How NFL concussion protocol works and what it means for Patrick Mahomes & AFC Championship Game

The Kansas City Chiefs advanced to the 2021 AFC Championship Game with a win on Sunday, but now they have to wait and see what happens with Patrick Mahomes. Their star quarterback suffered a concussion when he was tackled on an option run. He wobbled as he got up and was clearly dazed by the play. He went to the locker room to be evaluated and was eventually ruled out with a concussion.

Chad Henne came on in place of Mahomes, and would start against the Buffalo Bills this coming Sunday if Mahomes does not clear the NFL’s concussion protocol. But how long will that take and how does the protocol work?

Return to play process

The league has a five-step process for a player who has suffered a concussion. It involves ramping up from rest and recovery through to full football activity clearance. Here are the five steps as mandated by the NFL’s Head, Neck and Spine Committee.

1. Rest and recovery: The player is prescribed rest until his signs and symptoms and neurologic examination, including cognitive and balance tests, return to baseline status.
2. Light aerobic exercise: Under direct oversight of the team’s medical staff, the player should begin graduated cardiovascular exercise and may also engage in dynamic stretching and balance training.
3. Continued aerobic exercise and introduction of strength training: The player continues with supervised cardiovascular exercises that are increased and may mimic sport-specific activities, and supervised strength training is introduced.
4. Football specific activities: The player continues cardiovascular, strength and balance training and participates in non-contact football activities (e.g. throwing, catching, running, and other position-specific activities).
5. Full football activity/clearance: Upon clearance by the Team Physician for full football activity involving contact, the player must be examined by the Independent Neurological Consultant (INC) assigned to his Club. If the INC concurs with the team physician that the player’s concussion has resolved, he may participate in his Club’s next practice or game.

The Chiefs return to practice on Wednesday to begin on-field preparations for the AFC Championship Game. It is possible Mahomes could return to limited practice at that point, but more often than not, players in the protocol don’t participate in that first practice of the week.

The Chiefs will provide practice participation reports on Wednesday, Thursday, and Friday. The key will be seeing if Mahomes progresses from not practicing to limited work at some point. The team will also have a walkthrough on Saturday, but usually if a player is not practicing in at least limited capacity on Friday, he’s unlikely to play on Sunday.

All that being said, every concussion is different and it is impossible to predict Mahomes’ status for next Sunday until we see what happens at practice this week.