Tua Tagovailoa’s Injury: The NFL must change its concussion protocol rules

Miami Dolphins quarterback Tua Tagovailoa was taken to University of Cincinnati trauma care after suffering head and neck injuries against the Cincinnati Bengals.

Social media posters, pundits, fans and media analysts alike questioned whether he should have been playing against the Bengals after his initial injury against the Buffalo Bills last Sunday.

In Sunday’s win over the Buffalo Bills, Tua underwent concussion evaluations at halftime after he hit his head on the ground and then stumbled while trying to return to the huddle. The team initially listed him as questionable to return because of a head injury but later said it was a back injury that caused him to stumble. 

Coach Mike McDaniel stated in his post-game conference that he did not have a concussion. “Yeah, otherwise we would have reported him having a head injury,” McDaniel told reporters. “That’s why the NFL has these protocols.”

Concussion protocol for Tua Tagovailoa’s injury

When any player receives an impact to the head and exhibits symptoms or signs of a concussion, the player goes into concussion protocol. Per the the NFLPA and NFL player health and safety checklist it goes as follows:

Here is the NFL and NFLPA concussion gameday checklist.

This is the checklist which is followed when any player goes into concussion protocolhttps://t.co/UBLRN7vcww pic.twitter.com/xXct4Dr6Sr

— Hussam Patel (@HussamPatel) September 30, 2022

It is required for all players who undergo any concussion evaluation on game day to have a follow-up evaluation conducted the following day by a member of the medical staff.

Who is to blame?

First reaction to Tua Tagovailoa’s injury was the initial question, “Why did the Dolphins play him if he had a concussion against the Buffalo Bills?” Secondary reaction was, “The Dolphins lied about Tua injury on Sunday and put him in this predicament.” Thirdly, the reaction was to hold the Dolphins coaches, trainers and medical staff accountable for putting Tua Tagovailoa out on the field and increasing his risk of injury.

"Somebody needs to be fired! Now I don't know who, but somebody got to go."

—@stephenasmith reacts to Tua Tagovailoa's injury pic.twitter.com/pYor8YpwL3

— First Take (@FirstTake) September 30, 2022

The blame game has already started and the focus is on the Dolphins organization and their handling of Tua Tagovailoa’s injury from last Sunday’s win against the Buffalo Bills. What was initially thought to have been a head injury, turned out to be a back injury. The Dolphins quarterback was tested for a potential concussion injury, Tagovailoa did clear the concussion protocol.

My understanding of the Tua Tagovailoa situation: He tweaked his back in the 1st quarter on a sneak and didn’t miss time. After the Matt Milano hit, his back locked up — leading to him wobbling. Into the locker room for a full concussion check. Fully cleared. Now on the field.

— Ian Rapoport (@RapSheet) September 25, 2022

As with many concussion protocol predicaments, the NFL and NFLPA conduct their investigations, in which a team physician and unaffiliated neurologist cleared him to return Sunday. The investigation is still ongoing in regards to Tua Tgaovailoa’s injury. 

Yet, the narrative exists that the Dolphins coaching staff, team doctors and independent neurologist did not follow proper protocols, lied or are covering up what truly happened. 

Timeline of Tua Tagovailoa’s injury:

– Tua receives impact to the head against the Bills, looks to have gross motor instability which is then determined by team physician and independent neurologist on the sideline

– Dolphins team account tweets out Tua Tagovailoa has a head injury and is questionable to return.

-Tua Tagovailoa is then taken into the locker room to conduct the locker room exams as per the NFL concussion gameday checklist

– The “no go” rule has to be followed up with the team physician and the independent neuro- they took him to the locker room to be examined. 

– NFL SCAT and Neurological exam is conducted per the concussion gameday checklist. Tua is returned to play meaning the assessments were normal 

– After the game it is cited from Tua and Coach McDaniel that he tweaked his back at the goaline earlier in the game. Injury reports for the week listed him with Back/Ankle injury

“On the quarterback sneak, 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.”

Tua Tagovailoa on his injury against the Buffalo Bills

–He was given daily examinations from NFL Chief Medical Officer Allen Sills above what the concussion protocol dictates “is required for all players who undergo any concussion evaluation on game day to have a follow-up evaluation conducted the following day by a member of the medical staff.”

My report on the Tua situation. This followed @judybattista’s interview with NFL Chief Medical Officer Allen Sills. I initially misspoke about Tua’s designation on the injury report leading into Thursday’s game but corrected it later. A lot to chew on. From NFL Now @nflnetwork pic.twitter.com/pzWFfKIbDz

— Steve Wyche (@wyche89) September 30, 2022

Optics on Tua Tagovailoa’s injury

Tua Tagovailoa remained motionless on the ground, was eventually stretchered off the field, and taken by ambulance to University of Cincinnati trauma care. After the game, the Dolphins said that Tagovailoa would be discharged from the hospital and fly home with the team.

The incident leaves questions that many ask the NFL and the Dolphins. Was his injury on Sunday really a back issue?

Why wasn’t the NFL and the union able to complete their investigation in time for Thursday night’s game, considering the potential risk of exposing a young star’s brain to multiple traumatic injuries in one week?

The optics look terrible, but if the investigation finds everything was properly followed, then again, that’s a failing on the league’s part, not on the Dolphins or anyone else.

Mike McDaniel explains why Tua was cleared to play. Says he got all checkups, including independent doctor clearing. They didn’t misreport injury.

“We don’t mess with that. Never have. As long as I’m the head coach that’ll never be an issue you guys will have to worry about.” pic.twitter.com/TjTcIPWLFF

— Will Manso (@WillManso) September 30, 2022

There has been scrutiny of the NFL’s handling of concussions. The league is able to claim that it is battling this fight through small adjustments like safer helmets or more stringent roughing-the-passer penalties—but we know that their main goal is to avoid consequences rather than actually solve the issue.

Normally, the NFL’s strategy works, because the players want to play. The NFL and NFLPA’s investigation wont be concluded up until the end of the week to finally understand what exactly happened, if the protocols were followed and if they were effective. However, the league must see the effects of putting a star QB’s brain at risk captured in great detail and replayed continuously. The NFL must review its concussion and injury policies while also telling the truth.

Hussam Patel is a Miami Dolphins contributor and Lead NFL Draft analyst at Five Reasons Sports Network, Director of Scouting at PhinManiacs and Editor at Dolphins ATB. Follow him on Twitter at @HussamPatel