NFL and players’ union agree to change concussion rules
By Jenny Vrentas and Emmanuel Morgan
The NFL and its players’ union said over the weekend that doctors followed the concussion protocol in treating Miami Dolphins quarterback Tua Tagovailoa after he hit his head in a Sept. 25 game, but that the protocol will be changed because Tagovailoa’s return to the field was not what was intended by the rules covering the evaluation of brain injuries.
In the second quarter of a game against the Buffalo Bills, Tagovailoa hit the back of his head against the turf after a late hit by a defender, then he grabbed his helmet, struggled to get up and fell again. He returned to the game in the second half. The players’ union — the NFL Players Association — initiated a joint investigation with the league into how the episode was handled by the Dolphins team medical staff and an unaffiliated neurotrauma consultant on the sideline.
That review showed that the protocol was followed and that Tagovailoa did not display concussion-like symptoms during a locker room evaluation or in the days after. Instead, he said that he aggravated a back injury, which led him to stumble and fall. The scene of Tagovailoa wobbling as teammates held him up after the hit led many people to assume that he had sustained a concussion. The team physician and the consultant did not examine Tagovailoa’s back before concluding that the back injury caused his instability and sending him back into the game, the review showed.
Tagovailoa also played four days later against the Cincinnati Bengals and again hit his head when he was slammed to the field after a tackle. He was taken to the hospital and released that night. Tagovailoa is now in the concussion protocol, which requires concussed players to complete a five-phase recovery process before they can be cleared to play. Tagovailoa was ruled out for Sunday’s game against the New York Jets.
The amended protocol, which was to take effect during Sunday’s games, prohibits a player from returning to play if he shows ataxia, a term describing impaired balance or coordination caused by damage to the brain or nerves. Under the previous protocol, which was used in Tagovailoa’s case, a player with “gross motor instability” — difficulty getting up or walking, for example — could return to play if doctors decided there was an orthopedic reason for his unsteadiness.
Allen Sills, the NFL’s chief medical officer, did not definitively say that Tagovailoa did not suffer a concussion in the Bills game — only that the review showed the doctors took appropriate steps and made a medical judgment based on the information they had at the time. Under the new rules, Sills said, Tagovailoa would have been ruled out and not allowed to return to that game.
“We want to become even more conservative, and if we think that ataxia is present, let’s just go ahead and assume it is coming from the brain and we will hold someone out,” Sills said Saturday. “Because if we are going to be wrong, we would rather hold someone out who doesn’t have a brain injury but we are being cautious, than to put someone out who might have a brain injury and we weren’t able to diagnose it.”
If ataxia is observed during the game, the player will automatically be diagnosed with a concussion, as is the case with symptoms such as loss of consciousness or an impact seizure. The player then will be required to follow the five-step return-to-play process.
The players’ union took the unprecedented step of dismissing the unaffiliated neurotrauma consultant involved in Tagovailoa’s care during the Bills game, a decision the NFL said it did not support. The doctor’s name was not released. According to the concussion protocol, while the consultant collaborates in the evaluation of the player, the responsibility for the diagnosis of a concussion and the decision to return a player to the game “remains exclusively” with the judgment of either the head team physician or the team doctor designated to handle concussion care.
The Dolphins’ head team physician, John Uribe, is a board-certified orthopedic surgeon and, according to his profile on the NFL Physicians Society website, received a certificate of added qualification in sports medicine in 2007. He is affiliated with the Baptist Health Medical Group in southern Florida and is also a team physician for the NHL’s Florida Panthers.
The Dolphins did not respond to a message seeking comment on the results of the joint review and asking if Uribe, who accompanied Tagovailoa to the locker room during the Bills game, was the team doctor who cleared him to return.