Tua Tagovailoa: A breakdown of his potential concussion.
Concussion or Back Injury?
A fan of NFL football or not, you may have seen the video of Tua Tagovailoa this past Sunday. In case you didn't, here is the general sequence of events.
We saw the quarterback, Tua Tagovailoa, get pushed at the end of a throw.
We saw Tua stumble and fall onto his back, ultimately whipping the back of his head on the turf.
We then saw Tua get back up slowly and eventually buckle like a baby deer on his way back to the huddle.
The big question and concern here was, "Oh sh**. Did he sustain a concussion (i.e., mild traumatic brain injury; mTBI)?" Luckily, he was removed from play to be evaluated for a concussion. According to ESPN, this is the general protocol for NFL players:
"The protocol's sideline concussion assessment involves a six-step process that tests the player for any "no-go" signs, a video review of the play, a review of concussion signs and symptoms, an inquiry regarding the history of the event, all Maddocks questions and a focused neurological exam. If any element of the sideline assessment comes back positive or inconclusive, the player must be taken to the locker room for a full comprehensive review, accompanied by the team's best-suited physician and an unaffiliated neurological consultant." - ESPN
That sounds good, right? The process seems thorough enough.
If it sounds like I'm setting you up for a plot twist... Well, I am.
Nearly every concussion specialist I regularly chat with from multiple disciplines of medicine was as upset with the result as I was: he returned to play after halftime. You're kidding yourself if you think you stumble like that with a back injury. I've treated many folks with acute back pain (“thrown out back”), and they don't move with such laxity. There’s a rigidity and stiffness, with great attention directed toward the back. But I digress...
The problem is this:
We have an observed mechanism of injury.
We have an observable sign of concussion (more below).
It is EXTREMELY doubtful that he did not have even one symptom on the PCSS (more below).
“Expert members from seven national and international sporting codes agreed on the inclusion of six signs for the identification of a possible concussion: lying motionless, motor incoordination, impact seizure, tonic posturing, no protective action—floppy and blank/vacant look.”
This is the Post-Concussion Symptom Scale (PCSS). Having even ONE symptom after an impact, warrants removal from play and suspicion of a concussion.
Diagnosing Concussion: The Quick & Dirty
In sports concussions, if we see a mechanism of injury (e.g., a hit resulting in head contact) and we have even one symptom on the PCSS, we have enough information to diagnose a concussion. There's no need to repeat baseline tests or anything fancy. "You were hit, and now you have symptoms. Let's play this safe."
In Tua's case, we had a mechanism of injury and an observable sign of concussion. Only Tua and the folks inside the organization know if Tua had any symptoms. Regardless, the hit and the stumble (ataxia) are enough to doubt his brain's health - and that doubt is enough to remove him from play for at least the rest of this game. "Tua, you were hit. You walked like Bambi. We'll take it easy today and test you more over the next 24-72hrs."
A quick reality check.
Ultimately, you never want to see a player get hurt. Whether you like a team or not, you genuinely don't like to wish any athletes (i.e., humans with families) pain and suffering. It's a miserable piece of competition. Even worse, you hate to see their organizations fail them.
Tua Tagovailoa sustained a head contact that resulted in subsequent ataxia. At the very least, he should have sat the rest of the game. At best, he will undergo autonomic/exercise, visual, vestibular, and cervical spine testing. Additionally, he will only return to play once he can pass these tests following an exertion protocol (approx 21 days of rehab total).
Imagine he fell and tore his ACL. No questions. He should take care of it, right?
Well, friends, after slamming into the ground, his brain sloshed in his skull and caused spontaneous and chaotic firing, resulting in his temporary inability to stand up or walk.
So... Do we just ignore a concussion because we can't "see" it?
If you think you have sustained a concussion or would like testing to know if you meet the criteria for concussion/PCS go ahead and schedule a consultation below.
In my practice, I offer in-person care here in Arizona and virtual programs for folks outside the state and abroad. Over the course of three visits, we dive deeply into autonomic, metabolic, visual/vestibular, cervical, and psychological assessment and screening. By completing this comprehensive assessment in a matter of 2-3 weeks, patients are provided with a comprehensive rehab plan that can shave months off their recovery times.