What is the NFL’s concussion protocol? Explaining how the procedures work for return to play

In the high-contact world of the NFL, player safety must be a top priority. In the recent few years, the league has been under scrutiny for its handling of concussions and the long-term health impacts on players.

Back in February this year, the NFL reported an alarming 18% increase in regular-season concussions in the year 2022. This sharp rise in head injuries has raised questions about the effectiveness of the league’s ongoing efforts to protect its players. However, let’s take a closer look at how this protocol works.

What is the NFL’s concussion protocol? Explaining how the procedures works

The NFL’s concussion protocol outlines the steps that must be taken by the players when they are suspected of having a concussion and provides a roadmap for their safe return to play. When a player is assumed to sustain a head injury, they have to mandatorily get off the field immediately and tested in a medical tent to know about the nature of the injury.

The player can resume play only when he passes a five-step evaluation by the concussion doctor. On the contrary, if the athlete is suspected of having gross motor instability due to neurological reasons, he won’t be able to return to the field once again. The protocol was updated in the last year by adding language addressing abnormality of balance/stability to their protocol list of symptoms to keep a player from returning to the play.

However, a player has to pass five steps to return to the play while the Independent Neurological Consultant will ultimately decide if he is fit to play. In phase 1, “symptom-limited activity”, footballers are required to take rest avoiding many physical activities to minimize the symptoms. Nevertheless, they can do limited stretching and light aerobic exercises, so long as team training staff are supervising.

In phase 2, “aerobic exercise”, players can start doing cardio exercises, stretching, and training before working on balance testing. In phase 3, “Football-specific exercise”, they can continue football-specific exercises as well as can practice with the team for a maximum of 30 minutes.

In phase 4, “club-based non-contact training drills”, players can start catching, throwing, and running or do other activities relevant to their duties in the squad before undergoing neurocognitive and balance testing. In phase 5, “full football activity/clearance”, the physician and the independent neurological consultant clear them from the protocol to resume play.

When was the NFL’s concussion policy first implemented?

Despite football being a dangerous game, the league considered evaluating for concussions for the first time in 1994. The commissioner Paul Tagliabue hired Dr. Elliot Pellman to lead the Mild Traumatic Brain Injury (MTBI) committee, albeit the doctor reportedly lacked experience in the area. The commissioner later had nothing but to describe it as a “pack journalism issue.”

However, following the death of Hall of Fame center Mike Webster in 2002, the idea of a concussion protocol started to bloom as he died from chronic traumatic encephalopathy (CTE). In the following year, Dr. Kevin Guskiewicz published a paper saying repeated concussions might result in slower recovery of neurological function.


In 2007, the NFL first took the initiative to think about their protocol for returning players to the field after sustaining a head injury. Two years later, they reached the conclusion that concussions could have long-term impacts on the health of the footballers.

The league first implemented its concussion protocol back in 2011 by the Head, Neck, and Spine Committee, a board of independent and NFL-affiliated physicians and scientists as well as NFLPA advisers. Following the concussion of the Miami Dolphins quarterback Tua Tagovailoa in the last NFL season, the league and NFLPA made an update of their protocol in a joint statement released back in October 2022.

What’s your take on the NFL concussion protocol? Tell us in the comments.


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Maliha is an insightful sports writer with over a year of experience focusing on the NFL. Initially venturing into both NFL and NBA coverage, her journey began without a particular affinity for American football. However, her passion for the sport blossomed as she started following football more. Now, a huge NFL fan, Maliha meticulously follows every development within the league. She always wants to ensure her analysis is comprehensive and up-to-date to fellow readers.


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