Without updated tools, NFL still missing concussions
Review determines play on which Dolphins QB suffered harmful hit didn’t merit his removal from field last week
In September, Miami Dolphins quarterback Tua Tagovailoa was hit in two games over five days. He slammed his head on the turf so severely in both instances that they became a flash point for criticism of the NFL’s, and the team’s, handling of concussions and prompted pro football to amend its policy regarding benching players after head hits.
But last week Tagovailoa took a third hit, after which he gathered himself and played the next snap, an illustration of the difficulties that the league’s evolving concussion strategy is facing.
In the game against the Green Bay Packers, Tagovailoa was sacked from behind as he tried to shovel a pass to a Dolphins receiver. His momentum swung him around, and Tagovailoa fell backward, his head smacking the field again. Tagovailoa did not display the obvious loss of motor skills he had in the previous instances — loss of consciousness, trouble standing, involuntary hand movements — but he threw three interceptions on three consecutive possessions in the second half of the Miami loss.
Not until Monday, the day after the game, did Tagovailoa report concussion symptoms to team personnel, who placed him under league-mandated observation and out of play.
“I totally didn’t realize that Tua went through that,” Dolphins running back Raheem Mostert said of the concussion. “But it also kind of made sense toward the end of the game. You know, I was asking myself in the huddle, like, ‘What are we doing? What’s going on?’ ”
The NFL and the players’ union said in a joint statement Saturday that they had reviewed the game and that
the play involving Tagovailoa did not immediately merit taking him out of the game. “The review established that symptoms of a concussion were neither exhibited nor reported until the following day at which time the team medical personnel appropriately evaluated and placed Tagovailoa in the concussion protocol,” the league and union said.
The league mandates nearly 30 medical professionals are on hand for every game. They include athletic trainers and neurotrauma consultants on the sidelines and medical experts scanning the field from press boxes in order to spot any potential head injuries that might be missed below.
But concussions can cause much subtler symptoms, including headaches, sluggishness and difficulty sleeping, some of which are not present immediately after a trauma. The absence of obvious symptoms makes the type of instant diagnosis that is urged in the NFL difficult without the adoption of updated tools that can measure concussion symptoms with a higher degree of specificity.
“Basically, anything that your brain controls can be disrupted by a concussion,” said Dr. Uzma Samadani, a neurosurgeon who was an unaffiliated neurotrauma consultant for four years at Minnesota Vikings games and who developed an eye-tracking device to more definitively diagnose concussions. “Is it possible to make an objective assessment of someone’s total capacity of brain function on the sideline that rapidly? It’s very difficult.”
While self-reporting symptoms can be key to diagnosing concussions, studies have found that players can be reluctant to speak up for a variety of reasons. Those include the risk of going against football’s next-man-up culture and the loss of compensation in a sport without guaranteed contracts.
The NFL uses a series of physical and cognitive exams to assess players for concussions, but experts in brain injuries say that there remains no objective tool to identify a concussion. Elite athletes, even with diminished mobility, can often handle the physical tests designed to gauge their balance and motor skills.
“Unfortunately, even today with all of our technology, we don’t have a blood test or an X-ray scan or an MRI scan to reliably diagnose concussion. We’re still very reliant upon self-report of symptoms and identification of symptoms as kind of the cornerstone of our diagnosis,” said Dr. Allen Sills, the NFL’s chief medical officer.