Dolphins coach Mike McDaniel got a little defensive Thursday night when asked if he was confident Tua Tagovailoa hadn’t suffered a concussion four days earlier against Buffalo.
“That’s why the NFL has these protocols,” McDaniel said shortly after a 27-15 loss to the Bengals. “It starts with your medical staff, but there’s independent specialists that look into it, too. There’s an independent specialist that specializes in the specialty of brain matter.
“You’re talking, I don’t know, 5-6 layers of a process and decision-making.”
But Tagovailoa’s frightening concussion Thursday night exposed a handful of significant flaws in the NFL’s protocols.
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Those independent brain specialists McDaniel speaks of? They don’t have final authority to diagnose concussions.
Those 5-6 layers of protection? It really comes down to one person. And that person often isn’t a neurological expert.
The Dolphins and the NFL are adamant that they strictly followed the league’s protocols last Sunday against the Bills, and that Tagovailoa suffered only a back injury.
But it was shocking to see Tagovailoa return to the game after everyone saw him get slammed to the ground and then wobble while trying to stand. And it was jarring to then see Tagovailoa taken off the field on a backboard Thursday night after getting his head slammed to the turf.
The NFL Players Association is investigating whether the Dolphins properly followed the protocols last Sunday. Thursday night, NFLPA executive director DeMaurice Smith vowed to “pursue every legal option” in investigating Tagovailoa’s situation. But the real issue may be the concussion protocols themselves, which were last agreed upon by the NFL and NFLPA in July 2020.
“To the letter of the protocols, they probably did what they were supposed to do,” said Brad Sohn, a South Florida attorney who represented hundreds of former players as part of the NFL’s multibillion-dollar concussion settlement in 2017. “But the question is why have a policy if it lacks impact?”
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Tagovailoa’s situation shined a glaring light on at least three flaws with the protocol:
1. The final diagnosis of a concussion is not always made by a brain expert.
At every NFL game, there is an unaffiliated neurotrauma consultant (UNC) on each sideline, plus one in the instant replay booth; two athletic trainers serving as concussion spotters; and upward of two dozen medical professionals on hand who can help spot concussions.
But the protocol is clear that the head team physician is in charge of determining whether a player has suffered a concussion:
“For the avoidance of doubt, the responsibility for the diagnosis of concussion and the decision to return a player to a game remain exclusively within the professional judgment of the Head Team Physician or the Club physician designated as responsible for the diagnosis and management of concussion.” (Emphasis mine.)
In this case, the Dolphins’ head physician is Dr. John Uribe — a respected orthopedic surgeon, but not a neurologist.
An NFL spokesman said Friday, “Either the team medical staff or the UNC can rule out a player following an evaluation.”
But the policy states that if there is a disagreement over whether a player has a concussion, the most a UNC can do is “explain the basis of his/her opinion. This will be discussed in a collegial fashion in private as to why the player should or should not be returned to the game. The team physician will communicate his final decision to the player.”
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The policy is clear: The team doctor, not any of the unaffiliated brain experts, makes the final call.
2. “Gross motor instability” isn’t an automatic no-go.
The protocol identifies four symptoms that, if shown by a player, “the player shall be considered to have suffered a concussion and may not return to participation on the same day under any circumstances.”
One of those four symptoms has a loophole (emphasis again mine):
1. Loss of consciousness
2. Confusion
3. Amnesia
4. Gross Motor Instability (identified in the judgment of the club medical staff in consultation with the sideline UNC, who observe the player’s behavior, have access to the player’s relevant history, and are able to rule out an orthopedic cause for any observed instability).
In Tagovailoa’s case, Uribe and the UNCs determined that his wobble last Sunday was the result of a back injury, not a concussion.
Uribe’s diagnosis was made in conjunction with the UNC, and Uribe doesn’t deserve to have his character impugned. But the Dolphins and the NFL should still be more transparent about how everyone came to the decision that Tagovailoa had only a back injury and not a concussion. The Dolphins did not respond Friday to a request for comment from Uribe.
The NFL and NFLPA also would be wise to do away with the loophole and make “gross motor instability” an automatic no-go for the rest of the day.
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3. The “return to play” protocols don’t apply in this situation.
The NFL has a lengthy protocol regarding the return to participating following a concussion. The problem is, it only applies to players who are officially diagnosed with a concussion.
The NFL has nothing on the books about players who are checked for concussions, deemed OK, and sent back out to the sideline. Tagovailoa missed just three snaps against the Bills.
It’s certainly possible that Tagovailoa only had a back injury last Sunday and not a concussion. But the protocol is still set up where the player and team physician have the most say over a concussion diagnosis.
Whether or not the Dolphins did everything properly, this episode exposes several ways players and teams can get around the concussion protocol.
“There has to be a system with a lot of checks in it, is the bottom line,” Sohn said. “You certainly need to be erring more on the side of caution than you are right now.”
HEALTHY STATS
New coach has brought about a new Tagovailoa
Thankfully, Tua Tagovailoa appears to have avoided serious short-term injury. He was cleared by medical staff to fly home with the team (although that’s another decision that deserves more transparency), and he didn’t appear to suffer any injuries beyond the concussion.
Hopefully Tagovailoa feels 100 percent soon and can get back to football, because he’s having a terrific start to the 2022 season. Through four games, Tagovailoa ranks third among QBs in passer rating (109.9), is completing an impressive 69.6 percent of passes, has eight touchdown passes against three interceptions, and is averaging a fantastic 9.0 yards per attempt. Most notably, the Dolphins are 3-1 and still in good position in the AFC despite Thursday’s tough loss at Cincinnati.
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Former Dolphins quarterback Ryan Fitzpatrick, who was with Tagovailoa during his 2020 rookie season, said Tagovailoa is blossoming under the positive reinforcement from Mike McDaniel. Left unsaid is that former head coach Brian Flores was often tough on Tagovailoa and didn’t seem to support him. Flores and Tagovailoa reportedly got into a shouting match during halftime of a loss to the Titans last season.
“I think maybe the way he’s being coached right now and the confidence from interactions is the big thing in his development,” Fitzpatrick, now an analyst with Amazon Prime, said before Thursday’s game. “Tua, from the second he stepped on the field at Alabama, has had more pressure [than] any quarterback ever with the scrutiny and success right away. That doesn’t need to be manufactured for him. He’s played in big games with the weight of an entire team on him, and he’s performed.”
Fitzpatrick added: “I don’t think it hurts having Tyreek Hill.”
ETC.
Sorrows come for McDaniels in battalions
Josh McDaniels’s Raiders will have 13 games left on the schedule after this Sunday, so in the literal sense, there is still plenty of season ahead. But at 0-3, their playoff hopes are already on life support. Since the NFL expanded the playoffs in 1990, only 4 of 157 teams that started 0-3 ended up making the playoffs.
And if the Raiders fall to 0-4 this Sunday, their season is basically over. Since 1990, only 1 of 103 teams to start 0-4 has reached the playoffs (the 1992 Chargers).
And wouldn’t you know it, but guess who is coming to Las Vegas on Sunday? The Denver Broncos, who once employed McDaniels as their head coach for two mostly-disastrous seasons.
The story lines in Sunday’s game are almost Shakespearean: McDaniels can get his first win as Raiders coach against his hated former team . . . or the Broncos can put the dagger in their former coach-turned-hated rival.
McDaniels knows he needs a win Sunday, but is trying to stay level-headed about it.
“We know we can make better progress here as we go forward. And we know we need to do it quickly,” he said.
It’s already playoff season
The opening month of the NFL season plays a fairly significant factor in determining the playoff field.
Here is how teams have fared dating to 1990, when the playoffs were expanded to 12 teams (and since expanded to 14 in 2020):
▪ 3-0 start: 74 percent made the playoffs (119 of 160 teams). But a hot start didn’t result in a playoff spot for the 2021 Broncos, 2019 Cowboys and Rams, 2018 Dolphins, or four teams in 2016.
▪ 2-1 start: 54 percent made the playoffs (181 of 334 teams). The best finish in the regular season was 15-1 by the 2004 Steelers.
▪ 1-2 start: 25 percent made the playoffs (84 of 334 teams). The best regular-season finish was 13-3 by the 2012 Broncos, while the 1993 Cowboys, 2001 and 2018 Patriots, and 2007 Giants won the Super Bowl.
▪ 0-3 start: 2.5 percent made the playoffs (4 of 157). The 1992 Chargers, 1995 Lions, 1998 Bills, and 2018 Texans pulled it off. The Chargers and Texans even finished 11-5. But none of the four teams won a playoff game.
As for this year’s 0-2-1 Texans and 1-1-1 Colts, none of the seven previous teams that began the season with those records reached the postseason.
Shanahan, Garoppolo stuck with each other
San Francisco 49ers coach Kyle Shanahan and quarterback Jimmy Garoppolo have said the right things. But there’s five years of history in the relationship, and it can’t be erased.
The harsh reality is that Shanahan has felt limited by Garoppolo and tried his best to move on to a different quarterback. But here Shanahan is, four weeks into 2022, still tied to Garoppolo as his starting quarterback after Trey Lance got hurt.
It makes for a fascinating, powder keg of a situation, with Garoppolo appreciative of the opportunity he’s getting, but fully aware that he’s not the quarterback Shanahan truly wants.
Last week, a clip circulated on social media of Garoppolo coming off the field in Denver in disgust. Thousands of amateur lip readers surmised that Garoppolo surmised, “All your plays suck.”
“The clip to me is a joke, so I can’t believe we’re talking about it,” Shanahan said. “I’m pretty sure that’s not what he said, but we were extremely frustrated from the whole game.”
But don’t be too surprised if we see a lot more frustration play out publicly between Shanahan and Garoppolo this season.
The more you know . . .
All head coaches need good people around them — Bill Belichick probably wouldn’t have won six Super Bowls without Ernie Adams crunching the numbers and giving him advice from the press box.
So the news two weeks ago wasn’t surprising that Broncos coach Nathaniel Hackett was hiring longtime coach Jerry Rosburg as a senior assistant to help him with game management decisions. But the fact that Hackett didn’t realize until Week 3 that he would need analytical help on game day was, frankly, pretty embarrassing. It doesn’t help the impression that he’s in over his head.
Even worse, Hackett, Rosburg, and the Broncos still got it wrong in the Broncos’ ugly 11-10 win over the 49ers last week. After the game, Hackett praised Rosburg for persuading him to punt on fourth and inches, trailing 10-5 early in the fourth quarter. But going for it was the better decision, per NFL Next Gen Stats, by 4.8 percent win probability.
Per Next Gen, the Broncos have gotten just 1 of 7 calls right between going for it or kicking, costing themselves 31.5 percent of win probability this season. They are 2-1, but their coaching decisions are holding them back.
Extra points
Lamar Jackson is off to an incredible start, winning AFC Offensive Player of the Month after accounting for 12 touchdowns in three games and ranking first in the NFL with a ridiculous 9.35 yards per carry. He is theoretically earning himself a lot of money on his next contract, but perhaps not. Though he will be a free agent after this season, the Ravens can elect to go the franchise tag route, which is estimated to pay Jackson $45 million in 2023 and $55 million in 2024. The franchise tag is one of the greatest tools NFL teams have in suppressing the salaries of superstar players, and could prevent Jackson from truly reaching his full market value for another two years. It would never happen, but it would be fascinating if Jackson decided to just stop playing right now until the Ravens gave him a new contract. He has proven that he is an elite quarterback, he can only hurt himself with an injury or poor play, and an in-season holdout now could be his only defense against the franchise tag . . . The 1-2 Cardinals are certainly looking for a faster start Sunday at Carolina. They are the only team not to have scored a point in the first quarter, and their minus-31 point differential in the first quarter is worst in the NFL by 13 points . . . Aaron Rodgers needs two touchdown passes to reach 500 in his career, including postseason. And Travis Kelce is 51 receiving yards from breaking Rob Gronkowski’s career mark of 9,286, fifth most all time among tight ends . . . The NFL’s Defensive Rookie of the Month for September was Jaguars linebacker Devin Lloyd. The Jaguars traded up to No. 27 to draft Lloyd because they believed the Patriots were going to take him at No. 29. The Patriots then drafted guard Cole Strange . . . The most important news is that Browns star pass rusher Myles Garrett is OK after flipping his Porsche in a one-car wreck last week. But hopefully this is the incident that finally scares Garrett into driving safely. Garrett, who suffered injuries to his shoulder and biceps and a burst blood vessel in his eye, had at least five previous speeding citations, per Cleveland.com, and last year was cited for speeding 120 miles per hour and 99 m.p.h. on consecutive days. “I’m grateful to be here,” Garrett said Friday. “From what I saw right after, the pictures . . . it was a hell of an event.”
Ben Volin can be reached at ben.volin@globe.com.