Tua Is Set To Start Week 7

On Saturday October 15, Miami Dolphins’ Quarterback Tua Tagovailoa was cleared to return to the field when he passed the NFL’s five step return to play protocol after missing two games due to a very scary concussion that he suffered against the Cincinnati Bengals on September 29, after already likely suffering one against the Buffalo Bills four days earlier.[1] Even though Tagovailoa practiced in full and was cleared to play ahead of the Week 6 game, the Dolphins decided to be cautious and play it safe and give him an extra week before playing him, a sharp contrast to how they treated Tagovailoa’s initial injury against the Bills.

The NFL’s return to play protocol features five phases, (1) Symptom Limited Activity, (2) Aerobic Exercise, (3) Football-Specific Exercise, (4) Club-Based Non-Contact Training Drills, and (5) Full Football Activity/Clearance.[2] Progression through these stages is directed by the team’s concussion specialist and confirmed by an independent neurological consultant after they determine that the player tolerated the activities of that phase.[3]

https://www.nfl.com/playerhealthandsafety/resources/fact-sheets/nfl-return-to-participation-protocol

Tagovailoa went beyond the NFL’s requirements to ensure it was safe for him to return to play, seeking multiple second opinions by specialists in Detroit and Pittsburgh.[4] While players frequently get second opinions on injuries, it is worth asking the question why Tagovailoa did this. Could it be that he does not trust the Dolphins’ medical staff, the NFL’s protocols, and/or the independent neurological consultants after how poorly they botched the first situation? Is there doubt to the NFL’s ability to look after its players’ safety? Or perhaps could it be that the Dolphins want to make themselves look better after their initial mishandling of the situation? Regardless of the reasoning behind the second opinions, it was definitely smart by Tagovailoa to make sure it was safe for return to play after such a scary situation.

Tua’s Statements

In his first media availability since the concussion, Tagovailoa detailed what he remembers. Tagovailoa said that he remembers everything that happened up until the hit, but he does not remember being carted off the field. He did remember the ambulance ride and going to the hospital.[5] Tagovailoa said that when he finally came to, he was just trying to figure out what had happened, rather than worrying about any short- or long-term consequences he may be facing.[6] When asked how many concussions he has had, he said he does not know.[7]

When Tagovailoa was asked if he has learned anything about his potential long-term risks, he almost downplayed the risks, alluding to the fact that his risks for CTE and other similar things are lower because he is a quarterback.[8] Tagovailoa said, “Let’s say guys get about six concussions, well those guys that only have six concussions that are playing the position that I’m playing, where we don’t hit as much, are less susceptible to getting CTE later on in their years than someone who’s playing a position where they’re constantly taking hits or blows to the head, which would be O-line, D-line, linebackers.”[9] This is good news for Tagovailoa, however he should not act as if he not at risk still, just because the risk is lower.

Tagovailoa and Coach McDaniel discussed how to further lower Tagovailoa’s risk by having him get rid of the ball faster, and take less hits.[10] Tagovailoa says that this will help the longevity of his career, sometimes just getting rid of the ball is the smartest thing for him to do and it is something he needs to learn how to do better.[11]

Change Throughout The League

Since the Tagovailoa situation in Week 3 and the new protocols being implemented in Week 5, the NFL has reported more concussions. Throughout the league, in Week 1, there were 5 concussions reported, in Week 2 there were 6 concussions reported, in Week 3 there were 9 concussions reported, in Week 4 there were 18 concussions reported, and in Week 5 there were 8 concussions reported.[12] This is likely a combination of the heightened scrutiny and the updated protocol in action.

In addition, to Tagovailoa being cleared to return, Dolphins’ quarterback Teddy Bridgewater cleared the NFL’s concussion protocol after being removed from the game for apparent ataxia. Bridgewater did not report any concussion symptoms and was cleared to return the following week.[13]

It appears that the NFL may have acted with too much caution in Bridgewater’s circumstance, as they did not scrutinize players the following week as much as they scrutinized Bridgewater. Most notably, Dolphins’ fans were up in arms after Bears’ Quarterback Justin Fields appeared to stumble after a hit on Thursday Night Football.[14] Unlike Bridgewater, Fields appeared to display ataxia (more so than Bridgewater) and was not removed from the game by the NFL’s concussion spotter.

https://chicago.suntimes.com/bears/2022/10/13/23403928/justin-fields-cant-take-many-more-beatings-bears-commanders-matt-eberflus-khalil-herbert

Now the question is, which standard should be applied going forward? While there are no reports of Fields having any symptoms of a concussion, neither did Bridgewater. Fields showed more ataxia than Bridgewater, but he was not removed from the game. Will the NFL continue to let players play after potentially showing minor ataxia like Fields, or will they go back to the standard that they applied to Bridgewater, which is essentially zero tolerance? It seems like the way the new protocol is written, the league wants it to be enforced like it was on Bridgewater, but as I discussed before, this just is not realistic. While the old protocol was flawed, Bridgewater’s treatment was an overreaction, and the way Fields was treated is what we will see more of. There has been practically no discussion about the way Fields was treated, so it appears that that may be the way that the protocol is enforced (or unenforced) moving forward.

Tagovailoa is set to start the Dolphins’ Week 7 game against the Pittsburgh Steelers, whose quarterback, Kenny Pickett, is currently in the concussion protocol.

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[1] https://www.washingtonpost.com/sports/2022/10/15/tua-tagovailoa-cleared-concussion-protocols/

[2] https://www.nfl.com/playerhealthandsafety/resources/fact-sheets/nfl-return-to-participation-protocol

[3] Id.

[4] https://www.washingtonpost.com/sports/2022/10/15/tua-tagovailoa-cleared-concussion-protocols/

[5] https://www.youtube.com/watch?v=wdajwQdvfSk

[6] Id.

[7] Id.

[8] Id.

[9] Id.

[10] https://www.palmbeachpost.com/story/sports/nfl/2022/10/19/miami-dolphins-quarterback-tua-tagovailoa-recounts-concussion-experience/10525608002/

[11] Id.