Kansas City Chiefs quarterback Patrick Mahomes is in the NFL’s concussion record, and that’s really all we can say about his status six days before the AFC Championship Game.
We do not know how long he will be sidelined. We do not know if he will be able to play on Sunday. We do not even know for sure if he suffered a concussion.
What we do know is that brain health was one of the most important storylines in the NFL’s division playoffs. Mahomes was removed from the Chiefs’ win over the Cleveland Browns on Sunday after hitting a hit at the end of a run. A day earlier, Baltimore Ravens quarterback Lamar Jackson was ruled out of a loss to the Buffalo Bills after dropping his head on the ground.
What awaits Mahomes this week? Let’s take a closer look.
How can Mahomes be in the concussion protocol if he has not suffered a concussion?
First, we do not know somehow how Mahomes was diagnosed. And importantly, it is not necessary that a player be immediately diagnosed with concussion to be placed in the protocol. All the Chiefs have confirmed is that he is in the protocol. On Monday, coach Andy Reid stopped saying that Mahomes had suffered a concussion.
Why would the NFL do that?
In 2018, the NFL adapted its protocol to require in-game evaluations for ‘all players who show great motor instability (e.g., stumbling or falling to the ground when trying to stand) to determine the cause of the instability.’ That fits roughly with what happened to Mahomes on Sunday. The protocol further states that if a doctor ‘determines the instability caused neurologically, the player is designated’ No-Go ‘and may not return to play.’
This change was in response to the narrow injury sustained in December 2017 by Houston Texans full-back Tom Savage, who can be seen trembling on the ground after a hit but was allowed to stay in the game. He was later ruled out and diagnosed with a concussion. That adjustment enabled doctors to exclude players from games after examining them for these symptoms.
Already, Mahomes has said he did not run in the stadium tunnel.
Does it matter if Mahomes really suffered a concussion?
Natural. But whether he has done so or not, he must go through the same five-step process to be cleared for return.
What are those steps?
The first thing you need to know is that every NFL player takes neurological and balancing tests before the season in a non-injured condition to give a ‘normal’ score. These results can later be used to diagnose a concussion and to determine when a player’s neurological activity and balance return to their previous state after a brain injury. The five steps are:
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Step 1: Based on symptoms, the player can stretch lightly, balance and eventually progress to light aerobic exercises.
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Step 2: The player can study after cardiovascular exercises and dynamic stretching, and then do neurological and balance tests. He can go through this step as soon as the test results match his baseline scores.
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Step 3: The player can move to a limited amount of football-specific exercises. This includes up to 30 minutes of training time, under the supervision of an athletic trainer.
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Step 4: Soccer activities can increase to non-contact exercises such as throwing and running. Another set of tests should show the basic results again.
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Step 5: This requires the team doctor to clear the player of contact. Once this happens, the player should be examined by an independent neurological consultant (INC). If the “INC” confirms the decision of the team doctor, the player is selected to practice and play in the next match of the team.
How long will it all take?
The protocols deliberately contain no time requirements. It is not necessary for a player to postpone a match, mainly because the science of concussion shows that brain injuries heal at unpredictable speeds. Players may be able to return to baseline quickly without missing a game, or they may miss several games or even the rest of a season.
So there is no data on it?
That is not entirely true. According to the NFL, the average time for quarterbacks from the concussion protocol is to use seven days, using data from the 2015-19 seasons.
The AFC Championship is a very important match. Do players not push through injuries all the time?
It is and they do, but the NFL has drafted this protocol to ensure it does not happen with brain and neurological injuries. By returning to the result of the base test, the implicit policy of the NFL is that a player with a brain or neurological injury cannot return until he is completely healed. Soccer contact after only partial recovery can aggravate the injury.
Mahomes is not supposed to be able to “want” or “suck up” on the field again. And the Chiefs are not supposed to even take the chance to risk that kind of calculated risk if they allow a player back on the field if, for example, he has a slight sprained knee.
How can the NFL prevent this?
The biggest distinction of the concussion protocol is that an independent doctor must confirm the return. 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 the approval of the independent doctor is intended as a failure for the player or team acting too aggressively.
Reid told reporters on Monday: ‘There was a chance on the day Patrick returned [the game]. You saw him run up the tunnel. When he got to that point, he felt pretty good. But there is a certain protocol that you have to follow and it takes it from the coach’s hand, the player’s hand and the doctor’s hand. ‘
So when will we know more?
It will be a story for the whole week. It is possible that we will find out when (and whether) Mahomes moves on to step 3, based on the Chiefs’ injury participation report for practice. Otherwise it is possible that we will not know if Mahomes will be able to play until the weekend. The Bills-Chiefs game begins Sunday at 6:40 p.m. ET.
Mahomes himself had a reported concussion during his career during the 2014 season at Texas Tech. He returned to play in the next game of the team, which was two weeks later due to a scheduled farewell.