What are NFL’s concussion protocols? How long is an NFL player out for a concussion?

The NFL’s concussion protocol is a hot topic of discussion. Josh Allen didn’t have his best performance in the Buffalo Bills’ 23-20 Week 5 loss to the Houston Texans, but by the end of the game, people were questioning whether he should’ve been on the field at all.

In the fourth quarter, Allen seemed to suffer a head injury when he hit the ground hard after being sacked on third-and-8. His head bounced off the turf, and he stayed down before medical staff came to assist him.

He eventually walked off on his own and later returned to the game. However, many began to question the NFL’s concussion protocol when Allen, just five plays after the injury, was back leading the Bills.

Here’s a breakdown of what you need to know about the NFL’s concussion protocol.

What is the NFL concussion protocol?

The NFL concussion protocol outlines five steps that players must follow after a concussion before they can return to the game.

What happens when a player shows signs of a head injury?

If a team’s medical staff suspects that a player could have a concussion, they are required to pull the player from the game for a focused neurological exam. This exam checks the player’s cervical spine, speech, movement, and eye responses. If the player shows any signs of losing consciousness, motor instability, confusion, or amnesia, they are not allowed to continue playing.

How does the NFL concussion protocol work?

When a player displays symptoms of a concussion, the protocol is triggered by the person who identifies those signs. The player is then taken to the sideline for an assessment. They’re checked for any “no-go” symptoms like “loss of consciousness, gross motor instability, confusion, amnesia, fencing response, or impact seizure.” After Tua Tagovailoa’s injury in 2022, ataxia, which refers to issues with balance, motor coordination, or speech caused by neurological problems, was also added to the list of no-gos. If any of these symptoms are present, the player is not permitted to return to the game.

If there are any doubts about a concussion, a team doctor or an unaffiliated neurotrauma consultant must examine the player. The protocol starts if the medical professionals believe the player has suffered a concussion. The player will then undergo follow-up exams and periodic checks by the medical team, and they cannot return to play during this period.

What symptoms do medical staff look for?

Players will be taken out of the game and examined if they display symptoms like dizziness, nausea, or sensitivity to light and sound. If any of the following “no-go” symptoms are noticed, the player is sidelined for the rest of the game:

• Loss of consciousness
• Ataxia (issues with balance or coordination)
• Confusion
• Amnesia

The “no-go” list was updated after Miami Dolphins quarterback Tua Tagovailoa was taken off the field on a stretcher following his concussion against the Bengals in 2022.

How does a player return to play after entering the protocol?

Once a player is placed in the concussion protocol, they must complete the return-to-participation program, which is divided into five phases:

1. Symptom-limited activity: The player rests and avoids anything that might worsen symptoms. Some light stretching or balance exercises are allowed, with progress to light aerobic workouts under supervision. The player can also attend meetings and watch film if tolerated.
2. Aerobic exercise: Supervised cardio activities, such as biking or treadmill workouts, are introduced along with stretching and balance training.
3. Football-specific exercise: The player continues cardio under supervision and can mimic sports movements and strength training specific to football.
4. Non-contact training drills: The player keeps up with cardio, strength, and balance work, and can join non-contact football drills with the team.
5. Full football activity/clearance: The team doctor can clear the player for contact if they believe the concussion has fully healed. Before returning to full play, an independent neurological consultant must also examine the player and agree with the team physician’s assessment.

Who makes the final decision on a player’s return?

If a player doesn’t show any of the “no-go” symptoms, the decision to progress through each step of the concussion protocol is made by the team physician, in coordination with an unaffiliated neurotrauma consultant on the sideline.

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