How long is Patrick Mahomes out? Explaining the NFL’s concussion protocol, Chiefs QB’s status vs. Bills

The NFL’s concussion protocol and its very specific timeline and guidelines could determine the fate of the Kansas City Chiefs’ season. Patrick Mahomes is widely thought to be concussed, and his status for the AFC Championship Game is in doubt.

The Chiefs’ superstar quarterback was injured during the third quarter of Kansas City’s divisional round win over the Cleveland Browns. While scrambling, he was brought to the ground with the tackler wrapped around his neck. Mahomes’ head collided with the ground while his neck appeared to be twisted. Mahomes tried to get up and initially struggled before falling back to the ground. He eventually ran off to the locker room before being ruled out for the remainder of the contest, forcing backup Chad Henne to hold on to Kansas City’s lead.

A CBS report on Monday suggested Mahomes suffered a tweaked nerve in his neck rather than experiencing a concussion, but that assertion has not been confirmed elsewhere.

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With the win, the Chiefs set up an AFC Championship matchup with the Bills for the right to play in Super Bowl 55. But because of the NFL’s five-step concussion protocol, Mahomes’ availability may not be known until late in the week ahead of the Sunday, Jan. 24 game. 

After Sunday’s game, Chiefs coach Andy Reid said, “He’s doing great now, which is a real positive as we looked at this. He passed all the deals that he needed to pass, so we’ll see where it goes from here.”

Mahomes himself tweeted twice after the game, first writing “#HenneThingIsPossible” and then telling Browns linebacker Mack Wilson, who had the tackle that injured Mahomes, “All good brother!” 

How long is Patrick Mahomes out?

There is no set timetable for a player’s return from the NFL’s concussion protocol, at least in terms of number of days. Mahomes’ return to practice and game action will depend on how quickly he moves through the five steps of the league’s protocol.

According to The Athletic, the median time for the 29 quarterbacks who suffered a concussion between 2015-2019 to return was seven days. But that’s just the central length among the sampling of 29, which includes both longer and shorter absences.

It’s also important to note that concussion recovery doesn’t necessarily follow the same line for each individual. Just because Reid said Sunday that Mahomes was “feeling good,” and just because Mahomes tweeted a couple times after the game, doesn’t specifically point to how fast he may get back from his concussion.

Mahomes has had one recorded concussion in his college/NFL career, which came in 2014 while he played quarterback for Texas Tech. He didn’t return to the game he was injured in, and the Red Raiders had a bye the next week. When Texas Tech played again 14 days after the injury, Mahomes was back.

The process for Mahomes getting through the NFL’s concussion protocol starts with a concussion evaluation Monday, the day after the injury. From there, he’ll have to pass each of the five steps of protocol and be cleared by both the Chiefs medical staff and an independent neurologist before he can play. 

NFL concussion protocol, explained

In order to handle head injuries with standard procedure, the NFL has a five-step concussion protocol that every team must follow when a player is diagnosed with a concussion. This ensures that no team/player receives preferential and potentially dangerous treatment in being rushed back to action from a head injury. 

The NFL Head, Neck and Spine Committee developed the protocol in 2011, and it’s reviewed each year by independent and NFL-affiliated physicians and scientists to ensure that identification, diagnosis and treatment of concussions is up to current medical standards. 

The following five steps of concussion protocol feature the NFL’s official wording from its July 2020 revisions to the Return-to-Participation Protocol:

Step 1: Symptom Limited Activity

The player is prescribed rest, limiting or, if necessary, avoiding activities (both physical and cognitive) which increase or aggravate symptoms. Under athletic training staff supervision, limited stretching and balance training can be introduced, progressing to light aerobic exercise, all as tolerated. 

Step 2: Aerobic Exercise

Under direct oversight of the team’s medical staff, the player should begin graduated cardiovascular exercise and may also engage in dynamic stretching and balance training. Neorocognitive and balance testing can be administered after completion of Phase Two and the results should be interpreted as back to baseline.

Step 3: Football Specific Exercise

The player continues with supervised cardiovascular exercises that are increased and may mimic sport-specific activities, and supervised strength training is introduced. The players is allowed to practice with the team in sport-specific exercise for 30 minutes or less with ongoing and careful monitoring.

Step 4: Club-Based Non-Contact Training Drills

The player continues cardiovascular, strength and balance training, team-based sport-specific exercise, and participates in non-contact football activities (e.g. throwing, catching, running, and other position-specific activities). Neurocognitive and balance testing should be completed no later than the end of Phase Four with the results interpreted as back to baseline.

Step 5: Full Football Activity/Clearance

Upon clearance by the Club physician for full football activity involving contact, the player must be examined by the Independent Neurological Consultant (INC) assigned to his Club. If the INC concurs with the Club physician that the player’s concussion has resolved, he may participate in his Club’s next practice or game.

Who has to clear Patrick Mahomes from concussion?

As can be seen in step five above, Mahomes has to be cleared by two separate entities to return to full practice and game action. First, the Chiefs’ medical staff must clear Mahaomes, essentially saying that he’s progressed through the first four steps of concussion protocol and passed all the testing along the way.

Once the Kansas City medical staff clears Mahomes, he also has to be cleared by an Independent Neurological Consultant, essentially a brain expert who isn’t employed by the team and thus can make decisions independent of how they impact that Chiefs on the field. If Mahomes is also cleared by that independent consultant, he can return to full practice and game activity.