What Is a Concussion Protocol?

A concussion protocol is a set of guidelines and tools for the treatment and management of a concussion. Concussion protocols are established by organizations like the Centers for Disease Control (CDC) and sports leagues like the National Football League (NFL).

Concussion protocols 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.

This article explores the purpose of concussion protocols, the steps that may be included in one, and why they are necessary for evaluating this potentially dangerous type of injury.

What Is a Concussion Protocol?

A concussion protocol is a set of policies for the treatment and management of a concussion. It helps healthcare providers and caregivers establish a timeline for recovery. The protocol helps the care team ensure 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

Recovery from a concussion can vary based on its severity and location. The goal is to return to baseline measures of health and resolve all symptoms.

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?

Concussion protocols are used by sports organizations and medical care facilities such as hospitals and urgent care clinics. Each organization may have a slightly different concussion protocol based on the type of facility, available medical equipment, and on-staff specialists.

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 healthcare providers clearing patients for more activity once they’re certain it’s safe. For athletes, the protocol 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 sport 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 healthcare provider's clearance, 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. Concussions are serious injuries and can remove athletes from competition for significant stretches.

The general progression of the NFL concussion guidelines is similar to others: The athlete gradually escalates the level of their activity, steering clear of full-contact work until cleared to do so. However, the NFL protocol includes 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 non contact practice drills with the team for 30 minutes a day in this phase.
• Club-based non contact 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 healthcare provider assigned by the league).

How Long Is a 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, sometimes for months.

When to See a Healthcare Provider

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

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 at once. 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
  

Summary

A concussion protocol is a set of policies and procedures for treating someone with a concussion. It provides the tools healthcare providers need to decide when it is safe for someone who has experienced a concussion to return to activity.

Different sports organizations and medical facilities may have slightly different concussion protocols, but they typically include limitations on activities, careful monitoring, and a gradual return to play. There is no set time for a concussion protocol as every injury is different.

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.

1. Centers for Disease Control and Prevention. Managing return to activities.
2. American Association of Neurological Surgeons. Concussion.
3. Weill Cornell Brain and Spine Center. Diagnosing and treating concussion.
4. McCrory P, Meeuwisse W, Dvorak J, et al.Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Brit J Sport Med 2017;51:838-847. doi:10.1136/bjsports-2017-097699
5. NFL. NFL Head, Neck and Spine Committee’s concussion diagnosis and management protocol.
6. Beaumont. What to expect after a concussion.
7. Centers for Disease Control. Signs and symptoms of concussion.

By Mark Gurarie
Gurarie is a freelance writer and editor. He is a writing composition adjunct lecturer at George Washington University.