NFL/NFLPA agree to modify Concussion Protocol after Tua Tagovailoa injury investigation

On Saturday, the NFL/NFLPA completed their joint review of the application of the NFL’s Concussion Protocol following the injury to Miami Dolphins Quarterback Tua Tagovailoa during the team’s game against the Bills in Week 3.

Tagovailoa left the team’s win over the Bills with what appeared to be a head injury. However, he did return, and the Dolphins stated that he left the game due to a lower back injury. A few days later, against the Bengals, Tagovailoa left the game in the first half with head and neck injuries. He was taken to a local Cincinnati hospital and later released.

According to the NFL/NFLPA, they reviewed the relevant reports and video and jointly interviewed members of the team’s medical staff, the Head Athletic Trainer, the Booth ATC Spotter, the Unaffiliated Neurotrauma Consultant (UNC), and Tagovailoa.

Following the complete review, the parties concluded that while the step-by-step process outlined in the Concussion Protocol was followed, the outcome, in this case, was not what was intended when the Protocol was drafted.

According to the NFL/NFLPA, the review established:

• During the play in question, the player was tackled and fell on his back, and then hit his head on the ground. The player grabbed his helmet, shook his head several times, and after he took several steps, he stumbled and fell.

• The Club medical team and the UNC properly viewed the video of the play in question as required by the protocol and engaged in a locker room examination of Mr. Tagovailoa before the player was cleared to return to play. The Team physician cleared Mr. Tagovailoa, following consultation with the UNC. The steps set forth in the Concussion Checklist were, therefore, conducted.

• Mr. Tagovailoa suffered and reported back and ankle injuries earlier in the game. Mr. Tagovailoa told the medical staff involved that he aggravated his back injury on the play in question and that his back injury caused him to stumble.

• Mr. Tagovailoa did not report or exhibit any signs or symptoms of concussion during his locker room exam, during the remainder of the game, or throughout the following week.

The medical staff involved determined that the Gross Motor Instability (“GMI”) suffered by Mr. Tagovailoa was not neurologically caused. They concluded the player’s back injury was the cause of his observed instability. However, the team physician and UNC did not conduct an examination of Mr. Tagovailoa’s back during the concussion examination but instead relied on the earlier examination conducted by other members of the medical staff. 

Conclusions and findings:

According to the NFL/NFLPA, while the investigation determined that the team medical staff and unaffiliated medical professionals followed the steps of the Protocol as written, the NFL and NFLPA agree that the outcome, in this case, is not what was intended when the Protocols were drafted. As such, as has been done in previous cases, based on the advice of the parties’ respective medical experts, the Protocol will be modified to enhance the safety of the players. Specifically, the term “ataxia” has been added to the mandatory “no-go” symptoms. “Ataxia” is defined as abnormality of balance/stability, motor coordination, or dysfunctional speech caused by a neurological issue. In other words, if a player is diagnosed with “ataxia” by any club or neutral physician involved in the application of the Concussion Protocol, he will be prohibited from returning to the game and will receive the follow-up care required by the Protocol.  

At this point, there’s no word on when Tagovailoa will return to the Dolphins’ lineup. Miami battles the Jets on Sunday.