Tua Tagovailoa is expected to return to the NFL this weekend after recovering from his latest concussion.
Six weeks ago, the Miami Dolphins quarterback suffered his third concussion in less than two years – and fourth overall, including his college career.
Many pundits and former players have called for the 26-year-old Hawaiian player to retire. Some even said the NFL should take the decision away from him.
BBC Sport examines why Tagovailoa chose to continue playing and Dr. Allen Sills, the NFL’s chief medical officer, explains the league’s position.
Will Tagovailoa return to play against the Cardinals?
After last month’s concussion, Tagovailoa was immediately placed on Miami’s injured reserve (IR) list, meaning he must miss at least four games.
In doing so, he returned to practice Wednesday and completed the final step in the NFL’s concussion protocol – a session involving contact – so he could play in Sunday’s home game against the NFL Cardinals. Arizona (5:00 p.m. GMT).
While away, Tagovailoa consulted with medical experts across the United States. He said that after two concussions in 2022, he considered retiring following discussions with his wife and family.
On Monday, he told reporters that this time “no (medical) advice had affected anything I thought in terms of coming back” and that he “had a few conversations with my wife but that was it “.
What is the NFL’s concussion protocol?
The concussion protocol is a way to evaluate players after they appear to have concussion symptoms.
This is a series of neurological checks, carried out by a team doctor and an independent neurological consultant.
During a match, it is called a “match day checklist” and players must complete each step to return to the field.
Outside of games, players must follow a five-step “return to participation protocol,” which Tagovailoa followed this week.
How many concussions are too many?
Tagovailoa has already suffered four concussions and previous studies suggest three can have a lasting impact. However, there is no definitive data.
Writing for the NFL website in 2015, one neuropsychologist said experts “just don’t know” how many concussions are too many, and that remains the case.
“No one has an absolute answer,” says Dr. Sills. “It depends not only on the number of concussions, but also on their severity, the time between these injuries, the age of the athlete and their general condition.”
Will the NFL make players retire?
The NFL and players’ union (NFLPA) manage concussion protocol to ensure players have fully recovered before returning to action.
They also ensure they have access to the best care and advice, but, as with potentially setting a concussion limit, predicting the risk of future injury is problematic.
“Again, we are really handicapped by the limitations of medicine,” says Dr. Sills. “We give patients our best estimate, but that’s what it is: an estimate.
“The final decision rests with the patient, their family and their advisors, based on their understanding of the risk and their risk tolerance.
“It’s something that different players respond to differently, particularly at different stages of their career.”
This approach reflects general medical practice, and the right of players to continue their careers is something the NFL and NFLPA are “deeply committed to.”
“It’s a very personal decision,” adds Dr. Sills. “We try to give patients all the relevant facts and information, and then we have to respect the decision they make.
“It’s patient autonomy and I think that’s what each of us would want if we were the patient.”
Will Tagovailoa wear a goalkeeper cap?
The NFL first recognized in 2016 that football-related head injuries can lead to chronic traumatic encephalopathy (CTE).
Several high-profile cases have raised awareness in British sport and during the last round of matches in London, the NFL called a meeting with the likes of the Football Association and the Rugby Football Union to share data and research which helped to improve the health of players. and security.
This season, the NFL changed its kickoff rules and, for the first time, players are allowed to wear Guardian Caps – soft, padded covers that fit over a player’s helmet and reduce force head collisions.
Their use has been mandatory during pre-season training since 2022 and this year the number of concussions decreased by 31%, from 26 to 18.
None of the nine players wearing them so far during games are quarterbacks and Tagovailoa said he would not wear one, because of a “personal choice.”
The NFL tests helmets annually, with position-specific models now available, because head impacts are different for players in different positions.
Tagovailoa, who signed a four-year contract worth $212 million (£161 million) in July, wears the helmet specific to the top-ranked quarterback and told reporters on Monday that he was “ready to play with all the odds”.
He added: “How much risk do we take when we get up in the morning and drive to work? There’s just risk in anything and everything.
“I love this game and I will love it until I die. That’s it.”
