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NFL makes “Tua Tagovailoa rule change” to concussion protocol

Dolphins Football
Miami Dolphins quarterback Tua Tagovailoa (1) greets his family before an NFL football game against the Cincinnati Bengals, Thursday, Sept. 29, 2022, in Cincinnati. (AP Photo/Emilee Chinn)

(MIAMI GARDENS, FLA) — The NFL and players association have made a “Tua Tagovailoa rule change” to the league’s concussion protocol preventing a player from returning to a game if he shows gross motor instability, which infamously happened with the Miami Dolphins quarterback in Week 3.

The NFL and NFL Players Association released a joint statement Saturday regarding changes to the league’s concussion protocol following Miami Dolphins quarterback Tua Tagovailoa’s apparent head, not back/ankle injury Sept. 25 against the Bills.

The quarterback fell backward and hit his head on the turf. When he stood up, he was unstable, made a few wobbly steps and fell down again. But, according to the investigation he passed concussion protocol in the locker room and returned to the game.

Following the review of the handling of Tua Tagovailoa’s head injury, the NFL and the NFLPA agree ‘the outcome in this case is not what was intended.’

As a result, the NFL and players association have amended the league’s concussion protocol.

“If there is any suspicion of the payer having sustained a concussion, the player must be removed from the field of play, and not allowed to return. If the player has been removed from the field of play because of a suspected or confirmed concussion, they should be monitored until deemed fit and able to leave the venue.”

The statement concluded that even though in Tua’s case, the concussion protocol was followed, “the outcome in this case was not what was intended when the Protocol was drafted.”

The quarterback suffered obvious “gross motor instability or ataxia.” Ataxia is a neurological condition that causes “poor muscle control that may cause difficulty with walking and balance, hand coordination, speech and swallowing, and eye movements. Ataxia usually results from damage to the part of the brain that controls muscle coordination (cerebellum) or its connections.”

The NFL states that #1’s stumble was considered a “display of gross motor instability,” which is one of the protocol’s “no-go” symptoms that requires a player be removed from a game without the possibility to return.

He was immediately taken to the locker room for a concussion evaluation but informed both the team’s physician and the unaffiliated neurotrauma consultant (UNC) jointly hired by the NFL and NFLPA that a back and ankle injury caused him to stumble; the report found that Tagovailoa had previously reported both injuries prior to hitting his head on the ground.

Once it was determined that his observed instability was not neurologically caused, Tagovailoa passed his evaluation and was allowed to return to the game.

However, neither the team physician nor the UNC examined his back during the evaluation, “but instead relied on the earlier examination conducted by other members of the medical staff.”

After the game, the NFLPA exercised its right to terminate the UNC who performed Tagovailoa’s initial evaluation after the union found he made “several mistakes” during the process, despite following the step-by-step process of the protocol, multiple sources told ESPN.

“Rather than being simply a ‘check the box’ process, the Protocol was designed to ensure that highly credentialed and experienced physicians — approved and paid for by the NFL and NFLPA — are available on game day and to create a standardized approach to concussion evaluation where competitive decisions never usurp quality care,” the joint statement read. “If a concern arises over compliance with the Protocol, either the NFLPA or the NFL can request an investigation into the actions of the medical staff which will be conducted jointly.”

Both parties agreed to amend the protocol by adding ataxia to the list of “no-go” symptoms.

Less than a week after the first head injury, Tagovailoa started against the Cincinnati Bengals in a Thursday night game. He suffered a concussion in the first half after taking a hard sack, and displayed the “fencing response” after the scary hit.
He was stretchered off the field and immediately taken to the hospital.

Multiple concussions within a short timeframe can leave the brain more vulnerable to injury. If symptoms from a previous concussion persist and another concussion occurs, the player could be at risk of a rare but fatal condition called “second-impact syndrome” that causes swelling in the brain.

Tagovailoa is currently in concussion protocol and seeking outside medical attention. He did not travel with the team and will not play Sunday against the New York Jets. Teddy Bridgewater will start for Miami.