The NFL and the NFL Players Association (NFLPA) have released a joint statement to address the NFL concussion protocol, after concerns arose regarding Miami Dolphins quarterback Tua Tagovailoa's injury evaluation.
The announcement stated that while "the step-by-step process outlined in the concussion protocol was followed, the outcome in this case was not what was intended".
Following league-wide outrage, Tua was cleared to return to play after suffering a head injury against the Buffalo Bills on Sept. 25, which sparked a league-wide discussion on the league's concussion protocol. The NFL have now modified the protocol, which took immediate effect last Sunday.
The evaluation process now includes 'Ataxia' in its list of "no-go" symptoms, which medical staff use to determine whether a player will be eligible to return to the game.
The joint statement read:
As such, as has been done in previous cases, based on the advice of the parties' respective medical experts, the Protocol will be modified to enhance the safety of the players. Specifically, the term 'ataxia' has been added to the mandatory 'no-go' symptoms. 'Ataxia' is defined as abnormality of balance/stability, motor coordination or dysfunctional speech caused by a neurological issue. In other words, if a player is diagnosed with 'ataxia' by any club or neutral physician involved in the application of the Concussion Protocol, he will be prohibited from returning to the game, and will receive the follow-up care required by the Protocol.
NFL and NFLPA
Why is the protocol changing?
After the Dolphins' 21-19 win over the Bills, Miami head coach Mike McDaniel said that Tagovailoa suffered a lower-back injury, which was exacerbated by the hit from Milano, and that was the cause of Tagovailoa's stumble.
An investigation has since been conducted, which concluded that "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 team physician and unaffiliated neurotrauma consultant (UNC) that investigated Tagovailoa's injury were found to have not conducted a full analysis of the Miami QBs back during the examination, and simply relied on an earlier exam undertaken by other members of the medical team.
The UNC has since been terminated, citing a failure to understand their role as a UNC and also observing hostility from the UNC over the course of the investigation, as factors that contributed to his dismissal.
It is widely suspected that, despite the investigation reports, Tua was in fact suffering from Ataxia which would mean the severity of his concussion was massively underestimated.
The following week, Tua suffered a concussion against the Bengals on Sept. 29th, in which he exhibited a fencing response, just four days after the Bills injury. This concussion left Tua on the floor for over 7 minutes before he was removed from the field and sent to hospital, from which he has since been cleared.
Although Tagovailoa remains in concussion protocol, and did not participate in Week 5's game against the New York Jets, the league's handling of his situation sparked a conversation about what the NFL needs to do to avoid this happening again. Ataxia's addition to the symptom list is the current solution, though it's clear there's still more work to do.
What is Ataxia?
Per the Mayo Clinic, Ataxia is defined as:
Poor muscle control that causes clumsy voluntary movements. It may cause difficulty with walking and balance, hand coordination, speech and swallowing, and eye movements.
For reference, this is the stumble that occurred in the Miami-Bills matchup that has since been called into question - many suspect this was concussion-induced Ataxia.
Yea Miami might be in trouble…..you can see Tua’s head slam into the ground last week, see him shaking his head, then stumble multiple times, and almost fall….and he has a seizure tonight…..not good Dolphins pic.twitter.com/hQEZirgCM6— WHO IS SWAC IF I AIN'T SWAC!!??? (@RobIsRandomAF_6) September 30, 2022
What are the symptoms of Ataxia?
The National Ataxia Foundation states that the symptoms are eerily similar to being drunk. Someone experiencing Ataxia may have problems using their extremities, and could have difficulty talking and/or moving their eyes.
These are the most common symptoms of ataxia:
Abnormalities in eye movements - Such as: involuntary back-and-forth movements (nystagmus)
Poor coordination, or lack thereof
Ataxia's use in the concussion protocol
The NFL and NFLPA have agreed that any player who demonstrates ataxia will be ruled out from play for the remainder of the game and placed immediately in concussion protocol.
Here’s the new NFL-NFLPA concussion game day checklist, which adds ataxia to loss of consciousness, confusion and amnesia as “no-go” symptoms for return to play, replacing gross motor instability.— Tom Pelissero (@TomPelissero) October 8, 2022
Full updated protocols: https://t.co/YZkOscGT1M pic.twitter.com/p31u3dnJR7
The protocol's new stipulation was already used in Sunday's matchup between the Dolphins and Jets, as Teddy Bridgewater was ruled out from competing after a heavy hit from Jets DB Sauce Gardner on Miami's first offensive play.
Bridgewater was not diagnosed with a concussion but the spotter stated that he was experiencing ataxia, and ruled him out for the rest of the game.
If anything, it's good to see the NFL introducing a ruling that will help protect players across the league. But, we are left questioning why such a key symptom of concussions was not already included in the protocol.