Should Tagovailoa sit extended time after concussions? One neurosurgeon has different view
Dolphins quarterback Tua Tagovailoa left fans holding their breath last Monday night when he lowered his head to try to tackle Christian Rozeboom after the Rams linebacker intercepted him.
Fortunately, disaster was averted. Rozeboom’s shin clipped the side of Tagovailoa’s helmet, but not violently enough to trigger Tagovailoa’s second concussion of the season or what could have been the fifth or sixth of his life.
The general consensus among neurologists has been that any future concussions would keep Tagovailoa sidelined an extended period, just as the Sept. 12 concussion against Buffalo kept him sidelined longer than several other NFL players who have been concussed.
Evan Packer, managing partner of the Brain and Spine Center of South Florida, told the Miami Herald last month that “the length of time” following future Tagovailoa concussions “would be greater and greater.”
But not all neurologists believe that’s necessary.
Dr. Jamshid Ghajar, the former chief of Neurosurgery at Jamaica Hospital-Cornell Trauma Center, reached out for an interview, via his public relations firm, and said there’s simply no need to automatically sit Tagovailoa a month or longer if he sustains another concussion, provided he clears the NFL’s five-step concussion protocol.
In my handful of interviews with neurologists, Ghajar is the first to express that view.
His credentials are impressive: He founded the Brain Trauma Foundation, was director of Stanford’s Concussion and Brain Trauma Center and invented and patented several neurological devices that are used worldwide.
I asked Ghajar if he believes it’s necessary for Tagovailoa to sit out at least a month after all future concussions.
“I don’t think so,” he said. “As far as I’m concerned, it doesn’t matter the past history. If they have repeated concussions, something is going on. But if they are back to normal, there is no reason to say they have had this many concussions before and [you need to be far more cautious]. If they perform normally, they can go back in.
“If they are fully recovered after a week and they had prior concussions, I would put them through tests -- eye tracking, balance, coordination tests. If they perform well, they can go back in.”
The Dolphins sat Tagovailoa for five weeks because he and they were advised, by well regarded neurologists across the country, that extended rest was helpful. The question, which remains unknown, is how much time off the field is actually needed before it’s safe to play again.
The Dolphins have never revealed exactly how many weeks Tagovailoa was advised to sit out. Let’s be clear: The decision to place him on injured reserve - which covered four games and a bye week - was made with his best interests in mind and thus can be thoroughly defended. The Dolphins and Mike McDaniel genuinely care about Tagovailoa’s health; that couldn’t be more obvious.
That said, whether a fifth week sidelined was medically necessary is not something qualified neurosurgeons agree on; he obviously could have helped in that costly loss against Indianapolis.
One neurosurgeon not mentioned in this article, who asked not to be named because he doesn’t want backlash, said he expects doctors associated with treating Tagovailoa to be overly cautious with future concussions because of the publicity around his case and because most doctors err on the side of caution anyway.
Ghajar also said public pressure regarding Tagovailoa could affect future recommendations about how much time he should sit out after mild concussions: “When you have a lot of eyeballs on you, your judgment is more conservative,” said Ghajar, who determined when Stanford athletes should return from concussions during his time there.
“Doctors are all individuals; they make their own decisions. At Stanford, I would clear them as soon as they were normal. I wouldn’t say, ‘you have had a concussion three times, so you have to be out longer.’”
Tagovailoa has made clear that he has no interest in retiring, and that never was a consideration after his Sept. 12 concussion. Ghajar said there would be no reason to retire after future concussions unless one of two things happened:
1). If symptoms simply never went away. (Tagovailoa said he did not experience symptoms since the day after the Sept. 12 concussion.)
“If you wanted evidence to keep a player out, if they have functional impairment -- can’t balance themselves, can’t follow things with their eyes, can’t make quick judgments -- if you are not getting back to your baseline, those would be” factors to keep a player sidelined, Ghajar said.
2). If brain imaging testing reveals something worrisome.
“You look at white matter in the brain,” Ghajar said. “You can’t do it early on because if you get swelling in those tracks, the white matter tracks look better than normal. You have to wait a week or two before doing it. If you do MRIs, and see structural damage, you could present that to the player and say it’s acute and maybe chronic and degeneration.”
Ghajar said an MRI “would show swelling, but the problem with swelling is unless you have a contusion, imaging would be normal for a concussion. And if you do see something, is it permanent or temporary? There’s no magic wand to say you have a brain injury.”
Ghajar said if a concussed player “had brain imaging signs of subdural hematomas -- a collection of blood on the outside of the brain that leak from blood vessels and push the brain in, between the skull, you would say that’s a good reason for retirement.
“But even with that, suppose he has a thin subdural and it goes away after a couple weeks and he scores well in all the tests and has a discussion with his neurologists and they decide everything is normal?”
That feeds into Ghajar’s point: None of this is black and white.
Ghajar, who started the Pac-12 Brain Trauma Task Force before 10 member schools left for other conferences, said one reason that respected neurologists can have different opinions about how long a concussed athlete should sit out is because so much about concussions remains a mystery.
“Concussions are not well defined,” he said. “There are 30 plus definitions for concussions. Some doctors will say ‘it’s not a concussion; it’s a neck whiplash.’ There’s no test to say without a doubt you shouldn’t play football anymore.”
There’s also no test to determine exactly how long a concussed athlete should sit out.
And that’s why multiple neurosurgeons interviewed by The Miami Herald can have dramatically different views about whether Tagovailoa needs to sit out a month or longer, or potentially much less, after future concussions.
This much is clear: The likelihood is that even after any future mild concussion, Tagovailoa will be put on ice for a while, out of an abundance of caution, his past history and fear something terrible could happen if he returns within a couple of weeks. But Ghajar is part of a minority who wonders if that’s really necessary.
This story was originally published November 19, 2024 at 2:22 PM.
