EFA (EuroLeague Framework Agreement) Explained: EuroLeague Concussion Protocol

Jan 21, 2024 | Home News, Media, News

Concussions pose a severe threat to short and long-term health of basketball players. Therefore, the EuroLeague concussion protocol aims to provide cutting-edge care for the players throughout the year, and ensure that when concussions do occur, they are accurately diagnosed and properly treated. This protocol serves as a standardized procedure for all team doctors and physiotherapists, and prioritizes proper recognition and treatment to ensure that players recover fully without risking further injury when they step back onto the court.

  1.  Baseline Assessment

The first step of the protocol is a mandatory baseline neurocognitive assessment of each player before preseason training begins. The assessment must be conducted by a member of the team medical staff, prior to the start of any physical activity. This comprehensive preseason screening provides relevant background information, including:

  • Prior history of brain or spine injury
  • Migraines or seizure disorders
  • Medications
  • Drug and alcohol use
  • Depression or other mood disorders

The assessment also includes various tests of the player’s neurocognitive function, including:

  • Concussion symptoms checklist
  • Balance and postural stability
  • Sport Concussion and Assessment Tool 5 (SCAT5) test
  • Vestibular Ocular Motor Screening (VOMS) test

This assessment serves two primary purposes. First, it establishes a baseline level of neurocognitive function against which the player can be tested in the event of an injury. Secondly, it also identifies and records any pre-existing factors that might increase risk of a player sustaining a concussion, or complicate his recovery. In short, the pre-season baseline assessment ensures that team medical personnel have all the relevant information needed to identify and treat a concussion, if the player sustains a head injury.

  1. Initial Concussion Assessment and Evaluation

If a potential head injury occurs during a game or practice, a concussion screening must be immediately conducted by a team doctor or paramedic. After first ensuring that critical bodily functions are intact (airway and breathing, spinal cord, circulation, etc.), the player will be evaluated for symptoms of a concussion. Such symptoms include (but are not limited to): headache, double vision, seizure, loss of consciousness, vomiting, etc.

This initial assessment should take place in three minutes or less. If there is any suspicion that the player has sustained a concussion, he will not be allowed to continue his participation. The player will only be allowed to continue if he is explicitly cleared by the team doctor or paramedic conducting the assessment.

If the initial assessment indicates that the player might have sustained a concussion, he will be taken to a quiet area for further examination, and the SCAT5 and VOMS tests will be conducted. Afterwards, the test results shall be compared to the baseline data collected during the preseason assessment. If a concussion is suspected, only the physician can authorize return to play. Otherwise, continued monitoring and removal are mandated.

If risk factors of a brain injury are present, an initial CT scan is recommended on the day of the injury.

  1. 24-Hour Observation and Re-evaluation

After a suspected concussion, the concussion protocol requires 24-hour observation, even if initial screening was normal. During this window, players are required to rest, both physically and cognitively. The player is required to avoid all physical activity, as well as reading, cell phones, computers, television, and all digital screens. The player should not be left alone during this period, nor should he consume alcohol or operate a vehicle.

After the observation period, the player should be re-evaluated for signs and symptoms, which may help confirm or rule out a concussion.

  1. Graduated Return-to-Play Protocol

If a player is diagnosed with a concussion, he must complete the Graduated Return to Play (GRTP) protocol. The GRTP is a data-driven, structured program which starts with light aerobic activity like walking, and gradually increases exertion over 24-hour periods, until the player is healthy and prepared to return to play.

The program begins at midnight on the day of the injury, and each step takes a minimum of 24 hours to be completed.

  • Step 1: No Activity
    1. The player must rest completely for 24-48 hours
    2. Progression to Step 2 can ONLY occur if the player has no symptoms, and is not using medications that can mask concussion symptoms
  • Step 2: Light Aerobic Activity
    1. The player may engage in light aerobic activities such as walking, jogging, swimming, or using a stationary bicycle
    2. Heart rate should remain below 70%
    3. Exercise limited to 15 minutes
    4. If player experiences concussion symptoms, return to Step 1
    5. Progression to Step 3 ONLY if symptom free for 24 hours
  • Step 3: Basketball Specific Activities (individual practice)
    1. Individual drills and workouts, not at full speed
    2. Heart rate should remain below 80%
    3. Exercise limited to 45 minutes
    4. If player experiences concussion symptoms, return to Step 2
    5. Progression to Step 4 ONLY if symptom free for 24 hours
  • Step 4: Non-Contact Drills
    1. Complex training activities with increased intensity, coordination and attention
    2. Passing, change of direction, shooting, resistance training
    3. Heart rate should remain below 90%
    4. Exercise limited to 1 hour
    5. If player experiences concussion symptoms, return to Step 3
    6. Progression to Step 5 requires specific approval from a doctor
  • Step 5: Full Contact Practice
    1. Normal training activities
    2. Build confidence and assess functional skills
    3. If player experiences concussion symptoms, return to Step 4
    4. Progression to Step 6 ONLY if symptom free for 24 hours
  • Step 6: Return to Play
    1. This step requires the express approval of the team doctor
    2. The club must submit the Return to Play form for validation by the EuroLeague Basketball Medical Officer

The GRTP is the most crucial aspect of the concussion protocol. By gradually progressing through each step of the program, clubs and players will ensure adequate recovery and prevent additional injury.


The EuroLeague concussion protocol uses data and care to protect long-term athlete health. As the competition continues to accelerate, comprehensive diagnosis, treatment and gradual re-integration prevent catastrophic risks and ensure full recovery for players. Continued progress on prevention and recovery is an important objective for all parties moving forward.


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