The joint NFL and NFL Players Association concussion protocol faces major questions Friday, a day after Miami Dolphins quarterback Tua Tagovailoa suffered a concussion and was briefly hospitalized during his team’s 27-minute loss to the Cincinnati Bengals. fifteen.

The injury occurred 5 minutes 15 seconds before the end of the second quarter at Peykor Stadium in Cincinnati. Tagovailoa’s head hit the ground as he was sacked by Bengals defenseman Josh Tupou. Tagovailoa’s arms tightened and her fingers clenched in what looked like a “fencing reaction”. Medical workers put him on a stretcher and took him to an ambulance.

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The timing of the concussion prompted a new investigation into a hit Tagovailoa landed four days earlier in Miami when Buffalo Bills linebacker Matt Milano pushed him to the ground after a pass. Tagovailoa grabbed his head and then stumbled off the ground. The Dolphins initially called it a head injury, but later attributed the trip to ankle and back injuries and allowed him to finish the game after he passed evaluation at halftime.

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The NFL and NFLPA are investigating the decision through a process that includes interviews with all medical professionals involved, as well as Tagovailoa himself.

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“We’re going to have all these interviews,” NFL Chief Medical Officer Dr. Allen Sills said in an interview with the NFL Network. “We will review all the videos, we will review all the data. And the purpose of this review is to make sure the concussion protocol was followed.”

Let’s take a closer look at the issues surrounding Tagovailoa’s condition, its next steps, and the implications of the NFL/NFLPA investigation, if any. –— Kevin Seifert

What happened at halftime after hitting a Bills game?

The fact that Tagovailoa stumbled after hitting his head on the ground was indicative of an unstable movement that, according to NFL concussion protocol, required him to be taken directly to the locker room for an examination. Dolphins coach Mike McDaniel said that Tagovailoa insisted that a back injury he suffered earlier in the game was to blame for the trip. The quarterback said Monday that he passed a concussion test at halftime on Sunday and was cleared to return to play.

McDaniel said on Monday that if “any red flag” had come up during the evaluation, Tagovailoa would not have played. He added that the team and an independent neurological consultant had gone above and beyond to the extent that Tagovailoa was “annoyed” by the number of questions he was being asked about a potential head injury. The Dolphins initially reported that he was unlikely to return due to a head injury, but later said it was ankle and back injuries. –Marcel Louis-Jacques

Why is someone with unstable gross motor skills allowed to return to the game?

After absorbing an initial hit in Week 3 against the Bills, Tagovailoa visibly stumbled after getting up and had to be stabilized by teammates. The NFL concussion protocol calls this type of trip “gross motor instability” and requires an assessment to determine the cause.

This section of the protocol concludes: “If the team doctor, after consulting with the sideline, [unaffiliated neurotrauma consultant]determines that the instability is due to neurological causes, the player is assigned the status “No” and cannot return to the game.

In Tagovailoa’s case, major motor instability was associated with a back injury rather than a concussion. Because it was not “neurologically induced” as determined by the team and independent doctors, he was allowed to play under the terms of the protocol. — Seifert

What was Tagovailoa’s week like when the team took the lead in Thursday night’s game?

On Friday, Sills said Tagovailoa was being tested for concussion symptoms every day this week, including Thursday. The Dolphins didn’t practice on Monday, which isn’t unusual after Sunday’s game. But they released an injury assessment report as if they were actually training, with Tagovailoa listed as “DNP” – not participating – due to back and ankle injuries. McDaniel said Tagovailoa was suffering from ankle and back pain and would not be contacted by Tagovailoa’s availability for Thursday’s game. Tagovailoa had limited viewing on Tuesday and Wednesday, and a league source told Sportzshala that he made “good progress” from Tuesday to Wednesday. The final decision on his readiness to play on Thursday was made only on Thursday morning. –— Louis Jacques

When Tagovailoa was sacked on Thursday, it was reported that he had taken up fencing. What’s this?

The swordsmanship response is an involuntary neurological response to a severe concussion in which the forearms briefly become rigid outward. This term comes from sports fencing (en garde), when one arm is bent and the other is extended. –– Stephanie Bell

What is the current situation with Tagovailoa and what has happened since he was taken off the field?

Tagovailoa was being treated at the University of Cincinnati Hospital and was discharged before the dolphins left the Cincinnati area for South Florida. Sources said that Tagovailoa underwent testing, which revealed no structural damage in the head or neck area. He was alert and felt in his limbs. He accompanied the dolphins on the team plane and was in good spirits upon arrival, wearing a neck brace as a precaution. Tagovailoa is expected to undergo an MRI and get a second opinion on his injuries. He is on concussion protocol, which includes a five-step process to get back on the field. — Jeremy Fowler

Tagovailoa is on concussion protocol, so what’s next?

Before returning to the field, Tagovailoa must go through a five-step process. Here’s what it looks like, paraphrasing part of the return-to-game protocol:

Phase 1: Rest and then limit or withhold physical and cognitive activities if they aggravate symptoms. Introducing limited stretching and balancing exercises and transitioning to light aerobic exercise.

Phase 2: Gradual transition to cardiovascular exercises, dynamic stretching and more balance work. Neurocognitive testing and balance testing can be done. If the results are interpreted as a return to baseline levels (pre-concussion), Phase 2 is satisfied.

Phase 3: Increase in sport-simulating cardio along with supervised strength training. The player can train with the team by doing specific sports exercises for 30 minutes or less.

Phase 4: The player can move on to non-contact football activities such as shooting, catching and running. Another round of neurocognitive testing and balance testing is done to confirm that the results remain at baseline.

Phase 5: The club doctor must allow the player to practice football, including contact. Then, an Independent Neurological Consultant (INC), assigned to the team under a joint agreement between the NFL and NFLPA, must agree with the team doctor that the concussion has been resolved. At this point, the player can participate in the next game of his team. — Seifert

What can we expect from the NFL/NFLPA investigation?

Under the minutes, the NFLPA requested a joint investigation into how the Dolphins handled Tagovailoa’s injury in a Bills game. The investigation began immediately. During a conference call three days later, NFL executive vice president Jeff Miller said that “every indication from our point of view” is evidence that the Dolphins followed protocol.

Miller estimated that a formal investigation would take one or two weeks.

Separately, NFLPA chief executive DeMaurice Smith said in a statement released Thursday night to Amazon that the union will pursue “all legal options” as the investigation continues. Generally speaking, under the terms of the collective agreement, disputes between the league and the union are resolved through private arbitration.

On Friday, NFLPA President JC Tretter released a statement saying, in part: “We are all outraged by what we have seen over the past few days and fear for the safety of one of our brothers.

“Until we have an objective and proven method for diagnosing traumatic brain injury, we must do everything possible, including amending protocols, to further reduce the possibility of human error. the well-being of our players.” — Seifert

Will the league review its concussion protocol?

This is a reasonable expectation, especially if the NFL/NFLPA investigation does not find protocol violations, as Miller pointed out. An obvious target for further discussion is whether a player with gross motor instability, for whatever reason, should be allowed to continue playing.

There is a recent precedent for making seasonal adjustments to the protocol. In 2017, Houston Texans quarterback Tom Savage was cleared to return to the game after he showed clear concussion symptoms after being hit, including fencing reactions and finger twitching. He was later diagnosed with a concussion and did not finish the game.

After an investigation found that there had been no breaches of protocol, the league and union made a number of improvements to existing rules to cover such cases. The additions required that a player be permanently removed from the game if they showed any signs of a shock seizure, and also required referees who witnessed symptoms to inform the team’s medical staff. In addition, the league has added an independent neurotrauma consultant to its New York City game day operations to help oversee the process. — Seifert

What can we expect from a Dolphins quarterback if Tagovailoa doesn’t play?

McDaniel said that in situations like this, you sign a veteran like Teddy Bridgewater, who has a 33-30 record in 63 games over the past seven seasons for the Minnesota Vikings, New Orleans Saints, Carolina Panthers and ” Denver Broncos. At this point in his career, Bridgewater is more like a game manager. His best moment on Thursday night was a 7-yard touchdown…