Brain injury charity Headway has warned that the progress made in recent times to improve the short and long-term health of footballers is being wasted by the sport’s inability to manage head injures during play.

The warning comes after fans watching Manchester United’s recent game against Fulham expressed concern that Harry Maguire was kept on the pitch despite showing clear signs of discomfort that seemingly required the intervention of the referee.

“We have come such a long way since Hugo Lloris was labelled a ‘hero’ for over-ruling club medics to return to the pitch after a clear concussion while playing for Spurs against Everton in 2013,” said Luke Griggs, Chief Executive of Headway.

“That shocking incident was a wake-up call for football. We called it ‘dangerous and irresponsible’ at the time, demanding it be used as a catalyst for change.

“That change has been a slow process, but attitudes have changed. Promises were made, such as the concept of players being immediately removed from play if there is any suspicion of concussion. An ‘if in doubt, sit it out’ approach was enshrined in a series of concussion protocols, eventually adopted by various footballing bodies.

“But this progress is eroded with every high-profile incident in which the safety first principle is set aside and players being allowed to continue despite showing signs that a concussion could have occurred.

“The incident with Harry Maguire is concerning for a number of reasons.

“An opponent’s shoulder strikes the side of his head; minutes later he goes down on his haunches, showing clear signs of discomfort. After a brief on-pitch assessment – again highlighting the nonsensical lack of temporary concussion substitutes in football – he was allowed to continue.

“The sight of the referee then having to intervene in the second half when the player continued to look in difficulty was deeply concerning. But again, after another brief assessment with medics, he was again allowed to play on.

“We are not privy to the discussions with his medical team, nor should their professionalism be questioned. This is an issue with the very culture of football and its stubborn refusal to put players’ health above all else – including the result of a game.

“Every time the ‘if in doubt, sit it out’ principle is seen to be ignored in elite level football, our chances of educating younger players and better protecting future generations from short and long-term brain injury is diminished. Temporary concussion substitutions would immediately help return some credibility to the process, but an evolution of attitude is urgently needed.”