The NFL should reevaluate its concussion protocol


Rachel Choi

Illustration of concussion

By Mariyam Quaisar, Managing Editor

There were five minutes and fifteen seconds left in the second quarter of the game between the Miami Dolphins and the Cincinnati Bengals when the Dolphins’ quarterback was rushed to the hospital. 

On Sept. 29, quarterback Tua Tagovailoa suffered a serious concussion when he was sacked by the Bengals’ defensive lineman Josh Tupou. Tagovailoa’s head hit the ground, causing his arms to go rigid and his fingers to curl into an involuntary position.

The popular quarterback took a similar hit four days earlier during a game against the Buffalo Bills, where he grabbed his head and stumbled as he stood back up. This first hit was originally labeled a head injury, but later attributed to Tagovailoa’s prior ankle and back injuries which supposedly caused him to stumble—a reaction considered a “gross motor instability.” Tagovailoa was cleared at halftime and permitted to finish the game. 

The NFL, its players, and fans are now asking one question: How thoroughly was concussion protocol followed? The question answered itself as Tagovailoa was laid on a stretcher not even a week later. 

Tagovailoa told reporters after the Bills game that his adrenaline kept him going. He insisted to the medical team, and to reporters, that his back hit the turf before his head, which was why it was difficult to maintain stability. However, it is highly likely that Tagovailoa stumbled on his way up because his head and already-weak back hit the ground almost simultaneously. The two back-to-back impacts on his body contributed to his loss of balance—one cannot analyze the situation without considering the hard hit his head suffered. 

“He displayed neurological trauma last week, we disregarded it, labeled it a ‘back injury’ and let him back in the game,” Emmanuel Acho, former linebacker and now-analyst on Fox Sports, said in a tweet. “When will we put player safety FIRST!”

Chris Nowinski, the CEO of the Concussion Legacy Foundation who has a doctorate in behavioral neuroscience, said he saw clear signs of a concussion—loss of vision and balance—during the Bills game, and Tagovailoa should never have been cleared to continue playing. 

“You never want to return a player because you can die from Second Impact Syndrome or you can get a second concussion that changes your life,” he said in an interview with ABC News

Following the first hit, Tagovailoa was listed as “DNP,” did not participate, because of back and ankle injuries—the same ones that supposedly caused him to stumble. He was made available to play on the morning of Sept. 29, and suffered the second hit later that day. It appears the coaches had him rest a few days to make sure his head was OK, then labeled it as ankle and back recovery to downplay their own fears. Nonetheless, he went back onto the field too soon—a disastrous step for the player and his coaching staff. 

“If he has a second concussion that destroys his season or career, everyone involved will be sued and should lose their jobs, coaches included,” Nowinski tweeted four hours before the Bengals game. “We all saw it, even they must know this isn’t right.” 

While concussions are common in football games, it is necessary to follow protocol regardless of how important a player is to the game. That player won’t be too valuable if they are not medically treated in the best way possible. Brain injuries, especially, can be extremely detrimental to not only an athlete’s playing ability but also their quality of life. 

Dolphins coach Mike McDaniel told reporters watching his quarterback on the field was “an emotional moment,” but was relieved that “he didn’t have anything more serious than a concussion.” 

Who said concussions are not serious? Especially when your concussed player is lying on the field in a contorted position due to a brain injury. 

“A concussion is a traumatic brain injury and posturing suggests brain stem injury,” Nowinski said in a tweet. “It’s pretty high on the list of serious medical consequences of football.”

Tagovailoa’s arms and fingers going rigid proves concussion protocol was not followed to its full extent. Moreover, it is clear the medical team made serious mistakes because the independent neurotrauma consultant who cleared Tagovailoa was fired

In January 2017, the Dolphins were cited for failing to follow concussion protocol when then-quarterback Matt Moore was cleared to re-enter a game versus the Pittsburgh Steelers after he was slammed onto the ground by linebacker Bud Dupree. 

Moore was bleeding from the mouth—a symptom that requires further evaluation in the locker room—yet he remained on the sideline with the medical team over the duration of one play before he returned to the field. Moore was unable to stand for two minutes before he was put back in. 

Athletes often downplay injuries so they can continue living up to their fans’ expectations. Professional athletes especially live and breathe their game, so it is up to their medical team and coaches to take charge and prohibit them from continuing if it is dangerous. 

Of course, Tagovailoa must also take responsibility for not taking his injury seriously, but an athlete’s mindset is clouded when they are in the midst of an important game. It’s their job to play, just like it is a team physician’s job to diagnose with jurisdiction regardless of how “annoyed” a player gets with the amount of questions he is asked, and regardless of how adamant he is about a diagnosis that he does not have expertise in. 

Nowinski told ABC News that while there is increased awareness of concussions, the NFL must be more thorough when it comes to preventing these injuries. 

“The NFL for the last 15 years has been trying to minimize the role of on-field signs of a concussion so that they would retain flexibility in returning someone to play if they seem cognitively sound enough in the locker room to go back into the game,” Nowinski said. “This is where it bit them in the butt.”

When Tagovailoa’s fingers curled during the Bengals game, they went into a “fencing response,” an involuntary neurological response to a significant concussive event where the forearms go rigid and position themselves outward. He was taken to University of Cincinnati Hospital, where he underwent testing that showed no structural damage to the head or neck area. Tagovailoa left Cincinnati with the rest of his team “in good spirits” for South Florida, and will undergo an MRI to more thoroughly evaluate his injuries. He will also go through a five-step process as part of the concussion protocol which will gradually work his body until he is cleared for full football activity. 

The fact that Tagovailoa is not seriously hurt is a miracle, but that does not mean the events he faced can be forgotten. The NFL Players Association will hold a joint investigation into the handling of Tagovailoa’s injury from the Bills game, which may take up to two weeks. The NFL and NFLPA stated in a joint statement that necessary modifications will be made to the protocol to enhance player safety.

At the end of the day, following concussion protocol to its fullest extent is more important than winning a game. Tagovailoa’s case is one of too many, and luckily ended better than it could have. 

A similar medical emergency happened with the Arizona Cardinals’ defensive end J.J. Watt, who went into atrial fibrillation on Sept. 28. Atrial fibrillation is an irregular heartbeat that can lead to blood clots in the heart. Watt’s heart was shocked back into rhythm on Sept. 29, and  he played a game against the Carolina Panthers three days later. How is it possible that somebody whose heart was literally shocked back to normal was allowed to pick up a football in just a matter of days? 

Players’ safety needs to be taken more seriously, especially in cases like Watt and Tagovailoa. It is up to the coaching staff to recognize when a player needs more recovery time.

Five years have passed since Moore’s blood was wiped and he was sent back to finish a game. How has the NFL not learned basic human safety in the past five years? Winning a game won’t seem so important when your player’s heart suffers from a blood clot or their body gets paralyzed. 

The NFL is the most watched professional sports league in America, and players make millions putting their bodies on the line in pursuit of victory. How long will such a popular sport happily advertise dangerous play? 

Football is the heart of America, but the consistent news of concussions and hard hits are pushing parents to enroll their children in soccer and baseball instead. Scholastic football programs are drastically shrinking, which is motivating the NFL to spend millions on convincing parents the game can be made safer. So, when exactly will that happen?

Making millions of dollars means nothing if you’re not alive to claim it.