What the NFL Concussion Protocol Requires Before Jason Pinnock Can Play Again

Giants safety Jason Pinnock left the Oct. 4 win over Arizona with a concussion and did not return. He did not practice Wednesday or Thursday. Friday's report had not posted as of Friday morning.

Before he plays again, the NFL's concussion protocol requires two doctors to clear him: the Giants' team physician and an independent neurological consultant who is not affiliated with any club.

The protocol is written by the NFL Head, Neck and Spine Committee, whose members include independent and league-affiliated doctors and scientists as well as advisers to the players' union. The league reviews it every year. The most recent version posted on the NFL's site is dated September 2024.

How a player is removed on game day

Every game has observers who do not work for either team. Certified athletic trainers in a booth above the field watch the broadcast and replay feeds, and an unaffiliated neurotrauma consultant in the booth does the same. Either can radio the team physician and the sideline consultant when a player shows signs of a concussion after a hit to the head or neck. The booth trainer can also call a medical timeout, which stops the game until the player is removed for evaluation.

The first exam takes place in the sideline medical tent. It covers the player's symptoms, video of the play and a neurological check of the cervical spine, speech, balance and eye movement. Any positive or unclear result sends the player to the locker room for a longer exam that is compared with his preseason baseline.

The protocol lists four "No-Go" signs: loss of consciousness, ataxia (a problem with balance, coordination or speech), confusion and amnesia. A player who shows any of them "must be removed immediately," the protocol says, and "may not return to participation (practice or play) on the same day under any circumstances." The team physician makes the diagnosis, working with the sideline consultant. Every player evaluated on game day gets a follow-up exam the next day, whatever the result.

The five phases

A player diagnosed with a concussion then works through five phases:

1. Symptom-limited activity. Rest and daily activities, light aerobic work, and team meetings and film study if he tolerates them.
2. Aerobic exercise. Graduated cardio, such as a stationary bike or treadmill, plus stretching and balance work.
3. Football-specific exercise. Supervised cardio that begins to mimic sport-specific activity, plus supervised strength training. The protocol allows the player "to practice with the team in sport specific exercise for 30 minutes or less."
4. Club-based non-contact training drills. Throwing, catching, running and position drills, building to non-contact team practice. No contact with players, tackling dummies or sleds.
5. Full football activity/clearance. Full practice, including contact.

A player moves up only after he completes a phase without symptoms returning. If symptoms return, he drops back to the previous phase. His neurocognitive testing must be back to his baseline before he does any contact work. The protocol states that "there is no set timeframe for return to participation."

Who clears a player

When the team physician concludes a player's concussion has resolved, the independent neurological consultant examines the player. The league and the union jointly approve those consultants. Under the protocol, "all return to full participation decisions are to be confirmed by the Independent Neurological Consultant." Once the consultant agrees with the team physician, the protocol says, the player "is considered cleared and may participate in his Club's next game or practice."

Teams that do not follow the protocol face fines, and possible forfeited draft picks, under an enforcement policy the league and the union adopted in 2016.

What the injury report can show

The Giants' daily report lists each injured player as a nonparticipant, limited or full. It does not list protocol phases.

The protocol does not tie its phases to injury-report categories. A player in the first two phases does not practice with the team, so he would be listed as not participating. The third and fourth phases allow partial or non-contact work in team practice, which a team would ordinarily report as limited. The fifth phase is full practice with contact.

An injury-report listing of nonparticipant, limited or full does not show which phase a player is in or whether the independent neurological consultant has signed off. A limited listing does not by itself point to the protocol, either. Asked at his Oct. 7 news conference whether running back Cam Skattebo, who practiced in a red no-contact jersey, was in the protocol, coach John Harbaugh said, "No, he's not." Skattebo is listed with a shoulder injury.

Washington's report this week also lists a concussion. Guard Sam Cosmi was limited Wednesday and a full participant Thursday.

Pinnock's week

Asked at his Oct. 5 news conference whether Pinnock and defensive lineman Chauncey Golston had come out of the game OK, Harbaugh said, "We'll know more tomorrow on all those guys." As of Friday morning, the Giants had said nothing on the record about Pinnock beyond the injury report. He is not on injured reserve.

The Giants (3-1) play at Washington at 1 p.m. Sunday. Friday's injury report, due after practice, will carry game designations.