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NFL faces intense scrutiny over concussion protocols


It’s been a turbulent fortnight for the NFL and its concussion protocols, with the league coming beneath intense scrutiny over the problem of gamers’ well being.

The saga round Miami Dolphins quarterback Tua Tagovailoa, which resulted in him being taken to the hospital after struggling a concussion in a scary wanting incident, has raised various questions concerning the dealing with of head accidents.

An investigation is now underway into the dealing with of Tagovailoa’s obvious head damage, whereas the unaffiliated neurotrauma consultant who was concerned within the quarterback’s first concussion analysis is reportedly now not working with the Nationwide Soccer League Gamers Affiliation (NFLPA).

NFL Chief Medical Officer Dr. Allen Sills advised CNN Chief Medical Correspondent Dr. Sanjay Gupta on Friday that “we are going to get this proper.”

Tua Tagovailoa sits on the turf during the first half of the game against the Buffalo Bills.

Tagovailoa will miss the workforce’s subsequent recreation in opposition to the New York Jets on Sunday.

“It’s too early to present a particular timeline,” Dolphins head coach Mike McDaniel mentioned. “I can comfortably say he’ll be out for this recreation in opposition to the Jets. However something past that, once more we’re simply targeted on ensuring he’s at optimum well being after which crossing that bridge so it’s somewhat early for definitive timelines past that.”

McDaniel added that Tagovailoa was at present contained in the workforce’s facility and has had “a pair good days.”

“He’s simply attempting to undergo with the correct process and protocol so he’s feeling 100%,” McDaniel mentioned. “I do know he’s going to be diligent with it and if there’s clearly any issues which can be giving him points when it comes to lights and people issues, we are going to shut that down.”

All of it started on Sunday, September 25, within the Dolphins’ 21-19 win over the Buffalo Payments.

Tagovailoa was knocked out of the sport briefly within the second quarter after a success by Payments linebacker Matt Milano pressured the again of the Dolphins QB’s helmet to hit the turf.

The 24-year-old quarterback acquired up stumbling and was taken to the locker room for a concussion verify. Milano was flagged for a roughing the passer penalty.

The Dolphins initially introduced Tagovailoa was questionable to return to the sport with a head damage, however he got here again out onto the sphere within the third quarter and completed the sport throwing for 186 yards and a landing.

Tagovailoa advised reporters after the sport that he fell onto his again earlier than his head hit the turf inflicting his again to lock up and the ensuing stumble. He added that he was evaluated for a concussion however was finally cleared.

McDaniel, the Dolphins head coach, alluded to a again damage after the sport, saying that Tagovailoa again acquired “bent” on an earlier play however the hit “loosened his again” inflicting his legs to get wobbly. McDaniel added that Tagovailoa advised him that his again was like “Gumby” – a reference to the basic inexperienced animated character.

Then, simply 4 days later, Tagovailoa took to the sphere because the Dolphins performed the Cincinnati Bengals on Thursday Night time Soccer.

Tagovailoa was sacked by Bengals defensive lineman Josh Tupou within the second quarter and laid immobile on the sphere for a number of minutes.

Your complete Dolphins sideline walked onto the sphere as he was positioned on a backboard and stretcher. Bengals followers in attendance at Paycor Stadium in Cincinnati confirmed their respect as Tagovailoa was carted off the sphere.

Medical staff tend to Tagovailoa as he is carted off on a stretcher after an injury during the second quarter of the game against the Bengals.

Video confirmed Tagovailoa’s forearms had been flexed and his fingers contorted – an indication that Gupta, a neurosurgeon, mentioned is a “fencing response” and might be linked to a mind damage. Gupta requested Sills, who can also be a neurosurgeon, how involved he was after seeing that video.

“Properly, after all, I’m involved similar to you as a neurosurgeon, and anybody with a major damage and neurologic indicators like that,” Sills mentioned.

“The quick concern is … ensuring that the second we do every little thing that we are able to to supply essentially the most knowledgeable and well timed care … securing the airway, ensuring that there’s not a backbone damage and so forth and so forth.

“I’m involved about that damage and the entire accidents.”

Tagovailoa was cleared to return to Miami after visiting the hospital, and McDaniel advised reporters on Friday that his quarterback was in “good spirits.”

However Chris Nowinski, who’s co-founder and CEO of the Concussion Legacy Basis, has advised the NFL it should “do higher.”

“That is larger than protocols,” tweeted Nowinski. “A concussion can change a life. For me, it’s private. We are able to’t let some other youngsters develop up with out their fathers.” CNN has provided the NFL the suitable of reply to Nowinski’s tweet.

Minnesota Vikings large receiver Adam Thielen mentioned the league has an obligation to “defend” quarterbacks after they’re hit on their head.

“Clearly, these undoubtedly must be referred to as as a result of we acquired to guard our quarterbacks on this league,” Thielen mentioned when requested about hits to Vikings quarterback Kirk Cousins’ helmet. “They’re large and crucial to the success of this league and to those groups, having an excellent product on the sphere. Bought to guard these guys.”

The NFL and the NFLPA launched a joint assertion saying that each side agreed that updates to the protocols are required, specifically to “gross motor instability” incidents.

Sills advised Gupta that the continuing overview consists of the gamers, the NFL and the NFLPA, in addition to trainers, physicians and unbiased consultants.

“We’ll be very clear and really open about what we realized from that and precisely what the sequence of occasions are,” added Sills.

Gupta famous on Sunday that Tagovailoa had hassle strolling after his helmet hit the turf within the recreation in opposition to the Payments – a possible “no-go” signal, that means a participant shouldn’t and wouldn’t return to the sphere.

Tagovailoa warms up before the game against the Bills.

Sills mentioned that such “gross motor instability” is a “no-go” signal if it’s decided to be from a neurological trigger.

The Payments hit continues to be beneath overview, he mentioned, and “that’s very laborious to evaluate from video alone.” Sills emphasised that the choice about whether or not a participant can return to a recreation is rarely made by one particular person however fairly a bunch of physicians, together with an unbiased neurological knowledgeable.

On Sunday, two quarterbacks left video games because of the concussion protocol: Tyrod Taylor of the New York Giants and the New England Patriots’ Brian Hoyer.

Baltimore Ravens head coach John Harbaugh has called the occasions “astonishing” whereas NFLPA president JC Tretter said he was “outraged” at what occurred.

“Till we now have an goal and validated methodology of diagnosing mind damage, we now have to do every little thing attainable, together with amending the protocols, to additional cut back the potential of human error,” JC Tretter mentioned in an announcement on Twitter.

“A failure in medical judgement is a failure of the protocols relating to the effectively being of our gamers.”

A participant goes into the concussion protocol if they’ve obtained a blow to the top and displays or studies signs or indicators suggestive of a concussion or stinger (a nerve pinch damage) or the workforce athletic coach, sales space ATC spotter, workforce doctor, recreation official, coach, teammate, sideline Unaffiliated Neurotrauma Marketing consultant (UNC) or sales space UNC initiates the protocol.

The participant is eliminated to sideline or stabilized on the sphere and undergoes testing.

The workforce doctor and the UNC carry out a sideline survey which incorporates evaluating issues corresponding to “no-go” indicators (lack of consciousness, gross motor instability, confusion, amnesia), historical past of occasion, concussion indicators/signs, video overview in addition to a targeted neurological examination together with a cervical backbone examination, analysis of speech, commentary of gait and eye actions and pupillary examination.

If any ingredient of testing is deemed optimistic, inconclusive or suspicious of concussion, the participant is escorted to the locker room for additional analysis which incorporates full NFL SCAT and an entire neurological examination.

If irregular, the participant isn’t permitted to return to play and stays within the locker room the place they’re periodically evaluated by the medical workforce.

Each NFL participant recognized with a concussion should comply with a five-step course of earlier than being cleared to totally observe or take part in a recreation.

Concussions and their prevention have develop into an necessary difficulty lately as a result of their connection to mind illness later in life.

In 2017, a research published within the medical journal JAMA (Journal of the American Medical Affiliation) discovered that persistent traumatic encephalopathy, referred to as CTE, was present in 99% of deceased NFL gamers’ brains that had been donated to scientific analysis.

The neurodegenerative mind illness might be present in people who’ve been uncovered to repeated head trauma. The illness is pathologically marked by a buildup of irregular tau protein within the mind that may disable neuropathways and result in a wide range of scientific signs. These embody reminiscence loss, confusion, impaired judgment, aggression, despair, nervousness, impulse management points and typically suicidal habits.

It might solely be formally recognized with an post-mortem, and most instances, though not all, have been seen in both veterans or individuals who performed contact sports activities, notably American soccer.

A 2018 study discovered that CTE can begin early and with none indicators of concussion. Dr. Lee Goldstein, one of many authors on the research printed within the journal Mind, and his colleagues from Boston College evaluated the brains of 4 deceased athletes, ages 17 and 18 years outdated. All 4 had died inside a day to 4 months of receiving some kind of sport-related head damage and had a historical past of taking part in soccer.

Earlier this 12 months, former NFL participant Demaryius Thomas died immediately on the age of 33. Months after, Thomas’ household said he had been affected by stage 2 CTE when he died.

Additionally lately, Vincent Jackson, who died aged 38, and Phillip Adams – who fatally shot six individuals earlier than taking his personal life – had been each posthumously recognized with CTE.

A research in 2021 additionally discovered that NFL gamers are about 4 occasions extra prone to die of amyotrophic lateral sclerosis (ALS), also called Lou Gehrig’s illness, than most people.

ALS is a neurodegenerative illness extra prone to be recognized in older White males. The foundation causes are nonetheless unknown, and most instances are thought-about sporadic.

The researchers hypothesized a couple of relationship between head trauma and ALS due to an identical hyperlink detected between soccer and the neurodegenerative illness CTE. Earlier analysis has famous that CTE and ALS might have some related impacts on the mind.

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