Tua Tagovailoa’s Injury Wasn’t Just a Failure of Protocol

Not long after the Miami Dolphins quarterback Tua Tagovailoa was thrown to the ground, with six minutes left in the first half of a matchup against the Cincinnati Bengals, slamming the back of his head into the turf, Joe Burrow, the Bengals quarterback, took the field. By then, the game, which took place on the second-to-last day in September, was an afterthought to many people. Everyone watching on television had seen replay after replay of Tagovailoa’s hands flying up over his face as he rolled onto his back after the hit, his fingers gruesomely splayed—it appeared to be an automatic response known to indicate a serious brain injury. Everyone inside the stadium had seen paramedics place him on a stabilizing board and load him into a stretcher. Everyone knew, after more than a decade of well-publicized research, about the possible long-term effects of brain trauma experienced by N.F.L. players—the higher rates of amyotrophic lateral sclerosis (A.L.S.), of dementia, of mood and personality disorders, of the scourge of chronic traumatic encephalopathy (C.T.E.), a brain disorder brought on by repeated blows to the head.

A decade ago, concussions seemed like an existential threat to football. Even the N.F.L. has been forced to acknowledge the damage done by the sport to the people who played it, settling for a billion dollars with former players who brought concussion-related lawsuits. Spotters were hired to sit in stadiums during games and watch out for players exhibiting signs of concussions; there are now protocols in place to test whether a player has suffered one, and there is a five-phase process that a player needs to follow if he’s diagnosed with one, before he can return to the field. This year, new guidelines required padded helmets during training camp for some players. The number of reported concussions has declined, and the subject has ceased to dominate conversation around the sport.

The impulse after Tagovailoa’s injury, naturally, was to point fingers: the rules must not have been followed properly; the protocol was flawed, or had broken down. Miami’s coach, Mike McDaniel, had been criticized for putting Tagovailoa back into a game after he hit his head on a similar sack and stumbled as he made his way to the huddle. McDaniel had said that Tagovailoa had been evaluated in the locker room and passed all tests, and was simply suffering from a back injury. He had responded hotly to the suggestion that he had put a player in harm’s way, and was anguished by what had happened. “That is not part of the deal that anyone signs up for,” McDaniel said, after Tagovailoa was stretchered off the field, his voice thick with emotion.

Burrow, the Bengals quarterback, knew better. “You can make all the rules you want to make the game as safe as you possibly can, but there’s an inherent risk and danger with the game of football,” he said last week, on “The Colin Cowherd Podcast.” “You have three-hundred-pound men running twenty miles an hour trying to take your head off while you’re standing still, trying to ignore it and find receivers that are open. You’re running twenty miles an hour and somebody else is running twenty-two miles an hour, you’ve got to try to get the first down. That’s part of the game, I think. Part of what we signed up for.”

Burrow had held his breath with everyone else as Tagovailoa had gone down, he said, and his thoughts were with him as he was taken to the hospital. But injuries, he went on, including head injuries, were part of the game. Three plays after the Bengals blocked a field goal, while three-hundred-pound men tried to take his head off, Burrow stood still, found an open receiver, and calmly launched a long touchdown pass.

Burrow knows the rewards of being a football player as well as anyone—the rush of the fight, the satisfaction of mastery, the sound of a hundred thousand people cheering him on. After winning the national championship with L.S.U., in 2020, he sat in the locker room, smoking a cigar, still wearing his pads—the big man on campus and across the country. A few months later, the Bengals drafted him with the No. 1 pick, and signed a four-year contract for thirty-six million dollars. Three seasons later, he was playing in the Super Bowl.

But he also knows the costs. His rookie season ended when he was hit and the ligaments in his left knee were shredded. The next season, he was sacked a league-leading fifty-one times, then was sacked another nineteen times in the playoffs. That number could have been higher if he hadn’t eluded a number of them in the A.F.C. title game, against the Kansas City Chiefs, spinning and high-stepping through tackles, sweeping off the long limbs of giant men. In the Super Bowl, he was sacked seven times, and limped off the field after the last of them. The Bengals revamped their offensive line in an effort to protect him, but the beatings didn’t stop. In this season’s first week, he was sacked seven times and hit another eleven. In the second, he was sacked six times. In the third, he was dropped twice. None of them have resulted in injuries—reported ones, anyway. But the ground is unyielding.

On his podcast, Cowherd asked Burrow if he had ever had his “bell rung.” Burrow, who has not been diagnosed with a concussion since joining the league, laughed a little as he answered yes. “I think everybody has who plays this game,” he said. He’d never had any long-lasting effects, he added—no headaches that lingered for an entire week, for instance. But there were times that he was dizzy, halves that he couldn’t remember, entire games he couldn’t recall.

This is one of the major challenges surrounding head injuries: a doctor can’t cut open the brain in the middle of the third quarter; diagnosing a concussion can involve a judgment call. In the same week that Tagovailoa went down, the Tampa Bay Bucs tight end Cameron Brate collided head first, violently, with a teammate’s body, but stayed in the game until halftime, when he started describing symptoms of a head injury. Asked afterward why he wasn’t immediately tested for a concussion, the Bucs head coach, Todd Bowles, said, “He complained about his shoulder, not his head. You can’t see a neurologist or talk about concussions if you only complained about the shoulder.”

Ultimately, the N.F.L. relies on players to report symptoms, and it gives them every incentive not to. On the “E.S.P.N. Daily” podcast, the former Kansas City quarterback Alex Smith described a time when he was determined to pass the tests administered in the locker room after suffering what he sensed was a concussion—and succeeding. He was competitive, and wanted to play, and he knew the stakes: he’d lost his starting job in San Francisco when he’d missed time for a concussion. Players in less high-profile positions are even more vulnerable: their contracts are not guaranteed, and, in most cases, the public wouldn’t decry their disappearance. They’re conditioned to celebrate “toughness,” and hardwired to compete.

After Tagovailoa’s injury, the N.F.L. Players Association announced the firing of the unaffiliated neurotrauma specialist who was involved in evaluating Tagovailoa, citing mistakes in the process of letting him get back on the field in week three. The N.F.L. conducted an investigation and concluded that the protocol had worked, just not as intended. It added “ataxia,” or abnormal balance or motor coördination, to the reasons to keep a player out of a game—even if they passed the concussion tests. Had that rule been in place, Tagovailoa wouldn’t have been allowed to play.

On Sunday, the new rule was tested immediately: on the first offensive drive, Teddy Bridgewater, Tagovailoa’s replacement as the Dolphins’ quarterback, was slammed down hard. He passed the concussion tests, but a spotter claimed that he stumbled, and so he was not allowed to return to the game. It was possible that he was suffering from some other physical impairment, but the N.F.L. has said it is willing to err on the side of caution. It is touting its conservative approach.

But the hits go on—and so will the concussions, and those spells of dizziness, headaches, and fuzzy memories which go undiagnosed. The protocols have been designed by a league that has settled, in court, with players who accused it of misleading them about head trauma. They are administered by doctors paid by teams who want their players on the field, and by unaffiliated doctors who, given their willingness to send players back onto a football field in most circumstances, in some sense violate their Hippocratic oath. It is accepted, even by those who love it, that football does harm.

Perhaps the biggest issue, then, is that the rules allow for what the sport is built on—repeated subconcussive trauma that is linked to long-term health problems, the kind of hitting that’s a part of every N.F.L. play. Rules that ended that would end the sport. And so we’re left with ones that are designed to protect players from the worst—and to protect us from our discomfort—so that the game goes on. 

Tua Tagovailoa’s Injury Wasn’t Just a Failure of Protocol
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