Tua Tagovailoa concussion controversy: Some neurologists aren't quick to point accusatory finger at Dolphins

Two days after the blow to the head that left Tua Tagovailoa flat on his back with his eyes closed and his fingers twisted and rigid, the Miami Dolphins are still facing some of the same questions about their concussed quarterback.

Should Tagovailoa have been on the field Thursday night? Did they put him at too much risk by allowing him to play against Cincinnati?

Only four days earlier, Tagovailoa sustained his first apparent blow to the head when a Buffalo Bills linebacker shoved him to the ground. Tagovailoa stood up shaking his head as though he needed to knock his eyes back into focus. He then staggered a handful of steps before falling to his knees.

Tagovailoa missed only three plays last Sunday while being evaluated for a head injury and downplayed concerns after the game. The quarterback told reporters that he’d hurt his back and ankle earlier in the game against the Bills. When asked about his stumble, Tagovailoa explained that his back “kind of locked up” on him after the shove and ensuing hard fall.

Although the Dolphins and NFL are adamant that the team followed every safety protocol before clearing Tagovailoa to play against the Bengals on Thursday night, at least one medical expert voiced concerns before the game. Chris Nowinski, the co-founder and CEO of the Concussion Legacy Foundation, tweeted Thursday afternoon, “If Tua takes the field tonight, it's a massive step back for #concussion care in the NFL.”

“If he has a 2nd concussion that destroys his season or career, everyone involved will be sued & should lose their jobs,” Nowinski added.

Nowinski doubled down during Thursday night’s game after watching Tagovailoa take another blow to the back of the head and leave the field strapped to a stretcher.

“I predicted this and I hate that I am right,” Nowinski wrote. “Two concussions in 5 days can kill someone. This can end careers. How are we so stupid in 2022.”

Other concussion experts who spoke to Yahoo Sports took a more measured stance regarding the Dolphins' decision.

CINCINNATI, OHIO - SEPTEMBER 29:  Quarterback Tua Tagovailoa #1 of the Miami Dolphins is sacked by defensive tackle Josh Tupou #68 of the Cincinnati Bengals during the 2nd quarter of the game against the Cincinnati Bengals at Paycor Stadium on September 29, 2022 in Cincinnati, Ohio. (Photo by Andy Lyons/Getty Images)

Sports neurologist Kate Essad, the director of concussion management at Aurora Health Care in Milwaukee, watched video clips of Tagovailoa trying to shake off the effects of his first blow to the head last Sunday against Buffalo. Essad admitted it’s “hard to be certain without examining” Tagovailoa in person, but she said from what she saw, “it seems like he wasn’t feeling like his normal self” and “it seems like he was having neurological symptoms.”

Steven Broglio, director of the Michigan Concussion Center, also saw clips of Tagovailoa during the Buffalo game. “When somebody stumbles or shakes their head like that, it is a potential sign of concussion,” Broglio said, “but it doesn’t necessarily mean that he has one.”

“I trust the team on the ground, the athletic trainers, physicians and independent neurologists that looked at him,” Broglio said. “If they’re all saying he was cleared, then I trust their decision.”

The NFL Players Association reportedly took a stronger stance of opposition in how the situation was handled in Miami last weekend. The union fired the independent neurologist who helped clear Tagovailoa against the Bills, according to Pro Football Talk on Saturday.

The reported move follows a strong statement Friday from union president JC Tretter, who said, “We are all outraged by what we have seen the last several days and scared for the safety of one of our brothers. What everyone saw both Sunday and last night were “no-go” symptoms within our concussion protocols.

“We need to figure out how and why the decisions were made last Sunday to allow a player with a “no-go” symptom back on the field.”

The NFL has come a long way in how it approaches concussions since the days of players taking smelling salts on the bench and returning to a game. The league has hired engineering teams to design safer helmets, implemented detailed safety protocols and brought in unaffiliated neurotrauma consultants to work alongside team physicians and help diagnose concussions.

Under the NFL’s current concussion protocol, a player must be removed from a game right away and evaluated for a concussion if he reports symptoms or if a coach, teammate or athletic trainer observes them. Four symptoms are considered no-gos, meaning that players who exhibit them are considered to have suffered a concussion and may not return to the game: Loss of consciousness, confusion, amnesia and gross motor instability.

Miami head coach Mike McDaniel told reporters Friday that Tagovailoa was evaluated for a head injury during the Buffalo game, was cleared “by several layers of medical professionals” and was deemed to have suffered only a back injury. The NFLPA is investigating whether the Dolphins properly followed the league’s concussion protocols.

Tagovailoa was discharged from a Cincinnati hospital on Thursday night and given permission to fly home with his team. The quarterback issued a statement Friday saying that he was “feeling much better and focused on recovering so I can get back out on the field with my teammates.”

Neurologists said that the contorted posture of Tagovailoa’s fingers on Thursday night were a symptom of a traumatic brain injury.

“When his head hit the turf, that causes a jarring in the brain,” Broglio said. “There’s this massive, uncontrolled release of neurotransmitters in the part of the brain that would control arm and hand motion. It causes the muscles to all fire at once so visibly it looks like his fingers are contorted and his arms are out just because all those muscles are firing simultaneously.”

The Dolphins have not yet said whether they intend to put Tagovailoa on short-term IR or how much time the quarterback is expected to miss. Concussion experts say how long Tagovailoa will be sidelined is difficult to predict.

“We know that multiple concussions over a career can cause problems,” former Orlando Magic team doctor and orthopedic spine and neck surgeon Rahul Shah told Yahoo Sports. “We’ve seen plenty of evidence of that. The question is how many is too many and we don’t have the answer yet.

“Right now, the most important thing to do is to watch and see how he is able to make incremental steps. The rate that he is able to make those incremental steps to return back will give doctors good information for how resilient he is to this.”