Tua Tagovailoa Returns to N.F.L. Motion After Three Concussions in Two Years

by Christina S. Brown
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Miami Dolphins quarterback Tua Tagovailoa is anticipated to make his return to motion Sunday in opposition to the Arizona Cardinals after lacking 4 video games attributable to a concussion he suffered in Week 2. It was Tagovailoa’s third recognized concussion in two years, which prompted league-wide dialogue about whether or not he ought to proceed taking part in soccer.

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Offered he was medically cleared to play, that call was all the time going to relaxation with Tagovailoa. He thought of retiring after lacking 4 video games attributable to two separate head accidents in 2022 however mentioned it wasn’t a consideration this time round. He selected to maintain taking part in after discussing the scenario along with his spouse, Annah.

“Nobody’s … recommendation had affected something that I assumed by way of returning,” Tagovailoa mentioned Monday. “(I) had some conversations with my spouse, however that was it.

“I really like this sport,” he continued, “and I adore it to the demise of me.”

Requested if he would put on a Guardian Cap — the padded shells some gamers put on over their helmets to minimize the influence of collisions on the mind — Tagovailoa mentioned he wouldn’t, calling it a “private selection.” He does, nonetheless, put on a VICIS-brand helmet deemed the “most secure” amongst normal helmet choices for quarterbacks.

Like different gamers recognized with concussions, Tagovailoa needed to undergo the league’s return-to-participation program.

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What’s the NFL’s concussion protocol? The steps that happen earlier than return to play

Step one for gamers is changing into asymptomatic. Earlier than the beginning of coaching camp, each NFL participant is evaluated by his workforce’s neuropsychologist to determine a neurological baseline. Gamers need to return to that baseline to be deemed asymptomatic.

Tagovailoa mentioned he felt symptom-free the day after struggling his newest concussion, however the Dolphins nonetheless positioned him on injured reserve. There’s no required timeline to clear the NFL’s concussion protocol, however being positioned on IR meant he must miss at the least 4 video games.

“Given what the medical doctors have informed me that having a considerable period of time to relaxation and recuperate would have been good for me, I believe they did what was greatest by way of defending myself, you recognize, from myself,” Tagovailoa mentioned.

As soon as the Dolphins’ neuropsychologist deemed Tagovailoa to be asymptomatic, the quarterback entered a five-phase train program. As we wrote following his Week 2 damage, the protocol consists of step by step growing exercise, and the workforce is informed to search for any recurrence of signs throughout every part.

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• Section 1, symptom-limited exercise: The participant is prescribed relaxation and is informed to restrict or keep away from actions that improve or worsen signs. Beneath athletic coaching employees supervision, restricted stretching and stability coaching could be launched, progressing to gentle cardio train. If tolerated, the participant can attend conferences and movie research.

• Section 2, cardio train: Beneath the supervision of workforce employees, gamers can start graduated cardiovascular train, corresponding to on a stationary bike or treadmill. The participant can also have interaction in stretching and stability coaching.

• Section 3, football-specific train: The participant continues supervised cardiovascular workouts and should mimic sport-specific actions and supervised energy coaching.

• Section 4, non-contact coaching drills: The participant can proceed cardiovascular, energy and stability coaching, team-based sports-specific train and take part in non-contact soccer actions.

To proceed to Section 5, Tagovailoa needed to be examined and cleared by an impartial neurological professional. That physician, who doesn’t work for the NFL or the Dolphins, needed to decide Tagovailoa was totally recovered. Though the NFL’s concussion protocol doesn’t change based mostly on what number of concussions a participant has suffered, that impartial professional takes the participant’s full medical historical past under consideration.

“The checks that that physician performs — after which the steps that the participant has to clear to even get to that time — are going to be the identical no matter whether or not he’s had one or two or three concussions,” Jeff Miller, the NFL govt vp overseeing participant well being and security, mentioned earlier this month. “That physician’s going to contemplate no matter steps she or he wants to contemplate to make it possible for they’ve reached a conclusion they’re comfy with as a scientific supplier of concussion care.”

• Section 5, full soccer exercise/clearance: The participant is lastly cleared by the workforce physician for full soccer exercise involving contact. Tagovailoa acquired that full clearance on Wednesday.

“Each scenario and each concussion is exclusive,” Dr. Allen Sills, the NFL’s chief medical officer, mentioned earlier this month. “And so, we don’t put a time stamp on these processes as a result of they are going to differ relying on the severity of the damage. … This return-to-play course of is supposed to be conservative. It’s meant to be rigorous. … Finally, the ultimate resolution of return to play is made by the participant.”

The NFL believes it has made progress with the way it handles concussions by enhancing its concussion protocol, making rule adjustments and enhancing tools. That mentioned, the variety of concussions suffered within the league has elevated yearly since 2020.

In response, the NFL launched 12 new helmet fashions this season, broadened its mandate on the usage of Guardian Caps in practices, allowed gamers to put on Guardian Caps in video games and altered the kickoff guidelines largely within the title of participant well being and security. Through the preseason, the variety of concussions suffered in practices and video games dropped to 44, the bottom determine since monitoring started in 2015. Nevertheless it stays to be seen whether or not that can carry over to the common season.

Even when it does, a blind spot that is still for the NFL is the complete scope of the short- and long-term dangers related to gamers who are suffering a number of concussions. A 2022 report demonstrated a causal hyperlink between repetitive head impacts and persistent traumatic encephalopathy (CTE), however the league can’t predict the probability that gamers who beforehand suffered concussions will undergo extra of them.

“We, sadly, wouldn’t have an in depth system that may predict future threat of damage,” Sills mentioned. “It’s not like we will put in your variety of concussions and the way lengthy between them and your age and a few uncommon fixed and … give you a threat. It simply doesn’t work that means. … We strive as medical professionals to supply our greatest guess, however that’s actually what it’s — a guess at what somebody’s future threat of concussion is.

“In my very own follow,” Sills continued, “I’ll see sufferers who’ve had possibly two concussions in a 12-month interval after which gained’t have one other concussion for one more eight or 10 years. After which, different instances, you see those that appear to be having them extra incessantly. So, there’s acquired to be one thing about genetic susceptibility and particular person physiology, however we simply aren’t on the level of our medical understanding to actually be capable of quantify that to a level that lets us be tremendous prescriptive about that.”


Tua Tagovailoa has not performed since Sept. 12, when he suffered his third recognized concussion in two years. (Jasen Vinlove / Imagn Photographs)

The medical doctors tasked with clearing gamers from concussion protocol are taught to take the totality of the affected person’s expertise under consideration. That features the whole variety of concussions, the interval between concussions, the length of signs after every concussion and extra. If a participant is cleared by each the impartial and workforce medical doctors, it’s as much as him whether or not he continues to play.

Tagovailoa isn’t the primary participant with a prolonged historical past of concussions to maintain taking part in, and he seemingly gained’t be the final. And, even when the league or gamers affiliation needed to step in and cease him from taking part in, there isn’t a choice allowing them to take action.

“There’s a level of medical autonomy,” Sills mentioned. “It’s actually not that totally different from day-to-day medical follow. I’m a surgeon. If I stroll in and speak to a affected person within the room and I like to recommend that they’ve an operation for a wide range of causes and I define these causes and I give them the dangers and the advantages of that surgical procedure, then finally, it’s the affected person’s resolution whether or not they wish to have that surgical procedure accomplished or not.

“Affected person autonomy in medical decision-making actually issues. That’s what now we have to acknowledge goes on with our concussion protocol as properly. When sufferers make choices about their careers, it has to mirror that autonomy that’s generated from discussions with medical specialists giving them one of the best medical recommendation.”

For Tagovailoa, the danger was one he was comfy taking.

“How a lot threat will we take once we rise up within the morning to drive to work?” Tagovailoa mentioned. “There’s threat in any and all the pieces. And I’m keen to play the chances.”

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(High picture: Carmen Mandato / Getty Photographs)

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