately, then in the event his injured player is cleared to play and he would have lost the services of his starter. With this in mind most coaches will close an eye to the obvious danger and cajole the team doctor to put the player back risking serious harm to him.

The player also will want to go back knowing very well if he is subbed, he cannot come back in. so why don’t we make it easy for everyone involved by adopting the rolling substitution system. Player gets injured; you immediately bring on a sub whiles the evaluation goes on for four minutes. In case the player is cleared you can re-insert him into the game and take out his ‘sub’ and still maintain the coaches game plan.

We have all watched an old clip of games from the 1930’s to as recent as the 1960’s. Football then was played at a leisurely pace and the early World Cups involved only eight teams. No wonder people played well into their late thirties and early forties.

This is nothing compared to the modern game which has changed in a lot of ways. The players are bigger and faster, the playing grass is machine cut to fine blades and watered down to make the ball, move at a ridiculous speed.

Just watch commercials from Nike, Adidas, Puma and the equipment manufacturers and you will hear all the magic that the modern football boots can do. The modern ball is literally created in a physics lab and checked for speed, flight path and a lot more.

Bigger and fitter young men are now playing the game and it is fast. Injuries of various degrees are common. Most of the elite players will tell you they get burned out by the end of the season because they play too much football. The average player runs about eight kilometers per game not to mention the kicking, jumping and heading of the ball. Players get tired and tired players get injured and it will help if there was a rolling substitution where players can play for short periods and rest in between.

I watched the game between England and Italy played in the Amazonia jungle city of Manaus in sweltering heat and humidity. By the second half most of the players had developed cramps from dehydration. There was a water break which is a novelty introduced by FIFA.

The problem about the water break is that not all players may need to rehydrate at whatever time the referee calls it. Some may want it earlier, while others later.

Coaches will begin to complain (and some complained) that it messed up their tactics. Allegations of officiating bias will be levelled if a team seems to have the momentum and suddenly the referee calls for a water break. Fast forward to the year 2022 when the World Cup is scheduled to be held in the desert country of Qatar where temperatures can go as high as fifty degrees Celsius.

This is going to be a real health hazard for the teams and surely there will have to be water breaks every fifteen minutes. One simple solution to this problem is to be able to use all your subs.