Time for a Change in NFL Concussion Protocol

October 21, 2022

Another high profile injury catapulted the National Football League’s concussion protocol back into the limelight recently. Let’s look at how we got here, what occurred and where we can expect this to go moving forward. Our prediction: the changes will have an immediate impact. Could these recent atrocious roughing the passer calls be in direct response to an elevated concern for head trauma? Let’s dive into it all.

The History of Concussions

The NFL neglected to recognize head trauma and the short and long term effects it had on its players for years. This ultimately led to lawsuits, movies about the issue and thousands of disgruntled former players. In 2013, the NFL reached a $765 million settlement over concussion-related brain injuries among its 18,000 retired players. They agreed to compensate victims, pay for medical exams and underwrite research. The initial settlement capped individual awards to $5 million for men with Alzheimer’s disease; $4 million for players diagnosed with chronic traumatic encephalopathy (CTE) following their death; and $3 million for players with dementia.

In response to the suit, the NFL and NFLPA formalized the Concussion Evaluation and Management Protocol in 2013. Since that time, the parties’ medical experts have recommended and the parties have agreed to numerous modifications of the protocols to improve the health and safety of players. Some of these include the creation of the ATC spotter program, Booth UNCs, Emergency Action Plans, mandatory post-game reports and improved video surveillance. Instead of creating a “check the box process,” they designed a Protocol to ensure that highly credentialed and experienced physicians – approved and paid for by the NFL and NFLPA – are available on game day and to create a standardized approach to concussion evaluation where competitive decisions never usurp quality care. 

What is Concussion Protocol in the NFL?

The current concussion protocol removes players immediately from a game for evaluation if he reports symptoms, or if a trainer, coach, teammate or someone tasked to observe the game suspects a concussion. How often do players report they have a concussion? Rarely (if ever) hence why we always see a staff member grab the player for an evaluation.

The player then must undergo quick exams, such as repeating words in a memory test, showing coordinated eye movement and demonstrating balance. Those diagnosed with a concussion must undergo a five-step process before returning to play, including being able to complete football-related activities without any symptoms — a hurdle that some players complete within a week, but that has ended others’ careers. Additionally, a team doctor and independent physician must clear the player for play. Most fans do not realize the league and NFL mutually agree on this independent physician, meaning they do not work for either party, but rather act in accordance with their medical license.

However, certain loopholes within the protocol allow a physician to medically clear a player even when the player exhibits symptoms. For example, doctors can send the player back into the game if he concludes that signs of an apparent concussion — like a player stumbling to stand after a blow to the head — are caused by something besides a head injury.

What Happened to Tua?

Miami Dolphins quarterback Tua Tagovailoa appeared to suffer head trauma a few weeks ago while playing the Buffalo Bills in a Sunday afternoon game. Video evidence showed the franchise quarterback stumbling after the hit as if he was in a daze. He briefly left the field in the second quarter to go into the locker room and the Dolphins reported he was questionable to return. Tua returned at the start of the third quarter and led his team to a win. Tua and the Dolphins attributed his stumble to a lingering back issue following the contest. As noted above, this is a carved out exception to the protocol.

Four days later, Tua started the game against the Cincinnati Bengals on a Thursday night showdown with Joe Burrow. He endured a scary hit early where his head hit the turf and he remained on the ground holding his arms and fingers splayed in front of his face. Experts said it evoked conditions known as “decorticate posturing” or “fencing response,” where brain damage triggers the involuntary reaction. Experts further explained that what occurred to Tua was potentially life threatening.

How did the NFL & NFLPA Respond?

Either the NFLPA or the NFL can request an investigation into the actions of the medical staff if they have a concern over compliance with the Protocol. However, the Collective Bargaining Agreement limits the scope of the parties’ review to an objective assessment of whether the medical staff followed each step required by the protocol. The NFLPA ultimately initiated such an investigation in connection with the incident involving the young signal caller.

While the investigation determined the team medical staff and unaffiliated medical professionals followed the steps of the Protocol as written, they both agreed the Protocol did not intend for an outcome of this nature to occur. Oddly enough, the NFL-NFLPA fired the medical professional who ultimately cleared Tua for play during the Bills game. Perhaps a scapegoat?

What Can We Expect Moving Forward?

The NFL-NFLPA jointly announced they will modify the Protocol to enhance the safety of the players. Specifically, they added the term “ataxia” 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.

We predict this change will have an immediate impact in protecting players. More players have been diagnosed with concussions and ruled out from their respective games at a rate higher than ever in recent memory. Many fans have complained of the recent roughing the passer penalties, but could these penalties be rising as a topic of concern in relation to head trauma? We believe they are, especially when you consider the public relations issues the NFL is currently dealing with.

Tua’s situation is scary and it certainly has happened way too many times over the last few decades throughout the sport. However, to both the NFL and NFLPA’s credit, they made adjustments on the fly in attempts to address the concern. What are your thoughts on whether the policy will more adequately protect the players?


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