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What’s the NFL’s concussion protocol and WHY was Miami’s Tua Tagovailoa taking part in in Cincinnati

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After formally escaping a concussion on Sunday in Miami, Dolphins quarterback Tua Tagovailoa had a distinct final result in Cincinnati on Thursday, the place he was recognized with a head damage following a medical analysis course of that’s all of a sudden on the middle of a rising controversy for the NFL.

Tagovailoa was cleared to return Sunday, regardless of stumbling to the bottom and persevering with to wrestle even after getting again on his ft. Teammates wanted to assist hold the 24-year-old Hawaiian upright earlier than he was faraway from the sport moments earlier than halftime.

However as each he and the group later claimed, Tagovailoa was not affected by a head damage, however somewhat, an aggravated and current again drawback. And his play definitely supported that assertion, as he returned within the second half to guide an upset win over the visiting Buffalo Payments. Afterwards, Tagovailoa and the Dolphins each stated he was cleared by docs, who had examined him for concussion signs. 

Critics weren’t shopping for it.  

‘If Tua takes the sector tonight, it is a huge step again for #concussion care within the NFL,’ Chris Nowinski, a Harvard-educated neuroscientist and critic of the NFL’s concussion protocol, tweeted earlier than Thursday’s recreation. ‘If he has a 2nd concussion that destroys his season or profession, everybody concerned might be sued & ought to lose their jobs, coaches included. All of us noticed it, even they have to know this is not proper.’

The opportunity of struggling a second head damage in lower than every week did not cease Tagovailoa from taking the sector on Thursday in Cincinnati, the place he was briefly hospitalized after being ripped to the turf by 6-foot-3, 340-pound Bengals defensive sort out Josh Tupou. Tagovailoa maintained feeling in his extremities and was on the return flight to Miami after Thursday’s loss to Cincinnati, in accordance with the Dolphins.

The response, naturally, has targeted on the Dolphins’ determination to permit Tagovailoa to play in Cincinnati, the place he might have suffered a doubtlessly important head trauma.

‘You guys ought to go to jail for letting him play 5 days after an apparent #concussion you coated up,’ Nowinski tweeted after Thursday’s damage. ‘If he dies from second-impact syndrome, I am pushing for homicide fees.’

Corridor of Famer Shannon Sharpe tweeted: ‘That is a severe damage . Tua should not have been on the market with Sunday Thursday flip round. Generally gamers want defending from themselves. Dolphins failed Tua.’ 

Second-impact syndrome happens when somebody suffers two concussions inside a brief time period, and might trigger the mind to swell quickly. The swelling could be so intense that it could possibly finally damage blood circulate to the mind, leading to demise, in accordance with a 2009 examine within the Nationwide Library of Medication.

Bengals defensive sort out Josh Tupou (68) sacks Dolphins QB Tua Tagovailoa (1) within the first half. Tagovailoa sustained a head damage on the play and left the sport for remedy

Members of the Miami Dolphins surround quarterback Tua Tagovailoa (1) as he is carted off the field after a hit in the first half against the Cincinnati Bengals

Members of the Miami Dolphins encompass quarterback Tua Tagovailoa (1) as he’s carted off the sector after a success within the first half towards the Cincinnati Bengals

Chris Nowinski, a Harvard-educated neuroscientist and critic of the NFL's protocol, called the decision a 'step back'

Chris Nowinski, a Harvard-educated neuroscientist and critic of the NFL’s protocol, referred to as the choice a ‘step again’

Miami Dolphins quarterback Tua Tagovailoa (1) runs off the field after defeating the Buffalo Bills at Hard Rock Stadium

Tagovailoa was cleared to return Sunday, despite stumbling to the ground and continuing to struggle even after getting back on his feet. Teammates needed to help keep the 24-year-old Hawaiian upright before he was removed from the game moments before halftime

Tagovailoa was cleared to return Sunday, regardless of stumbling to the bottom and persevering with to wrestle even after getting again on his ft. Teammates wanted to assist hold the 24-year-old Hawaiian upright earlier than he was faraway from the sport moments earlier than halftime

Miami Dolphins quarterback Tua Tagovailoa (1) is assisted off the field after he was injured during the first half of an NFL football game against the Buffalo Bills, Sunday

Miami Dolphins quarterback Tua Tagovailoa (1) is assisted off the sector after he was injured through the first half of an NFL soccer recreation towards the Buffalo Payments, Sunday

‘It was a scary second. He was evaluated for a concussion and he is within the concussion protocol,’ Dolphins coach Mike McDaniel stated.

Some who watched the scary damage need to know why Tagovailoa was taking part in simply 4 days after his fast return Sunday prompted a joint overview by the NFL and NFL Gamers Affiliation.

Many former gamers had been important of the choice to permit Tagovailoa to return towards Buffalo and begin towards Cincinnati.

‘Participant well being and security is on the core of the union’s mission,’ the NFLPA wrote on Twitter. ‘Our concern tonight is for Tua and we hope for a full and speedy restoration. Our investigation into the potential protocol violation is ongoing.’

NFL government vp Jeff Miller stated the overview normally takes every week or two.

A lot of that point might be spent selecting aside a league concussion protocol that many really feel stays insufficient.


A participant who displays or reviews signs or indicators suggestive of a concussion or stinger enters protocol.

Throughout every recreation, impartial licensed athletic trainers (ATC spotters) monitor the gamers on the sector. In the event that they see an affect to the top, they name a timeout and the participant have to be faraway from the sport, examined and evaluated. Group trainers, coaches or physicians, teammates, NFL recreation officers, sideline unaffiliated neurotrauma consultants (UNC) or sales space ATCs can also provoke the protocol.

Any participant in concussion protocol undergoes a six-step analysis by a group doctor and UNC to find out the severity of the damage and whether or not or not they’re match to return to the sector. The ultimate step is a neurological analysis that includes a cervical backbone examination, together with vary of movement/ache, analysis of speech, statement of gait, eye actions and pupillary examination.

If any parts are constructive, inconclusive or suspicious of concussion, the participant is escorted to locker room.

Within the locker room, a group doctor and UNC conducts a full neurological examination and full NFL Standardized Concussion Evaluation Device.

If irregular, the participant does not return to play, undergoes periodic analysis by a medical group and has a follow-up neurological examination.

The league instituted the system in 2011 after Cleveland Browns quarterback Colt McCoy took a helmet-to-helmet hit in a recreation and returned with out being examined for a concussion. The Browns stated that the group’s trainers did not see the hit as a result of they had been tending to different gamers and that nobody informed them about it. After the sport, McCoy was recognized with a concussion.

Quarterback Tua Tagovailoa of the Miami Dolphins lays on the turf during the second quarter

Quarterback Tua Tagovailoa of the Miami Dolphins lays on the turf through the second quarter


In line with, ‘when an individual experiences an affect that is sturdy sufficient to trigger traumatic mind damage, reminiscent of a concussion, their arms usually go into an unnatural place.’

Tagovailoa appeared to take that place, his fingers flexed awkwardly in entrance of his facemask for a number of seconds as he laid on the turf.

‘The fencing response is usually seen when a participant is knocked down or knocked out throughout full-contact athletic competitions reminiscent of soccer, martial arts, boxing, rugby, and hockey,’ per

It occurred to Los Angeles Chargers tight finish Donald Parham throughout a Thursday evening recreation towards Kansas Metropolis final Dec. 17. Parham was eliminated on a stretcher and stayed in a single day at a hospital for statement after being recognized with a concussion.


The severity of Tagovailoa’s concussion isn’t identified, however it’s seemingly encouraging he was allowed to fly with the group. He should bear a five-step course of earlier than being allowed to take the sector once more. The fifth section is a full follow adopted by clearance from the group doctor. After that, he have to be examined by an impartial neurological marketing consultant.

New York Jets wide receiver Jeff Smith (16) is checked for a concussion during the NFL Football Game between the New York Jets and the Kansas City Chiefs at Arrowhead Stadium

New York Jets vast receiver Jeff Smith (16) is checked for a concussion through the NFL Soccer Recreation between the New York Jets and the Kansas Metropolis Chiefs at Arrowhead Stadium


The battle between NFL earnings and participant well being is nothing new, though the hassle to scale back traumatic mind accidents (TBIs) is, comparatively talking. And it is that discrepancy that resulted in numerous avoidable instances of mind harm, in accordance with epidemiologist and George Washington College professor David Michaels.

An skilled on environmental and occupational well being who served as OSHA assistant secretary underneath Barack Obama from 2009 till 2017, Michaels wrote a e-book in 2020, The Triumph of Doubt, illustrating numerous industries’ methods to suppress information on the  inherent risks of their merchandise.

‘It stays a elementary contradiction inside soccer – for each the league and the gamers – that extra soccer brings in additional income, however it additionally will increase the quantity and severity of mind harm instances,’ Michaels informed the Every day Mail in 2020.

‘No different career—not one—outranks skilled soccer in inflicting life-altering accidents.’


Power traumatic encephalopathy (CTE) is a degenerative mind illness that’s brought on by repeated hits to the top. Over time, these hits consequence within the accumulation of tau protein across the mind, which might result in confusion, despair and ultimately dementia.

There have been a number of retired soccer gamers who’ve come ahead with mind illnesses, lots of whom attribute their situation to the sport. 

Greater than 1,800 former athletes and army veterans have pledged to donate their brains to the Concussion Legacy Basis for CTE analysis.

CTE was normally related to boxing earlier than former NFL gamers started revealing their situations. 

A number of notable gamers who dedicated suicide had been posthumously recognized with the illness, reminiscent of Junior Seau and Aaron Hernandez. 

Whereas usually related to concussions, many researchers like Lee E. Goldstein, MD, PhD, an affiliate professor at Boston College, now imagine sub-concussive hits additionally play a serious half in CTE. 

‘Over the course of an NFL season, the overwhelming majority of hits are sub-concussive,’ Goldstein informed ‘I am not saying [the NFL is] improper for specializing in concussions. However I’m saying they’re mis-prioritizing.’ 

With defective science and flawed research performed by conflicted researchers, Michaels argues, the NFL delayed significant preventative motion on persistent traumatic encephalopathy (CTE) till the early 2000s – a decade after first resolving to handle head accidents and practically a century after the neurodegenerative illness was found in 1928.

‘The steps which can be being taken now, which we predict might be helpful in decreasing the horrible harm to the brains of gamers, they might have been carried out years earlier,’ stated Michaels. ‘The lives of many gamers might have been enormously improved had that been carried out.’

The NFL didn’t reply to’s request for remark in response to the 2020 interview with Michaels. Nevertheless, the league did refute any similarities between itself and the tobacco business in a press release given to the New York Instances in 2016: ‘The NFL isn’t the tobacco business; it had no connection to the tobacco business.’

Earlier than the Nineties, the NFL did not want such techniques. It was when journalists and followers started noticing a spike in concussions that the league took motion, and that was solely after then-commissioner Paul Tagliabue referred to as it a ‘pack journalism problem’ whereas claiming that concussions solely occurred ‘each three or 4 video games.’

Tagliabue’s feedback ignited a small controversy on the time, prompting him to begin the Delicate Traumatic Mind Accidents (MTBI) Committee, which was aimed toward decreasing the ‘damage dangers in soccer.’

The issue, except for its euphemistic selection of the phrase ‘gentle,’ was that the committee did not do very a lot.

‘For eight years, the committee printed nothing,’ Michaels stated. ‘Proof accrued, however even once they began publishing papers, the papers had been actually masking up the issue. They requested questions within the improper method. To me, it seemed like they knew the solutions they wished to seek out earlier than they even did a examine.’

The NFL had claimed the MTBI committee was neutral, however when it lastly did publish 13 papers in ‘Neurosurgery’ between 2003 and 2006, Michaels defined, ‘apparent conflicts of pursuits’ emerged.

A number of members of the committee had been scientific consultants for NFL groups, together with the group’s chairman, Elliot Pellman, a rheumatologist who served because the New York Jets’ group physician and in addition occurred to be Tagliabue’s private doctor.

The truth is, over a dozen of the MBTI members had connections to league franchises. And that is to not point out Michael L. J. Apuzzo, a Neurosurgery editor who occurred to be a medical marketing consultant to the New York Giants.

It isn’t identified if these conflicts affected the analysis straight, however Michaels argued that the MBTI committee’s misguided conclusions did reduce the long-term dangers of soccer.

For one, the concussion information was hardly complete.

The data between 1996 via 2001 omitted greater than 100 recognized concussions, in accordance with the Instances.

In response to that discovering, the NFL acknowledged that ‘the golf equipment weren’t required to submit their information and never each membership did.’

And whereas the NFL admitted that element ought to have been made clearer, the league denied any effort to ‘alter or suppress the speed of concussions.’

Invoice Barr, a neuropsychologist who as soon as labored for the New York Jets, stopped wanting accusing the NFL of a cover-up, however did criticized the MBTI’s findings to the New York Instances.

‘You are not doing science right here; you might be placing forth some concept that you have already got,’ he stated in 2016.

Michaels took intention at one examine from Pellman and his co-author David Viano that asserted ‘gentle [traumatic brain injuries] in skilled soccer usually are not severe accidents’ as a result of so many gamers return to the sector inside every week, usually throughout the similar recreation.

Moreover, the paper argued, concussed gamers may safely return to the sector, as long as they did not present any lingering results.

‘These gamers needed to be asymptomatic, with regular outcomes on scientific and neurological examinations, and be cleared by a educated group doctor,’ learn the paper. ‘There have been no adversarial results, and the outcomes as soon as once more are in sharp distinction to the suggestions in printed pointers and the usual of follow of most faculty and highschool soccer group physicians.’

That very same six-year examine claimed that ‘no NFL participant skilled second-impact syndrome, persistent cumulative damage, or persistent traumatic encephalopathy (CTE) from repeated accidents.’

CTE can solely be recognized posthumously so the absence of any confirmed instances on this examine ought to have been anticipated.

In 2017, researchers at Boston College discovered some extent of CTE in 99 % of former NFL gamers, 91 % of gamers who stopped taking part in after faculty, and 21 % of those that solely made it to the highschool stage.

Specialists warning that there’s a choice bias on this examine, because the households of gamers who had evident indicators of head accidents had been way more prone to donate to the BU mind financial institution.

Even so, the paper’s declare that ‘no NFL participant skilled… persistent traumatic encephalopathy from repeated accidents’ hasn’t withstood the take a look at of time.

However maybe there was no better overreach than the declare made inside a paper titled: ‘Concussion in Skilled Soccer: Mind Responses by Finite Component Evaluation.’

The authors, together with Pellman, posited that gamers who attain the NFL stage is likely to be one way or the other immune from concussions.

‘[T]right here could also be a pure choice of athletes that make it to the NFL as a result of gamers extra vulnerable to concussion might have been weeded out throughout highschool and faculty play,’ learn the paper, which was printed in Neurosurgery. ‘Mind responses proven right here might characterize these of gamers who’re most proof against the damaging results of neural deformation throughout head affect.’

The MTBI committee was dismissive when neuropathologist Bennet Omalu recognized the signs of CTE in former Pittsburgh Steelers middle Mike Webster’s post-mortem in 2002. And when Omalu wrote a paper for Neurosurgery in 2005, calling for additional CTE examine by the NFL, the MTBI committee formally referred to as for a retraction.

‘Then, after all, when Bennet Omalu printed the outcomes of Iron Mike Webster’s post-mortem in 2005, the main members of the committee did not welcome the brand new information,’ Michaels stated. ‘They attacked it. They demanded that Omalu retract his paper.’

The NFL even dismissed a league-funded 2009 examine that confirmed former gamers are 19 instances extra prone to get dementia or different memory-related illnesses.

Then-NFL spokesman Greg Aiello informed the New York Instances that the examine didn’t formally diagnose dementia, claiming that phone surveys of former gamers had been inadequate.

Miller finally acknowledged a connection between CTE and soccer earlier than congress in 2016.

As important as a step as that was, it got here amid different efforts to suppress unflattering media protection.

The 2015 Sony movie based mostly on Omalu’s work, Concussion, was altered underneath strain from the NFL to undertaking a extra favorable view {of professional} soccer and the league, in accordance with reviews by the New York Instances and Deadspin.

‘The league has quite a lot of leverage – in some methods greater than a chemical firm might have,’ Michaels stated. ‘They know that they management the eyes of America for a number of hours each week. If the NFL went, took their enterprise to different leisure firms, then that may put a giant dent within the earnings of the businesses that they work with.’

The NFL started altering guidelines within the 2000s, prohibiting harmful tackles and formalizing a concussion protocol whereas threatening to high-quality non-compliant groups.

Group house owners took additional steps, pledging to fund $30 million to the Nationwide Institute of Well being for impartial CTE analysis in 2012, later giving one other $100 million to Harvard researchers in 2013, and settling the aforementioned $1 billion concussion lawsuit with former gamers.

However even because the league’s examine e-book remained open, critics argued that the NFL’s generosity got here with strings hooked up.

Within the face of mounting lawsuits, the tried to tug NIH funding for a Boston College CTE examine over objections to BU’s Dr. Robert Stern, a critic of the league, in accordance with

‘The NFL had their very own researchers that they supported,’ Michaels stated. ‘When researchers who’re impartial of the NFL, particularly the group at Boston College, was designated by the Nationwide Institute of Well being to be the first recipients of this funding, the NFL objected and wished the NIH to herald scientists who have already got a relationship with the NFL, who basically had a battle of curiosity.

‘That effort of the NFL failed, however it did present that the NFL didn’t need impartial researchers this drawback.’

Knowledge launched in February by the NFL confirmed 187 concussions through the 2021 season, together with preseason, all practices and video games. Whereas that’s up from 172 the earlier season, there have been no exhibition video games in 2020 due to the COVID-19 pandemic. The concussion charge total declined.

Inspired by the pattern of decreased concussions, Dr. Allen Sills, the NFL’s chief medical officer, believes far more could be carried out.

‘We’re happy with the concussion numbers, however we really feel it isn’t the total image,’ Sills stated, ‘and we actually need to aggressively scale back and work to get rid of avoidable head contact.’

Miller famous that the rise from 16 to 17 video games within the common season, dropping one preseason recreation, didn’t seem to have an effect on damage traits.

The preseason had the very best damage charge — gentle tissue accidents are frequent in coaching camp and in exhibition video games — and the brand new 18th week did not end in a spike of accidents.

‘We did not see it,’ Miller stated. ‘The damage charge within the final week of the common season was no increased than earlier weeks; there appeared to be a little bit of a drop-off.’


Two years after a pair of former gamers sued the NFL over the remedy of black retirees within the league’s $1 billion concussion settlement, tons of of males whose medical exams had been rescored to get rid of race bias now qualify for awards.

The newly accepted payouts, introduced in a report final month, had been a victory for NFL households within the decade-long authorized saga over concussions. The 2020 lawsuit unearthed the actual fact the dementia exams had been being ‘race-normed’ — adjusted on account of assumptions that black folks have a decrease cognitive baseline rating. Adjustments to the settlement made final 12 months are supposed to make the exams race-blind.

The brand new outcomes will add tens of millions to the NFL’s payouts for concussion-linked mind accidents. A league spokesman didn’t return a telephone name Friday or reply to emails despatched in latest weeks in search of touch upon the rescoring.

Defensive lineman Kevin Henry #76 of the Pittsburgh Steelers looks on from the sideline during a game against the Cincinnati Bengals at Three Rivers Stadium on September 19, 1993 in Pittsburgh, Pennsylvania. The Steelers defeated the Bengals 34-7

Former Pittsburgh Steelers player Najeh Davenport is shown in Pittsburgh. Lawyers for the NFL and retired players filed proposed changes to the $1 billion concussion settlement on Wednesday, Oct. 20, 2021, to remove race-norming in dementia testing, which made it more difficult for Black players to qualify for payments

Former Pittsburgh Steelers gamers Najeh Davenport (proper) and Kevin Henry (left) are proven in Pittsburgh. Attorneys for the NFL and retired gamers filed proposed modifications to the $1 billion concussion settlement on Wednesday, October 20, 2021, to take away race-norming in dementia testing, which made it harder for Black gamers to qualify for funds. Each Henry and Davenport had sued the league over the problem 

Of the 646 black males whose exams had been rescored, practically half now qualify for dementia awards. Sixty-one are labeled as having early to reasonable dementia, with common awards topping $600,000; practically 250 extra have milder dementia and can stand up to $35,000 in enhanced medical testing and remedy, in accordance with the claims administrator’s report.

Former gamers, legal professionals and advocates say they’re going to now flip to getting the phrase out to extra gamers who may obtain awards.

‘Our work has produced some nice outcomes and has opened many eyes,’ stated Ken Jenkins, a former Washington participant who, alongside together with his spouse, petitioned the federal decide overseeing the settlement to make the modifications and urged the Justice Division’s Civil Rights Division to analyze. ‘Now we’re actually targeted on getting as many gamers who deserve compensation to be compensated.’

This primary group of gamers had one of the best probability of success as a result of they in any other case handed the testing protocols and would have certified in the event that they had been white. 1000’s of different Black former gamers can ask to be rescored or retested, however their instances may not be as sturdy based mostly on earlier outcomes on dementia, validity and impairment exams. About 70 % of lively gamers and 60 % of dwelling retirees are Black.

The truth that the testing algorithm adjusted scores by race — as a tough proxy for somebody’s socioeconomic background — went unnoticed for a number of years till legal professionals for former Steelers Kevin Henry and Najeh Davenport sued the league. Elements reminiscent of age, schooling and race have lengthy been utilized in neurology to assist diagnose dementia. However specialists say the system was by no means meant for use to find out payouts in a authorized case.

‘In 2022, how will you probably suppose that one other human being comes out of the womb with much less cognitive capability? It is simply inconceivable to imagine that that may be true,’ Jenkins stated. ‘It is unspeakable.’

Advocates worry that many former gamers do not know they are often rescored or retested, particularly if they’ve cognitive points and stay alone.

‘Males who’re homeless, males who initially signed up however their cognitive operate modified, males who’re divorced or remoted — we’re going to go on the lookout for them,’ stated Amy Lewis, Jenkins’ spouse.

The couple, as soon as important of sophistication counsel Chris Seeger for his response to the problem, now work with him to unfold the phrase.

Seeger — lead lawyer for the practically 20,000 retired gamers, who negotiated the settlement with the NFL — has apologized for initially failing to see the scope of the racial bias. He vowed in a latest interview to ‘be certain the NFL pays each nickel they need to.’

The league’s tally simply handed $1 billion in accepted claims. Nevertheless, appeals and audits imply precise payouts lag behind that quantity and now stand at about $916 million. Payouts embody awards for 4 different compensable diagnoses: Alzheimer’s illness, Parkinson’s illness, Lou Gehrig’s illness and deaths earlier than April 2015 involving CTE, or persistent traumatic encephalopathy.

As reviewers sort out the thornier dementia claims, the method has slowed and audits and appeals intensified.

‘Their mantra is deny, deny, delay till you die,’ stated James Pruitt, 58, a large receiver who performed for Indianapolis and Miami from 1986 to 1991.

After his NFL retirement, Pruitt turned a instructor and center college principal in Palm Seashore County, Florida. However in 2010, in his mid-40s, the district requested him to step down. He may not carry out his duties. Over time, he stopped calling on associates from his taking part in days.

‘I do not get out, and I do not bear in mind a number of issues. I have been informed that I repeat issues,’ he stated. ‘I am form of embarrassed by the entire scenario.’

After the settlement was accepted in 2015, he and his spouse attended conferences with legal professionals who traveled the nation to promote the plan to retired gamers’ teams.

‘We had been informed … this was going to be a very simple course of, you simply have to go to the docs, get a qualifying analysis from them,’ stated Traci Pruitt, 42. ‘But right here we’re six years later, and we’re nonetheless getting the runaround.’

The couple has twice been accepted by docs solely to have the choice overturned — as soon as after their first physician was faraway from this system. Their lawyer believes they’re going to achieve success on their third strive, underneath the race-neutral scoring system. They’re nonetheless ready to listen to.

Traci Pruitt, an accountant who works from dwelling, stated an award would guarantee she will get the assistance she must take care of her husband: ‘Whereas I really like him, I do not essentially have that background and talent set.’

Seeger stated he believes the claims course of is selecting up steam after a gradual begin.

‘I do know people have stated they weren’t transferring that properly for awhile. I feel we have gained some appellate battles with the courts,’ Seeger stated. ‘I do not suppose the NFL anticipated to pay $1 billion — and we’re about to cross $1 billion.’

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