While the NFL has made strides on concussion protocol, the Tony Romo situation in Dallas this past week shows that the league still has far to go when it comes to putting return-to-play decisions in the right hands

By Andrew Brandt
November 02, 2014

The Monday night sack set off a national discussion. (Tom Pennington/Getty Images) The Monday night sack set off a national discussion. (Tom Pennington/Getty Images)

The Cowboys’ handling of the Tony Romo injury on Monday night and throughout the week raises a constant and important question for football players at all levels, including the NFL: whether injured players should continue to play and risk further (or greater) injury and, perhaps more importantly, who should make the call regarding return to play.

On Monday night, while no one knew the extent of the Romo injury, it was plain for the nation to see—let alone Romo's owner, coach and doctor—that he was compromised upon returning to the game. His re-entry, of course, was the result of animated conversations between Romo and the team doctor and Jerry Jones and Jason Garrett. The news on Sunday morning that he would be out for the game against the Cardinals just puts Monday night's decision to play him after his back injury—reportedly two small fractures in his back—in even starker relief. 

I get it the emotional pull: We love the theater of the moment, with the potential Willis Reed-like triumphant return of an injured hero. And I understand the NFL badge of honor to players playing through injury. The real question is: to what end and at what risk?

The NFL has now—at least in theory, if not always in action—moved past the "tough it out" attitude when dealing with head injuries, mandating that return-to-play decisions be made by medical, not football, staffs. This independence and empowerment of the medical side speaks to a changing (changed?) culture, at least in regard to brain trauma. Here is the question: If we are positively changing the culture regarding head injuries, should we not do the same for orthopedic injuries such as, in Romo's case, back injuries? And if not, does that mean that we want players to "play through" injuries if they can, but just not if it's a concussion?

As I always say, players want to play: It is what they do and who they are. They do not think about long-term impacts—they think about the next play, the next game, the next contract. They will always "play through" if at all possible to do so. In the heat of a game situation, it is up to others to be the "adults," to protect players from their hard-wired impulses. Who are the proper protective "adults"? That would be team medical staffs, but only if they're empowered by the league (as with concussions) or the team. Some teams are further along with that empowerment than others, but we are certainly not there yet across the board. The culture is too ingrained.

On Monday night, in the midst of a hotly contested game with a division rival, it appeared that the people who should not be making return-to-play decisions—those without medical training—were doing so. The report by NFL Media on Sunday morning that it was Romo himself who chose not to play against the Cardinals shows that, with time and reflection, players can make decisions in their best long-term interest. The lesson from this episode should be: medicine must trump emotion.


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