Why the NFL/NFLPA’s concussion protocol modifications won’t work on the field

On Saturday, the NFL and NFLPA released a joint statement following an investigation into the protocol followed in the matter of Miami Dolphins quarterback Tua Tagovailoa following his injury in Week 3 against the Buffalo Bills.

“The NFL-NFLPA Concussion Evaluation and Management Protocol was formalized and adopted in 2013,” the two parties said in a statement. “Since that time, the parties’ medical experts have recommended and the parties have agreed to numerous modifications of the protocols to improve the health and safety of players (e.g., the creation of the ATC spotter program, Booth UNCs, Emergency Action Plans, mandatory post-game reports, and improved video surveillance). Rather than being simply a “check the box” process, the Protocol was designed to ensure that highly credentialed and experienced physicians – approved and paid for by the NFL and NFLPA – are available on game day and to create a standardized approach to concussion evaluation where competitive decisions never usurp quality care.

“If a concern arises over compliance with the Protocol, either the NFLPA or the NFL can request an investigation into the actions of the medical staff which will be conducted jointly. The NFL-NFLPA CBA limits the scope of the parties’ review to an objective assessment of whether each step required by the protocol was undertaken when a potential head injury is identified.”

Here’s what they were investigating.

With 2:28 left in the first half of that game, Tagovailoa was hit hard by Buffalo linebacker Matt Milano, and his head hit the turn equally hard. Tagovailoa was wobbly and shaking his head as he got up, and this looked for all the world to be a prototypical concussion.

Tagovailoa was taken into the NFL’s concussion protocol, and came out to play for the entire second half. As the game progressed, news leaked regarding the supposed source of Tagovailoa’s malady.

Given the NFL’s highly specious history regarding head trauma, this was met with massive suspicion, and rightly so. After the game, Dolphins head coach Mike McDaniel echoed this diagnosis.

“That was live-speed action,” McDaniel said. “Now, Tua, he went out with a lower back, and I hadn’t had that rep with him yet. He kind of got bent back pretty significantly on a quarterback sneak earlier. I was kind of with everyone else. When he hit his head on the ground, I assumed it was a head injury, but his legs got wobbly because his lower back was completely loose and as he described it, he said his lower back was like Gumby or something. That is a challenge.

“That happens all the time in NFL games. It was kind of fast and furious. We had some skill position players get dinged. We had some linemen fight through it, but those are things that you just have to be able to adjust on the fly. Your whole staff better be in concert. You better have contingencies, and you better know some plays you want to go to if things happen. We were able to do the best we could, but it was a lot better when we had everyone back. That’s for sure.”

Tagovailoa really wanted everybody to know that he’s good.

“On the quarterback sneak [the play before], I kind of got my legs caught under someone, and then they were trying to push back and then kind of felt like I hyper-extended my back or something. Then on the next play I kind of hit my back and kind of hurt. Then I got up and then that’s kind of why I stumbled – my back kind of locked up on me. For the most part, I’m good. I passed whatever concussion protocol they had, so I’m good.”

Tagovailoa was not good, as it turned out, and we’ll get into that in a minute. But here’s what the NFL and the NFLPA found in their internal investigation, which is the first problem right off the bat.

Any internal investigation should be viewed with extreme cynicism.

(Rich Storry-USA TODAY Sports)

“The NFLPA initiated such an investigation in connection with the incident involving Mr. Tagovailoa,” the statement continued. “The NFL and NFLPA reviewed the relevant reports and video and jointly interviewed members of the Team’s medical staff, the Head Athletic Trainer, the Booth ATC Spotter, the Unaffiliated Neurotrauma Consultant (UNC) and Mr. Tagovailoa. Following the complete review, the parties concluded that while the step-by-step process outlined in the Concussion Protocol was followed, the outcome in this case was not what was intended when the Protocol was drafted (emphasis theirs). Specifically, the review established:

• “During the play in question, the player was tackled and fell on his back and then hit his head on the ground.  The player grabbed his helmet, shook his head several times, and after he took several steps, he stumbled and fell.

• “The Club medical team and the UNC properly viewed the video of the play in question as required by the protocol and engaged in a locker room examination of Mr. Tagovailoa before the player was cleared to return to play. The Team physician cleared Mr. Tagovailoa, following consultation with the UNC. The steps set forth in the Concussion Checklist were, therefore, conducted.

• “Mr. Tagovailoa suffered and reported back and ankle injuries earlier in the game.  Mr. Tagovailoa told the medical staff involved that he aggravated his back injury on the play in question and that his back injury caused him to stumble.

• “Mr. Tagovailoa did not report or exhibit any signs or symptoms of concussion during his locker room exam, during the remainder of the game, or throughout the following week.

• “The medical staff involved determined that the Gross Motor Instability (“GMI”) suffered by Mr. Tagovailoa was not neurologically caused. They concluded the player’s back injury was the cause of his observed instability.   However, the team physician and UNC did not conduct an examination of Mr. Tagovailoa’s back during the concussion examination, but instead relied on the earlier examination conducted by other members of the medical staff.”

So, internal investigations should be viewed with extreme prejudice under any circumstances, and certainly when it involves the NFL and head trauma of any kind. The level to which players in pro football history have been misdiagnosed, or diagnosed and told that it was safe to return to play, is burned into history. In this case, if Tagovailoa was concussed, how could his opinion that he was not concussed be taken seriously? It should not have been. The point of such a protocol is to protect the player from himself.

The UNC in this case was fired by the NFLPA, but the protocol was followed, and all the findings say is that “the outcome in this case was not what was intended when the Protocol was drafted?”

That is utterly ridiculous.

The protocol modifications are meaningless unless they're actually followed.

(Photo by Andy Lyons/Getty Images)

The NFL probably could have skated on that one series of mistakes, were it not for the injury actually classified as a concussion Tagovailoa suffered four days later, when the Dolphins played the Cincinnati Bengals on Thursday Night Football. Tagovailoa was incredibly given the go-ahead to play in THAT game.

And with 5:57 left in the first half of THAT game, Tagovailoa was sacked and suffered what looked to be severe head and neck injuries. This time, as Tagovailoa immediately displayed what’s known as “fencing response position.” the NFL had no choice but to follow its own murky protocol.

Baltimore Ravens head coach John Harbaugh spoke in a press conference the day after the Bengals game, expressing his incredulity about the entire matter.

“I couldn’t believe what I saw,” Harbaugh said about Thursday night. “I couldn’t believe what I saw last Sunday. It was astonishing to see. I’ve been coaching for 40 years — college and the NFL — and I’ve never seen anything like it before. I couldn’t believe what I was seeing. I really appreciate our doctors, and I appreciate our owner.”

Harbaugh had the credibility to speak as he wished. In the third quarter of the Ravens’ divisional round loss to the Buffalo Bills on January 16, 2021, quarterback Lamar Jackson threw the ball away on an errant snap, was flagged for intentional grounding, and was sent to the sideline to go through concussion symptom testing after his head was slammed to the ground.

The Ravens were down 17-3 in a playoff game, Jackson showed symptoms, and he was taken out of the game for his own good. The Ravens were unable to score with backup Tyler Huntley, and they were eliminated from the postseason.

“I’m not frustrated at all. He was in the concussion protocol. He had a concussion and was ruled out with a concussion. That’s where it stands,” Harbaugh said of the situation after the game.

That was an example of a team looking out for a player’s interests, no matter the result. These protocol changes do nothing to protect a player unless they’re actually followed. The league can talk all it wants about “gross motor instability” or “ataxia,” (abnormality of balance/stability, motor coordination or dysfunctional speech caused by a neurological issue), but if you have allegedly “independent” neurologists going daredevil with what neurological issues, which has been the NFL’s history more often than not, protocol is meaningless.

And we still don’t know if Tagovailoa’s symptoms in the Bengals game were exacerbated by an undiagnosed concussion in the Bills game. That’s where we are with this.

The NFL already bollixed another concussion case during its own investigation.

(Photo by Mike Ehrmann/Getty Images)

Last Sunday night, and after Tagavailoa’s issues in the Bills and Bengals games, Tampa Bay Buccaneers tight end Cameron Brate was injured following a collision with teammate Chris Godwin in Tampa Bay’s loss to the Kansas City Chiefs. This was in the first half. Brate was allowed to go back into the game a few plays later, despite the fact that it took the team so long to get him off the field, the Buccaneers were penalized for having too many players on the field.

Brate was not permitted to return to the game in the second half; apparently that’s when the protocol kicked in.

Here’s what Buccaneers head coach Todd Bowles said after the game (all via Greg Auman of The Athletic):

Again, this all happened while the NFL and the NFLPA were in the throes of its own internal investigation on the mishandling of potentially concussed players. Brate’s only advocates failed him, and again, no change in protocol is going to stop that from happening unless the protocols are followed. Think of what could have happened had Brate suffered another traumatic brain injury soon after his first one, while the people in charge of protecting him were doing whatever it is they were doing.

Which brings us to the NFL’s inevitable damage control.

The NFL is circling the wagons.

(AP Photo/Rebecca Blackwell)

Dr. Allen Sills, the NFL’s Chief Medical Officer, was all over the damage control as the findings about, and modifications to, the protocol were revealed.

So, the NFL is circling the wagons as it does, eschewing meaningful policy in favor of optics. It’s why more players will return to play when possibly concussed no matter how many guardrails are added, because the NFL should not be in charge of its own on-field diagnosis. Neither Sills, nor Roger Goodell, nor any member of any team, should be involved at all. These medical professionals should be hired on the basis of referrals from an outside agency, and if a member of that outside staff says that a player must be taken out of a game and cannot return, that’s law.

There is no more room for consultants who don’t even understand the protocol. There is no more room for protocols that can only be investigated and changed internally. If the NFL really cared at all about player health and safety, those steps would already have been taken, as opposed to the half-solved mess we have now.

Sadly, the NFL has already told you that the appearance of caring is far more important than the real thing.

Story originally appeared on Touchdown Wire