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We Need Answers to the Questions Surrounding Tua Tagovailoa’s Injuries

The Dolphins quarterback’s week exposed a dangerous loophole in the league’s concussion protocol, which has never been more important.

Imagine you’re Tua Tagovailoa.

Growing up in a demanding household in Hawai‘i, with everything centered on your football dreams. At Alabama, many of those dreams and aspirations were fulfilled, but your future was also thrown into flux with two high-ankle sprains that led to tightrope surgeries, a broken hand and, most devastatingly, a dislocated hip that ended your college career.

And while that didn’t stop the Dolphins from taking you as the fifth pick in the 2020 NFL draft, for whatever the reason, be it the injuries or your size or your athletic limitations, your coach and your team’s owner your first two years never fully buy into you. You’re yo-yo’ed in and out of the lineup as a rookie. You break your ribs, then your finger, and miss time in your second year. Your team makes a run at trading for Deshaun Watson in the interim, then pursues Tom Brady after the season.

Bengals defensive tackle Josh Tupou (68) sacks Miami Dolphins quarterback Tua Tagovailoa (1) in the first half at Paycor Stadium. Tagovailoa sustained a head injury on the play and left the game for treatment.

Tagovailoa suffered a head and neck injuries  after being sacked by the Bengals' Josh Tupou.

But in your third year in the league, with new coach Mike McDaniel, it’s finally all coming together. The team signs a great left tackle (Terron Armstead) and trades for a star receiver (Tyreek Hill) to round out the offense. The new staff installs a system similar to the one you excelled in at Alabama to highlight your talents. You start the season 2–0, and you’re playing the kings of your division, the Bills, in Week 3. Suddenly, everything has turned—your team’s present and future look bright, and a contract at $50 million per year isn’t out of the question.

What would you have done over the past week?

Would you have self-reported concussion symptoms, if you had them, during the Bills game on Sunday? Or would you have done all you could to get yourself back out there, because it’s football, and God knows your teammates get their bells rung plenty, playing a more physical position than you do? Would you have entered yourself into the concussion protocol with another big AFC game coming Thursday night against the Bengals? Or would you have pinned the way you stumbled to the ground against the Bills, after having your head slammed to the turf, on a balky back?

This is the reality of being an NFL player, where guys are always making bargains with their physical well-being to live out their dreams, get the highs of playing a sport that’s unlike any other, pursue team success, build legacies and, ultimately, try to generate generational wealth.

So what Tagovailoa may have done on Sunday afternoon, Thursday night and through the time in between—only he knows how he felt through the two hits in particular, and the period of time encompassing them in general—is not unlike what thousands of football players have done over the years. But one of the greatest things about football, how it teaches the people who play it to keep going when things get hard, is also what can create scenes such as the one we saw on Thursday night in downtown Cincinnati.

I love football, and have since before I can remember. I think it’s the greatest sport on the planet. Which is why I think it’s so important that all of us ask the right questions now.

And the overarching one, to me, is whether enough was done to protect Tagovailoa from himself. Because the truth is, so many players have stories such as Tagovailoa’s and, through no fault of their own, need that protection.

Dolphins quarterback Tua Tagovailoa is taken off the field after slamming his head on the field.

Tagovailoa was taken off the field Sunday after he was pushed backward and slammed his head off the turf.

I wrote in Wednesday’s mailbag that I believed too many people would have to be complicit to keep Tagovailoa on the field on Sunday and out of the protocol on Monday—from the Dolphins to the league, to the independent doctors, to the quarterback himself.

I’d like to walk that back a little now, which is where my big question comes.

One thing the public may not understand is there’s no test that definitively tells the doctors examining players on game day whether a player has a concussion. They’re testing for symptoms and using what’s called the SCAT5, short for Sport Concussion Assessment Tool, 5th edition. There are four steps to the test: red flags, observable signs, memory assessment using Maddocks questions and examination using the Glasgow Coma Scale.

Under Step 2, observable signs, there are two check boxes: one for “witnessed” and the other for “observed on video,” meaning either applies. And one of the yes/no categories is balance/gait difficulties/motor incoordination: stumbling, slow/labored movements.

It doesn’t take a neurologist to have watched what happened after Tagovailoa had his head slammed to the turf on Sunday by Bills linebacker Matt Milano and check off the yes boxes.

Additionally, the NFLPA website’s overview of the protocol has a graphic that states: “If a player demonstrates gross motor instability that is determined by the team physician, in consultation with the UNC [the independent neurologist], to be neurologically caused, then the player is designated a No-Go.”

Again, in this case, it’s a slam dunk to say Tagovailoa demonstrated “gross motor instability” on Sunday at Hard Rock Stadium. The larger question, then, is whether that event was “neurologically caused.” In Tagovailoa’s case, the team doctors could make that determination—which, by a strict reading of the policy, they’d be able to do—and which could potentially undermine having an independent neurologist. There would also be the question of whether there was any follow-up testing after the game or during the week to confirm it.

Which is where another problem lies. Once Tagovailoa was cleared and went back into the game on Sunday, there wasn’t a requirement for him to enter the concussion protocol during the week. In fact, on Monday the Dolphins actually said Tagovailoa wasn’t in the protocol, so unless he complained of symptoms, it’d likely be a nonissue for the team at that point.

So that’s the loophole here. In the heat of the moment, the team doctor (or the independent neurologist) could, on paper, determine that Tagovailoa’s stumbling was caused by his back, and not his head, and send him back into what was a very big game for the Dolphins. And then, because of that result, there’d be no requirement for further testing, with motivation, at that point, for everyone involved (doctors, team, player, league) to confirm the original finding—because if they were wrong on Sunday, what would that say about them?

And to be clear, I don’t know that Sunday’s event had anything to do with Thursday’s outcome. But I also don’t know how, at this point, you can rule it out.

There’s a scene at the end of Oliver Stone’s Any Given Sunday in which linebacker Shark Lavay, played by NFL legend Lawrence Taylor, gets knocked unconscious making a play to give the Miami Sharks a win and hit a $1 million incentive in his contract.

It was the result of a lot of build-up—team doctors had squabbled over his fitness to play after a pair of earlier concussions, coach Tony D’Amato (played by Al Pacino) struggled with it, owner Christina Pagniacci (played by Cameron Diaz) advocated for it and, ultimately, all parties gathered in an office with Lavay signing a waiver that would take liability off the team. Lavay, along the way, implored others to let him play, because he was so close to hitting markers for the million-dollar bonus.

So as Lavay woke up after the hit in the game, still motionless, he asked D’Amato, “Coach, did I make the stop?”

“You stopped them cold, goddammit!” D’Amato responded.

The doctors then loaded Lavay onto a backboard, he smiled, and said, “Don’t you guys drop me. I’m worth a million dollars.”

That movie came out in 1999, and a lot has changed since then in the culture, and rules, around concussions in football.

But one thing that hasn’t changed is that players are still making bargains with their bodies such as Stone’s fictional linebacker did 23 years ago. It’s not optional in the NFL. It’s required that, to at least some degree, players do that to survive in a brutal game.

Tagovailoa showed us that, again, over the past five days.

Now it’s important that we all ask the right questions, and get answers, on whether those around him did enough to protect him from pushing way more chips to the middle of the table than he should have.

It needs to happen not, as some are pursuing it, to the detriment of football.

It needs to happen, as I see it, for the good of football.

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