Should Miami Dolphins quarterback Tua Tagovailoa play after his head injuries? It’s complicated.
Fans and former football players question the NFL’s concussion protocol and fear for Miami Dolphins quarterback Tua Tagovailoa, 24, after yet another concussion diagnosis.
The concussion came after Tagovailoa was tackled and slammed onto the back of his head during a Christmas Day game against the Green Bay Packers, Dolphins head coach Mike McDaniel said on Wednesday.
The Dolphins player has sustained at least two concussions and three head injuries this season, one of which knocked him unconscious on the field.
Concussions occur when a hit to the head causes the brain to twist or slam into the skull. Hundreds of football players have ended up with a degenerative brain disease linked to suicide and violent acts after repeated hits.
“We know that there’s an association with head trauma and increased frequency head trauma and mood disorders, psychiatric disorders, learning difficulties, cognitive difficulties, etc.,” Nemours Children’s Health physical medicine and rehabilitation physician Dr. Rochelle Haas said.
The Centers for Disease Control and Prevention notes there’s growing concern that head injuries can be harmful long-term even if they don’t cause symptoms or lead to a concussion, but there’s not enough research to say.
Former players are advising Tagovailoa to leave the sport for his own safety.
“If indeed it’s another concussion he has [to] think long and hard about continuing to play this game ever again … period,” tweeted former NFL defensive back Charles Woodson on Monday.
The issue, however, is there’s no way to know for sure whether Tagovailoa needs to give up the game.
“There is no magic formula that says after three strikes you’re out,” Haas said. “We don’t necessarily have a great prediction model for what’s going to happen down the line.”
Research on concussions is still evolving and outcomes from similar injuries can vary dramatically for different people, said Tiffany Ogalageo, program manager for the AdventHealth Sports Concussion Clinic.
“Each concussion is unique. No two have presented the same, ever, in my experience,” Ogalageo said.
Ogalageo and Haas declined to comment on the Dolphins player’s case specifically.
Tagovailoa is not playing in Sunday’s game against the New England Patriots, and his coach was noncommital about whether he will play again this season. Former NFL running back Kenny King encouraged the quarterback to decide for himself.
“Knowing what I know now about concussions I definitely would’ve taken things more seriously when I played and not rushed getting back in. Your brain is more important than the game,” King tweeted Tuesday.
Tagovailoa’s experience highlights the difficulty of diagnosing concussions.
Typically, they are diagnosed based on a neurological assessment done by a professional and, if the assessment raises red flags, a CT scan.
Deciding whether a person’s symptoms warrant concern is a process that leaves room for error, however.
In a September incident, Tagovailoa showed symptoms consistent with a neurological condition called ataxia and was put back into the game anyway.
Days later, he was hit again, knocked unconscious and hospitalized, prompting the NFL to update its gameday concussion protocols and add ataxia to a list of “no-go” concussion symptoms that require a player to be pulled from the game.
In addition to specifying “no-go” symptoms, the NFL’s 19-page protocol includes guidelines for spotting and assessing potentially concussed players as well as a series of steps players diagnosed with a concussion must complete in order to return to the game.
Last Sunday, Tagovailoa didn’t report any symptoms, so his concussion in the second quarter went unnoticed until coaches replayed game footage and saw him hit his head.
“The thing that scares most doctors is something called second impact syndrome,” Ogalageo said. “If you’re still symptomatic, and you sustain another concussion … you run the risk of your brain rapidly swelling, and crazy things like death, paralysis, coma, permanent changes in your IQ.”
Dr. Linda Papa, emergency medicine physician and director of Academic Clinical Research at Orlando Health Orlando Regional Medical Center, said in an October interview that she hopes one day team medical professionals will be able to better assess whether someone is concussed, regardless of whether they have symptoms.
Papa is involved in researching biomarkers — biological signs — of brain injury, measured through blood samples.
She led a small study published in September that evaluated brain injury biomarkers in different football positions, finding that speed and high-strain positions such as quarterbacks had the highest concentrations.
A biomarker blood test is currently approved by the Food and Drug Administration to help doctors decide whether to order a CT scan for a patient.
Papa hopes future studies will tackle the question of whether these biomarker blood tests could be used to diagnose concussions on the sidelines of football games that might otherwise have been missed.
“Medicine is an art,” Papa said. “The biomarkers offer us something that’s a little bit more objective.”
Ccatherman@orlandosentinel.com; @CECatherman Twitter
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