What Is a Concussion Protocol?

A Guideline for Safe Return to Activity Following Concussion

The most common form of traumatic brain injury (TBI), concussions are periods of changed brain activity following an impact or blow to the head, causing a range of symptoms. Repeated concussions—those occurring before the brain has had the time to heal—are particularly dangerous and can even be fatal. Management of this condition hinges on ensuring you get enough rest and not rushing back into activity too soon.

A concussion protocol, established by organizations like the Centers for Disease Control (CDC) or sports leagues like the National Football League (NFL), seeks to do just that. These protocols are sets of guidelines and tools for the treatment and management of the condition. They lay out a timeline for evaluation, recommendations for activity, as well as a set of benchmarks a patient must pass before it’s safe for them to resume normal activities or play.

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What Is a Concussion Protocol?

As a codification of how concussions are to be treated and managed, concussion protocols help doctors and caregivers establish a timeline for recovery. The idea is to make completely sure that the patient has completely healed from the brain injury and that it’s safe for them to return to their usual activities. This means establishing:

  • Guidelines for diagnosis and agreed-upon clinical signs
  • Monitoring practices performed throughout recovery
  • A timeline for reintroducing physical activity
  • Tools for assessing symptoms and signs
  • Policies for receiving medical clearance to return to activity/play

There’s no set amount of time for a concussion protocol, as recovery from a TBI can vary based on its severity and location. The goal is to return to baseline measures of health and resolve all symptoms. While symptoms themselves usually resolve within one to two weeks, the protocol can last a matter of weeks to a matter of months.

Evaluation and Diagnosis

Concussions can be challenging to diagnose, as symptoms can mimic those of other conditions or may be missed entirely. Diagnosis typically occurs in the emergency room setting or on the athletic field following the fall or head impact. This involves three basic steps:

  • Interviews evaluate any loss of memory of events before the incident (retrograde amnesia) and afterward (anterograde amnesia), as well as overall responsiveness and awareness.
  • Assessment of severity involves rating the scope and scale of symptoms. Scales, such as the Sideline Concussion Assessment Tool (SCAT-2), are used to measure any effects on attention, memory, and balance.
  • Neurological tests assess strength, sensation, reflexes, coordination, and mental status to see if there’s any damage or injury to the brain itself.

Notably, imaging techniques, such as magnetic resonance imaging (MRI), may be used in more severe cases, when bleeding in the brain is suspected.

What Are The Protocol Steps?

CDC Guidelines

The CDC’s concussion protocol details a gradual timeline for return to normal activities, school, and athletics. Progress is monitored at every stage, with doctors clearing patients for more activity once they’re certain it’s safe. For athletes, it can be broken into six stages, following an initial rest period of 28 to 72 hours:

  • Rest and return to limited activity: Ensuring adequate rest and avoiding exertion is the first stage. Once you’re clear to return to school or work, screen time should be limited. The aim is to return to physical activities that aren’t risky, such as short, 10-minute walks.
  • Light aerobic exercise: Once light activity is reincorporated and symptoms subside further, the aim is to do exercise to boost heart rate. This might mean walking, swimming, or using a stationary bicycle for 20 minutes at 70% of your maximum heart rate.
  • Sport-specific exercise: Gradually, exercises associated with the specific source are reintroduced. This might mean noncontact activities like running sprints or doing skating drills.
  • Noncontact drills: Once it’s safe to do so, athletes begin to engage in more strenuous drills and start strengthening and resistance training.
  • Full-contact practice: Before being allowed to return to competition, with the doctor’s OK, the athlete takes part in full-contact training and practice and is carefully monitored after each practice.
  • Return to play: As long as there are no symptoms or issues following practice and a final evaluation, the athlete is cleared for competition.

NFL Guidelines

Due to high numbers of traumatic brain injury among active and retired professional football players, the NFL established a concussion protocol in 2009, and it’s since been updated several times. Sports fans might know all too well that this is a serious injury, taking athletes away for significant stretches. There’s no set amount of time for this protocol as it depends on getting medical clearance to return to activity.

The general progression of the NFL concussion guidelines are similar to others—the athlete gradually escalates the level of their activity, steering clear of full-contact work until cleared to do so—but there are additional stipulations and recommendations.

An NFL player immediately goes into the concussion protocol the moment there is an on-field concussion or a concussion is suspected. That player cannot re-enter the game. Team medical staff or neurology specialists must immediately assess symptoms, with a follow-up evaluation stipulated 24 hours after the injury. Regular monitoring of progress is required.

The NFL’s return-to-play protocol features five, rather than six, steps:

  • Symptom limited activity: Following a period of rest, the athlete gradually reintroduces light physical activity.
  • Aerobic exercise: When cleared, the football player does aerobic work, balance training, stretching, and other work while being monitored.
  • Football-specific exercise: Gradually, the player can begin exercises and drills geared specifically to the game. They can do noncontact practice drills with the team for 30 minutes a day in this phase.
  • Club-based noncontact drills: While keeping up with aerobic and other kinds of football-specific exercises, players can begin taking part in noncontact activities like throwing, catching, and running. By this phase, the player needs to have had neurocognitive balance testing.
  • Full football activity/clearance: In order to return to full-contact practice and play, the player must have a complete evaluation both by the team’s physician and an independent neurological consultant (a doctor assigned by the league).

When To See a Doctor

If you have a concussion, you may not necessarily require emergency medical attention. That said, you do need emergency help if someone is unconscious for any period of time following a blow to the head.

However, if the trauma is more severe or if there are signs of hematoma, a pooling of blood in the brain, you must get emergency medical help. Call 911 if you experience any of the following:

  • Worsening headache, stiff neck
  • Different-sized pupils
  • Drowsiness and inability to wake up
  • Problems with speech and coordination
  • Weakness and numbness in parts of the body
  • Frequent vomiting/nausea, seizures (convulsive, jerky arm movements)
  • Confusion, changes in mood and behavior

A Word From Verywell

Concussions vary greatly in severity, causing a range of symptoms that can sometimes be hard to differentiate from other conditions. If you sustain a bump or blow to the head, it's always best to check in with a doctor as soon as possible. They can assess your injury and determine the best course of action for your individual case.

FAQs

What is concussion protocol?

A concussion protocol is a set of guidelines for the medical management of concussion established by an organization such as the CDC or NFL. It lays out the tools and assessments needed for evaluation, as well as the benchmarks a patient must meet before it’s safe for them to resume full activity. These guidelines may also establish return to play policies for athletic teams and leagues.

How long is concussion protocol?

There’s no set duration for a concussion protocol because there’s a great deal of variation in how long it takes for the brain to recover and heal. In general, the length of the protocol depends on the length of recovery, which in most cases is about two weeks. More severe cases, however, lead to prolonged symptoms, which can lengthen the concussion protocol period.

What is the NFL’s concussion protocol?

The NFL concussion protocol is a set of clear guidelines for managing concussion in a football player. This means it does the following:

  • Establishes criteria for concussion/suspected concussion
  • Disallows same-day return to play of those with concussion/suspected concussion
  • Sets up a timeline for monitoring, evaluation, and reintroduction of physical activity
  • Creates strict criteria for return to play, including medical evaluation by an independent party
  • Establishes fines and sanctions for teams caught violating these guidelines
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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Weill Cornell Brain and Spine Center. Diagnosing and treating concussion. Updated September 2020.

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