NFL Concussion Protocol: What Are The 5-Stages For Diagnosis And Management?

The NFL is at the height of its popularity as it approaches Super Bowl 50, but the league still faces a major issue regarding head injuries. Concussions have played a major role this postseason with Pittsburgh Steelers wide receiver Antonio Brown being forced to miss the divisional playoffs, and they could come into play in the final three games.

Because of lawsuits that have been filed against the NFL and discoveries regarding the seriousness of head injuries, it isn’t easy for players who show signs of a concussion to get back onto the field. Each concussion is treated differently and it can take between a few days and several weeks before players are allowed to play again, but everyone in the NFL that suffers a concussion must go through the same process.

The exact steps are listed in the NFL Head, Neck and Spine Committee’s Protocols Regarding Diagnosis and Management of Concussion.

Return-to-Participation Process

After a concussion has occurred in practice or play, the concussed player must be examined and monitored in the training room on a daily basis or as decided by the medical staff. Components of the NFL Sideline Concussion Assessment can be utilized to check for symptoms as well as continue to monitor the other aspects of the examination. The following measures must occur in order for a player to return to play:

a. A player returns to baseline status of symptoms and neurologic exam, including cognitive and balance functions.

i. Repeat neuropsychological evaluation is performed before return to practice or play with interpretation of the data by the team neuropsychology consultant. The team neuropsychology consultant reports the findings back to the team physician.

b. A graduated exercise challenge, followed by a gradual return to practice and play, is initiated when the player returns to baseline status. The RTP protocol following a concussion follows a stepwise process to be outlined in the NFL Head, Neck and Spine Committee’s Return to Participation Protocol.

c. Prior to return to practice or play, not only must the team physician clear the player, but the Independent Neurological Consultant with expertise in concussion must also evaluate and clear the player for return to practice and play.

d. A player may be considered for return to practice and play only after the player has returned to baseline status with rest and exertion, has repeat neuropsychological testing which is interpreted by the team neuropsychology consultant as back to baseline levels of functioning, and has completed the Return to Participation Protocol referenced above and is cleared by the Team Physician and the Independent Neurological Consultant.

If a player appears to have potentially suffered a concussion during a game, he’ll be pulled from the contest and evaluated by a team doctor and an unaffiliated neuro-trauma consultant. If the precaution is not recommended by someone in the game or on the sideline, it can be suggested by an independent spotter that is watching from the press box. Players that show signs of a concussion are given a more extensive evaluation in the locker room.

There is no length of time required for players to wait between the steps of the protocol. There were nearly 200 concussions suffered by NFL players in the 2015 season.