Why Dolphins QB Tua Tagovailoa now should face questions on concussions and his future

Within the moments earlier than and after Miami Dolphins quarterback Tua Tagovailoa was taken away on a stretcher, his youthful brother, Taulia, saved making an attempt to name his mother. There was no reply. Their dad and mom, Diane and Galu Tagovailoa, had been on the Dolphins-Bengals sport in Cincinnati. Taulia was 500 miles away and wanted somebody to inform him Tua was OK.

Like his brother, Taulia is a soccer participant, however what he had simply seen scared him — Tua spun round and violently flung to the turf, smacking the again of his head on the bottom. He remained on the Bengals’ emblem, together with his forearms raised and his fingers stiffened in a contorted place close to his face.

It was Thursday night time, Sept. 29, greater than three months earlier than Buffalo Payments security Damar Hamlin would lie on the identical area in Cincinnati whereas a group of medics rushed to resuscitate him and assist save his life. On each nights, every little thing eerily stopped. The sport ultimately went on the night time of Sept. 29, however Taulia Tagovailoa, the beginning quarterback for the College of Maryland, had a walk-through follow the subsequent day and a sport towards Michigan State to prep for and all he might take into consideration was discovering a flight, instantly, to see Tua.

He tapped his mother’s quantity once more, and once more, and began to cry. “It just looked really bad,” he mentioned.

When Diane Tagovailoa answered, she mentioned Tua was with the docs and needed to be rushed to the hospital. His father ultimately received on the telephone and informed Taulia to give attention to Michigan State. However he barely slept that night time. On his solution to the Terrapins’ group resort the subsequent day, he acquired a FaceTime name from his brother. Tua was smiling.

In an effort to allay his brother’s fears, Tua, 24, recited his identify, birthday and different primary data. He joked that he did not have a concussion. However by then, he had hit his head on the bottom twice that final week of September; the primary was not reported as a concussion, the second was. He’d be the impetus for an investigation by the NFL and NFL Gamers Affiliation into how he was cleared to play, which prompted adjustments within the league’s concussion coverage.

On Christmas Day towards Inexperienced Bay, Tagovailoa suffered one other concussion, and he hasn’t performed since. Miami’s fortunes have risen and fallen on the again of Tagovailoa, whose transformation in his third 12 months prompted chants of M-V-P and faraway ideas of a Tremendous Bowl. With Tagovailoa, the Dolphins are 8-4 in video games he is completed and 1-4 with out him. His passer ranking leads the NFL (105.5), forward of Kansas Metropolis quarterback Patrick Mahomes (105.2).

So naturally, a long-suffering fan base will hold on each damage report and replace from coach Mike McDaniel this week because the Dolphins put together for Sunday’s wild-card matchup at Buffalo, their first playoff sport since 2016. Shortly after Miami pulled out an 11-6 playoff-clinching victory over the New York Jets with rookie quarterback Skylar Thompson on Sunday, Tagovailoa stood within the tunnel, in avenue garments, and celebrated the playoff berth together with his group.

McDaniel mentioned he will do “what’s best” for Tagovailoa and will not even consider any situations involving him till he is medically cleared. As of Monday, Tagovailoa had not been cleared for soccer actions. “When he’s cleared to practice, he’ll practice,” McDaniel mentioned. “Until then, I’m not doing anything.”

However take away the paradox in Week 3, through which Tagovailoa was listed with a again damage within the Buffalo sport, and his standing this week may not even be in query. Two famend concussion specialists informed ESPN that Tagovailoa’s head trauma in the course of the Payments sport had the looks of a concussion. Dr. Julian Bailes, chairman of the division of neurosurgery at NorthShore College Well being System, mentioned that is vital as a result of three concussions in a finite interval is usually the edge that requires a participant to be held out for an prolonged period of time, presumably months. If Tagovailoa has had three concussions, Bailes believes he ought to sit.

“The brain doesn’t know whether it’s the playoffs or not,” he mentioned. “The brain doesn’t appreciate what part of the season you’re in. It needs to recover.”

ON SEPT. 26, the day after Tagovailoa hit his head on the bottom in the course of the Payments sport, Dr. Chris Nowinski was in rural Nebraska telling the widow of former Harvard teammate Chris Eitzmann that her husband, who died in 2021 of alcohol poisoning, was discovered to have had CTE. Within the years since Nowinski co-founded Boston College’s Persistent Traumatic Encephalopathy Middle, he has had many conversations like this. However this time, he was making an attempt to elucidate to Eitzmann’s 14-year-old son why his dad wasn’t there anymore.

It had been an extended week for Nowinski, vacillating between disappointment and anger. He fired off three tweets throughout and shortly after the Dolphins-Payments sport, calling the back-tweak diagnosis “bull$hit.”

Tagovailoa had been pushed to the bottom within the second quarter towards the Payments and hit his head. He received up on his personal, shook his head, staggered and quickly needed to be propped up by two teammates. However he returned to the sport after halftime and led the Dolphins to a 21-19 victory. Tagovailoa informed medical workers he aggravated a again damage on the play. Though Miami by no means dominated the damage a concussion, Nowinski informed ESPN he believed that it was.

On Thursday, Sept. 29, a number of hours earlier than the Bengals sport, Nowinski tweeted, “If Tua takes the field tonight, it’s a massive step back for #concussion care in the NFL. If he has a 2nd concussion that destroys his season or career, everyone involved will be sued & should lose their jobs, coaches included. We all saw it, even they must know this isn’t right.”

Tagovailoa performed that night time in Cincinnati and later would say he was knocked unconscious. His fingers had been in a modification of the fencing response place — computerized actions of the physique that happen from affect. His cousins had been so affected by the scene that it prompted a bunch chat amongst about 15 folks, together with their spouses, they usually fearful and prayed for him.

After Tagovailoa’s concussion in Cincinnati, Miami reached out to Bailes. The Dolphins had been inspecting how they need to proceed with their quarterback, and Bailes mentioned he was one among a small group of docs contacted.

Bailes, a member of the NFL’s Head, Neck and Backbone Committee and the NFLPA’s Mackey-White Well being and Security Committee, was a Pittsburgh Steelers group physician in the course of the latter a part of the profession of middle Mike Webster, the primary participant Dr. Bennet Omalu recognized with CTE. Analysis from Omalu and Bailes ultimately compelled the NFL to rethink its insurance policies on gamers’ well being and mind security.

Bailes mentioned that he did not study Tagovailoa and that he believes the Dolphins dealt with the Cincinnati concussion correctly in sitting the quarterback from Sept. 30 to Oct. 22. In all three of Tagovailoa’s blows to the top, Bailes mentioned that the mechanisms of damage had been “very similar” in that he was thrown to the bottom and hit the again of his head. As a result of he fell backward, he could not break his fall.

On Oct. 1, the NFLPA fired the unaffiliated neurotrauma marketing consultant concerned within the determination to permit Tagovailoa to return to the Buffalo sport. A number of sources mentioned the firing got here after it was discovered the marketing consultant made “several mistakes” in his analysis. Every week later, after its joint investigation with the NFLPA, the league added “ataxia” to its record of signs for which a participant can’t return to a sport. Ataxia is outlined by the Nationwide Well being Service as a bunch of problems that have an effect on coordination, stability and speech.

Nowinski mentioned there’s a rising consciousness that hits to the top occurring shut collectively in time are “riskier” for long-term points. He additionally mentioned research present that with every concussion the percentages of getting one other one improve.

“Why we think that happens includes what they call the neurometabolic cascade, the chemical and metabolic changes that occur with a concussion,” Nowinski mentioned. “Once they’re triggered once, it may require a slightly lower threshold to make that happen again. Your brain’s resilience may be diminished in the sense that you’ve got 86 billion or so neurons and trillions of connections between them, and when you get a concussion, you lose some, but it’s not enough to permanently impair you.

“But when neurons die, if axons are severed, they do not come again. And should you simply hold taking some away with every concussion, ultimately your mind cannot overcome the harm and the [ability to recover] turns into diminished.”

TAGOVAILOA’S FORTUNES, at least from a football perspective, changed with one call on Feb. 7, 2022.

McDaniel had just been named head coach of the Dolphins and was flying from the West Coast to South Florida when he FaceTimed his new quarterback from the plane. McDaniel told Tagovailoa that he knew he had the ambition to be great and that his job as coach was to get all that greatness out of him.

“I will make it possible for if you look again at this present day, you are going to be like, ‘Rattling, that was among the finest days of my profession, too,'” McDaniel told him.

Tagovailoa, the Dolphins’ fifth overall pick in the 2020 draft, had been widely considered a bust up to that point, so much so that in 2021 Miami considered pursuing and did due diligence on Deshaun Watson amid civil litigation alleging sexual assaults. This past August, an NFL investigation concluded that Dolphins owner Stephen Ross and minority partner Bruce Beal had violated the league’s anti-tampering policy on three occasions, from 2019 to 2022, in conversations with quarterback Tom Brady and the agent for then-New Orleans Saints coach Sean Payton.

Brian Flores, the Dolphins’ coach at the time, had a chilly relationship with Tagovailoa. Flores was defensive-minded and known for being intense. In close games, he would bench Tagovailoa in favor of veteran Ryan Fitzpatrick.

Mike Locksley, Tagovailoa’s offensive coordinator at Alabama, said Tagovailoa is a people person who doesn’t necessarily operate well with dysfunction.

“Not you could’t soar his butt. I’ve seen occasions when coach [Nick] Saban would get after him,” said Locksley, now the head coach at Maryland. “He isn’t laborious to teach. He needs to please his coaches and please his teammates, virtually to a fault, the place he’ll put another person above himself.”

McDaniel was seemingly the anti-Flores — loose, funny, nerdy and oozing with positivity. Tagovailoa didn’t know how to respond to it at first and proceeded with cautious optimism. But McDaniel inspired him to work harder and be better.

The 2022 season began, essentially, in a park near Tagovailoa’s house in South Florida. It was summer. Tagovailoa’s receivers met their quarterback, some in shoulder pads and helmets, for workouts that stretched as long as 2½ hours in the punishing heat. Tua Tagovailoa’s brother, Taulia, trained with them and could sense the chemistry building.

The Dolphins had just added All-Pro receiver Tyreek Hill and top free-agent tackle Terron Armstead in the offseason in part to build a support system around their quarterback, and there was Hill, formerly a favorite target of Mahomes’, in that heat, on Tagovailoa’s turf, running routes.

The first game of the season inspired hope, a 20-7 win against the New England Patriots. But Miami fans have seen hope wane through more than a dozen quarterback failures in the lost decades post-Dan Marino. Skepticism was a given.

All that eroded in Week 2. Tagovailoa put together a six-touchdown, 469-passing-yard performance, rallying his team from a 21-point fourth-quarter deficit in a victory over Baltimore that made the Dolphins 2-0 and brought hysteria that Tagovailoa wasn’t just their franchise quarterback — he was going to take them to places they hadn’t been since the 1980s. “That was f—ing superior,” Marino said after the comeback.

But every high seemingly came with a subsequent low of equal value, and the Buffalo win the next week was met with the reality of Tagovailoa’s first head injury.

Miami would win five games, then go on a five-game losing streak. It would go to Buffalo on Dec. 17 and nearly beat the Bills in frigid temperatures, then, just when it appeared as if the Dolphins were back on track, would lose Tagovailoa to another concussion in a home loss to Green Bay.

In the first half of that game, he was tackled after a throw and fell and hit the back of his head. He got to his feet and did not leave the game. He threw three interceptions in the fourth quarter. McDaniel told reporters that the Dolphins reviewed film from the game and saw things that “brought about them to prod” Tagovailoa. After further discussion and observation of him Monday after the game, they advised him to visit with team doctors, and he was placed into the concussion protocol.

It prompted another investigation by the NFL and the NFLPA, which concluded that concussion protocols were not violated because Tagovailoa didn’t exhibit visible signs of a concussion during the game.

Tagovailoa has eschewed one-on-one interviews this fall, saying he wanted his play to do the talking. When healthy, it has. He threw for 3,548 yards and 25 touchdowns despite the chunks of season taken away by concussions. He completed 64.8% of his passes, with three of his eight interceptions coming in the fourth quarter of that Green Bay game.

Vinny Passas, his high school quarterback coach at Saint Louis School in Hawaii, was in the middle of a training session Dec. 26 when an alert popped on his phone that Tagovailoa had suffered another concussion. He said he couldn’t remember seeing Tagovailoa endure as many setbacks and challenging moments as he has in 2022.

He knows how hard it must be for Tagovailoa to sit. Passas has coached high school football in Hawaii for more than 40 years, and mentored quarterbacks such as Marcus Mariota and Timmy Chang. In Polynesian culture, Passas said, a mentality of toughing it out and playing through injuries is deeply ingrained.

“I bear in mind teaching in a Polynesian Bowl sport the place a quarterback took himself out after a success,” he said. “At halftime, a few Polynesian gamers informed him, ‘Gosh, if we did what you probably did by taking your pads off and never enjoying the second half, our dad and mom would come down right here and provides it to us as a result of we might be, like, embarrassing our household like that.'”

Tagovailoa’s parents did not respond to interview requests for this story. In an interview with Maria Taylor for “Soccer Evening in America” in late October, as Tagovailoa returned from his Cincinnati concussion, he said that his injuries had been “slightly robust” for his parents. He also acknowledged to reporters that week that he’s always been a quarterback who opted to try to make something happen, who’d wait for receivers to get open instead of throwing the ball away. But he was learning, he said, and was now thinking about his longevity.

His first game back against Pittsburgh, he tried to bulldoze defenders, twice.

Adam Amosa-Tagovailoa, a former offensive lineman at Navy who is Tua’s cousin, said that when they were children and needed to be reminded to never give up, their grandfather Seu would tell them about the story of the lion and the gazelle.

“The gazelle wakes up working away from hazard,” Amosa-Tagovailoa said, “whereas the lion wakes up hungry, all the time ravenous, making an attempt to get to the subsequent meal.”

IN THE END, McDaniel’s positive vibes and Tagovailoa’s spurts of brilliance could not withstand an offseason inevitability: Tua’s future in Miami is once again murky. The Dolphins have until May to decide whether to exercise his fifth-year option.

Will they sign Tagovailoa to a long-term extension after a year in which he has proved he is capable of high-level play but also with durability issues a concern? Tagovailoa was considered an injury risk in the 2020 draft because his college career at Alabama ended when he took a sack and dislocated his right hip, also fracturing its posterior wall, and suffered a concussion and a broken nose.

“You possibly can’t tie the cash to a participant you are unsure can keep wholesome,” an AFC exec told ESPN. “If he did not have the medical historical past, possibly you assume tougher about doing one thing. The concussion dynamic is tougher to determine since I am unsure his medical on that.

“The Dolphins are in a tough spot, because he’s a good player but a lot like Kirk Cousins. If you give him good football players, he’s going to be productive. If you ask him to go win a game and put a team on his back, that’s asking a lot.”

Regardless of all of the hits in 2022, Nowinski, a neuroscientist who co-founded the Concussion Legacy Basis, mentioned he doesn’t think about Tagovailoa to be concussion-prone. He mentioned that is a subjective label given to individuals who have had a number of concussions over a few years. However he’s fearful that NFL groups would possibly label him that to justify paying him much less or not giving him as many alternatives.

“I’m highly concerned that he will get that label, and not fairly,” Nowinski mentioned. “I would look at it as he had one concussion, which happens. He then receives an improper diagnosis and care and received what is either a second concussion or a hit that exacerbated the first. But either way, it left him susceptible for months to a future hit, causing another concussion, more susceptible than he had been prior, which is, I think, what we saw.

“None of this was his fault. He is been enjoying soccer for an extended, very long time and by no means had these points. … We have to give him time to correctly get well earlier than he ought to be given any labels.”

The NFL does not share concussion tracking information during the season but provides injury data at the end of each season. In 2021, there were 187 reported concussions in the regular and preseason combined. This year, the league has conducted three investigations into the application of concussion protocol — one with New England receiver DeVante Parker and two with Tagovailoa.

Tagovailoa’s agent is Leigh Steinberg, who for decades has represented the top quarterbacks in the NFL, from Steve Young to Mahomes. Steinberg is known for being at the forefront of player safety in regard to brain injuries long before football acknowledged them. Steinberg was holding seminars to educate his players on the long-term effects of concussions as early as the 1990s. He declined to comment for this story.

In an interview in November, Taulia Tagovailoa said he was “actually nervous” to watch his brother play in his Week 7 return against Pittsburgh. He didn’t know how he’d play or move. But he said Tua didn’t skip a beat, and that gave him comfort.

There are decisions to be made by the Dolphins, and by Tagovailoa. He and his wife, Annah, became parents this year. When asked what was the difference in his brother’s game this season, Taulia cited chemistry, then thought about it some more. The biggest difference, he said, is that Tua has a son, and that motivates him and helps him block out everything else.

“I believe his son actually modified his life,” Taulia said. “When he comes dwelling, it is larger than soccer. It is your son. You all the time need to be good for him. You all the time need him to develop up and say, ‘That is my father.'”

ESPN’s Jeremy Fowler contributed to this report.