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What is the NFL’s concussion protocol and how much time do players usually miss?

Trevor Lawrence of the Jacksonville Jaguars is hit by Roquan Smith and Odafe Oweh of the Baltimore Ravens during the fourth quarter at EverBank Stadium on December 17, 2023 in Jacksonville, Florida. (Photo by Courtney Culbreath/Getty Images) (Courtney Culbreath, 2023 Getty Images)

JACKSONVILLE, Fla.Trevor Lawrence went to team doctors after Sunday night’s loss to the Ravens and said that he needed to be checked out for a head injury, a move that led to the Jaguars quarterback being placed in the NFL’s concussion protocol program.

RELATED: Trevor Lawrence goes into concussion protocol following loss to Ravens

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So, what exactly is the concussion protocol and what does that mean for a timetable for Lawrence’s return? On Monday, Coach Doug Pederson didn’t have a timeframe on when Lawrence could come back.

“I can’t, I’m not at liberty to speculate with head injuries so I can’t I can’t say one way or the other,” Pederson said on a Lawrence return.

The league implemented the safety feature in 2011 following years of being dogged by issues that it overlooked or downplayed the severity of head injuries. The protocol is a five-tier system that puts players in a program meant to give their brains time to heal following a head injury. They must make it through all five levels and be cleared by two medical professionals before they are cleared to return.

The NFL's five-tier concussion protocol system. (NFL)

The first level is symptom-limited activity where players in the protocol rest and limit activity that could exacerbate their issues. Once players pass that stage, they are cleared for step No. 2, aerobic exercise. Players can take part in cardio, stretching and training under medical supervision. Balance testing comes later in this step.

At the third level, players can work with the team for up to 30 minutes under medical supervision and step up their cardio activity. In step No. 4, players can throw, run, catch and start working on position-specific activities, as well as increase cardio. Players must have completed and passed the neurocognitive and balance testing at the fourth tier of the protocol.

The fifth state is a return to full activity. The player must be cleared by two separate medical entities, the team physician and an independent neurological consultant.

Pederson said Monday that he thought Lawrence suffered the injury on a run play with five minutes left in the game. Lawrence took a big hit at the end of it on a tackle by Odafe Oweh and was in for 10 plays after that hit. The NFL has tasked multiple entities at games with recognizing signs of head trauma, including game officials, unaffiliated medical personnel or certified athletic trainers acting as spotters during the game.

Lawrence didn’t go to the medical tent at that point or any other during the game that would have revealed a problem. Pederson said that Lawrence “self-disclosed” his issue after the game to trainers.

In a six-year period (2015 to 2020), players who suffered a concussion missed a median of nine days, according to data from the National Library of Medicine. Among those players, 59% missed one or more games.

Jerry Stevens, a former NFL spotter and Duval County Public Schools Supervisor of Sports Medicine said the path forward for athletes in concussion protocol isn’t a one-size-fits-all all approach.

“I’ve interviewed players that, unfortunately, played an entire game and don’t remember the second half because they were concussed at some point in the second quarter. And they’re just kind of on autopilot, you know, the brain is very good at compensating and trying to correct itself,” Stevens told News4JAX. “Back in the early days, we did, we did grade concussion, you know, first, second, third-degree concussion, it is now just classified as mild traumatic brain injury.”

Stevens said concussions typically resolve in 7 to 10 days, adding that adults like NFL athletes generally recover faster than teenagers because their brain has fully developed. What’s unknown is just how long it will take for Lawrence to recover. Stevens said any symptom of a brain injury could result in setbacks.

“Those symptoms could be a headache, it could be nausea, it could be a balance issue, could be a memory issue. And so until those things, you know, you’re free of that, then you can’t move on to the next step,” Stevens said.

Stevens said because professional athletes are conditioned to compete at such a high level and their adrenaline is pumping, it’s not uncommon for them to realize they may have had a concussion until after the game like in Lawrence’s case.


About the Authors
Justin Barney headshot

Justin Barney joined News4Jax in February 2019, but he’s been covering sports on the First Coast for more than 20 years.

Tarik Minor headshot

Tarik anchors the 4, 5:30 and 6:30 p.m. weekday newscasts and reports with the I-TEAM.

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