Kansas City Chiefs quarterback Patrick Mahomes is on the NFL’s concussion protocol, which is basically all we can say about his status six days before the AFC Championship Game.
We don’t know how long he will be offside. We don’t know if he can play on Sunday. We’re not even sure if he had a concussion.
What we do know is that brain health was one of the most important storylines of the NFL’s playoff round. Mahomes was removed from the Chiefs’ victory over the Cleveland Browns on Sunday after a hit at the end of a run left him baffled. The day before, Baltimore Ravens quarterback Lamar Jackson was ruled out from a loss to the Buffalo Bills after his head was knocked to the ground.
What awaits Mahomes this week? Let’s take a closer look.
How could Mahomes be on the concussion protocol if he didn’t have a concussion?
First, we somehow don’t know what Mahomes was diagnosed with. And most importantly, a player is not required to be immediately diagnosed with concussion in order to be included in the protocol. All the Chiefs have confirmed is that he’s in protocol. On Monday, coach Andy Reid stopped saying Mahomes had suffered a concussion.
Why would the NFL do this?
In 2018, the NFL amended its protocol to require in-game evaluations for “all players who exhibit gross motor instability (for example, tripping or falling on the floor trying to stand) to determine the cause of the instability.” That roughly matches what happened to Mahomes on Sunday. The protocol goes on to say that if a doctor “determines that the instability is neurologically caused, the player will be called a ‘No-Go’ and may not return to play.”
This change was in response to the scary injury sustained in December 2017 by Houston Texans quarterback Tom Savage, who shook the ground after a hit but was allowed to stay in the game. He was later ruled out and diagnosed with concussion. That adjustment allowed doctors to keep players out of games after examining them for these symptoms.
Mahomes was, in fact, ruled out, even though he ran into the stadium tunnel after the injury, Reid said.
Does it matter if Mahomes actually had a concussion?
Of course. But whether he did or not, he must go through the same five-step process to be approved for return.
What are those steps?
The first thing to know is that each NFL player takes neurological and balance tests in an uninjured state prior to the season to get a “normal” score. Those results can later be used to diagnose a concussion and determine when a player’s neurological activity and balance have returned to their previous state after a brain injury. The five steps are:
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Step 1: Based on the symptoms, the player can do light stretching exercises, do balance training and eventually progress to light aerobic exercises.
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Step 2: The player can graduate from cardiovascular training and dynamic stretching, then take neurological and balance tests. He can go through this step as soon as those test results match his base scores.
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Step 3: The player can follow a limited amount of football specific exercises. That includes up to 30 minutes of practice time, supervised by an athletic trainer.
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Step 4: Football activities can progress to non-contact exercises such as throwing and running. Another set of tests should again show baseline results.
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Step 5: This requires the team doctor to release the player for contact. Once that happens, the player should be examined by an Independent Neurological Consultant (INC). If the “INC” confirms the team doctor’s decision, the player may fully practice and play in the team’s next game.
How long does it all take?
The protocols deliberately don’t need time. They don’t require a player to sit out a match, largely because the science of concussion shows that brain injuries heal at unpredictable rates. It is possible for players to quickly return to the baseline without missing a game, or they could miss several games or even the rest of a season.
So there is no data on that at all?
That is not entirely true. According to the NFL, using data from the 2015-19 seasons, the median length of time for quarterbacks to get out of the concussion protocol is seven days.
The AFC Championship is a very important game. Don’t players push through injuries all the time?
It is and they do, but the NFL built this protocol to make sure that doesn’t happen with brain and neurological injuries. By demanding a return to baseline test results, the NFL’s implicit policy is that a player with a brain or neurological injury cannot return until fully healed. Football contact after only partial recovery can aggravate the injury.
Mahomes is not supposed to “suck” himself back onto the field or “suck” it up. And the Chiefs shouldn’t even have the chance to take the kind of calculated risk they do when they let a player back on the field if he has a slightly sprained knee, for example.
How does the NFL prevent that?
The main difference of the concussion protocol is that it requires an independent physician to confirm recurrence. That doctor is not affiliated with the team or player, but is jointly approved by the league and the NFL Players Association. The final step of obtaining approval from the independent doctor is meant to be a safety for both the player and the team acting too aggressively.
On Monday, Reid told reporters, “There was a chance back the day Patrick comes back in [the game]. You saw him running through the tunnel. By the time he got there, he was feeling pretty good. But there is a certain protocol that you have to follow that takes it from the hand of the trainer and the hand of the player and the doctor. “
So when will we know more?
This is going to be a story all week. We may find out when (and if) Mahomes moved to Step 3, based on the Chiefs’ injury participation report before practice. Otherwise it is possible that we will not know whether Mahomes will be able to play until the weekend. The Bills-Chiefs game starts on Sunday at 6:40 PM ET.
Mahomes himself suffered a concussion in his career, during the 2014 college season at Texas Tech. He returned to play in the team’s next game, which was due to a scheduled bye two weeks later.