Time is on the Ravens' side as QB Joe Flacco recovers from Kiko Alonso hit and concussion

The Ravens' first emotion was anger, an understandable reaction after watching quarterback Joe Flacco, glassy-eyed and bleeding from his left ear, walk gingerly off the field and straight to the locker room following a head shot from Miami Dolphins linebacker Kiko Alonso.

Then, after they put the finishing touches on a 40-0 victory and celebrated the most lopsided shutout in team history, the Ravens' focus shifted to concern for the well-being of their longtime quarterback. Flacco was diagnosed with his first reported concussion in the NFL and he also needed stitches to repair the damage to his ear.


"We're praying for Joe, we hope the best for him and his family," Ravens right tackle Austin Howard said after the game. "Right now, we know he's probably under it a little bit, so we hope for the best and we've got to go with what comes."

Alonso's forearm/shoulder hit Flacco flush in the head as he slid feet first to complete a 9-yard run late in the second quarter Thursday night, and knocked the Ravens quarterback's helmet off. The league is reviewing Alonso's hit for possible fine and/or suspension.

Ndamukong Suh grabbed Ryan Mallett by the throat during Ravens-Dolphins game.

Flacco, who is in the concussion protocol, was at the Ravens' facility Friday morning and all indications are that he's feeling OK given the circumstances. However, concussions are unpredictable with symptoms not necessarily surfacing immediately. The Ravens, who are off over the weekend, will obviously monitor Flacco closely, but they do have time on their side.

They have nine days before their next game, a Nov. 5 road matchup against the Tennessee Titans. They'll then go on their bye week after that, meaning that after Thursday night's win which improved them to 4-4, they'll play just one game in 23 days.

"One of the advantages is this happened on a Thursday, and that definitely gives more time," said Dr. Erin E. Manning, a neurologist for the Hospital of Special Surgery in New York. "It's very difficult for players to come back when there's only a week before games. It's hard to get through the protocol in that time. The 10-day timeline, it seems like it's definitely reasonable, but not everyone responds to concussions in the same way. It's very person dependent. You really can't know [a timetable]. It varies so much from person to person. It's really important to give the brain time to recover after the concussion because it is a brain injury."

The NFL has made a strong effort to talk about and prevent concussions, but if it wanted to send another message, the officials should have tossed Alonso from the game.

Head coach John Harbaugh didn't provide any updates late Thursday night about the severity of Flacco's concussion. That's hard to know anyway because the symptoms can change so quickly, said Dr. Andrew Lincoln, the director of the Sports Medicine Research Center for the MedStar Health Research Institute and program coordinator of the MedStar Sports Medicine Concussion Program.

"What he may have experienced in the first hour may be very different than today and even tomorrow. We'd be interested in things like headaches and any dizziness, sensitivity to light or noise, nausea, also his sleep and his mood. Things that don't get as much attention but they may be related to an injury like this," Lincoln said.

"[Concussions] are kind of like snowflakes. Everyone is different. The fact that he hasn't had a concussion that we're aware of recently, that's a positive thing. We'd be a little more worried if he was coming off a recent concussion. But there is no timetable really for this and that is frustrating both for him and his family, the team. Everybody wants him to get better as soon as possible, but it's important not to rush to say he's feeling better because a lot of this is based on symptoms he reports."

Here's what players and coaches had to say about the hit that forced Joe Flacco out of the game with a concussion during the Ravens' 40-0 win over the Dolphins on Thursday night.

The decision on when Flacco returns will be out of the quarterback's hands. Per the NFL's concussion protocol, Flacco won't be allowed to return to action until he passes all the cognitive tests and proves he's symptom free. The Ravens have had guys play the following week after sustaining a concussion in the previous game and they've had others who have missed entire seasons with head injuries.

But the five-step recovery process, in accordance with the concussion protocol, doesn't change. In the rest and recovery phase, Flacco will be limited to stretching and balance activities until he achieves the "baseline level of signs and symptoms and neurological examination." Flacco will be permitted light exercise in the second phase and then be allowed to resume strength training as part of the third.

In the fourth phase, Flacco will be allowed to practice on a limited basis with no contact. The fifth and final phase is full clearance.

"Why there is a slow return to activity is because people may feel fine doing their daily activities but if they try and do light exercise, that can make their symptoms come back," Manning said.

The Ravens will return to practice early next week with Ryan Mallett leading the starting offense until Flacco is ready. The veteran backup completed 3-of-7 passing attempts for 20 yards and a touchdown in relief of Flacco Thursday night.

The Ravens get their second shutout of the season in improving to 4-4.

Mallett has made eight career starts but none since 2015, when he was signed by the Ravens with Flacco out with a torn ACL and MCL in his left knee. Flacco missed six games with the season-ending knee injury in 2015. He hasn't missed a start in any of his nine other NFL seasons.


"I've been a starter in this league before," Mallett said. "Every week, I prepare like the starter just to be ready to go. So who knows what's going to happen, but I'll be ready to go next week."

Several Ravens ripped into Alonso after the game, calling it a dirty play and challenging the league to fine or discipline him. For his part, Alonso said repeatedly that it was a "bang-bang" play and he didn't have time to alter the hit because Flacco slid late.

But the Ravens clearly won't be buying that explanation.

"I hope the NFL takes the correct actions and takes care of that, but, right now, the game is over so we're just looking forward to moving on," Howard said.

They hope a healthy Flacco is part of the process. However, as Harbaugh noted following the game, the team has dealt with injuries all year and they wouldn't expect a dropoff no matter who goes down.

Being without their starting quarterback, though, would take things to another level.

"That's a huge challenge," left tackle Ronnie Stanley said. "It's the most important position on the field, and going forward without him is definitely going to be a big challenge to the offense. But it's something we're very capable of handling."

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