Review of NFL return-to-participation process

Review of NFL return-to-participation process
December 26, 2013, 12:15 pm
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FOXBORO -- When Nate Solder suffered a concussion against the Browns in Week 15, he was back at practice the following Thursday and played against the Dolphins in New England's next game. After he suffered his second concussion in as many weeks down in Miami, he was back on the practice field once again the following Thursday.

Though he practiced two days last week, he sat out Sunday's game against the Ravens -- his first game missed due to injury since entering into the NFL in 2011.

Solder was back on the practice field both on Christmas Day and Thursday afternoon. He told Jeff Howe of the Boston Herald on Tuesday that he understands team doctors have his best interests in mind.

“My health is important, and I know the doctors have my best interest [in mind],” Solder said.  “I’m more concerned right now about Buffalo and getting prepared for them.”

The Patriots had another starter suffer a concussion last weekend in Baltimore when early in the third quarter safety Devin McCourty hit his head awkwardly while trying to make a tackle. He did not return to the game.

McCourty told reporters in the Patriots locker room on Tuesday that he was "all right," but he wasn't cleared for Tuesday's walkthrough and has missed both Wednesday and Thursday's practices.

McCourty and Solder's differing situations and differing timetables highlights the fact that no two concussions are the same. The protocol for players who have suffered a concussion to return to the field is uniform, however.

From the NFL Head, Neck and Spine Committee's Protocols Regarding Diagnosis and Management of Concussion, here is what players like Solder and McCourty are required to do before allowed back on the field:

Return-to-Participation Process
After a concussion has occurred in practice or play, the concussed player must be examined and monitored in the training room on a daily basis or as decided by the medical staff. Components of the NFL Sideline Concussion Assessment can be utilized to check for symptoms as well as continue to monitor the other aspects of the examination. The following measures must occur in order for a player to return to play:

a. A player returns to baseline status of symptoms and neurologic exam, including cognitive and balance functions.
        i. Repeat neuropsychological evaluation is performed before return to practice or play with interpretation of the data by the team neuropsychology consultant. The team neuropsychology consultant reports the findings back to the team physician.

b. A graduated exercise challenge, followed by a gradual return to practice and play, is initiated when the player returns to baseline status. The RTP protocol following a concussion follows a stepwise process to be outlined in the NFL Head, Neck and Spine Committee’s Return to Participation Protocol.

c. Prior to return to practice or play, not only must the team physician clear the player, but the Independent Neurological Consultant with expertise in concussion must also evaluate and clear the player for return to practice and play.

d. A player may be considered for return to practice and play only after the player has returned to baseline status with rest and exertion, has repeat neuropsychological testing which is interpreted by the team neuropsychology consultant as back to baseline levels of functioning, and has completed the Return to Participation Protocol referenced above and is cleared by the Team Physician and the Independent Neurological Consultant.