In a football game on September 25, Miami Dolphins quarterback Tua Tagovailoa caught the pass but was dropped. Fans watched him shake his head and stumble to the ground as he tried to shake it off. After a medical, 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, Tagovailoa, 24, was hit again. This time, he left the field on a stretcher with what was later diagnosed as a concussion.
Many observers suspect that the first hit — given Tagovailoa’s subsequent head shake and wobble — left the athlete with a concussion, also called a mild traumatic brain injury. If these were indeed signs of a head injury, that first blow may have led to an even worse brain injury a few days later.
“The science tells us that yes, a person who is still recovering from a concussion is at increased risk of having another concussion,” says Kristen Dams-O’Connor, a neuropsychologist and director of the Brain Injury Research Center at the Icahn School. of Medicine at Mount Sinai in New York. As one example, one concussion roughly doubled the chance of a second in young Swedish men, researchers reported in 2013 in British Medical Journal.
“That, I think, was avoidable,” Dams-O’Connor says of Tagovailoa’s brain injury in the Bengals game.
After a blow to the head, when the soft brain hits the unyielding skull, the injury starts a cascade of changes. Some nerve cells become overactive, inflammation occurs and blood flow changes. These downstream events in the brain — and how they relate to concussion symptoms — can happen over hours and days and aren’t easy to measure quickly, Dams-O’Connor says.
This makes it difficult to diagnose a concussion. Clinicians often have to rely on patients saying they feel nauseous or foggy. Professional athletes may not be willing to share these symptoms if it means being sidelined. “These are elite athletes who are prepared to soak it up,” says Dams-O’Connor.
Other signs may indicate a concussion, such as a person’s gait or a dilated pupil. “As clinicians, we often triangulate multiple sources of information to make that call — was it or wasn’t it a concussion?” says Dams-O’Connor. The scientific uncertainty in this call should lead clinicians to be cautious, he 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 suffers a second stroke in a short period of time,” says Daniel Daneshvar, a brain injury physician and neuroscientist at Mass General Brigham in Boston and Harvard. Medical School. Examining the brains of the mice after two close hits, the researchers saw signs of worse damage and a longer recovery time (SN: 2/5/16).
For athletes, this vulnerability comes in part from the concussion symptoms themselves. Slow reaction times, dizziness and double vision confuse a speedy quarterback who must avoid tackles and see opponents coming in from the sideline. These symptoms can lead to further injury to the head — and the rest of the body. A concussion increases the risk of lower extremity injuries, according to a recent analysis of National Football League players published in August Arthroscopy, Sports Medicine and Rehabilitation.
Additionally, a healing brain is more prone to agitation. While the brain is still recovering in the weeks after an injury, “the threshold for concussion is lower,” says Daneshvar. A lighter hit, the researchers suspect, might cause more damage. A rare condition called second impact syndrome depicts an extreme outcome of consecutive brain injuries. This devastating, often fatal swelling of the brain occurs when a brain that is healing again is hit again.
That was not the case with Tagovailoa. But two concussions in close proximity can delay recovery, Dams-O’Connor points out. “I think people underestimate how life-changing it can be.”
In a statement, the NFL and NFL Players Association said they are jointly investigating whether their concussion protocols were followed in this case. Tagovailoa might have been allowed to return in that first game because his stumble was attributed — rightly or wrongly — to a back injury, not a stroke. The NFL and NFLPA are considering changing the protocol to keep a player out of the game for any apparent motor instability, regardless of the cause.
For now, Tagovailoa is moving through the stages of recovery outlined in the concussion protocol. In a post on social media on September 30, Tagovailoa thank you his team, his friends and family and everyone who has been supportive. “I feel much better and am focused on recovery so I can get back on the field with my teammates,” he wrote.