As the NFL Season Comes to a Close, Concussion is on Everyone’s Mind

If you watched the NFL AFC Divisional game this past weekend, with the Kansas City Chiefs vs the Cleveland Browns, you would have seen Patrick Mahomes suffer what many believe to be a concussion.  The concussion occurred on an option run, in the 3rd quarter, after Mahomes was tackled by Cleveland Browns Linebacker Mack Wilson. The tackle itself did not seem like a major impact on the head. However, in watching Mahomes try to stand and wobble off the field, it was clear that he was dazed. 

Could it still be a concussion even though he was not hit in the head? As it turns out, while concussions typically occur after a blow to the head, they can also occur as a result of the brain being shaken inside the skull. For example, in a situation with a car accident, the sudden stop caused by the crash causes the brain to slam into the skull, often leading to a concussion even if there is no direct blow to the head. 

It is possible that Patrick Mahomes suffered a concussion through a similar mechanism. As a result, he was evaluated in the locker room, ruled out for the remainder of the game, and placed in the NFL Concussion Protocol.

Over the past several years, the NFL has taken a more significant stance on concussions.  With the pivotal AFC Championship game looming, how the NFL handles this particular concussion will be on center stage. Will Patrick Mahomes be ready to play? It will all hinge on how he progresses through the NFL Concussion Protocol. So what is the NFL Concussion Protocol and what does it work?

NFL Concussion Protocol is a five-step process for a player who has suffered a concussion. It involves ramping up from rest and recovery through to clearance with unrestricted football activity.  The NFL’s Head, Neck, and Spine Committee mandate player progress through the following five steps before being allowed to return to play in a game. 

1. Rest and recovery: The player is prescribed rest until his signs, symptoms, and neurologic examination, including cognitive and balance tests, return to baseline status.
2. Cardiovascular exercise: Under direct oversight of the team’s medical staff, the player should then begin graduated cardiovascular exercise and may also engage in dynamic stretching and balance training.
3. 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 team. If the INC concurs with the team physician that the player’s concussion has resolved, he may participate in his team’s next practice or game.

Patrick Mahomes may return to a limited practice on Wednesday.  The key indicator will be if Mahomes progresses from not practicing to limited practice at some point. However, if a player is not practicing in at least a limited capacity on Friday, that player is not likely to play on Sunday.  The pressure to return marquee players to the field is real and significant in the NFL, especially in the playoffs. Considering all factors, every concussion is different and unique for each person, and it is very difficult to predict the recovery period before returning safely to athletics.  

The NFL Concussion Protocol is similar to the Virginia Spine Institute’s (VSI) Concussion Protocol.  Our protocol also incorporates Computerized Cognitive Testing.  Computerized Cognitive Testing can be used for athletes to establish a baseline measure prior to a concussion.  The athlete then undergoes the test after sustaining a concussion, and the results post-concussion can be compared to the baseline results. It is likely the NFL has baseline measures on all their players, but this data is not officially a part of the NFL’s Return to Play Concussion protocol.  

At VSI, the initial Concussion Evaluation is performed by a Neurologist. In addition to Computerized Cognitive Testing, Virginia Spine Institute’s Concussion Evaluation identifies different symptom presentation trajectories.  Optimal treatment for concussions includes specific treatment strategies by the Neurologist and Concussion-trained Physical Therapists for any symptom trajectories present following concussion. 

• Post-Traumatic Migraine Headaches
• Cervical / Neck Injuries
• Vestibular Therapy (Dizziness / Balance)
• Ocular Therapy (Vision)
• Exercise Intolerance
• Neurocognitive Testing
• Memory Difficulties
• Sleep / Mood Disturbances

In most situations, the pressures to return to play are not as significant as in the NFL. As a result, proper recovery and treatment progressions are taken to allow for a safe and healthy return to school, activities, and sports. Here at Virginia Spine Institute, our neurologist and a team of concussion-trained physical therapists will guide a patient suffering from a concussion through every step of the process.