NFL will not mediate in Tua's potential return

As NFL officials touted a record low of preseason concussions Friday, they pledged that the league won’t impose an outcome for its most notable concussion patient.

Dolphins quarterback Tua Tagovailoa, who has been on injured reserve since Sept. 17 after suffering the third documented concussion of his pro career, is “seeing top experts” around the country, NFL chief medical officer Dr. Allen Sills told reporters during a conference call.

But other than enforcing the concussion protocol it administrates along with the NFL Players Association, Sills said the league will not have a role in determining when — or if — Tagovailoa returns to the field.

“Patient autonomy and medical decision-making really matters,” Sills said. “And I think that’s what we have to recognize goes on with our concussion protocol as well. Ultimately when patients make decisions about considering their careers, it has to reflect that autonomy that’s generated from discussions with medical experts giving them best medical advice.”

Sills, a neurosurgeon, added that there is no “detailed formula” that can predict the future risk of concussions for Tagovailoa or anyone else.

“It’s not like we can put in your number of concussions and how long between them and your age and some unusual constant or Avogadro’s number that always seemed to be in freshman chemistry somehow, and come up with a risk,” Sills said, speaking generally and not about Tagovailoa in particular. “It just doesn’t work that way. So what we end up having to do is look at the totality of the patient’s experience, how many concussions, the interval between those concussions, some about duration of symptoms after each concussion, and then very much the patient’s voice about where they are in their journey, their career, their age and things of that nature.

“And from that, we try as medical professionals to provide our best guess. But that’s really what it is, is a guess at what is someone’s future risk of concussion.”

Meanwhile, NFL players suffered 44 reported concussions this preseason, including practices and games. That represented a 25% drop from the same timeframe in 2023 and the lowest total since the league began collecting such data in 2015. For context, there were 91 reported preseason concussions in 2017.

Sills and Jeff Miller, the NFL’s executive vice president overseeing player health and safety, attributed the drop to a number of factors, including new rules and the ongoing adjustments to practice schedules.

But the introduction and eventual mandate of Guardian Caps helmet supplements, which must be worn in every practice by every player except quarterbacks and specialists, has been an “unqualified success,” Sills said.

The NFL first introduced Guardian Caps to lower the force transferred between players when there is contact involving at least one helmet. But the gradual mandate of use over the past two summers led to fewer concussions both times. In 2024, players were given a list of six top-performing helmets they could use that would exempt them from wearing Guardian Caps. Approximately 200 players tried those helmets, according to the league.

“I think both of those factors are contributing to the lower rates of injury that we’ve seen,” Sills said.

Players have the option of wearing Guardian Caps during games, and about 5-10 players per week have worn them. But Sills said there is not enough data about their performance in those situations to consider a mandate for games.

In other NFL health and safety news:

• The overall injury rate on kickoffs during preseason games dropped by 32% from 2023, a step toward achieving the league’s goal for redesigning the kickoff play this offseason. There were more concussions than expected, however. Miller said they totaled in the “low single digits.”

• There were no concussions on kickoffs during the first three weeks of the regular season, according to the league.