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NFL: Median number of days to return from concussion is nine

Mike Florio examines all the steps to the NFL’s return to participation protocol and explains why this procedure is based on different stages, not an overall timeline.

Dolphins quarterback Tua Tagovailoa returns tonight only 24 days after a concussion. Steelers quarterback Kenny Pickett is returning only seven days after a concussion.

That disparity has caused some questions about the NFL’s concussion protocol -- not the game-day procedures, which have been the subject of much conversation this year, but the return-to-participation protocol.

The return-to-participation protocol consists of a five-step process. First, the player is prescribed rest, limiting or avoiding activities that exacerbate symptoms. Some minor stretching and balance training can be utilized, as tolerated. Light aerobic exercise also can be introduced.

After clearing the first step, the player can engages in aerobic exercise, under the supervision of the medical staff. He also can engage in balance training and dynamic stretching.

At the third step, football-specific exercises can be introduced, along with supervised strength training. The player is limited to 30 minutes of sport-specific exercise.

Fourth, the player progresses to non-contact football activities. The question becomes when/if the neurocognitive and balance testing returns to baseline.

Fifth, the team physician clears the player to return to play, followed by confirmation from a Independent Neurological Consultant. The INC (not to be confused with the game-day UNC) has final say.

There’s no timetable for a player being cleared; every player is unique, and every concussion is unique.

The median number of days for a player to clear the return-to-participation protocol is nine.

Some players miss a game. Some don’t. Some miss more than one game. Again, it depends on the player. It depends on the concussion. It depends on his ability to progress through the five steps.

For Pickett, he has secured all relevant clearances. He’ll be back in action tonight.