Home Health Tips Tua Tagovailoa’s head injury puts NFL concussion protocol under scrutiny

Tua Tagovailoa’s head injury puts NFL concussion protocol under scrutiny


A high-profile NFL harm has put the highlight again on soccer’s persistent concussions, that are linked to go trauma and quite a lot of long-lasting signs, and may be worsened by dashing again to bodily exercise.

Miami Dolphins quarterback Tua Tagovailoa, who appeared to endure head trauma in a sport Sunday afternoon that was later described as a again harm, was diagnosed with a concussion Thursday night following a sort out. After Tagovailoa’s head hit the turf, he remained on the bottom and held his arms and fingers splayed in entrance of his face — which specialists mentioned evoked situations referred to as “decorticate posturing” or “fencing response,” the place mind injury triggers the involuntary response.

“It’s a doubtlessly life-threatening mind harm,” mentioned Chris Nowinski, a neuroscientist and co-founder of the Concussion Legacy Basis, a nonprofit group targeted on concussion analysis and prevention, including that he frightened about Tagovailoa’s long-term prognosis, provided that it will possibly take months or years for an athlete to totally get better from repeated concussions. Nowinski mentioned he was notably involved about conditions the place individuals endure two concussions inside a brief interval — a situation generally referred to as second influence syndrome — which might result in mind swelling and different persistent issues.

“That’s why we must always a minimum of be cautious with the simple stuff, like withholding gamers with a concussion from the sport and letting their mind get better,” Nowinski mentioned.

The Dolphins mentioned Tagovailoa had motion in all of his extremities and had been discharged Thursday night time from College of Cincinnati Medical Middle.

The NFL’s prime well being official mentioned in an interview on Friday that he was frightened about Tagovailoa’s well being, and pointed to a joint evaluate the league and its gamers affiliation was conducting into the Dolphins’ dealing with of the quarterback’s preliminary harm on Sunday.

“Clearly, I’m upset and anxious similar to any fan — and similar to any doctor is any time one among our gamers suffers any sort of harm,” mentioned Allen Sills, the NFL’s chief medical officer. “We wish to be thorough, and we wish to be constant and be honest to everybody concerned and ensure that we now have all the info available earlier than we attain a remaining willpower.”

How athletes — and the remainder of us — get concussions

The causes and signs of concussions fluctuate broadly. Some athletes compete for years involved sports activities like soccer with out struggling a concussion, whereas different individuals may be concussed from a sudden jolt, equivalent to whiplash from a automobile accident, with out even hitting their heads.

However in lots of instances, the situation is triggered by a blow to the pinnacle, which might result in days or even weeks of complications, reminiscence issues, temper adjustments and sleep problems. Individuals recovering from concussions could also be unable to stability themselves, see clearly or management their feelings. Neurologists even have warned that repeated concussions seem like a contributor to a neurodegenerative illness referred to as chronic traumatic encephalopathy, or CTE.

“Once you’ve seen one concussion, you’ve seen one concussion … there’s simply such broad variability,” mentioned Jennifer Wethe, the lead neuropsychologist for the Mayo Clinic Arizona Concussion Program, including that such accidents are additionally widespread outdoors {of professional} sports activities. “Most of us in some unspecified time in the future in our life most likely could have a concussion … and if it’s managed appropriately, and [you’re] not having one concussion on prime of one other, we’ll find yourself recovering high quality.”

More football leads to worse CTE, scientists say. Consider NFL great Willie Wood.

Medical specialists who deal with concussion say it may be tough to diagnose, notably in athletes who might conceal their accidents as a result of they concern dropping taking part in time and alternatives, or as a result of they don’t expertise signs for hours after the preliminary blow.

“This can be a subjective harm till you get one thing like” Tagovailoa’s seen signs, mentioned Dustin Fink, head athletic coach for the Mount Zion, Unwell., faculty district, who additionally runs The Concussion Blog. “As medical professionals, we’re so reliant upon the athlete telling us what’s occurring with them, to assist us make a judgment or determination. As a result of they will cross exams that we give them.”

Fink mentioned that on Thursday night time — as tens of millions tuned in to look at the Dolphins face the Cincinnati Bengals — he was working as a coach at a freshman soccer sport in Illinois the place a 14-year-old participant visibly stumbled after getting hit, however was initially evasive about his signs.

“He was afraid that this was concussion quantity X and he was accomplished for his profession,” Fink mentioned. Below the college’s concussion protocol, Fink mentioned the participant was held out of the sport and can be reevaluated Friday inside 24 hours after the obvious harm.

Consultants say the dangers are usually cumulative; an individual who has suffered repeated blows to the pinnacle, equivalent to a soccer or rugby participant, is extra more likely to endure a concussion and incur long-lasting signs. An individual therapeutic from a latest concussion can also be extra prone to struggling one other concussion.

“On uncommon events, receiving one other concussion earlier than the mind has healed can lead to mind swelling, everlasting mind injury, and even demise, notably amongst kids and teenagers,” the Division of Well being and Human Companies warns.

The implications are notably extreme for psychological well being, with specialists warning of a robust affiliation between head accidents and doubtlessly lifelong neurological issues.

“Concussions are a reason for novel psychological well being problems like nervousness, melancholy, self-harm and suicidal ideation,” mentioned Nowinski.

In uncommon instances, a concussion can result in a blood clot forming on the mind, creating stress within the cranium and requiring surgical procedure to take away the clot.

What’s the NFL concussion protocol?

The NFL finalized a brand new concussion protocol in 2011 and has repeatedly up to date it amid intense scrutiny and lawsuits filed by 1000’s of former gamers, alleging the league downplayed head harm dangers for many years.

How ‘race-norming’ was built into the NFL concussion settlement

Below the present protocol, a participant should be faraway from a sport instantly and evaluated for a concussion if he stories signs, or if a coach, coach, teammate or somebody tasked to watch the sport suspects a concussion. The participant then should endure fast exams, equivalent to repeating phrases in a reminiscence check, displaying coordinated eye motion and demonstrating stability.

These identified with concussion should endure a five-step process earlier than returning to play, together with with the ability to full football-related actions with none signs — a hurdle that some gamers full inside per week, however that has ended others’ careers. The participant should even be cleared by a staff physician, in addition to by an unbiased doctor collectively authorized by the league and its gamers’ union.

However Nowinski famous potential “gaps” within the NFL’s protocol: A health care provider can ship a participant again right into a sport, for example, if he concludes that indicators of an obvious concussion — like a participant stumbling to face after a blow to the pinnacle — are attributable to one thing moreover a head harm.

NFL gamers are also initially evaluated for concussion in a blue tent on the sideline of the sector, which is meant to offer privateness for a prognosis, however has usually led to gamers returning inside a couple of minutes.

“Possibly it’s time to rethink whether or not the protocol isn’t sturdy sufficient and that each participant who’s suspected [of concussion] must be out and do a full 15-minute locker room analysis,” Nowinski mentioned, though he famous that Tagovailoa did undergo a locker room analysis earlier than returning to play.

NFL, NFLPA to review if concussion protocols followed with Tua Tagovailoa

Rep. Invoice Pascrell Jr. (D-N.J.), who based the Congressional Traumatic Mind Damage Job Power, additionally mentioned he was alarmed by Tagovailoa’s harm and questioned whether or not the NFL’s concussion protocols have been working.

“I’ve had an excellent relationship with the NFL, however I advised them in the event that they’re not going to maintain up with the protocol, I’m gonna go after them,” Pascrell mentioned, sharing a letter he despatched Friday to the league and the Dolphins, demanding solutions on whether or not Tagovailoa had been rushed again to play.

Sills, the NFL’s medical officer, defended the protocols on Friday, saying they have been developed in session with specialists on mind and spinal trauma, most of whom don’t work with NFL groups. “We’re consistently updating and trying to modify the protocol as we study extra from our personal information and likewise as we study extra from the scientific neighborhood,” he added.

Concussion care has quickly advanced in recent times, as specialists study extra about how the mind heals. As an illustration, the maxim “relaxation is finest” was a cornerstone of concussion remedy for years, with sufferers urged to cloister in darkish rooms for days till their signs resolved.

“Now, we acknowledge that too lengthy of that relaxation and form of cocoon remedy can nearly be detrimental,” Wethe mentioned, including that “one to a few days of relative relaxation adopted by a gradual return to regular actions is finest. And we’ve even realized that previous these acute levels, train can truly be rehabilitative.”

Wethe mentioned that she and her colleagues have labored to develop a program to coach mother and father and coaches on how you can verify younger athletes for head accidents. “When doubtful, verify them out,” she mentioned.

Why Tagovailoa might have been at larger threat

Heading into Thursday night time’s sport, Nowinski had known as for the Dolphins to bench their quarterback, arguing the staff was hiding a concussion that Tagovailoa suffered simply days earlier and was dashing him again to competitors, elevating the danger of a extra severe mind harm.

“If Tua takes the sector tonight, it’s a large step again for #concussion care within the NFL,” Nowinski wrote on Twitter on Thursday, a number of hours earlier than the sport.

Nowinski mentioned he took no pleasure predicting Tagovailoa’s harm. “Frankly, it didn’t take a genius to determine that this was attainable,” he mentioned.

On Sunday afternoon, Tagovailoa had stumbled and appeared to have bother standing following a sort out the place his head snapped again into the bottom. Whereas the Dolphins initially mentioned the quarterback had suffered a head injury, the staff shortly reclassified it as a again harm, and he returned to the sport. The transfer prompted an outcry from public well being specialists, and the league and its gamers affiliation opened an investigation, though the NFL on Wednesday said the Dolphins appeared to have adopted the league’s concussion protocol.

A new study shows that hits to the head, not concussions, cause CTE

Nowinski mentioned that Tagovailoa’s harm on Sunday “confirmed 5 separate indicators of concussion,” and that it was not believable he was struggling solely from a again harm.

“First, he grabbed his helmet after his head hit the bottom. Then he stood up and had [to] … step backwards as a result of he was off stability. Then he shook his head side-to-side in a basic shaking off the cobwebs movement, which I have no idea one more reason why you do this except you’re having a visible disturbance after concussion. Then he fell. Then when he stood up, he was gonna fall once more if … his teammates didn’t maintain him up,” Nowinski mentioned.

How widespread are soccer concussions?

Greater than 100 NFL gamers per yr report concussions, with the true quantity thought-about to be a lot larger.

“I’ve undoubtedly had concussions,” quarterback Tom Brady acknowledged in a 2020 interview with Howard Stern, a number of years after his spouse, Gisele Bündchen, claimed that Brady had suffered multiple concussions regardless of by no means being identified with the harm.

Whereas many athletes return to play shortly after concussions — doubtlessly lured by the incentives or the concern of dropping alternatives — others can battle to make it again. NFL gamers like Austin Collie, Kyle Fitts and Jordan Reed have retired in recent times, citing a number of concussions.

Donald Parham Jr., a good finish for the Los Angeles Chargers, was injured in a nationally televised sport in December, the place — like Tagovailoa — he rigidly positioned his arms after influence and was admitted to a hospital.

Whereas Parham has mentioned he has recovered from that concussion, he has not performed within the NFL since that sport, with the staff citing a hamstring harm this season.

Why specialists are involved about Tagovailoa

Nowinski, who performed soccer at Harvard College earlier than turning into an expert wrestler with World Wrestling Leisure, mentioned he was frightened about Tagovailoa’s long-term prognosis following Thursday night time’s harm.

“The issue is Tua has two mind accidents in 4 days, which can finish his profession,” Nowinski mentioned. “And I do know this as a result of I had two concussions in a month 19 years in the past, and that ended my [professional wrestling] profession. And I now have met dozens and dozens of people that had their profession ended by too many concussions in a row.”

Physicians, lawmakers and different specialists cite progress within the NFL and different leagues in combating concussions, however say athletes and groups nonetheless have incentives to cover accidents.

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Following Tagovailoa’s elimination from Thursday’s sport, the announcers on Amazon Prime didn’t instantly tackle his harm on Sunday, and prevented utilizing the time period concussion. (Amazon founder Jeff Bezos owns The Washington Submit.)

“When are we lastly going to place our foot down and say that sufficient is sufficient? ” Rep. Jan Schakowsky (D-Unwell.), who has spent years urgent the NFL on its concussion protocols, mentioned in a press release to The Washington Submit. “As long as this sport is performed, extra assets should be dedicated to prioritizing participant security, The NFL should take full accountability for the harms inflicted on its gamers, and anybody within the Dolphins’ group, together with management, discovered to have damaged concussion protocols should be held accountable.”

Pascrell, the New Jersey congressman, mentioned the implications of Tagovailoa’s harm prolong far past the NFL. “The professionals set the tone for the remainder of the game. Kids get their cues from the highest,” he mentioned.