Dr. John Leddy Weighs In on the Tua Tagovailoa Incident

The NFLPA has launched an investigation into the Miami Dolphins’ handling of an injury to quarterback Tua Tagovailoa.[1] In the second quarter of the Dolphins’ game against the Bills, Tagovailoa was hit by Bills’ linebacker Matt Milano and fell back, slamming the back of his head on the ground. After getting up, Tagovailoa tried to walk and stumbled multiple times, eventually needing to be held up by teammates.

After what seemed to be a clear head injury, Tagovailoa was taken into the locker room to be evaluated for a concussion. Based on Tagovailoa’s blow to his head and the ensuing stumbling, the concussion protocol evaluation seemed like a mere formality, and Dolphins’ backup quarterback Teddy Bridgewater was set to finish the game. After the injury, the Dolphins’ official Twitter account tweeted that Tagovailoa “has a head injury and is questionable to return.”[2]

As the second half began, Tagovailoa ran out onto the field and was apparently ready to play, a massive surprise to everyone, as the player who could not even walk without stumbling 20 minutes ago was now ready to go. Apparently, during halftime Tagovailoa passed concussion protocol.[3]

Contrary to the Dolphins’ own team reports, Ian Rapoport, one of the leading NFL insiders, tweeted that Tagovailoa did not actually suffer a head injury, it was actually a back injury.[4] Rapoport tweeted that Tagovailoa tweaked his back earlier in the game and the hit by Milano caused it to “lock up,” resulting in him stumbling and being wobbly.[5] Apparently, slamming the back of your head into the ground can cause your back to lock up.

The first question many people asked is, how did Tagovailoa pass concussion protocol after visibly looking concussed? The NFL’s concussion protocol is administered by independent physicians and scientists in conjunction with team doctors when a player receives an impact to the head that may have caused a concussion.[6] Per the NFL’s “Concussion Gameday Checklist,” physicians are to look at things such as speech, observation of gait, and eye movement and pupil evaluation; among other things, a player cannot be cleared to return to play if there is “Gross Motor Instability” after an impact to the head.[7] Apparently the physicians did not see the wobbling and stumbling as “Gross Motor Instability.”

Dr. John Leddy’s Thoughts

Since I am not an expert on concussions or sports injuries, I spoke to Dr. John Leddy from UBMD Orthopedics and Sports Medicine to see what he saw based on his expertise. Dr. Leddy is a primary care sports medicine physician and is a leading concussion expert who has conducted extensive research on concussions and post-concussion syndrome. Dr. Leddy is currently the medical director of the University at Buffalo Concussion Management Clinic.

Dr. Leddy believes that based on what he saw he was “very surprised if not stunned” that Tagovailoa was allowed to continue playing. Based on what he saw on his TV, at first glance he suspects that it looked like a classic concussion. Dr. Leddy says it looks like a classic concussion because “the back of his head slammed into the turf and when he got up, he was immediately ataxic (unbalanced gait), almost falling down,” which is a classic observable sign of a concussion. Dr. Leddy believes that any player who is suspected of having a concussion should be removed from the game to prevent risk of further brain injury. If Tagovailoa actually sustained a concussion and he were to have sustained another hit to the head, there could have been serious consequences, such as a significant worsening of the concussion, that could result in weeks to months of lingering symptoms. Although Dr. Leddy says it is unlikely, it is even possible to sustain “Second Impact Syndrome,” which is devastating.

Dr. Leddy did not have the opportunity to actually examine Tagovailoa himself, so his comments are just general comments from what he observed. Dr. Leddy has no idea if the legitimate suspicion for concussion that Tagovailoa’s behavior indicated was confirmed on follow up examination. Tagovailoa did return to the game without apparent sequelae.

After the game, both head coach Mike McDaniel and Tagovailoa stuck with the story that the quarterback cleared concussion protocol and it was just a back injury. Tagovailoa describes that his back had apparently locked up, and he felt wobbly, loose, and flexible. [8] When I spoke with Dr. Leddy, he said that he has never seen anyone experience what happened to Tagovailoa as a result of their back “locking up,” but again Dr. Leddy did not examine Tagovailoa to say that is not the case here. McDaniel said that he shared the same thoughts as the general public, assuming that it was a head injury.[9]

What Happens Next?

It appears that the NFLPA saw the same thing that everyone else saw, and it has now launched an investigation into how the Dolphins and the NFL handled this situation. The current CBA permits claims of possible concussion protocol violations to be investigated by the NFLPA and the NFL’s Management Council.[10]

Photo: https://www.nfl.com/playerhealthandsafety/health-and-wellness/player-care/concussion-protocol-return-to-participation-protocol

If this investigation finds that the Dolphins did violate concussion protocol, the penalties are harsh as agreed to by the NFL and the NFLPA. A team’s first violation of concussion protocol requires the employees and the medical team to attend remedial education and they can be fined up to $150,000.[11] If the investigation finds that protocols are not followed for a competitive advantage, teams can be forced to forfeit draft picks and be fined even more.[12] I think that it is fair to say that keeping a team’s starting quarterback in the game is a competitive advantage.

From guardian caps to new helmets, and new protocols – the NFL has spent a lot of money on concussion research and has seemed to take it seriously, especially as of late. The League has the opportunity here to help the NFLPA in its investigation and set the record straight that they value player safety over ratings and the product on the field. The NFL needs to prove that it is serious about its focus on concussions and other head injuries and make an example out of the Dolphins if the investigation warrants it.

Feature Photo: https://pbs.twimg.com/ext_tw_video_thumb/1574102286254723072/pu/img/eKZbSGy0NZf2Gip1.jpg

[1] https://www.nfl.com/news/nflpa-to-investigate-handling-of-dolphins-qb-tua-tagovailoa-concussion-evaluatio

[2] https://twitter.com/MiamiDolphins/status/1574102662500450304?s=20&t=xScgXHdeN5esIfcsubcHLQ

[3] https://www.usatoday.com/story/sports/nfl/dolphins/2022/09/25/dolphins-tua-tagovailoa-head-injury-return/8115020001/

[4] https://twitter.com/RapSheet/status/1574119706088378368

[5] Id.

[6] https://www.nfl.com/playerhealthandsafety/health-and-wellness/player-care/concussion-protocol-return-to-participation-protocol

[7] https://static.www.nfl.com/image/upload/v1629470683/league/ovinvbctariqolangujz.pdf

[8] https://www.usatoday.com/story/sports/nfl/dolphins/2022/09/25/dolphins-tua-tagovailoa-head-injury-return/8115020001/

[9] Id.

[10] https://www.nfl.com/news/nflpa-to-investigate-handling-of-dolphins-qb-tua-tagovailoa-concussion-evaluatio

[11] https://nflcommunications.com/Pages/NATIONAL-FOOTBALL-LEAGUE-AND-NATIONAL-FOOTBALL-LEAGUE-PLAYERS-ASSOCIATION-ANNOUNCE-NEW-POLICY-TO–ENFORCE-CONCUSSION-PROTOC.aspx#:~:text=A%20first%20violation%20will%20require,of%20%24100%2C000%20against%20the%20club

[12] Id.

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