When Miami Dolphins quarterback Tua Tagovailoa crashed headfirst with Buffalo Bills defender Damar Hamlin during Thursday night’s football game, it was instantly evident to medical specialists that Tagovailoa had sustained a major concussion.
Knocked down on the field and laying on his back, Tagovailoa’s right arm arched up into the air as the fingers on his hand curled, a response known as the fencing posture that develops after a serious brain damage. It was the third diagnosed concussion in his NFL career after two back-to-back concussions in 2022.
Experts say repeated head injuries can increase the risk for long-term health problems, such as chronic traumatic encephalopathy, or CTE, a neurodegenerative disorder that is associated with changes in mood, behavior and cognition, and has been diagnosed in hundreds of NFL players after their deaths. But just who goes on to suffer CTE or other long-term health difficulties following a head injury is somewhat of a mystery.
“We know that repetitive concussions have been shown to be associated with an increased risk of cognitive impairment later in life,” said Steve Rowson, an assistant professor of biomedical engineering at Virginia Tech and the head of the Virginia Tech Helmet Lab.
“But not everyone who has repetitive concussions develop brain health problems later in life,” Rowson noted. “Only a fraction of those people do, and we don’t know why it’s those people.”
Contributing to the confusion: Concussions are sometimes difficult to diagnose, and many are ignored, said Dr. Dan Daneshvar, chairman of the division of brain injury rehabilitation at Harvard Medical School.
A concussion is described as a minor traumatic brain injury from a hit to the head or the body that causes the brain to quickly rattle back and forth, creating symptoms that may include double vision, disorientation, difficulties concentrating and memory loss. Signs of a concussion range from stumbling and vomiting to loss of consciousness in extreme situations.
Those indications and symptoms are a significant aspect of a diagnosis: If two persons incur head trauma of comparable power but only one feels symptoms or displays indicators of a concussion, the other is believed to have experienced a nonconcussive strike, Daneshvar said.
However they are classed, the multiple head traumas pile up. Research from the Boston University CTE Center based on postmortem studies of former football players’ brains suggests that repetitive head impacts appear to be the major risk factor for CTE. Meanwhile, a 2023 research in the journal Nature Communications revealed that the most accurate predictor of CTE later in life was the total force of the head strikes to players over their careers, not the number of concussions they had experienced.
“What we’re finding is, when it comes to the long-term problems associated with these hits to the head, it doesn’t seem to matter whether that hit caused symptoms or not,” said Daneshvar, who was the primary author of the research. “What seems to matter more is the total amount of head injury burden you got over your life.”
CTE may be detrimental to mental health. It is suspected to have played a part in the suicides of several football players, including Junior Seau; Dave Duerson; Ray Easterling; and Aaron Hernandez, all of whom were later discovered to have CTE.
How many punches to the head are too much?
Football and other contact sports are far from the main source of concussions. Falls, automobile wrecks and bicycle accidents are additional top causes, according to Jay Alberts, director of the Cleveland Clinic Concussion Center.
“Typically, a single concussion isn’t going to cause long-term effects, major long-term effects, unless there’s maybe some underlying condition that we don’t know about for the individual,” he added.
“But there are data, obviously, looking at populations of former NFL players that show they have a higher incidence of neurological disease than the general public,” Alberts said. “What’s the dose that is going to result in these types of either neurological diseases or CTE? That’s something, regrettably, we don’t know that particular dose at the moment.”
Tagovailoa, 26, has revealed that following his second concussion in 2022, he momentarily pondered quitting. Although Tagovailoa was able to walk off the field following his hit in Thursday’s game, others in the NFL advised him to again contemplate retirement.
“I’ll be honest. I’d just tell him to resign. It’s not worth it – it’s not worth it to play the game,” Las Vegas Raiders Head Coach Antonio Pierce said in a news conference Friday, calling Tagovailoa’s three concussions “scary.”
“I just think at some point, you know, he’s going to live longer than he’s going to play football,” he continued. “Take care of your family.”
While the experts noted that pro football is safer than ever, with new helmets and adjusted rules, they said it’s not a sport that favors extended recovery times.
“The problem with football is that people say it has 100% injury rate. Everybody is hurt, every season, right? And so you can’t have a system in which you take time off for light injuries,” said Chris Nowinski, the co-founder and CEO of the Concussion Legacy Foundation, a nonprofit organization. “It’s not like a workman’s comp situation where you sprain your ankle and you stay home for a few days.”
In a statement to NBC News, the NFL announced that Tagovailoa has entered the league’s concussion protocol, in which players diagnosed with concussions complete a five-step return to participation procedure. The process includes a test and approval by an independent neurological expert before they are cleared to fully return to practices and games.
“In terms of return to play, each player and each concussion is unique, and there is no set time-frame for return to participation. A player’s return to fully practice or participate in an NFL game is predicated on medical clearance—including from independent doctors—always placing the player’s health first,” the NFL said. “Ultimately, a decision to return to the game is a decision the player makes with his doctors.”
Nowinski added that while it’s tough to tell if Tagovailoa will have long-term health concerns, numerous concussions in the period of several years is “never a good thing.” He indicated that physicians should be able to evaluate the severity of Thursday’s concussion shortly, anyway.
