Miami Dolphins coach Mike McDaniel called it the “best news” that could have come out of quarterback Tua Tagovailoa’s frightening injury in Thursday night’s 27-15 loss to the Cincinnati Bengals: The former Alabama All-American was diagnosed with a concussion, but a hospital evaluation indicated that was his only serious injury.
Tagovailoa was able to accompany his teammates on their return to Miami, where he was to undergo further examination.
The injury placed Tagovailoa in the NFL’s concussion protocol for the second time in four days, but this stay will be longer than the one on Sunday.
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In Sunday’s 21-19 victory over the Buffalo Bills, Tagovailoa went to the locker room with two minutes left in the first half after seeming unsteady getting to his feet after the back of his helmet banged off the turf on a roughing-the-passer hit. But he played in the second half after passing through the NFL Game Day Concussion Diagnosis and Management Protocol.
That indicated that an unaffiliated neurotrauma consultant had determined the symptom that had flagged him as a concussion candidate – gross motor instability -- was not related to brain trauma. In Tagovailoa’s case, he said that his unsteadiness came from the late hit aggravating a back injury sustained earlier in the game.
The NFL Players Association has started an investigation of the process that cleared Tagovailoa on Sunday to determine if the procedure was followed correctly. A player taken off the field to be evaluated for a concussion must clear a six-step checklist to return to the game.
On Thursday night, Tagovailoa left the field on a stretcher after exhibiting the first of the “no-go” criteria in the game-day protocol – manifesting the “fencing posture” with his arms ad hands upon being slammed to the ground during a sack by Cincinnati defensive tackle Josh Tupou.
Tagovailoa did not return to the game this time. He went to University of Cincinnati Medical Center.
What has to happen now for Tagovailoa to play again?
The quarterback will have to clear the return-to-participation protocol – a five-step process.
The return process begins with symptom-limited activity. This is mainly a rest period, although limited stretching, balance activities and light aerobic activity are allowed. If a player does not experience an increase in his symptoms or show signs of a concussion on neurological examination, he can proceed to the next phase. That requirement holds step-by-step throughout the return process.
The second step is aerobic exercise, a graduated exercise program of stationary-bicycle or treadmill work, stretching and balance training. The player also can return to team meetings at this stage.
Upon demonstrating that he can participate in cardiovascular exercise without an increase in symptoms, the player goes to the third step, which is football-specific exercise.
Now the player can engage in strength training and practice with the team in “sport-specific exercise” for no more than 30 minutes.
A player at this stage of return also will undergo neurocognitive testing. If that test shows he has not returned to his baseline readings, as interpreted by a neuropsychology consultant, the tests will be repeat until he does, typically every 48 hours. A player cannot return to contact activities until clearing the neurocognitive tests.
The fourth step in the return process is termed club-based, non-contact training drills. Those drills are position-specific. In Tagovailoa’s case, that would mean throwing the football. The player then could progress to participate in non-contact portions of his team’s practice.
The final step in the return to game action is the ability of the player to engage in full football activity. If the player can do that without setbacks, then the club physician can clear him to return. But first, the player must be examined by the independent neurological consultant assigned to the team to get the final OK.
The Dolphins’ next game is on Oct. 9, when Miami visits the New York Jets.
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Mark Inabinett is a sports reporter for Alabama Media Group. Follow him on Twitter at @AMarkG1.
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