A Retrospective on Josh Allen’s Concussion Management: What Went Wrong?

Disclaimer: This blog was AI-generated and human-reviewed by Dr. Mark Heisig to ensure accuracy and alignment with evidence-based concussion management practices.

On October 8, 2024, during a game against the Texans, Buffalo Bills quarterback Josh Allen sustained a significant head impact that raised questions about his management under the NFL’s concussion protocol. At the time, his quick return to play was celebrated as resilience. However, a retrospective analysis reveals this incident as a glaring example of systemic flaws in concussion management.

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The Incident Revisited.

During the fourth quarter, Allen suffered a hit that caused his head to bounce off the turf, followed by an unprotected, face-first collapse. In his post-game remarks, Allen stated:

“Big shot to the chest, and I rolled my ankle there… They flagged me for hitting my head, but felt good enough to go back in the game.”

Game footage paints a different story. While Allen may have rolled his ankle, the visible head impact and unprotected fall were undeniable signs of a potential concussion. Despite this, Allen missed only 6 minutes and 6 seconds of game time—a short period that raises serious doubts about the thoroughness of his evaluation.

The NFL and NFLPA’s Justification: A Critical Lens.

Following the incident, the NFL and NFLPA issued a statement defending the evaluation process, stating:

“Josh Allen was properly evaluated for a concussion in accordance with the league’s concussion protocol, and there was no indication of a head injury.”

This vague justification does little to address the observable evidence. The defense relies heavily on protocol adherence without clarifying the following:

1. What “properly evaluated” entails. Was Allen’s symptom report accurate, and were balance and neurological exams truly comprehensive in such a short timeframe?
2. How “no indication of a head injury” was concluded. Allen’s behavior on the field—rag-dolling, lying motionless, and slow to get up—met multiple concussion indicators outlined in both the CRT6 and SCAT6. The league’s dismissal of these observable signs undermines the credibility of its protocols.

The lack of transparency in the NFL’s response perpetuates concerns that player safety takes a backseat to game-day decisions.

What the Protocol Should Have Done.

The NFL’s concussion protocol is designed to safeguard players by emphasizing caution. Here’s how it should have applied in Allen’s case:

1. Recognizing Observable Signs
   Using the Concussion Recognition Tool 6 (CRT6) for non-medical professionals, Allen demonstrated two critical signs:
   • Falling unprotected onto the playing surface.
   • Slow to get up after a head impact.
2. Medical professionals referencing the SCAT6 would have noted additional criteria:
   • High-risk contact sport participation.
   • Unprotected fall.
   • Lying motionless.
3. Blue Tent Evaluation Steps
   Inside the blue tent, the protocol should include:
   • Symptom scoring. Was Allen symptom-free, or were symptoms dismissed in favor of a quick return?
   • Neurological examination. Did he genuinely pass the standard tests, or were subtle deficits & symptom-provocation overlooked?
   • Balance testing (BESS). A proper evaluation here is vital, especially in cases involving head impact and unsteady movement.

Even one symptom following a suspected concussion should disqualify a player from returning to play. Allen’s rapid return suggests protocol shortcomings or a failure to err on the side of caution.

Lessons Learned: What Should Have Happened?

Allen’s case highlights the need for a player-first approach to concussion management:

• Immediate removal for the remainder of the game. Observable signs with even ONE symptom should be enough to rule out return-to-play.
• Follow-up evaluations over the next 24-72 hours. Concussion symptoms, including red flags, often present delayed-onset, necessitating ongoing monitoring.
• Gradual return-to-play protocol. Confirming symptom resolution before resuming full-contact activity minimizes long-term risk.

The stakes of a 4th quarter-game—and Allen’s status as a star player—should never override the priority of his long-term health.

The NFL’s Broader Concussion Management Problem.

The NFL’s defense of Allen’s evaluation underscores systemic issues. While the league champions safety measures like Guardian Caps and enhanced protocols, these symbolic efforts fall short without rigorous enforcement. As I often say:

Concussion is not the problem—poor management is the problem.

Protocols must go beyond checkbox compliance. Transparency, accountability, and caution are essential to protect players from avoidable risks.

Moving Forward.

This retrospective analysis shows that, despite progress in concussion awareness, the NFL still has significant room for improvement. Key steps include:

1. Stricter enforcement of protocols. Players with observable signs must be removed from play, with no exceptions.
2. Greater transparency. The league must clearly explain how evaluations are conducted and justify decisions to clear players.
3. Education and culture change. Players, coaches, and fans must prioritize health over performance, especially in the face of brain injuries.

Josh Allen’s quick return to play may have seemed like a win for the team, but it represents a loss for player safety. It’s time to prioritize health over the scoreboard.