Explaining the NFL’s 5-step concussion protocol

With T.J. Hockenson in the midst of recovering from a concussion, now is a good time to revisit the NFL’s official concussion protocol to identify what players like Hockenson need to do in order to be determined fully healthy and capable to play.

The NFL has a five-step process in which players must clear not only medical and physical tests from team physicians, but from an assigned Independent Neurological Consultant as well. This is an ongoing process during which if the player exhibits any recurring symptoms of a concussion, they must revert to the previous step of the concussion protocol.

Here’s a quick recap of each protocol step (you can read the official outline from the NFL here).

Step 1: Rest and recovery

This one is simple. After suffering a concussion, a team must provide ample rest for their player. That means limited physical and cognitive activities. Stretching is still permitted, provided the medical staff approves.

Once a player has a baseline level of symptoms, they move onto the next step.

Step 2: Light aerobic activities

The player can participate in things like riding a stationary bike or treadmill. During this step, the player may also attend team meetings and film study.

Neurocognitive testing may begin at this phase, too, meaning players will be tested to see if their baseline symptoms have increased or decreased. If there is any sign of an increase, the player must revert to the previous step.

Step 3: More aerobic exercise and strength training

Exercise training can increase in intensity and can even mimic some specific sport activities at this step. Players may also participate in “supervised strength training.”

Step 4: Football specific activities

At this point, if the player has not seen an increase in concussion symptoms, they may practice at a non-contact level. That means throwing, catching, running, or any other positional drills that do not involve contact with players or objects (e.g. dummies, sleds).

If the player does not exhibit any post-practice symptoms, they can advance to the final step.

Step 5: Full football activity

The player can then take part in a full football practice, with pads, with full contact. One interesting stipulation is that a player can simulate this step if there is no full-contact practice left on the schedule that week (i.e. a walkthrough). Here’s how the NFL explains it:

if a player cannot participate in practice or full contact with other players due to the time of year and/or rules imposed by the Collective Bargaining Agreement, simulated contact activity will suffice to satisfy this step.

Once the player has fully practiced, he must be first cleared by the team physician. If he clears, he then must be examined by the Independent Neurological Consultant. If that consultant clears the player of concussion symptoms, he is free to play in the next game.

As it all relates to Hockenson, Lions head coach Matt Patricia indicated that the rookie tight end would be there during Wednesday’s practice, but had not cleared protocol. Depending on his level of involvement, that appears to suggest Hockenson has progressed to at least Step 4 of the protocol.

We’ll see if he advances far enough to play in Monday’s game against the Packers.