Tua Tagovailoa’s doctor ‘extremely pleased’ with hip injury recovery. Could it still affect his NFL draft fate?

Suffering a freaky football injury can be prohibitive enough for a star as they prepare for a professional career, but the timing of Alabama quarterback Tua Tagovailoa’s rehab hit the most unexpected roadblock with the global coronavirus pandemic.

The pandemic has completely changed the way people are living, and the effect has dramatically altered the NFL offseason, particularly the 2020 NFL draft cycle. The pro day that Tagovailoa had tentatively slated for April 9 was canceled, along with all workouts for prospects across the country.

Tagovailoa’s situation is unique. He suffered a dislocated hip and posterior hip wall fracture against Mississippi State on Nov. 16, an injury that Dr. Chip Routt repaired two days later in Houston. Tagovailoa returned to Alabama for rehab at the Andrews Sports Medicine & Orthopaedic Center for three months before teams doctors from all 32 franchises scrutinized the possible top-10 pick at the NFL scouting combine.

And that was the final time, in this post-COVID-19 world, that any NFL team will have any direct contact with Tagovailoa leading up to the first round of the 2020 draft, which begins April 23.

If you ask Dr. Lyle Cain, an Orthopaedic Surgeon & Sports Medicine Specialist at the Andrews Sports Medicine & Orthopaedic Center, Tagovailoa’s progress, nearly five months post-surgery, has been remarkable.

“I am extremely pleased,” Cain told Yahoo Sports. “If you told me four, almost five, months ago now that he’d be where he is now, I think I would have been very happy. I think he’s done extremely well for where he started out.”

Steinberg Sports & Entertainment president and COO Chris Cabott, whose firm represents Tagovailoa, told Yahoo Sports that “Tua is fully cleared and ready to compete without any restrictions.”

Will NFL teams agree with their assessments?

Details on Tua Tagovailoa’s medical progress

Tagovailoa’s injury was extremely rare, so much so that Cain was hard-pressed to think of other comparable situations he or his colleagues have seen in football. Typically, traumatic hip dislocations happen in significant car accidents.

“In fact,” Cain said, “it’s only the second one I know of that we’ve had in Tuscaloosa in the last 30 years at least.”

That case was former Alabama linebacker C.J. Mosley, who is now with the New York Jets. Mosley suffered his dislocated hip in the 2012 BCS national championship game against LSU. The difference with Mosley’s injury is that unlike Tagovailoa, he didn’t suffer the additional hip fracture.

“I actually reduced [Mosley’s hip] on the field when it happened,” Cain said. “He didn’t have a fracture. We did all the imaging and kept him on crutches for six weeks, and he actually came back quickly. It was only two months earlier, and he didn’t have much of a problem.”

How serious was Tagovailoa’s injury? Routt, the surgeon who performed the initial procedure in Houston, is not a sports medicine doctor, instead specializing in orthopedic trauma with an emphasis on treating multiply injured patients.

Tagovailoa’s fracture has added a layer to the recovery plan, which has resulted in a different timeline. Yet Cain has been encouraged by what he has seen, with Tagovailoa expected to pay him at least one more visit prior to the draft for another round of scans and observations at the Andrews Center.

After the three-month mark, Tagovailoa went to Nashville to work with former NFL QB Trent Dilfer. That’s where Tagovailoa excited the NFL world with a 10-second clip in which he appeared to move extremely well.

That video alone isn’t going to get a team to sign off on him medically. But Cain says that what he has seen in Tagovailoa’s rehabilitation — information he’ll be sharing with NFL teams — could instill confidence in using a high pick on him.

The process of returning from this injury is threefold. First, there’s the fracture healing. NFL teams got a look at that during the combine medical evaluations.

The next phase was to monitor Tagovailoa’s blood flow. Immediately after suffering the injury, many fans and media recalled Bo Jackson’s career-altering hip dislocation that he suffered in 1991. What plagued Jackson was avascular necrosis — when the blood supply to the head of the femur is disrupted.

Cain doesn’t believe Tagovailoa has any reason to fear a similar result.

“The risk of the blood-flow problem and the cartilage damage, everyone felt [would be] pretty well determined by the fourth or fifth month, which is where we are now,” Cain said. “So the last MRI that Tua had a few weeks ago at the four-month mark showed that he didn’t have any damage or blood-flow problems or necrosis or anything like that. That’s something you’re always worried about potentially happening, so that was a positive.”

The final phase of recovery is getting the hip back in shape. That’s where Tagovailoa is now.

“You have to get the muscles around the hip strong because they do atrophy and get weak,” Cain said. “All the muscles that control the pelvis, your trunk and those are all affected. We try to get that back into shape so you can exert force and run and twist, all the activities that come along with football.”

It’s a process that will take time, but it’s probably the easiest portion to control through physical therapy and strength training. Cain says that process is similar to ACL rehab.

How NFL teams are receiving accurate, updated info on Tua

Once pro days were eliminated amid the COVID-19 outbreak, Cabott and the Steinberg team sprung into action to determine Tagovailoa’s best strategy.

Plans to stage and record a single pro-day style of workout were tabled, with the agency instead fielding bespoke requests from teams. Cabott declined to get into specifics about whether teams are requesting workout or drill videos, but he suggested that they’re willing to listen to whatever NFL teams are asking for.

Cabott and Cain both said they’re unsure whether the NFL will reschedule the canceled combine medical recheck, which typically occurs in mid-April for serious injury updates on prospects. Cain said he believes the most likely course of action will be that Tagovailoa undergoes another round of imaging in that same time frame, which will then be sent to all 32 teams.

Not every NFL team has a hip specialist on staff; every team uses one or more for consultation, but they aren’t typically required as often as other specialists because of the rarity of severe hip injuries.

Cain said he considers there to be five preeminent hip-related specialists among the physicians approved by the NFL Physicians Society: Bryan T. Kelly, M.D., with the New York Giants; Chicago-based Benjamin Domb, M.D.; J.W. Thomas Byrd, M.D., with the Tennessee Titans; Asheesh Bedi, M.D., with the Detroit Lions; and Christopher Larson, M.D., the head physician of the Minnesota Vikings.

Those doctors will share information and their findings with the rest of the league’s physicians for observations and review. It might not be as thorough as an in-person evaluation, but Cain believes he can help bridge that gap.

“So what we’ve tried to do with Tua specifically is reach out to [each of those hip specialists] early and often — and I know them all pretty well personally — and get their advice on treatment,” Cain said. “But we’re also keeping them abreast as we’re going through the process. When teams [met] with Tua, whether it was at the combine or whatever, they’ve already had the consultants tell them what’s going on.”

Which NFL teams might take the leap of faith on Tua?

NFL medical staffs will stamp a grade on each prospect that classifies their level of concern, either by letters (A through E) or numbers (1 through 5). An “A” or “1” grade represents zero health worries; an “E” or a “5” is considered a medical reject. Cain wanted Tagovailoa to understand that medicine is measured in gray as opposed to black and white, and that not every team’s physician or medical staff will interpret his health status the same.

“Every medical staff has its own tolerance for risk, so based on what their level of risk is and what their management is for their staff, some teams might think you’re a 4 and some might think you’re a failure,” Cain said. “We try to make the players aware of the varying degrees and remind them: Just because one team fails you doesn’t mean everyone is failing you.”

Some teams have been accused of being too conservative in recent years. Others have been labeled as having a higher level of risk in their evaluations. Those change based on which doctors are on staff. But the decision also could come down to how risk-averse each team’s front office and coaching staffs are, and how willing those staffs listen to the medical folks.

And when it comes to quarterbacks, there’s also the reality that most NFL rosters will end up with only two or three on the initial 53-man roster, so maximizing those spots is critical.

Three teams selecting in the top 10 of April’s draft appear to need a quarterback — the Cincinnati Bengals (who own the No. 1 overall pick), Miami Dolphins (No. 5) and Los Angeles Chargers (No. 6).

Had Tagovailoa never been hurt, perhaps we’d be immersed in a tremendous Tua-Joe Burrow debate. Given the way things have played out, all signs point to Burrow being the first pick. The Dolphins are loaded with draft-picks ammunition and have to be considered the team with the easiest chance to draft Tagovailoa if they clear him.

The Chargers, meanwhile, could feel desperate to land a big-name QB prospect after losing out in the Tom Brady sweepstakes as they move into the bigger SoFi Stadium they’ll share with the Rams.

Other teams that could be in the Tua market include the Washington Redskins (holders of the No. 2 overall pick), Oakland Raiders (Nos. 12 and 19), New England Patriots (No. 23) and Indianapolis Colts, who don’t have a first-round pick but own two in the second.

It’s easy to see why each of those teams would be hesitant to move into the top 10 to get Tagovailoa. The Redskins just traded for Kyle Allen and have 2019 first-rounder Dwayne Haskins on the roster. The Raiders just signed Marcus Mariota to big backup money and have Derek Carr on a significant deal.

The Patriots brought back Brian Hoyer, ostensibly to compete with Jarrett Stidham. The Colts traded away the No. 13 overall pick for a defensive tackle, signed Philip Rivers to a one-year deal and still have Jacoby Brissett under contract.

So you can handicap the Dolphins and Chargers as the favorites to land Tagovailoa, barring an unexpected fall for health reasons. And if you listen to Tagovailoa’s doctor, that isn’t expected — even in this strangest, most difficult of pre-draft years.

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