A grim and all too acquainted scene performed out on Thursday evening because the Miami Dolphins confronted off in opposition to the Buffalo Payments. Racing towards the tip zone, the Dolphins quarterback Tua Tagovailoa crashed headfirst right into a Payments defender. Tagovailoa went limp, his head ricocheting off the sphere whereas his proper arm involuntarily swung upward, fingers clawing on the sky. As Tagovailoa tried to rise up, he regarded dazed. Minutes later, he was taken out of the sport with a concussion.
Tagovailoa has turn out to be one thing of a poster baby for soccer’s concussion drawback: Going again to his senior yr of school, the 26-year-old has had at the least 4 of them in 5 years. Most notably, in 2022, he was knocked unconscious after hitting his head in opposition to the turf whereas taking part in the Cincinnati Bengals, and needed to be taken off the sphere in a stretcher. He returned later that season, earlier than struggling one other concussion in a recreation in opposition to the Inexperienced Bay Packers. After the 2022 season, Tagovailoa thought-about retiring, weighing the long-term results of the repeat head accidents.
Since Thursday evening, the requires Tagovailoa to retire have crescendoed. “He’s going to stay longer than he’s going to play soccer. Care for your loved ones,” Antonio Pierce, the top coach of the Las Vegas Raiders, advised reporters in a press convention. “That is one thing that may have an effect on you long-term … For me, it’s time to maneuver on,” Tony Gonzalez, a Corridor of Fame tight finish turned announcer, mentioned on the published after the Payments recreation. Concussions are linked to persona modifications, cognitive impairment, and psychological sickness, which generally manifest years or many years after the preliminary damage. Repeat accidents can result in persistent traumatic encephalopathy (CTE), a degenerative mind illness related to reminiscence loss and melancholy that has been identified in tons of of former gamers.
Whether or not Tagovailoa will return to the sport will not be but sure. But it surely’s unclear what dangers he faces by taking part in once more. 4 concussions looks like so much; whether or not that’s too many is difficult to say. There’s no “magic quantity that claims that past X variety of concussions, you really want to cease,” Thomas McAllister, a traumatic-brain-injury knowledgeable at Indiana College Faculty of Medication, advised me. Sadly, this additionally makes it unimaginable to know when an individual has had one too many. Not everybody who has a number of concussions goes on to develop CTE, whereas others have finished so with out ever knowingly getting a concussion.
Nonetheless, consultants typically agree on a couple of ideas, all of which level to the hazards of repeat blows. Individuals who have had many concussions over a comparatively brief interval are inclined to take longer to recuperate from subsequent ones. The same old short-term signs—complications, nausea, and sensitivity to mild, amongst others—linger longer than standard. With successive concussions, individuals will be extra vulnerable to future ones. The mind turns into delicate; with every blow, much less power is required to trigger a concussion.
Past that, few issues are sure. The tougher an individual is hit, the extra possible they’re to be concussed, however individuals reply otherwise to the identical form of blow. Sometimes, concussions happen with strikes of 90 to 100 g-force. “If I had been subjected to an 80-g concussion, I is perhaps down for the rely. You may bounce proper up and go about your online business,” McAllister mentioned. One clarification for this variability is that the mind is perhaps “primed” for concussion by any earlier, smaller hits earlier in a recreation, and the following giant blow is the “straw that breaks the camel’s again.”
Early information from McAllister’s ongoing analysis counsel that folks possible even have totally different thresholds for tolerating repeat concussions. (He’s co-leading the world’s largest concussion examine, which incorporates greater than 53,000 faculty athletes and army cadets.) Some might be able to face up to a excessive quantity and rapidly recuperate every time. The issue is that “we’re not capable of say that that is the one which places you excessive,” McAllister mentioned.
In terms of predicting long-term harm, the variety of concussions is probably not what issues most. A examine of NFL gamers revealed final yr recommended that the signs skilled instantly following a concussion—specifically, lack of consciousness—are a greater predictor of future cognitive decline than the variety of identified concussions. Some researchers argue that in uncommon instances, a concussion that happens earlier than a earlier one has resolved can result in a situation referred to as second-impact syndrome, which might trigger extreme neurological harm and even dying.
Consultants should depend on sure indicators to discern when concussions have raised the chance of everlasting hurt. The crimson flags embody when concussions begin occurring extra continuously and with much less of an related stimulus, and when an extended interval is required for an individual to return to their baseline, as decided by common neurocognitive testing. All the information assist the significance of getting a standardized evaluation and ready interval earlier than bringing gamers again onto the sphere, McAllister advised me. The NFL’s concussion protocol consists of directions on when a participant have to be faraway from the sphere, how lengthy he ought to be monitored, and which assessments he should cross to return to taking part in full-time.
There’s no query that repeat concussions are detrimental. The issue for Tagovailoa—and the way forward for the NFL—is that it’s unimaginable to quantify simply how a lot harm they trigger. If solely the league may set a tough restrict on the variety of concussions that gamers had been permitted to maintain in a sure interval, Tagovailoa would face a a lot simpler alternative. However that’s not how concussions work. As a substitute, they’re deeply particular person, their results inseparable from the participant’s historical past and biology. So long as so many unknowns about concussions stay, gamers will preserve discovering themselves in Tagovailoa’s place, weighing their profession in opposition to the remainder of their life.