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The NFL’s concussion protocols have changed and the Tua Tagovailoa case is resolved, but no one seems happy with it

The Boston Globe 10/15/2022 Ben Volin
Dolphins quarterback Tua Tagovailoa received medical attention after taking a hit during a loss to the Bengals last month. © Andy Lyons Dolphins quarterback Tua Tagovailoa received medical attention after taking a hit during a loss to the Bengals last month.

The NFL and NFL Players Association released a joint statement last Saturday night that was supposed to resolve the Tua Tagovailoa concussion episode.

The Dolphins’ doctors were cleared of wrongdoing when they sent Tagovailoa back into the game after wobbling on Sept. 25. And the NFL and union agreed to amend the concussion protocols to close the loophole that was exposed by this case.

Except the resolution hasn’t left anyone feeling satisfied.

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The NFL, the union, teams, and players have gripes about how the situation has been handled. And the changes to the concussion protocols could wreak havoc on the season.

The NFLPA, despite releasing the joint statement, flat out disagrees with some of the league’s conclusions. The statement read that the concussion protocol’s “step-by-step process … was followed,” but NFLPA president JC Tretter said on Twitter, “We do not believe this was a meaningful application of the protocols. Nobody, including the NFL, believes [Tagovailoa] should have been put back in the game.”

The NFLPA also isn’t as willing as the NFL to clear Dolphins head physician John Uribe, an orthopedist. Per the protocols, the head team doctor has the sole authority to diagnose a concussion during a game. Uribe, with the help of the unaffiliated neurotrauma consultant and other Dolphins doctors, determined that the “wobble” exhibited by Tagovailoa was due to a back injury suffered earlier in the game, not a neurological issue. But per the joint statement, Uribe never examined Tagovailoa’s back when the injury occurred in the first quarter, and didn’t examine it after the wobble in the second quarter.

“It is problematic that he was cleared for a back injury for which the lead doctors never took time to examine,” Tretter said.

NFL chief medical officer Allen Sills said Uribe did nothing untoward or out of the ordinary. A member of the Dolphins’ medical team examined Tagovailoa’s back in the first quarter, and Tagovailoa was insistent after his stumble that it was because of his back injury.

“The physicians who participate in that concussion evaluation had the knowledge of the previous diagnosis and exam based on their medical colleagues,” Sills said. “And they used that information, along with the patient’s self-report of back injury, back symptoms, and the lack of objective neuro findings, and the normal exam and the lack of any symptoms, to reach that diagnosis.”

Meanwhile, the NFL is furious at the NFLPA for dismissing the unaffiliated neurotrauma consultant who was working with the Dolphins on Sept. 25.

“We never supported terminating,” NFL executive vice president Jeff Miller said. “I think this is the first time that we’ve had an unaffiliated trauma consultant terminated. It wasn’t by the NFL, so you would have to ask the Players Association their thinking behind that decision.”

The NFLPA dismissed the UNC on Oct. 1, two days after Tagovailoa suffered a concussion against the Bengals. The NFLPA believed the UNC failed to understand the protocols and his role, and demonstrated hostility and unprofessionalism toward the investigation.

UNCs are contract employees jointly appointed by the NFL and NFLPA. Each side has the right to dismiss one, but doing so is unprecedented. The NFL is upset that the NFLPA created the impression of medical wrongdoing before the NFL-NFLPA joint investigation had been completed.

“We pointed out jointly in a statement about a week ago that some of the reporting and that point was premature or erroneous around medical errors and the like,” Miller said. “So the decision to terminate a UNC in that set of circumstances isn’t something that we would have done, and didn’t … And the notion that one could be fired at a time when the protocol was followed strikes us as something that the NFL wouldn’t do.”

Not only are the NFL and union still fighting, but teams and players will also take issue with the new concussion protocols.

There is just one change in the protocols — the term “gross motor instability” was replaced by “ataxia.” Under the old protocol, the team doctor could determine that Tagovailoa’s stumble, or gross motor instability, was because of a back injury, not a brain injury. With the new protocols, all subjectivity has been removed. If there is a stumble, it is considered ataxia, and the player is done for the day.

“This new protocol would have ruled him out,” Sills said of Tagovailoa. “We’ve simply said ataxia, as recognized by video, is now going to be automatically assumed to come from the brain and to signify that a brain injury is present.”

Certainly that’s a step in the right direction toward protecting the players and their long-term health. But in the short term, those rules are going to cause havoc, with players more easily pulled from games.

Last week’s Dolphins-Jets game was the first example. Dolphins quarterback Teddy Bridgewater suffered a hit on his first snap, and one of the concussion spotters thought he saw Bridgewater stumble, so he pulled him from the game.

Bridgewater passed every sideline test, and doctors found no video evidence of a stumble. But the belief by one person that he maybe saw a stumble was enough to get Bridgewater removed from the game and placed in the concussion protocol all week.

“Teddy, he had no symptoms today. He had no symptoms yesterday,” Dolphins coach Mike McDaniel said Monday. “But per the rule change, he is being treated as though he has a concussion. So he is in the subsequent protocol.”

The Dolphins had to play rookie seventh-round pick Skylar Thompson at quarterback for almost the entire game and lost, 40-17, to drop to 3-2. With Bridgewater having to progress through the protocol — no practice on Wednesday, and limited work on Thursday and Friday — the Dolphins determined Thompson will start against the Vikings on Sunday. Bridgewater cleared the concussion protocol Saturday, and he’ll start the game as the backup.

Sills said the new protocol is intended to be conservative. It will help protect players but could ruin games if key players are pulled.

“We may mislabel some situations,” Sills said. “Someone who does have an ankle or a knee injury may stumble or fall, and that may be identified as ataxia and ruled out as a concussion.

“I think what we’ve agreed, together with the union, is we want to become even more conservative … Because if we’re going to be wrong, we’d rather hold someone out who doesn’t have a brain injury, but we’re being cautious.”

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As Hurts soars, so do Eagles

The Eagles are back on top, just two years after going 4-11-1 and hitting rock bottom with Carson Wentz. They are 5-0 for the first time since 2004, and the last undefeated team entering Sunday night’s showdown against the Cowboys.

Eagles general manager Howie Roseman deserves credit for rebuilding the team on the fly — bringing in coach Nick Sirianni, turning the team over to third-year quarterback Jalen Hurts, and giving him a pair of dynamic weapons in A.J. Brown and DeVonta Smith.

“The idea of alignment in an organization is critical,” said former Cowboys coach Jason Garrett, now with NBC. “I don’t think there’s any disconnect in Philadelphia. To me, the personnel people and the coaching staff, they’re aligned. They’re on the same page. That’s one of the most impressive things to me about this team. There seems to be a harmony throughout the organization. They’re a complete team.”

Sirianni designed a scheme that takes advantage of Hurts’s skill set. And Roseman gave Sirianni the receivers to make it thrive — Smith and Brown, plus tight end Dallas Goedert, who can beat one-on-one coverage all day.

“The style of play that Philadelphia has on offense, it really limits you on defense,” NBC’s Tony Dungy said. “Because of their [run-pass option] game, you can’t play a lot of zone coverage. You have to play man-to-man because of their ability to run and [Hurts’s] ability to be a runner.

“So he’s seen a lot of straight, man-to-man, one-on-one, and he’s got receivers that can beat that, and he is making the throws. I just think the combination of his development and their offense, he’s going to put up some lights-out numbers.”

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The result is a remarkable, Josh Allen-like improvement for Hurts. He completed just 52 percent of his passes in four starts as a rookie, improved to 61.3 percent last year, and has shot up to 67.9 percent this year. Hurts has always been dynamic as a rusher — he has 266 yards and six touchdowns on the ground this year — but now he has matured into a top-10 passer in most categories.

“There’s no question, that’s the right word. He has matured greatly as a passer,” Garrett said. “You see him standing in and making throws and processing what the defense is doing and going from guy to guy to guy and throwing the ball on time. He’s such a dangerous player because he’s showing everybody that he can do both.”


Raiders’ reboot off to rough start

Raiders coach Josh McDaniels and quarterback Derek Carr have stressed patience this season, telling fans that it’s the beginning of a new program, and “we have to learn how to win.”

But it’s a message that isn’t quite resonating. Why do they need to learn how to win when the Raiders went 10-7 and made the playoffs last year under challenging circumstances — coach Jon Gruden was abruptly fired midseason, and wide receiver Henry Ruggs was jailed for felony DUI causing death?

Fans and players didn’t believe they needed a full reboot under McDaniels and new GM Dave Ziegler. The Raiders are 1-4 and have a bye this week.

“It’s hard. I’ve been around a lot of new regimes,” Carr said. “I think the frustrating part is it takes time to get everyone on the same page … We’re right there, but close doesn’t count in this game. It is frustrating. I’m human. Going through that again, seeing where we were, and we got a new regime and all this kind of stuff.”

But any blame and frustration should be cast not at McDaniels and Ziegler, but owner Mark Davis. He made the decision to start over and bring in McDaniels and his new offense. It’s Davis’s fault, not McDaniels’s, that the transition is taking time.

McDaniels and Ziegler haven’t blown up last year’s team, either. They gave contract extensions to team leaders Carr, Darren Waller, and Maxx Crosby, and kept Carr happy by trading for Davante Adams.

“I believe in Josh. I believe in our staff. I believe in our players,” Carr said. “It sucks what our record is. We’ve earned that. But I reinforce that we have a good team, we’re doing the right things.”

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New city, same story for Wentz

Carson Wentz seems like a nice enough guy. Always gives the team-first answer. Never takes shots at opponents or teammates. But Wentz has an incredible ability to frustrate his bosses and get them to lower their guard and rip him in public.

This past offseason, Colts owner Jim Irsay called out Wentz publicly multiple times, even calling him a “mistake.” Then last Monday, Commanders coach Ron Rivera was asked why his team was 1-4 and the rest of the NFC East was 4-1 or better. “Quarterback,” he responded.

Rivera apologized to Wentz the next day, but there’s obvious frustration with Wentz in Washington, just as there was in Indianapolis and Philadelphia.

If the 2-4 Commanders lose a few upcoming games, don’t be surprised if Wentz comes down with a mysterious injury. The Commanders owe the Colts a third-round pick for Wentz, and it becomes a second-round pick if he plays in 70 percent of snaps this year.

Snyder not taking the high road

Amazon announcer Al Michaels was correct Thursday night when he said that the preferred outcome for the NFL, and for millions of fans, is for Commanders owner Dan Snyder to sell his team and walk away without a fight.

But that’s not in Snyder’s nature, and the notoriously litigious owner is going to scratch and claw and fight dirty to keep his team. An extensive piece from ESPN on Thursday detailed how Snyder has hired private investigators to dig up dirt on commissioner Roger Goodell and fellow owners to use as leverage. And Snyder’s lawyers recently sent a scathing nine-page letter to the House Oversight Committee regarding its investigation into the culture of sexual harassment within Snyder’s team, calling it a “politically inspired hatchet job.”

Snyder and former team president Bruce Allen, whom Snyder is trying to blame as the man solely responsible for all of the horrible things that happened with the team, recently testified in front of the committee. It seems Snyder realizes the investigation isn’t going his way, and/or that his testimony is going to be released soon.

“From the beginning, the Committee set out with a singular purpose — to destroy Dan Snyder and his family and attempt, with deception, innuendo, and half-truths, to drive him from the National Football League,” Snyder’s attorneys wrote. “This investigation reeks of the lowest form of politics and its only purpose is personal destruction.”

So in case you were wondering — no, Snyder hasn’t changed a bit.

Extra points

The AFC Championship game preview will take place Sunday when the 4-1 Bills visit the 4-1 Chiefs. The Chiefs have the NFL’s No. 1 scoring offense (31.8 points per game) and Patrick Mahomes leads the league with 15 touchdown passes. The Bills are No. 2 in scoring (30.4 points per game), Josh Allen is second with 14 touchdown passes. Mahomes is 3-1 vs. Allen, including playoff victories in each of the last two seasons … When Dolphins players decided to remove the Ping-Pong table from their locker room this past week, coach Mike McDaniel cited their “leadership” and taking a “step forward” with their preparation. But on Thursday, Tyreek Hill said the old table was bent, that he was getting a new custom table built, and that the player Ping-Pong tournament was still on … Quite a stat line from Travis Kelce on Monday against the Raiders: Seven catches for 25 yards and four touchdowns. Prior to Kelce, the fewest receiving yards by a player with four touchdown catches was 93 yards by Marvin Jones in 2019 … David Andrews gave a poignant description to the Detroit Free Press of what it’s like to play for Bill Belichick: “I’ve always found here, being a Patriot my whole life, is it’s never good enough. I’ve won Super Bowls here, and the first meeting back that spring we’re sitting there watching film getting chewed out and getting corrected on a game that happened in February and it’s the middle of April, you know? So it’s never good enough. You have to learn, you have to always be working to improve.”

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