Injury types

Concussion Protocols Explained - NFL, NBA, NHL, MLB and Football's Concussion Substitutes

Published 2026-10-26 · Daily IL team

Of all the injuries that appear on a team report, concussions are the hardest to put a return date on. Ankle sprains and muscle strains come with rough recovery windows, but concussion symptoms clear at very different speeds from one player to the next, and even after they clear, a player has to pass a series of set steps before he can play. That is why most professional leagues do not give a fixed number of days. They set out a step-by-step protocol instead. This guide explains how those protocols work in each sport.

The common principle: steps, not dates

The details vary, but the approach is broadly the same everywhere:

If in doubt, take the player out. Anyone showing signs is assessed straight away, before a diagnosis is confirmed.
Rest until symptoms settle, avoiding physical or mental activity that makes them worse.
Build up gradually, from light aerobic exercise to sport-specific drills, then non-contact training and finally contact training.
Go back a step if symptoms return.
Wait for medical clearance before returning to games.

So when you read that a player has “entered the concussion protocol”, the right reading is that his absence has no set length. Some players are back within days; others need weeks.

NFL: five steps and an independent neurologist

The NFL publishes more detail about concussion management than any other league.

Spotting it during games. The team athletic trainer, a trainer spotter in the booth, team doctors, game officials, coaches, teammates and unaffiliated neurotrauma consultants (UNCs), who have no ties to either club, can all start the protocol. Since 2018 a third UNC has watched the broadcast feeds. A player who shows an impact seizure or a “fencing response” cannot return to that game. If problems with balance, coordination or speech (ataxia) are judged to be neurological, the player is also ruled out for the day.

Returning: five steps (based on the NFL’s official fact sheet):

Step	What happens
1	Symptom-limited rest and light activity
2	Graduated aerobic exercise such as a stationary bike; team meetings allowed
3	Football-style movement drills, strength training, short team sessions
4	Non-contact drills such as throwing, catching and running; cognitive and balance tests back to baseline
5	Full practice including contact, cleared by the team doctor and an independent neurologist

At the final step, clearance from the club physician is not enough on its own. The player must also be examined and cleared by an Independent Neurological Consultant, approved jointly by the NFL and the players’ union. The NFL states plainly that there is no set timeframe for completing the steps.

NBA and NHL

The NBA runs a league-wide concussion programme. According to its 2025-26 summary, a player diagnosed with a concussion cannot begin the return-to-participation exercise steps until 24 hours after the injury, and cannot return to full, unrestricted participation for at least 48 hours and until the process is complete. The steps build from a stationary bike to jogging, agility work and non-contact team drills; if symptoms come back, the player drops back to the last step he passed without symptoms. The team physician makes the final call but must first consult the director of the league’s concussion programme.

The NHL‘s protocol, agreed with the players’ association, leans heavily on spotters. Central league spotters in the Player Safety Room in New York watch every game and can require a player who shows visible signs of concussion after a hit to the head to be removed for evaluation, with in-arena spotters and on-ice officials supporting them. A player marked for evaluation cannot return to the game until the club’s medical staff have assessed and cleared him, and clubs that fail to remove a player face fines.

MLB: the 7-day injured list

Since the 2011 season, Major League Baseball has had a 7-day injured list reserved for concussions. Having a shorter list means a player who passes concussion testing can come back sooner, while making sure a player who still has symptoms is not rushed back. It can only be used for players with concussion symptoms, and placements can be backdated to the day after the player’s last game. It was originally called the 7-day disabled list and was renamed after the 2018 season. Seven days is only the minimum: players whose symptoms linger can be out for considerably longer.

Football (soccer): permanent concussion substitutes

Because football limits the number of substitutions, teams used to face a hard choice when a player took a blow to the head: take him off and lose a substitution, or keep him on. After a period of trials, football’s lawmakers, the IFAB, approved additional permanent concussion substitutions as an official competition option in Law 3 at their March 2024 meeting, effective from 1 July 2024.

A player taken off with an actual or suspected concussion cannot return to the match, including any penalty shoot-out.
The change does not count as a normal substitution and can be made even if a team has used all its usual substitutes.
Under the current IFAB protocol, each team can make a maximum of one concussion substitution per match.
When one team uses a concussion substitute, the opponent may also make one additional substitution for any reason.
Each competition decides whether to adopt the option, so availability varies.

Temporary concussion substitutes, where a player is assessed and can then come back on, are not part of the Laws; the IFAB declined to trial them.

On Daily IL

Daily IL sorts players into seven statuses: OUT, DOUBTFUL, QUESTIONABLE, PROBABLE, IL (injured list), SUSPENDED and RETURNED. A player in a concussion protocol can change status from one day to the next depending on which step he has passed, so he typically starts as OUT or QUESTIONABLE and moves to PROBABLE or RETURNED once medical clearance is reported. Players placed on an official list, such as MLB’s 7-day injured list, are shown as IL. Each status is explained on the status guide page.

Sources

Rules can change from season to season and between competitions, so always check the latest official announcements from each league or competition.