“He looked good,” Reid said in a video news conference Wednesday, adding later that Mahomes had not been cleared for contact. “He’s in the protocol, so there’s only certain things he can do, and it’s a limited basis. But today is a little bit limited practice, so this fit right into what he could do. But he took all the snaps, and he feels good.”
Mahomes, a fourth-year pro who already has won league and Super Bowl MVP honors, left the Chiefs’ victory over the Cleveland Browns on Sunday in a divisional-round playoff game after a hit at the end of a run and was ruled out for the game under the concussion protocol.
It is possible, under the protocol, for a player to be ruled out from returning to a game without being diagnosed with a concussion. Either way, Mahomes or any other player placed in the concussion protocol is subject to a step-by-step process that determines when a return to football activities is permitted, with the final say in the hands of an independent physician and no specific timetable attached.
“Each player and each concussion is unique, and there is no set time-frame for return to participation,” the NFL says in its concussion protocol published on its player health and safety website. “Team medical staff consider the player’s current concussive injury, as well as past exposures and medical history, family history and future risk in managing a player’s care.”
The NFL bolstered its protocol for the 2018 season to require a concussion evaluation “for all players demonstrating gross motor instability (e.g., stumbling or falling to the ground when trying to stand) to determine the cause of the instability.” That seemed to apply Sunday to Mahomes, who appeared wobbly on his feet after absorbing a third-quarter hit, although he was seen jogging to the Chiefs’ locker room soon after.
“He’s in [the] protocol there,” Reid said Monday, “and we’ll just follow that and see how he does here the next couple days.”
Reid did not specify Monday whether Mahomes had been diagnosed with a concussion.
Any NFL player placed in the protocol is subject to a five-step process to be cleared to play, with symptoms monitored closely throughout and the player’s results in neurocognitive and balance tests compared with his baseline scores.
The first phase involves rest and limited activities until the player can progress, under the supervision of the athletic training staff, to light aerobic exercise. Phase 2 involves increased cardiovascular exercise. The third phase allows for practice with the team in football-specific exercise for 30 minutes or fewer with careful monitoring. The player can participate in noncontact football activities in Phase 4, and the final phase involves being cleared medically for full on-field participation and contact.
After a player is cleared by the team physician, he must be examined and separately cleared by an independent neurological consultant jointly approved by the league and the NFL Players Association and not affiliated with any NFL team.
“Until cleared by this independent physician, a player may not return to contact practice or play in an NFL game,” the league says in its protocol.
The guidelines are designed to keep a player from attempting to play through a head injury and to remove the coaching staff from the decision-making process.
“I just leave that with Rick [Burkholder, who oversees the Chiefs’ athletic training staff] and the docs,” Reid said Monday. “Because of the protocol, it’s a no-brainer from the coach’s standpoint. You don’t have to think about it. You just have to go forward and make sure you have an answer if he’s there, an answer if he’s not there. I can’t tell you from a medical standpoint where he’s at. I mean, I don’t know that. So that’s their decision and I just follow it.”
The NFL developed and, over more than a decade, gradually strengthened its protocol and return-to-play policies after years of scrutiny and criticism over its handling of concussions suffered by players. It reached an approximately $1 billion settlement, first approved in 2015 by a federal judge in Philadelphia, with former players who sued over the effects of head injuries.
The league and NFLPA announced in 2016 that they had agreed to enforcement procedures by which any team determined to have violated the concussion protocol could be fined or stripped of draft picks. That came after a 2015 incident in which St. Louis Rams quarterback Case Keenum continued to play in a game in Baltimore after suffering a concussion.
The late-2017 enhancements to the policy came after Houston Texans quarterback Tom Savage was allowed to reenter a game not long after his hands could be seen shaking while he was on the ground following a hit during a game.
League leaders have said often in recent years they believe they have changed the sport’s culture and participants’ attitudes regarding head injuries. Another star quarterback and former league MVP, the Ravens’ Lamar Jackson, exited a playoff game Saturday under the concussion protocol. Coach John Harbaugh said following the Ravens’ loss at Buffalo that Jackson had been diagnosed with a concussion.
“I’m thrilled now that people have accepted this as the course of action,” DeMaurice Smith, the NFLPA’s executive director, said in a video news conference Tuesday. “But it only comes about by staking out a place that we think is right and then insisting that the protocol be followed.”
Thom Mayer, the union’s medical director, said it was “encouraging” to see a veteran coach such as Reid acknowledge that “those days are long gone,” as Mayer put it, when a player in Mahomes’s circumstances might have been allowed to reenter a game. Mayer said the NFLPA is “confident that things will be handled appropriately” with Mahomes this week but the union, as always, will monitor developments on the player’s behalf.
“No two concussions are the same, even in the same player,” Mayer said. “That’s important to recognize. … Competitive considerations have absolutely nothing to do it with it. This is a scientific exercise, a medical exercise guided by rigorous, evidence-based protocols with a clear five-step return to play. … We fully expect that protocol to be followed.”
Chiefs backup quarterback Chad Henne entered Sunday’s game after Mahomes’s departure from the field and finished the 22-17 victory, completing a key fourth-down pass to seal the outcome. Henne would start Sunday against the Bills at Arrowhead Stadium, with a Super Bowl berth at stake, if Mahomes is unable to play.
“There was a chance, back in the day, that Patrick … comes back in,” Reid said Monday. “This is a way of protecting, I think, the player most of all, also protecting the trainer and doctors that are making decisions. I think it’s a plus all the way around. I think Patrick would tell you. You saw him run up the tunnel. By the time he got to that point, he was feeling pretty good. But there’s a certain protocol that you have to follow and that takes it out of the trainer’s hand and player’s hand and doctor’s hand.”