Bell: Protocols keeping concussed NFL players sidelined longer

Jarrett Bell | USA TODAY Sports

"He’s in the protocol."

Ron Rivera said it three times to open his post-practice news conference Wednesday while being pressed for an update regarding the progress of all-pro Carolina Panthers linebacker Luke Kuechly, who has missed two games since suffering a Week 1 concussion.

Rivera was hopeful Monday that Kuechly would be cleared to return after a scheduled meeting with an independent neurologist Tuesday. Yet when the unbeaten Panthers hit the practice field Wednesday, Kuechly was nowhere in sight.

It’s no wonder the coach was at a loss for words.

“I told you guys the other day, I’m not a doctor," said Rivera. "I’m a football coach. I’m an optimistic guy. I go through this procedure, just like he is. Where he is (in the protocol stage), I don’t know.”

Kuechly’s case reflects how the timeline for players returning from concussions isn't what it used to be — teams themselves seemingly have less control than ever in influencing the return of players — given the major shift in the NFL landscape for dealing with head injuries, which includes clearance from an independent neurologist as well as the team's staff. That’s a good thing, especially for the players — no matter how gung-ho they may be — considering the mounting evidence of long-term damage caused by head injuries.

"The system is working,” Richard Ellenbogen, co-chair of the league's head neck and spine committee, told USA TODAY Sports on Wednesday. “Everybody affiliated with it has become more conservative.”

Just three weeks into the season, the NFL maintains it doesn't yet have definitive data showing how long players are spending in the protocol prior to receiving clearance. Yet anecdotal evidence suggests they are typically sitting out longer than in previous years — perhaps longer than ever — while subject to additional layers of mandated evaluation.

Ellenbogen said more than half of the players who have suffered concussions this season have not been cleared to return by the following week, and he estimated the typical time for a return is nine to 10 days. When reported concussion in the NFL dropped 36% last season, the average time to return was eight days, according to the league's figures. In 2012 and 2013, the average return was six days.

“Everybody wants it to fit in the NFL schedule, but that’s not how life is,” said Ellenbogen, who is also chair of the department of neurological surgery at the University of Washington’s School of Medicine.

Kuechly is no exception.

POWER RANKINGS:Change at the top?

Baltimore Ravens left tackle Eugene Monroe will miss his third consecutive game Thursday night. During preseason, Washington quarterback Robert Griffin III missed the final two games while in the protocol. Interestingly, RG3 not only lost his starting job while injured, he told reporters that he didn’t believe that he had even suffered a concussion — and then his initial clearance to return was essentially vetoed by team physicians who disagreed with the opinion of the independent expert.

“You see a big jump,” Ellenbogen said of the trend, “because you have multiple layers of checks and balances.”

Perhaps it’s coincidence. It’s tough to draw conclusions given the nature of head injuries and the individuality of players with unique medical histories. But the pattern does seem to reflect the times. The NFL, which settled a class-action lawsuit (without acknowledging responsibility) brought on by former players alleging conditions stemming from head injuries suffered while playing football, has been essentially forced to become more proactive in the face of immense criticism. As a result, it has constantly tweaked its policies.

This season, for example, the league instituted a medical timeout to attend to a player suspected of suffering a concussion.

“The culture’s changed,” said Ellenbogen, adding that the current generation of players is more educated about concussions — and more apt to express concern about teammates suffering them.

Dallas Cowboys defensive end Jeremy Mincey played Sept. 20 but self-reported symptoms four days later he believes were caused by head-butting teammate Tyron Smith in pre-game warmups. Mincey hasn't played since.

When Cleveland Browns quarterback Josh McCown returned last week after missing one game after being concussed in the Sept. 13 opener, he said that while he felt symptom-free at a certain stage of his recovery, he appreciated the requirement to pass a baseline test.

“Sometimes the testing will show things that ... our symptoms don’t show,” he said. “I’m thankful for that, because it’s a serious thing.”

***

Follow NFL columnist Jarrett Bell on Twitter @JarrettBell