Tackling the Concussion Protocol

Time stood still for football fans this past Thursday during the matchup between the Miami Dolphins and the Cincinnati Bengals. Tua Tagovailoa (shown left) lay motionless on the ground with his hands stuck in a rigid position after a hard hit which caused his head to forcefully strike the ground. The stadium, players, and fans across the nation watched in horror as they awaited any motion to indicate no paralysis. This hit immediately brought to the forefront of their mind a similar hit that Tua endured just five days prior. Fortunately, Tua was sent to the hospital where it was reported that he was conscious and had full mobility. However, questions regarding the concussion protocol and whether he should have been playing at all that night were the topic of discussion for the football world.

The Hit Before the Hit

Before suffering the hit that sent him to the hospital, Tua also suffered what people thought was a concussion-inducing hit the previous Sunday against the Buffalo Bills (see video below). After being thrown down, Tua could be seen struggling to get back up and shaking his head as if he was in a state of confusion. Then, after attempting to get back to the huddle, his legs seemed to have given out and he fell to the ground. 

Tua was immediately taken into the locker room to be evaluated for a concussion. However, they claimed the stumble was due to a back injury and was cleared to play in the second half of the game. 

                                                                        

Video Must Be Watched via Youtube

This sparked lots of controversy as many believed Tua should not have been allowed to play and suffered a concussion. The NFL Players Association (NFLPA) got involved and launched an investigation to see if the concussion protocol was breached. However, the Dolphin's still stood by their claim that it was only a back injury, and he was cleared to play in Thursday's game, where he suffered the major hit that sent him to the hospital.

The Concussion Protocol 

In short, the protocol for evaluating a concussion mid-game is...

- determination if concussion exists via assessment

- if determined it does, player must be removed from the game

- during the following week, player must go through the 5-step Return to Participation Protocol

    1. Symptom Limited Activity

    2. Aerobic Exercise

    3. Football Specific Exercise

    4. Club-Based Non-Contact Training Drills

    5. Full Clearance

If any of these steps are violated, the team and medical staff are subject to remedial education and fines up to hundreds of thousands of dollars. The neurologist who was part of Tua's evaluation was fired after investigation by the NFLPA. 

Call for Change

With research showing a rise in chronic traumatic encephalopathy (CTE) in retired football players, concussion awareness has been at the forefront of safety education. Yet, incidents like the one with Tua show that there are still several steps needed to be made.

Football is a violent sport and injuries such as concussions are unfortunately a part of the sport. There have been several calls to make changes to how organizations such as the NFL handle concussions. For example, the NFL concussion protocol has the player out for maybe a week at most. However, research shows that it may take up to two weeks for a concussion to fully heal. 

Also, how was Tua even allowed to return to the game even after showing gross motor instability? To answer this, the NFL has amended their concussion evaluation to include this instability in their list of "no-go's" that would prohibit the player from returning to play. This does require some judgement calls and common sense as falls due to ankle or knee injuries would not be included. 

Though the NFL is still attempting to be ahead of the curve in concussion prevention, there will still always be some flaws. This is simply due to the nature of the sport. It is fast and it is physical. Unless all high-impact collisions are outlawed (which is unlikely as this is what football is all about), concussions will continue to occur. The only solution is simply reduction of incidents and hope the long-term consequences lessen for future players.