During a football game on September 25, Miami Dolphins quarterback Tua Tagovailoa got the pass but was knocked down. Fans watched him shake his head and stumble on the ground as he tried to get him to run. 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, 24-year-old Tagovailoa 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 and shaking – left the athlete with a concussion, also known as mild traumatic brain injury. If these were indeed signs of a head injury, that first blow might have lined him up for an even worse brain injury a few days later.
“Science tells us that yes, someone who is still recovering from a concussion is at high risk for another concussion,” says Kristen Dams-O’Connor, a neuropsychologist and director of the Brain Injury Research Center at the Institute. Icahn School. medicine at Mount Sinai in New York. For exemple, a concussion roughly doubles the risk of having a second among young Swedish men, researchers reported in 2013 in the British medical journal.
“That, I think, was preventable,” Dams-O’Connor said of Tagovailoa’s brain injury in the game against the Bengals.
After a blow to the head, when the soft brain hits the inflexible skull, the injury triggers a cascade of changes. Some nerve cells become overactive, inflammation sets in, and blood flow is impaired. These downstream events in the brain — and their connection to concussion symptoms — can occur over hours and days and are not easy to measure quickly, says Dams-O’Connor.
This makes diagnosing a concussion tricky. Clinicians often have to rely on patients to say they are feeling unwell or confused. Professional athletes might not be willing to share these symptoms if it means they will be sidelined. “These are elite athletes who are conditioned to suck it,” Dams-O’Connor says.
Other signs may indicate a concussion, such as a person’s gait or dilated pupils. “As clinicians, we often triangulate multiple sources of information to make that call – was it or wasn’t it a concussion?” said Dams-O’Connor. The scientific uncertainty in this call should lead clinicians to err on the side of caution, she says.
After a head injury, recovery is crucial. “It’s much worse when an individual doesn’t have time to rest and recover and suffers a second impact within a short period of time,” says Daniel Daneshvar, brain injury physician and neuroscientist at Mass General Brigham. in Boston and Harvard. Medicine School. By examining the brains of mice after two close blows, the researchers observed signs of higher damage and longer recovery (SN: 05/02/16).
For athletes, this vulnerability stems in part from the concussion symptoms themselves. Slowed reaction times, dizziness and double vision confuse a quick quarterback who must dodge tackles and see opponents coming wide. These symptoms can lead to further injury to the head and the rest of the body. A concussion increases the risks lower limb injuries, according to a recent analysis of National Football League players published in August in Arthroscopy, Sports Medicine and Rehabilitation.
Additionally, a healing brain is more likely to be shaken. While the brain is still recovering in the weeks following an injury, “your threshold for having a concussion is lower,” Daneshvar says. A lighter blow, the researchers suspect, can do more damage. A rare condition called second impact syndrome illustrates an extreme outcome of successive brain damage. This catastrophic, often fatal brain swelling occurs when a still-healing brain is affected again.
This is not what happened to Tagovailoa. But two close concussions can delay recovery, Dams-O’Connor points out. “I think people minimize how life changing it can be.”
In a statement, the NFL and the NFL Players Association said they were jointly investigating whether their concussion protocols were followed in the case. Tagovailoa may have been allowed back in that opener 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 to remove a player from a game if there is obvious motor instability, regardless of cause.
For now, Tagovailoa is going through the recovery steps outlined in the concussion protocol. In a social media post on September 30, Tagovailoa thanked his team, his friends and family and all those who have reached out to support them. “I’m feeling much better and focusing on recovery so I can get back on the pitch with my teammates,” he wrote.