Will Miami Dolphins quarterback Tua Tagovailoa return to the field when he’s eligible on Oct. 27?
Miami coach Mike McDaniel said he hasn’t kept tabs on the quarterback’s progress two games into what, by NFL rule, must be a four-game stay on injured reserve. And the NFL’s chief medical officer said the league won’t have a hand in when – or if – Tagovailoa returns, other than seeing that its concussion protocol is enforced.
Dr. Allen Sills also said the NFL can’t provide the former Alabama All-American or any player with a way to predict with certainty if his concussion history forecasts more for his future or how his concussions might affect his cognitive abilities later in life.
“It’s not like we can put in your number of concussions and how long between them and your age and some unusual constant or Avogadro’s number that always seemed to be in freshman chemistry somehow, and come up with a risk,” Sills said while speaking to reporters on Friday. “It just doesn’t work that way, so what we end up having to do is look at the totality of the patient’s experience -- how many concussions, the interval between those concussions, duration of symptoms after each concussion, and then very much the patient’s voice about where they are in their journey, their career, their age and things of that nature. And from that, we try as medical professionals to provide our best guess. But that’s really what it is is a guess at what is someone’s future risk of concussion.”
Tagovailoa left the Dolphins’ 31-10 loss to the Buffalo Bills on Sept. 12 with a concussion. The quarterback’s injury caused heightened concern because he had sustained two concussions during the 2022 season that caused him to miss five games.
Miami placed Tagovailoa on injured reserve on Sept. 17, forcing the quarterback to the sideline for at least four games. The earliest that Tagovailoa could play again would be Oct. 27 against the Arizona Cardinals.
When asked on Tuesday if Tagovailoa was progressing toward a return on that date, McDaniel said he didn’t know.
“Where Tua is at in his protocol, I think it’s important for me that we did right by him from a health perspective and for the organization from a health perspective,” McDaniel said. “So before the bye week I hadn’t planned on checking on that process at all, considering he’s on IR. But he’s doing well and very active, so we’ll know more after the bye week.”
McDaniel has been adamant that a timeline not be attached to Tagovailoa’s recovery to avoid placing unnecessary stress and anxiety on the injured player.
The Dolphins play the New England Patriots on Sunday before having an open date for Week 6 of the NFL’s 2024 season. Miami plays the Indianapolis Colts on Oct. 20 before facing the Cardinals.
To return, Tagovailoa will have to complete the NFL’s concussion protocol, which includes being cleared by the team doctor and an independent neurologist.
The return-to-participation protocol is 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 repeated 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.
Sills said the NFL would have no role beyond that in Tagovailoa’s process.
“Patient autonomy and medical decision-making really matters,” Sills said. “And I think that’s what we have to recognize goes on with our concussion protocol as well. Ultimately when patients make decisions about considering their careers, it has to reflect that autonomy that’s generated from discussions with medical experts giving them the best medical advice.”
A neurosurgeon, Sills said Tagovailoa had consulted “top experts” about his concussion situation.
The quarterback has been in the bench area with his teammates for both games since he got hurt.
Sills met with reporters on Friday to discuss a release from the NFL about preseason injuries, which featured the fewest concussions ever recorded for that period.
