What exactly is the concussion protocol?

December, 20, 2013
12/20/13
12:00
PM ET
TEMPE, Ariz. -- If what Larry Fitzgerald is saying is true, then he's one step away from being cleared to play Sunday against the Seattle Seahawks, which would be a week removed from him suffering a concussion during an onside kick in Tennessee.

During his weekly media gaggle Thursday, Fitzgearld said he will see a third neurologist this week after Friday's practice. This one, however, is the most important because Fitzgerald said they are the independent neurological consultant assigned to the Cardinals by the NFL. Thus far, Fitzgerald has said he's passed the protocol throughout the week and even practiced fully on Thursday, but the Cardinals' injury report countered that, listing him as a limited.

But, what exactly is the protocol that Fitzgerald has been talking about?

The stage he is in is called the Return-to-Participation Process, and it's part of the NFL Head, Neck and Spine Committee’s Protocols Regarding Diagnosis and Management of Concussion.

It's a four-stage process players follow as they recover. For some players, allegedly like Fitzgerald, that can take less than a week. For others, it can take longer.
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.

Another tool used on the sideline and in the locker room is the post-injury concussion assessment that's completed by a medical professional.

Josh Weinfuss

ESPN Arizona Cardinals reporter

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