In a football game on September 25, Miami Dolphins quarterback Tua Tagovailoa got the pass but was knocked down. Fans saw him shake his head and trip on the ground as he tried to run away. After a physical, he returned to the game against the Buffalo Bills with what his coach later said was a back injury.
Four days later, in a game against the Cincinnati Bengals, the 24-year-old Tagovailoa took another hit. This time, he left the field on a stretcher with what was later diagnosed as a concussion.
Many observers suspect that the first blow, given Tagovailoa’s subsequent head sway and stagger, left the athlete with a concussion, also called a mild traumatic brain injury. If those were really signs of a head injury, that first hit could have lined him up with an even worse brain injury just days later.
“Science tells us that yes, a person who is still recovering from a concussion is at elevated risk for another concussion,” says Kristen Dams-O’Connor, a neuropsychologist and director of the Center for Brain Injury Research at the Icahn School. of Medicine at Mount Sinai in New York City. As an example, one concussion nearly doubled the chance of a second among young Swedish men, researchers reported in 2013 in the British medical journal.
“I think this was preventable,” Dams-O’Connor says of Tagovailoa’s brain injury in the game against the Bengals.
After a blow to the head, when the soft brain hits the unyielding skull, the injury triggers a cascade of changes. Some nerve cells become hyperactive, inflammation occurs, and blood flow is impaired. These later events in the brain, and how they relate to concussion symptoms, can occur over hours and days, and aren’t easy to measure quickly, says Dams-O’Connor.
That makes diagnosing a concussion tricky. Doctors often have to rely on patients saying they feel unwell or confused. Professional athletes may not be eager to share those symptoms if it means they’ll be sidelined. “These are elite athletes who are conditioned to endure,” says Dams-O’Connor.
Other signs may indicate a concussion, such as a person’s gait or dilated pupils. “As clinicians, we are often triangulating multiple sources of information to make that call: Was it a concussion or not?” Dams-O’Connor says. The scientific uncertainty in that call should lead doctors to err on the side of caution, she says.
After a traumatic brain injury, recovery is crucial. “It’s much worse when a person isn’t given adequate time to rest and recover and gets a second shock in a short period of time,” says Daniel Daneshvar, a brain injury physician and neuroscientist at Mass General Brigham in Boston and Harvard. Medicine School. By looking at the brains of mice after two knocks together, the researchers have seen signs of worse damage and longer recovery (Serial Number: 5/2/16).
For athletes, that vulnerability stems in part from the concussion symptoms themselves. Slow reaction times, dizziness and double vision confuse a fast-moving quarterback who needs to dodge tackles and see opponents coming from the side. These symptoms can lead to more injuries to the head and the rest of the body. a concussion increases the risks of lower-extremity injuries, according to a recent analysis of National Football League players published in August in Arthroscopy, Sports Medicine and Rehabilitation.
Also, a healing brain is more susceptible to shock. While the brain is still recovering in the weeks after an injury, “your threshold for concussion is lower,” says Daneshvar. A lighter hit, the researchers suspect, can cause more damage. A rare condition called second impact syndrome illustrates an extreme result of successive brain injuries. This catastrophic, often fatal brain swelling occurs when a brain that is still healing is hit again.
That is not what happened to Tagovailoa. But two concussions close together can delay recovery, Dams-O’Connor emphasizes. “I think people minimize what can be life changing.”
In a statement, the NFL and the NFL Players Association announced that they are jointly investigating whether their concussion protocols were followed in this case. Tagovailoa could have returned to that first game because his stumble was attributed, correctly or not, to a back injury, not a brain injury. The NFL and NFLPA are considering changing the protocol for keeping a player out of a game for any obvious motor instability, regardless of cause.
For now, Tagovailoa is moving through the recovery stages outlined in the concussion protocol. In a social media post on September 30, Tagovailoa thanked his team, friends and family and everyone who has reached out in support. “Feeling much better and focused on recovering so I can get back on the field with my teammates,” she wrote.