What Is the NFL’s Concussion Protocol? Everything About the League’s Rules Explained

When a player gets ruled out with a concussion, what steps are needed for the player to return? How does the NFL ensure player safety?

The NFL’s concussion protocol has a very extensive list of requirements for a player to return and play in a game after being diagnosed with a concussion. There was a lot of discussion around the league’s concussion protocol last year with Miami Dolphins quarterback Tua Tagovailoa.

There are several steps to diagnose a concussion during the game when a player receives an impact on the head. A player goes into the protocol if a player exhibits or reports symptoms or signs suggestive of a concussion or stinger. The team’s athletic trainer, booth spotter, team physician, game official, coach, teammate, or sideline Unaffiliated Neurotrauma Consultant (UNC) can also start the protocol.

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What Is a Sideline Survey?

A player will remove his helmet to allow the team doctor and UNC to examine the player. If a player has lost consciousness or displays confusion, amnesia, or a lack of muscle control, he is ruled out of the game immediately and brought to the locker room.

The next steps are to review the play that happened and Maddock’s questions with the player. The video of the play also gets reviewed while the player is being examined.

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The next step involves a focused neurological exam of the cervical spine, an evaluation of speech, an observation of gait, and an evaluation of eye movements. After this set of tests, a player can be cleared to return or be brought back to the locker room for further examination.

In the locker room, a player undergoes a more thorough neurological exam along with a complete NFL SCAT (sports concussion assessment tool). If a player needs to pass this step to return to the game, he will be ruled out of the game.

Return-To-Participation Protocol

As soon as a player is ruled out with a concussion, he enters into protocol to return to play, and each step must be passed. There is no set time to return to play or expected time to progress through each step of the protocol. Recovery time for concussions will vary from player to player.

Here are the five steps the NFL and NFLPA have agreed to for a player to return from a concussion:

Phase 1 (symptom-limited activity): The player is prescribed rest, limiting or, if necessary, avoiding activities (both physical and cognitive) that increase or aggravate symptoms. Under athletic training staff supervision, limited stretching and balance training can be introduced, progressing to light aerobic exercise, all as tolerated.

Phase 2 (aerobic exercise): Under direct oversight of the team’s medical staff, the player should begin graduated cardiovascular exercise and may also engage in dynamic stretching and balance training. Neurocognitive and balance testing can be administered after completion of Phase 2, and the results should be interpreted as back to baseline.

Phase 3 (football-specific exercise): The player continues with supervised cardiovascular exercises that are increased and may mimic sport-specific activities, and supervised strength training is introduced. The player is allowed to practice with the team in sport-specific exercises for 30 minutes or less with ongoing and careful monitoring.

Phase 4 (club-based non-contact training drills): The player continues cardiovascular, strength, and balance training, team-based sports-specific exercise, and participates in non-contact football activities (e.g. throwing, catching, running, and other position-specific activities). Neurocognitive and balance testing should be completed no later than the end of Phase Four with the results interpreted as back to baseline.

Phase 5 (full football activity/clearance): Upon clearance by the team physician for full football activity involving contact, the player must be examined by the Independent Neurological Consultant (INC) assigned to his club. If the INC concurs with the team physician that the player’s concussion has been resolved, he may participate in his team’s next practice or game.

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