NFL, NFLPA finalize review of updated concussion protocol in wake of Tagovailoa injury

The National Football League and the NFL Players Association have issued a joint statement finalizing review of the league’s concussion protocol, which now prohibits a player from returning to a game if diagnosed with ataxia.

According to the Oct. 8 statement, the term “ataxia” — defined in the updated protocol as abnormality of balance/stability, motor coordination or dysfunctional speech caused by a neurological issue — has been added to the mandatory "no-go" symptoms. 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, the statement said.

The NFL Concussion Diagnosis and Management Protocol, which was created in 2013 by the NFL Head, Neck and Spine Committee, defines a sport-related concussion as a traumatic brain injury induced by biomechanical forces, which may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.

Recent review of the protocol was triggered by an injury to Miami Dolphins quarterback Tua Tagovailoa during a Sept. 25 game, in which he was tackled, fell on his back and hit his head on the ground. Tagovailoa then grabbed his helmet and shook his head before taking several steps, stumbling and falling.

He was briefly taken out of the game, where he was examined by the club medical team and the unaffiliated neurotrauma consultant (UNC), who also reviewed video of the play. The team physician cleared Tagovailoa after consulting with the UNC, and Tagovailoa returned to play in the second half.

According to the statement, Tagovailoa suffered and reported back and ankle injuries and told the medical team that he stumbled because of an aggravation to a back injury. He did not report or exhibit signs of concussion during the exam, during the remainder of the game or in the following week. Although the team physician and UNC did not evaluate Tagovailoa’s back during the exam, the medical staff determined that the gross motor instability observed was due to a back injury and was not neurologically caused.

An investigation initiated by the NFLPA — which included a review of reports, videos and interviews with team staff, the UNC and Tagovailoa — determined that although medical personnel followed the existing concussion protocol, “the outcome in this case is not what was intended when the protocols were drafted.”

“The protocol exists to establish a high standard of concussion care for each player whereby every medical professional engages in a meaningful and rigorous examination of the player-patient,” the joint statement read. “To that end, the parties remain committed to continuing to evaluate our protocol to ensure it reflects the intended conservative approach to evaluating players-patients for potential head injuries.”

Reference:

• NFL Concussion Diagnosis and Management Protocol. https://static.www.nfl.com/image/upload/v1665264248/league/moexjmdzy2kvjtqsdpbx.pdf. Accessed Oct. 10, 2022.