Tag: Tua Tagovailoa concussion

Tua Tagovailoa has been failed once again by the NFL’s concussion policy

The NFL’s concussion protocol has done nothing to protect Tua Tagovailoa. This should frighten every NFL player.

The NFL has made all kinds of noise about improved player safety, and the steps the league has taken in that direction. You see it a lot, whether it’s true or not. One thing the NFL did do in recent years was to place Unaffiliated Neurotrauma Consultants (UNC) on the sidelines of every NFL game, as well as another UNC who monitors the broadcast video and audio feeds of each game from the spotters’ booth, and is supposed to notify on-field UNCs of possible head, neck or spine injuries.

The NFL’s current concussion protocol had already failed Miami Dolphins quarterback Tua Tagovailoa this season. Now, it appears that in Miami’s 26-20 Sunday loss to the Green Bay Packers, Tagovailoa was failed again. Tagovailoa was placed back in the concussion protocol today after reporting symptoms, quite possibly based on this tackle by linebacker Kingsley Enagbare in the second quarter.

Head coach Mike McDaniel mentioned Monday that Tagovailoa was not checked for a concussion at any point in the game.

“This is something that just came across my plate a couple hours ago,” McDaniel said. “As far as the game was concerned, no one recognized anything with regard to any sort of hit. I can’t really tell you exactly what it was. I’m not totally positive on that, but it was something that he met with the doctors today and discussed some symptoms and then from that, as you guys know, from there on, that’s between Tua and the doctors and we’ll move forward as information is projected towards us.

“As much as I know, he’s displayed symptoms and they [team doctors] enacted the protocol, which is all that needs to happen before you have to, by the player’s health, go through that whole process as they should, so it’s a little early. Like I said, I only found out a couple hours ago.”

On the second of Tagovailoa’s three fourth-quarter interceptions, Tagovailoa detailed after the game what was an obvious miscommunication by saying, “I might have said the wrong play. I’m not too sure. But there was just some communication errors on that.”

Which might have been cause for concern right there. Asked about the team’s and his own accountability for Tagovailoa’s health, McDaniel said all the right things, and also pointed to the massive holes in the process.

“You’re always accountable for it. The bottom line was collectively, guys that we’ve really relied upon all season had a – it’s a fast-paced decision that you get one shot at, and they collectively didn’t think that there was information enough to overturn it. Now you go and look back at it, I know there’s some assessment by people outside the league that have formerly been in the league. I’m aware of that. I’ll be interested to see what the league has to say. But I think you do it like everything else with regard to head-coaching responsibilities – you don’t just ever blow anything off, regardless of if it works in your favor or not. We’re always talking through, trying to get better at stuff so that the one thing you can control is not have something happen twice that maybe didn’t work out in your favor. So I’m happy with the guys that we work with and I expect that process to continually get better, regardless of what happens in the immediate.”

What’s especially shameful about this miss is that the NFL was supposed to have “improved” its concussion protocol after everybody missed Tagovailoa’s obvious concussion symptoms in Week 3, when the Dolphins faced the Buffalo Bills. Tagovailoa was permitted to return to action after this hit.

The NFLPA announced that it would review the process after that, and the UNC responsible for clearing Tagovailoa to play was subsequently fired by the NFLPA, which has unilateral authority to do so if it deems the action appropriate. In this case, it was, as the UNC had made “several mistakes.”

Team doctors cleared Tagovailoa to play just four days after that, in Miami’s Week 4 Thursday night game against the Cincinnati Bengals. Late in the first half of that game, Tagovailoa went into what it known as a “fencing response position” after another hit to his head.

What is a ‘fencing response position’ following head trauma?

It is “an overt indicator of injury force magnitude and midbrain localization to aid in injury identification and classification,” according to the National Library of Medicine. This time, the Dolphins released a statement during the game that Tagovailoa had suffered head and neck injuries and was being taken to the University of Cincinnati Hospital. Reports indicated that Tagovailoa had movement in all his extremities.

The NFL and NFLPA agreed to modify its concussion protocol after all that. From then on, any player showing signs of ataxia – an abnormality of balance/stability, motor coordination or dysfunctional speech caused by a neurological issue – is prohibited from returning to a game.

Not that this would have helped Tagovailoa in the Packers game. He would have had to rely on spotters who were seemingly unable to spot anything.

In 2016, The NFL and NFLPA announced a new policy to enforce the concussion protocol. The new policy was said to implement a “strict and fair” process that investigates incidents regarding concussion protocol and what discipline will be enacted.

  • A first violation by a team will require team employees or medical team employees to attend a remedial education and/or the team will pay a maximum fine of $150,000.
  • A second violation will result in a minimum fine of $100,000 against the team.
  • If it is agreed that a violation involved aggravating circumstances, the team will be subject to a fine of no less than $50,000.
  • If the NFL Commissioner determines that a medical team failed to follow the protocol in order to win a game, the Commissioner can require the team to forfeit draft picks and impose fines that can exceed the amounts above.

The NFL and NFLPA determined that the Dolphins followed concussion protocol before, saying in a statement that “The outcome in this case was not what was intended when the protocol was drafted.”

Obviously not.

Whether the Dolphins are penalized for this instance, or whether another UNC is fired after an investigation, the larger issue is that a 24-yard-old person, in his third NFL season, has been betrayed by the NFL’s concussion policies over and over, and the determination has been that the NFL did nothing wrong.

That should frighten Tagovailoa, as much as it should frighten any NFL player who could be easily and similarly betrayed by the league’s health and safety guidelines.

Sadly, any NFL player is only a few unfortunate hits away from a similar situation.

Doctor who evaluated Tua Tagovailoa fired by NFLPA following ‘several mistakes’

The neurotrauma consultant charged with clearing Tua Tagovailoa for play has been fired by the NFLPA regarding ‘several mistakes,’ per multiple reports.

Per multiple reports, the neurotrauma consultant who approved Miami Dolphins quarterback Tua Tagovailoa going back into Miami’s game last Sunday against the Buffalo Bills has been fired by the NFLPA after it was discovered that the doctor has made ‘several mistakes’ in his evaluation.

Under the current Collective Bargaining Agreement, the NFLPA can terminate the employment of any neurotrauma consultant without agreement from the NFL.

Tagovailoa was allowed to come back into the Bills game after this hit from linebacker Matt Milano.

The NFLPA started its investigation after that game.

NFLPA wants to review how Dolphins handled Tua Tagovailoa’s injury

Tagovailoa certainly looked wobbly when he got up from the turf, but he was cleared to play. He was also cleared to play before the Dolphins’ Thursday night game against the Cincinnati Bengals. Tagovailoa suffered a similar hit against the Bengals, and this time, the symptoms of head trauma were too obvious for even the league to ignore.

What is a ‘fencing response position’ following head trauma?

On Friday, Dolphins head coach Mike McDaniel said that he was entire comfortable with his team’s processes regarding Tagovailoa’s health and clearance to return to play.

What I was kind of referring to in terms of not changing anything that I’d do was because the whole process for what happened on the Bills game was he was evaluated for a head injury immediately,” McDaniel said. “That’s what we brought him into the tent for or brought him inside for. He was evaluated and then cleared by several layers of medical professionals, who – I don’t pretend to be one – but those people, the collection of them, cleared him of any head injury whatsoever. He had a back and ankle issue. So in terms of deciding whether or not to play a guy on a Thursday night game,

“I have 100 percent conviction in our process regarding our players. This is a player-friendly organization that I make it very clear from the onset that my job as a coach is here for the players. I take that very serious and no one else in the building strays from that. So when I am talking about deciding whether or not to play, the only thing that would keep me from playing him would be something going against medical advice that would be just completely abstract on top of all that. I had no worries whatsoever. I’m in steady communication with this guy day-in and day-out.

“There was no medical indication, from all resources, that there was anything regarding the head. If there would have been, of course. If there would have been anything lingering with his head, I wouldn’t have been able to live with myself if I prematurely put someone out there and put them in harm’s way. This is a relationship that I have with this human being. I take that serious. I wouldn’t have put him out there if there was any inclination given to me whatsoever that he was endangering himself from that previous game.”

Allen Sills, the NFL’s Chief Medical Officer, has said this week that Tagovailoa had been evaluated for concussion symptoms every day between Sunday and Thursday. The NFL’s concussion protocol states that the same neurotrauma consultant who performs the initial test should perform the subsequent evaluations, but that a member of the team’s medical staff can do so instead.

“We’ll have all of those interviews,” Sills told the NFL Network. “We’ll review all of the video, we’ll review all of the data. And the purpose of that review is to make sure that the concussion protocol was followed.”

All McDaniel can do is to go on the information he’s given, which makes sub-par evaluations so dangerous.

“Beyond an eyeball test, which I know for a fact you guys would not be very comfortable if I was just relying on that — I mean, it’s the reason why we have tests,” McDaniel concluded on Friday. “He did not have a head injury. So guys hit their heads all the time, and that’s why I was adamant [that] he was evaluated for having a head injury and he did not have one. And when I tell you he was in complete mental concert, talking to us through it, and then he played the whole game and then he did a press conference and then he did media all week.”

Also on Friday, Baltimore Ravens head coach John Harbaugh expressed extreme concern about the Dolphins’ concussion protocol through the week.

“I couldn’t believe what I saw,” Harbaugh said about Thursday night. “I couldn’t believe what I saw last Sunday. It was astonishing to see. I’ve been coaching for 40 years — college and the NFL — and I’ve never seen anything like it before. I couldn’t believe what I was seeing. I really appreciate our doctors, and I appreciate our owner.”

The extent to which that initial evaluation, and the subsequent evaluations, was made in Tagovailoa’s best interests is now extremely and obviously in doubt. One also wonders how this doctor was allowed to make multiple mistakes unchecked, and how many other neurotrauma consultants have done the same — also unchecked.

Ravens head coach John Harbaugh unimpressed with Dolphins’ concussion protocol

Baltimore Ravens head coach John Harbaugh was unimpressed by the ways the Miami Dolphins have handled Tua Tagovailoa’s on-field injuries.

In the third quarter of the Baltimore Ravens’ divisional round loss to the Buffalo Bills on January 16, 2021, Ravens quarterback Lamar Jackson threw the ball away on an errant snap, was flagged for intentional grounding, and was sent to the sideline to go through concussion symptom testing after his head was slammed to the ground.

The Ravens were down 17-3 in a playoff game, Jackson showed symptoms, and he was taken out of the game for his own good. The Ravens were unable to score with backup Tyler Huntley, and they were eliminated from the postseason.

“I’m not frustrated at all. He was in the concussion protocol. He had a concussion and was ruled out with a concussion. That’s where it stands,” Ravens head coach John Harbaugh said of the situation after the game.

That was an example of a team looking out for a player’s interests, no matter the result. So when Harbaugh was asked on Friday about the Miami Dolphins’ handling of the Tua Tagovailoa situation, in which Tagovailoa appeared wobbly and was shaking his head following a hit in Miami’s win over the Buffalo Bills last Sunday, the Dolphins putting Tagovailoa back into the game in the second half, and starting Tagovailoa four days later against the Cincinnati Bengals on Thursday Night Football? Well, Harbaugh has earned a bit of credibility on the issue.

From ESPN’s Kimberley A. Martin:

“I couldn’t believe what I saw,” Harbaugh said about Thursday night. “I couldn’t believe what I saw last Sunday. It was astonishing to see. I’ve been coaching for 40 years — college and the NFL — and I’ve never seen anything like it before. I couldn’t believe what I was seeing. I really appreciate our doctors, and I appreciate our owner.”

The NFLPA asked for an investigation into the Dolphins’ decision to put Tagovailoa back in the game against the Bills, and you can certainly add Tagovailoa’s presence in the Bengals game, as well. Of course, Tagovailoa suffered a head injury in that game (which the Dolphins confirmed), Tagovailoa was taken to University of Cincinnati Hospital, and flew back to Miami with the team last night.

Following the injury in the Bengals game, Tagovailoa appeared to exhibit a “fencing response position,” which is generally an involuntary physical response to head trauma.

What is a ‘fencing response position’ following head trauma?

Dolphins head coach Mike McDaniel’s response after the Bengals gave wasn’t quite as airtight as Harbaugh’s had been.

Well, we’d say that a concussion, and what appeared to be a physical reaction to what could be more serious head trauma — the results of which don’t usually present right away — is serious enough.

The point is, there are teams that handle concussions seriously, and teams that pay only the lip service to it that they’re obligated to pay. The safety of the players in this or that organization can clearly be greatly affected by the differences in adherence to an internal go/no-go policy.

What is a ‘fencing response position’ following head trauma?

Miami Dolphins quarterback Tua Tagovailoa likely went into a “fencing response position” after his concussion. Here’s what that means.

With 5:57 left in the first half of the Thursday Night Football contest between the Miami Dolphins and the Cincinnati Bengals, Dolphins quarterback Tua Tagovailoa was sacked and suffered what looked to be severe head and nek injuries. This happened just four days after Tagovailoa was hit by Buffalo Bills linebacker Matt Milano in Miami’s Sunday win over the Buffalo Bills. It looked a lot like a head injury when Tagovailoa got up woozy and shaking his head, but the team went out of its way to say that Tagovailoa had suffered a back injury. The injury against the Bills happened in the first half; Tagovailoa returned to play in the second half.

After the game, the NFLPA said that it intended to investigate the Dolphins’ handling of Tagovailoa’s injury

A lot of people are wondering about the positioning of Tagovailoa’s hands after the injury in the Bengals game — his hands were splayed above his head after his head hit the ground.

This is likely what is known as a “fencing response position,” which is “an overt indicator of injury force magnitude and midbrain localization to aid in injury identification and classification,” according to the National Library of Medicine. This time, the Dolphins released a statement during the game that Tagovailoa had suffered head and neck injuries and was being taken to the University of Cincinnati Hospital. Reports indicated that Tagovailoa had movement in all his extremities.

Sadly, Tagovailoa would not be the first NFL player to suffer head trauma on the field and go into a fencing response position. We will not post the videos here, but it happened to Pittsburgh Steelers quarterback Mason Rudolph against the Baltimore Ravens in 2019, and it happened to Los Angeles Chargers tight end Donald Parham against the Kansas City Chiefs last season.

More on the fencing response position from Healthline:

The name comes from the similarity to asymmetrical tonic neck reflex (ATNR), also referred to as fencing reflex, which occurs in newborns.

This is when newborn babies position themselves with one arm flexed and the other extended with their head turned toward the extended arm like a trained fencing athlete. This reflex usually stops after the baby reaches about 4 months old.

This reaction occurs after injury because it’s thought that if a blow impacts the brainstem, it will momentarily reactivate the ATNR.

Doctors use a number of indicators — such as the 15-point Glasgow coma scale — when assessing the severity of TBI [Traumatic Brain Injury]. For a variety of reasons, including the fact that concussions can’t be seen on MRI or CT scans, medical professionals are looking for more indicators to make diagnosis more accurate.

Whether or not fencing response was seen by witnesses may become part of that assessment process. If the fencing response is seen after an injury, it could be that it was likely worse than one where no response occurred, since the fencing response is thought to involve the brainstem.

NFLPA wants to review how Dolphins handled Tua Tagovailoa’s injury

The NFLPA wants to investigate how the Miami Dolphins handled Tua Tagovailoa’s first-half injury against the Buffalo Bills.

One of the more remarkable aspects of the Miami Dolphins’ 21-19 win over the Buffalo Bills on Sunday was that the Dolphins did that without their starting quarterback in some of the second quarter.

Why? Because with 2:28 left in the first half, Tagovailoa was hit hard by Buffalo linebacker Matt Milano, and his head hit the turn equally hard. Tagovailoa was wobbly and shaking his head as he got up, and this looked for all the world as a prototypical concussion.

Tagovailoa was taken into the NFL’s concussion protocol, and came out to play for the entire second half. As the game progressed, news leaked regarding the supposed source of Tagovailoa’s malady.

Given the NFL’s highly specious history regarding head trauma, this was met with massive suspicion, and rightly so. After the game, Dolphins head coach Mike McDaniel echoed this diagnosis.

“That was live-speed action,” McDaniel said. “Now, Tua, he went out with a lower back, and I hadn’t had that rep with him yet. He kind of got bent back pretty significantly on a quarterback sneak earlier. I was kind of with everyone else. When he hit his head on the ground, I assumed it was a head injury, but his legs got wobbly because his lower back was completely loose and as he described it, he said his lower back was like Gumby or something. That is a challenge.

“That happens all the time in NFL games. It was kind of fast and furious. We had some skill position players get dinged. We had some linemen fight through it, but those are things that you just have to be able to adjust on the fly. Your whole staff better be in concert. You better have contingencies, and you better know some plays you want to go to if things happen. We were able to do the best we could, but it was a lot better when we had everyone back. That’s for sure.”

Tagovailoa really wanted everybody to know that he’s good.

“On the quarterback sneak [the play before], I kind of got my legs caught under someone, and then they were trying to push back and then kind of felt like I hyper-extended my back or something. Then on the next play I kind of hit my back and kind of hurt. Then I got up and then that’s kind of why I stumbled – my back kind of locked up on me. For the most part, I’m good. I passed whatever concussion protocol they had, so I’m good.”

Maybe it’s all true, but the NFLPA stepped in right away, as it should have.

 

 

In 2018, the NFL made improvements to its concussion protocol in an attempt to improve its process.

From the league:

According to the policy, the NFL and NFLPA will each designate a representative to monitor the implementation of the protocol and investigate potential violations. The investigation will not reach medical conclusions; it will only determine whether the protocol was followed. Following the investigation, the NFL and NFLPA will review the findings to determine if a violation occurred and, if so, to recommend the proper disciplinary response. If the parties are unable to agree, the matter will be brought to a third party arbitrator. After conducting a thorough review, the arbitrator will issue a report to the Commissioner, NFLPA Executive Director and the involved parties.

As jointly agreed to by the NFL and NFLPA, the Commissioner retains absolute discretion in determining penalties for violations of the concussion protocol. Potential disciplinary action includes:

  • A first violation will require the club employees or medical team members involved to attend remedial education; and/or result in a maximum fine of $150,000 against the club.
  • Second and subsequent violations of the concussion protocol will result in a minimum fine of $100,000 against the club.
  • In the event the parties agree that a violation involved aggravating circumstances, the club shall be subject, in the first instance, to a fine no less than $50,000. The Commissioner shall determine appropriate discipline for subsequent violations involving aggravating circumstances.
  • In the event that the Commissioner determines that the club’s medical team failed to follow the protocol due to competitive considerations, the Commissioner may require the club to forfeit draft pick(s) and impose additional fines exceeding those amounts set forth above.

The enforcement policy is one of many collaborations between the NFL and NFLPA to improve player health and safety.

We’ll see how this goes for the Dolphins. Hopefully, Tagovailoa was not put in a position where any head trauma would be exacerbated by further head trauma, as so many players have before.