What's the protocol for Rob Gronkowski's return?


When Jaguars safety Barry Church connected on a helmet-to-helmet hit with Rob Gronkowski, it didn't just throw the Patriots' plan for the AFC title game out of whack. Once the Patriots won, the hit also cast some doubt on exactly how much Gronkowski would be able to do as the team prepares for Super Bowl LII.

Based on what happened in the game, it appears as though it was determined that Gronkowski showed "no-go" signs or symptoms soon after the hit. He was helped to his feet by receiver Chris Hogan, he met with Patriots medical personnel, and he was headed to the locker room less than a minute after hitting the sidelines.


According to the NFL's Head, Neck and Spine Committee's concussion management protocol, which we've quoted throughout this post, if a player exhibits or reports loss of consciousness, confusion or amnesia, "he must be removed immediately from the field of play and transported to the locker room." Players exhibiting those signs or symptoms are considered to have suffered a concussion and may not return to participation on the same day under any circumstances.

Inside the locker room, per the NFL's protocol, Gronkowski would have been evaluated by the team's medical staff and a designated unaffiliated neurotrauma consultant using the NFL Locker Room Comprehensive Concussion Assessment, which is based on the Standardized Concussion Assessment Tool, published by the International Concussion in Sport Group. In conjunction with preseason baseline testing, the assessment is meant to provide "a comprehensive and detailed picture of each athlete's injury and recovery course."

"The team physician shall be responsible for determining whether the player is diagnosed as having a concussion," according to the protocol, which may be the case even if a player can complete the locker room assessment "within normal limits" compared to their baseline because of the assessment's limitations.

"Such limitations underscore the importance of knowing the athlete," per the league's protocol, "and the subtle deficits in their personality and behaviors that can occur with concussive injury."


Once a player is diagnosed with a concussion, he then must pass through the return-to-participation protocol. Because recovery from concussions varies from player to player, there is no time-frame for return laid out by the league. The decision to return a player to participation "remains within the professional judgment of the head team physician or team physician designated for concussion evaluation and treatment," and all return to full participation decisions must be confirmed by an independent neurological consultant (INC). 

The return-to-participation protocol is a five-step process, and a player must demonstrate a tolerance of all activities in each step "without recurrence of signs or symptoms of concussion being observed or reported" before proceeding to the next step. 
1) Rest and Recovery: Players may take part in some stretching and balance activity. Once players reach their baseline level of signs and symptoms and neurological examination, he can proceed to Step 2. 


2) Light Aerobic Exercise: Players begin, under oversight of team medical staff, a graduated exercise program. Dynamic stretching and balance work is allowed, as is cardiovascular exercise, the duration and intensity of which may be gradually increased as long as players remain at baseline during and after activity. Players in Step 2 may attend team meetings and study film. Weight training is not permitted. 

3) Continued Aeobic Exercise and Introduction of Strength Training: The duration and intensity of aerobic exercise (for example, more intense or longer time on a stationary bike or treadmill) can be increased. Players can also begin to participate in supervised strength training and some sport-specific conditioning drills like change-of-direction drills and cone drills. 

4) Football Specific Activities: Players may participate in all non-contact activities -- throwing, catching, running and other position-specific activities -- for the typical duration of a full practice. Contact with players, tackling dummies or sleds is not permitted. 

5) Full Football Activity/Clearance: Players may participate in all aspects of practice without restrictions on contact. Upon clearance by the team physician, the player must then be examined by the INC assigned to the team. If the INC confirms the team doctor's conclusion, then the player is cleared and can fully participate in his team's next game or practice. 


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