The NFL's concussion protocol does little to protect players’ health


The NFL’s concussion protocol is a long-running controversy that does little to protect players’ health

Tua Tagovailoa’s two head injuries, just days apart, have many asking why he was playing at all.

The NFL’s concussion protocol is a long-running controversy that does little to protect players’ health

Thursday night, Miami Dolphins quarterback Tua Tagovailoa was carried off the field on a stretcher after he suffered head and neck injuries following a sack by Cincinnati Bengals defensive tackle Josh Tupou. Diagnosed with a concussion, Tagovailoa was released from the hospital and flew back to Florida with the rest of his team.


Some critics asked whether Tagovailoa should have been playing at all. Four days earlier, in a game against the Buffalo Bills, Tagovailoa’s head slammed against the turf following a hit by Buffalo Bills linebacker Matt Milano. Footage of him shows him get up, stumble and fall back down; he was ultimately helped off the field. But during halftime, the team said he passed concussive protocol, and he was back for the second half, leaving many fans saying, “I’m not a doctor, but …” His coach said it wasn’t a head injury but an aggravated back injury.

While Sunday’s footage was concerning, four days later it was downright hard to watch for many fans (this football fan included). On the ground, Tagovailoa’s fingers flexed into a “fencing response” near his face, a possible sign of injury to the brain.

The controversy surrounding the Tagovailoa story is renewing scrutiny on how the NFL handles traumatic brain injuries like concussions, which research increasingly shows can have long-lasting, harmful effects. Here’s a roundup of what to know.

Dolphins’ Tua Tagovailoa exits field on stretcher with head injury — The Washington Post

Business/Institutions Lens

The NFL has been under fire for how it handles brain injuries

The NFL Players Association was already investigating how the team handled Tagovailoa’s injury on Sunday’s Bills game when it announced it will review whether protocol was followed on Thursday night as well.

But many are skeptical of what an NFL investigation actually entails and if any changes will be made (and perhaps even more importantly, enforced — especially when it comes to the best and most valuable athletes).

Aaron Hernandez suffered from most severe C.T.E. ever found in a person his age — The Washington Post

NFL’s flawed concussion research and ties to tobacco industry — The New York Times

Study: CTE found in nearly all donated NFL player brains — NPR

Race Lens

Racial disparities in how the NFL has handled concussions

Another factor in the controversy is race. The league used to consider race as one of the evaluating factors when players made dementia claims that were part of a large concussion settlement. Two former players sued the league and won to stop the practice.

More Black former NFL players eligible for concussion payouts — The New York Times

Science Lens

When a concussion is especially dangerous

What’s a concussion exactly? It’s a kind of traumatic brain injury, where some portion of the brain’s billions of neurons get stretched or damaged because of a blow or jolt to the head. This kickstarts a cascade of chemical changes in the brain that can alter normal functioning, causing a wide range of symptoms including headaches, dizziness, difficulty concentrating, sensitivity to light or sound, anxiety and depression. While most concussions get better within days or weeks, some take much longer to recover, especially when the person has a history of knocks to the head.

And here’s where the controversy over Tagovailoa really comes in: If a person sustains a second concussion before an earlier injury has healed (what many believe happened to Tagovailoa) the consequences can, in rare instances, be fatal.

Called second impact syndrome, this extra blow can cause inordinate swelling in the brain, leading to potentially serious complications or death. More commonly, multiple concussions can compound damage to the brain, with each subsequent injury potentially causing worse symptoms that take longer to improve.

Smaller hits and jolts to the head, called subconcussive impacts, don’t cause noticeable symptoms in the moment, but can gradually take a cumulative toll on brain health. Collegiate football players can average 1,000 of such impacts per season, and recent research suggests these hits are associated with measurable dips in cognitive ability.

Exactly how dangerous is football? — The New Yorker

Different, but still whole: A young scientist reflects on his journey back from a brain injury — Dallas Morning News (Grid Public Health Reporter Jon Lambert writes about his own recovery from a traumatic brain injury.)


Even after a concussion heals, there can be effects down the road

Over the long term, individuals with a history of concussions and subconcussive head injuries have two to four times the risk of developing Alzheimer’s disease or other forms of dementia. Such individuals are also at higher risk of developing chronic traumatic encephalopathy, or CTE, a degenerative brain disease found in the brains of more than 320 former NFL players that also affects boxers and soccer and hockey players.

CTE causes mental deterioration that can cause violent mood swings, eventually resulting in dementia and death, but the condition can only be diagnosed posthumously. Afflicted brains contain tangles of a protein called tau, which gum up brain functioning. Scientists are still trying to understand how CTE develops, but it seems to be associated with accumulated subconcussive impacts; football players with longer careers, or who played positions more exposed to hits, tend to have more severe cases.

What to know about C.T.E. in football — The New York Times

Phillip Adams had severe C.T.E. at the time of shootings — The New York Times

110 NFL brains — The New York Times

Thanks to Alicia Benjamin for copy editing this article.

  • Jonathan Lambert
    Jonathan Lambert

    Public Health Reporter

    Jonathan Lambert is a public health reporter for Grid focused on how science, policy and the environment shape our collective well-being.

  • Suzette Lohmeyer
    Suzette Lohmeyer

    Senior Editor

    Suzette Lohmeyer is the senior editor at Grid, where she focuses on daily news.


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