This Sunday, Tua Tagovailoa returns as the Miami Dolphins’ starting quarterback in his first game since suffering a concussion in the Dolphins’ loss to the Bills back on Sept. 12. Tagovailoa’s concussion was memorable for two reasons.
It happened because he ran into Damar Hamlin, the Bills player whose heart stopped on the field two years ago. And there was an immediate and obvious concussion symptom after Tagovailoa’s hit, when his arm went into the so-called “fencing position,” which is an asymmetrical tonic neck reflex that happens when a blow impacts the brain stem. It was gruesome to watch.
The concussion was so scary to watch that it sparked immediate speculation about retirement. Many pundits and fans urged the former star quarterback at Alabama, now in his fifth NFL season, to prioritize his health over his career. Nevertheless, since September Tagovailoa has anxiously awaited the league’s all clear. And he did not have to wait long.
Notably, there is no set number of games players are required to miss after a head injury like Tagovailoa’s. The NFL has a five-step protocol for players to return from diagnosed concussions — which, of course, are not the only concussions players suffer and may not even be the most damaging. But the steps are squishier than you might suspect. These steps are:
- Phase 1, symptom-limited activity
- Phase 2, aerobic exercise
- Phase 3, football-specific exercise
- Phase 4, noncontact training drills
- Phase 5, full football activity/clearance.
You will note that these are not medical tests. If a player is no longer showing active concussion symptoms — which are often mostly gone by the time he leaves the field — they are allowed to progress to the next step. Once concussed, a player’s only choice is to try to make sure the brain is allowed to rest and, hopefully, heal. In 2022, the year Tagovailoa suffered his first (known) concussion, the median number of days players sat out because of the protocol was nine.
And while it may feel to the average fan like Tagovailoa has been cleared to play surprisingly quickly, the five weeks he was out is much, much longer than most players take. That’s because, after the injury, the Dolphins placed Tagovailoa on the injured reserve list, which requires a minimum four-week absence.
This is not typical. And while the Dolphins did not say this, I’d argue the move had a lot to do with public relations. We watched Tagovailoa’s concussion, the fencing motion, the memory of a similar concussion Tagovailoa had two years ago, and it was appalling. The hit provided a vivid reminder of how brutal and violent this game is, and in many ways has always been. Having Tagovailoa sit out nine days before his next game would have looked terrible, for both the Dolphins and the NFL.
Putting him on the injured list automatically took Tagovailoa out of the conversation for more than a month. But Tagovailoa himself said that he stopped having concussion symptoms relatively soon after the hit in September, which would likely have allowed him to start the five-phase process fairly quickly. The surprise isn’t that Tagovailoa is back so soon. The surprise is that it took him so long.
Much has been made of the fact that this is Tagovailoa’s third diagnosed concussion, but of course “diagnosed” is doing a lot of work there. Many concussions are not diagnosed and, as been widely documented, nonconcussive head impacts — the sort that happen constantly to players throughout a game — accumulate over time. Researchers at the Concussion Legacy Foundation now believe these impacts could be the “driving force” behind chronic traumatic encephalopathy, or CTE.
Ultimately, though, Tagovailoa’s three concussions aren’t all that unusual. (There was a kerfuffle a few years ago when Gisele Bündchen said then-husband Tom Brady had suffered “multiple” concussions in his career, mostly because Brady for years had tried to pretend it wasn’t true.) Fans have just seen all of them. They’ve been high-profile and, because of his fencing motion symptom, seared into our brains. When we think of Tua Tagovailoa, we now think of concussions. We don’t do that with other football players — even though we absolutely should.
Tagovailoa’s argument for returning, then, is simple: Everyone knows the risks. “I love this game. I love it to the death of me,” he said this week. That has made many people worry for him, and it should. Tagovailoa’s health is in danger because he plays football and may get another concussion.
But so is the health of all of his co-workers.
If you’re worried about Tua Tagovailoa, you should worry about every other player in the NFL. But not enough, I’d bet, not to watch.
