The NFL’s handling of concussions has evolved dramatically since the days when players were given smelling salts on the bench and sent back into the game.
The league and NFL Players Association have established extensive protocols and hired independent neurotrauma consultants (UNC) to work with team doctors at every game to diagnose concussions.
Still, football is a violent sport, and injuries inflicted on the frightening Miami Dolphins quarterback Tua Tagovailoa Thursday night seem inevitable unless the NFL bans tackling and turns the game into flag football, as the pro does Bowl was the case.
That is not happening and the most effective means of protecting players remains the enforcement of strict concussion protocols, which players, fans and others concerned did not do at Tagovailoa.
It would be difficult to prevent what happened to Tagovailoa when 6-foot-3, 340-pound Bengals defenseman Josh Tupou slammed him backwards onto the turf. The main question is why he only played four days after stumbling off the field at home against Buffalo and being struck to the head and unable to walk.
Tagovailoa’s hands froze and his fingers moved awkwardly in front of his face mask for several seconds as he lay on the lawn in Cincinnati, a frightening scene witnessed by millions of viewers. He remained on the ground for several minutes before being carried away on a stretcher and taken to a hospital.
This time – unlike Sunday, when he appeared to have symptoms of a concussion but was cleared to return by a team doctor and UNC – Tagovailoa was diagnosed with a concussion. He was discharged from the hospital and flew home with the team. Flight hours after a concussion raise questions, but NFL Chief Medical Officer Dr. Allen Sills said the hospital makes that decision.
Tagovailoa’s quick return on Sunday prompted a joint review by the NFL and NFLPA. The interview process has begun and the results are not expected for another week at the earliest. Tagovailoa and the team explained that his legs were shaky due to a back injury.
It is not known if there is a connection between the two incidents. Concussions are common in the NFL, especially when a player is thrown to the ground by a man Tupou’s size and his head hits the turf.
Sills said “it’s impossible to know” whether the injury Tagovailoa sustained on Thursday was aggravated by the hit he sustained on Sunday.
“That’s one of the factors we want to look at,” Sills said on the NFL Network. “We want to prevent any injury.”
Chris Nowinski, a founder of the Concussion Legacy Foundation who played soccer at Harvard, is adamant that Tagovailoa suffered a concussion against Buffalo and shouldn’t have played in Cincinnati.
“Tua showed five clear signs of concussion,” Nowinski told The Associated Press. “Anyone who has training for concussions or cares about Tua as a human being doesn’t put him on the field four days after what he showed on Sunday, that makes it that much worse because we know that’s that End of career or the season could be. It should be the end of the season in my opinion. And it just shows a lack of care for him as a person.
The league and NFLPA instituted concussion protocols in 2011 when Colt McCoy suffered a helmet-to-helmet hit in a game and returned without being tested for a concussion. Since then, the protocols have been expanded.
Each game has three UNCs that are paid jointly by the NFL and NFLPA. They work with team doctors to diagnose if a player has a concussion. Independent certified athletic trainers (ATC spotters) sit in a booth and monitor players on the field to remove someone from the game if they see an impact to the head. Team coaches, coaches or doctors, teammates, on-game officials, sideline UNCs, or standing ATCs may also initiate the protocol.
All players undergoing a game-day concussion evaluation must be followed-up by a member of the medical staff for a follow-up evaluation the following day. Sills said Tagovailoa was checked every day before the game, although he wasn’t on the concussion log.
Several players have talked about passing protocol even if they had concussions. Andrew Whitworth, the Rams’ former offensive lineman, said on Amazon’s show he once suffered a concussion during a game until a teammate realized he wasn’t right and alerted doctors.
The league has experimented with other means to mitigate head injuries. This year, for the first time, offensive linemen, defensive linemen, tight ends and linebackers were required to wear Guardian caps — a soft, padded cover over their helmets — during practice from the start of training camp through the second game of the preseason.
The average number of concussions in those position groups fell to 11 this summer from 23 in the previous three years, the league said. Of those 11 concussions, six resulted from hits on the face mask, which had no additional protection.
Tagovailoa is under pressure this season and has struggled with injuries in the past so it’s natural for him to want to play uninjured. Former players who have criticized the decision to let him play on Sunday say they wanted to protect players from themselves.
“We are all outraged by what we have seen over the past few days and fear for the safety of one of our brothers,” wrote NFLPA President JC Tretter on Twitter. “What everyone saw both Sunday and last night were ‘no go’ symptoms in our concussion logs. The logs exist to protect the player and that is why we have opened an investigation. Our job as the NFLPA is to take every action possible to get the facts and hold those responsible accountable. We need to find out how and why the decisions were made last Sunday to end a player with a “no-go” Let symptom back on the pitch.
“Until we have an objective and validated method for diagnosing brain injuries, we must do everything possible, including changing protocols, to further reduce the potential for human error. A failure of medical judgment is a failure of protocols when it comes to the welfare of our players. We’ve come a long way in the last 15 years, but last week showed how far we still have to go.”
The decision to allow Tagovailoa to return on Sunday was made by the team doctor and UNC. It was determined that Tagovailoa’s instability was caused by a back injury. The joint league-NFLPA review will review the steps taken and issue a report.
“Based on everyone I’ve spoken to and I know a lot of doctors who are people with brain injuries and sports medicine doctors, I don’t know anyone who thinks it’s sound medicine just based on observing what’s out in the field was seen and he stumbles after and says it’s okay for him to play in that game again and then four days later,” said attorney Brad Sohn, who has represented hundreds of players in concussion disputes and is one of the possible successors of NFLPA executive director DeMaurice Smith is.
NFL spokesman Brian McCarthy said there has never been an incident in which a team doctor and UNC have disagreed over a concussion.
In 2017, Seattle was fined $100,000 and the coaching and medical staff had to attend a protocol tutoring session after a joint review found the team had not been following protocol when Russell Wilson, after the referee, Walt Anderson, concluded that a medical examination was warranted.