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NFL, Players Union Conform to Change Concussion Protocol

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The N.F.L. and its players’ union said Saturday that doctors followed the concussion protocol in treating Miami Dolphins quarterback Tua Tagovailoa after he hit his head in a Sept. 25 game, but that the protocol will likely be modified because Tagovailoa’s return to the sphere was not what was intended by the principles covering the evaluation of brain injuries.

Within the second quarter of a game against the Buffalo Bills, Tagovailoa hit the back of his head against the turf after a late hit by a defender, then he grabbed his helmet, struggled to stand up and fell again. He returned to the sport within the second half. The players’ union — the N.F.L. Players Association — initiated a joint investigation with the league into how the episode was handled by the Dolphins team medical staff and an unaffiliated neurotrauma consultant on the sideline.

That review showed that the protocol was followed and that Tagovailoa didn’t display concussion-like symptoms during a locker room evaluation or in the times after. As an alternative, he said that he aggravated a back injury, which led him to stumble and fall. The scene of Tagovailoa wobbling as teammates held him up after the hit led many individuals to assume that he had sustained a concussion. The team physician and the consultant didn’t examine Tagovailoa’s back before concluding that the back injury caused his instability and sending him back into the sport, the review showed.

Tagovailoa also played 4 days later against the Cincinnati Bengals and again hit his head when he was slammed to the sphere after a tackle. He was taken to the hospital and released that night. Tagovailoa is now within the concussion protocol, which requires concussed players to finish a five-phase recovery process before they could be cleared to play. Tagovailoa has been ruled out for Sunday’s game against the Jets.

The amended protocol, which can take effect during Sunday’s games, will prohibit a player from returning to play if he shows ataxia, a term describing impaired balance or coordination attributable to damage to the brain or nerves. Under the previous protocol, which was utilized in Tagovailoa’s case, a player with “gross motor instability” — difficulty getting up or walking, for instance — could return to play if doctors decided there was an orthopedic reason for his unsteadiness.

Allen Sills, the N.F.L.’s chief medical officer, didn’t definitively say that Tagovailoa didn’t suffer a concussion within the Bills game — only that the review showed the doctors took appropriate steps and made a medical judgment based on the knowledge that they had on the time. Under the brand new rules, Sills said, Tagovailoa would have been ruled out and never allowed to return to that game.

“We wish to grow to be much more conservative, and if we predict that ataxia is present, let’s just go ahead and assume it’s coming from the brain and we’ll hold someone out,” Sills said. “Because if we’re going to be fallacious, we might moderately hold someone out who doesn’t have a brain injury but we’re being cautious, than to place someone out who may need a brain injury and we weren’t in a position to diagnose it.”

If ataxia is observed throughout the game, the player will routinely be diagnosed with a concussion, as is the case with symptoms like lack of consciousness or an impact seizure. The player then will likely be required to follow the five-step return-to-play process.

The players’ union took the unprecedented step of dismissing the unaffiliated neurotrauma consultant involved in Tagovailoa’s care throughout the Bills game, a call the N.F.L. said it didn’t support. The doctor’s name was not released. In keeping with the concussion protocol, while the consultant collaborates within the evaluation of the player, the responsibility for the diagnosis of a concussion and the choice to return a player to the sport “stays exclusively” with the judgment of either the pinnacle team physician or the team doctor designated to handle concussion care.

The Dolphins’ head team physician, John Uribe, is a board-certified orthopedic surgeon and, in keeping with his profile on the N.F.L. Physicians Society website, received a certificate of added qualification in sports medicine in 2007. He’s affiliated with the Baptist Health Medical Group in southern Florida and can be a team physician for the N.H.L.’s Florida Panthers.

The Dolphins didn’t reply to a message searching for comment on the outcomes of the joint review and asking if Uribe, who accompanied Tagovailoa to the locker room throughout the Bills game, was the team doctor who cleared him to return.

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