Concussion protocols change, but no one seems very happy

The NFL and NFL Players Association released a joint statement last Saturday night that was supposed to resolve the Tua Tagovailoa concussion episode.

The Dolphins’ doctors were cleared of wrongdoing when they sent Tagovailoa back into the game after wobbling on Sept. 25. And the NFL and union agreed to amend the concussion protocols to close the loophole that was exposed by this case.

Except the resolution hasn’t left anyone feeling satisfied.

The NFL, the union, teams, and players have gripes about how the situation has been handled. And the changes to the concussion protocols could wreak havoc on the season.

The NFLPA, despite releasing the joint statement, flat out disagrees with some of the league’s conclusions. The statement read that the concussion protocol’s “step-by-step process … was followed,” but NFLPA president JC Tretter said on Twitter, “We do not believe this was a meaningful application of the protocols. Nobody, including the NFL, believes [Tagovailoa] should have been put back in the game.”

The NFLPA also isn’t as willing as the NFL to clear Dolphins head physician John Uribe, an orthopedist. Per the protocols, the head team doctor has the sole authority to diagnose a concussion during a game. Uribe, with the help of the unaffiliated neurotrauma consultant and other Dolphins doctors, determined that the “wobble” exhibited by Tagovailoa was due to a back injury suffered earlier in the game, not a neurological issue. But per the joint statement, Uribe never examined Tagovailoa’s back when the injury occurred in the first quarter, and didn’t examine it after the wobble in the second quarter.

“It is problematic that he was cleared for a back injury for which the lead doctors never took time to examine,” Tretter said.

NFL chief medical officer Allen Sills said Uribe did nothing untoward or out of the ordinary. A member of the Dolphins’ medical team examined Tagovailoa’s back in the first quarter, and Tagovailoa was insistent after his stumble that it was because of his back injury.

“The physicians who participate in that concussion evaluation had the knowledge of the previous diagnosis and exam based on their medical colleagues,” Sills said. “And they used that information, along with the patient’s self-report of back injury, back symptoms, and the lack of objective neuro findings, and the normal exam and the lack of any symptoms, to reach that diagnosis.”

Meanwhile, the NFL is furious at the NFLPA for dismissing the unaffiliated neurotrauma consultant who was working with the Dolphins on Sept. 25.

Not only are the NFL and union still fighting, but teams and players will also take issue with the new concussion protocols.

There is just one change in the protocols — the term “gross motor instability” was replaced by “ataxia.” Under the old protocol, the team doctor could determine that Tagovailoa’s stumble, or gross motor instability, was because of a back injury, not a brain injury. With the new protocols, all subjectivity has been removed. If there is a stumble, it is considered ataxia, and the player is done for the day.

“This new protocol would have ruled him out,” Sills said of Tagovailoa. “