Concussion concerns remain for Miami QB Tua Tagovailoa

IT WAS GETTING late the night of Sept. 12, and Dr. Julian Bailes had settled in to watch a little football. The renowned neurosurgeon and concussions expert tuned in just as Miami Dolphins quarterback Tua Tagovailoa sustained yet another head injury.

There was Tagovailoa, lying on the ground with his arms outstretched and his fingers curled into the fencing response, an involuntary position that occurs after a brain injury. To Bailes, it looked almost like a replay from a previous Thursday night game, Sept. 29, 2022, with Tagovailoa on his back, his fingers splayed in front of his face in another automatic response to a concussion.

Bailes was one of the doctors the Dolphins consulted during Tagovailoa’s string of concussions two years ago, and the quarterback eventually sat out the rest of the season after suffering another one in a Christmas Day game against Green Bay.

“Why do you think we’re back here in the same situation two years later?” Bailes said. “It’s the style of play for him. He stuck his head in there and he’s not afraid and he’s a great athlete and he wanted to get a few more yards. He stuck his head in there without thinking in that split second.

“So, that’s a big part of why we’re back again. Same guy, same susceptibility and same style of play.”

Tagovailoa is a high-profile quarterback who has now sustained three diagnosed concussions over the span of two years, plus another head injury that prompted the NFL to change its concussion policy. So, naturally, Tagovailoa’s health and playing future have been among the most heavily scrutinized stories in the NFL this season.

Pundits have discussed how many concussions are too many; TV analysts and social media types implored Tagovailoa to retire; and South Floridians held their collective breath as Dolphins coach Mike McDaniel delivered updates in the weeks since Tagovailoa was placed on injured reserve.

When Tagovailoa addressed reporters’ questions Monday, the matter appeared to be settled. He plans to return to practice Wednesday with the hope of being cleared to play Sunday against the Arizona Cardinals. And he firmly stated he would not wear a Guardian Cap for additional head protection, saying that’s his “personal choice.”

“I love this game, and I love it to the death of me,” Tagovailoa said. “… For me, this is what I love to do. This is what makes me happy, and I’m going to do it.”

Tagovailoa said he has been symptom-free since the day after the Sept. 12 game against the Buffalo Bills and has been cleared by doctors to resume playing.

He said he has no plans to retire. It has never been an option for him.

Bailes, a system physician executive in neurosurgery with Endeavor Health in the Chicago area, was not one of the independent doctors consulting Tagovailoa this time. But he does have concerns about Tagovailoa’s intent to play this season.

“The biggest question is, does he need a prolonged period of rest?” Bailes said. “That’s No. 1, which would mean probably not returning this year.

“If you have three or more concussions in a finite period of time, then that’s consideration for pause. … I’m sure he and his advisers are going to make whatever decision they make, but you have to be concerned.”

ESPN spoke with concussion experts and former NFL athletes who have grappled with head-injury issues, and none of those interviewed the past few weeks said definitively that Tagovailoa should retire. That decision is nuanced, with no hard-and-fast guidelines to determine which concussed athletes can continue their careers and which ones should quit playing football.

But when it comes to Tagovailoa, everyone has an opinion.

IN MANY MODERN-DAY events, perceptions shift within a modicum of time. The declarations were swift in the hours after Tagovailoa’s concussion on Sept. 12, with passionate pleas for him to retire. On Hall of Famer Shannon Sharpe’s account on X, a post said that he hoped the quarterback was OK but that “he’s gotta seriously think about shutting it dwn … His concussions are getting worse and worse and he’s a young man with his entire life ahead of him.”

A post on ex-Cowboys receiver Dez Bryant’s account read:

“That’s it….

“NFL go ahead and do the right thing

“Tua has had entirely way too many concussions

“He need to retire for his longevity health concerns”

A day after Tagovailoa’s most recent concussion, a current NFL coach — a former linebacker, no less — told reporters he thought Tagovailoa should retire.

“It’s not worth it,” Las Vegas Raiders coach Antonio Pierce said. “I haven’t witnessed anything like I’ve seen that’s happened to him three times. Scary. You can see right away the players’ faces on the field. You can see the sense of urgency from everybody to get Tua help.”

Six weeks later, Tagovailoa is still the center of the NFL’s attention, but now that his return appears inevitable, the questions are shifting: Can he save the Dolphins’ season and protect himself?

Tagovailoa has become a modern-day avatar for the brutality of football. He was projected to be the No. 1 pick in the 2020 draft, part of the NFL’s next generation of dominant quarterbacks. He had ankle surgery in his final season at Alabama in 2019, and that was the least of his problems. He returned three weeks later and, in his second game back, was leading his team to a blowout victory over Mississippi State but wanted to keep playing.

Right before he was to be pulled, two defenders came up from behind and sacked him. His helmet spun off, his nose was bloodied and Tagovailoa had to be helped off the field. He suffered a dislocated hip, a fractured posterior wall, a broken nose and a concussion. Six months later, the Dolphins selected him with the fifth pick of the 2020 draft.

He broke several ribs in 2021 and was carted off the field. His head-injury issues in the NFL started in the third game of the 2022 season. In a game against Buffalo, Tagovailoa’s head bounced off the ground after he was pushed, and he shook his head as he got up, then stumbled and had to have two teammates prop him up. But Tagovailoa was listed with a back injury and returned in the second half.

Four days later, in Cincinnati, Tagovailoa was knocked unconscious and stretchered off the field. He was undeterred. Each of his three head injuries in 2022 was the result of him falling and hitting the back of his head, so Tagovailoa spent that offseason training in jiu-jitsu so he could learn a safer way to fall to lessen his risk of another concussion. And he went concussion-free in 2023, leading the NFL in passing yards.

Vinny Passas, Tagovailoa’s high school quarterback coach, said Tagovailoa has a high threshold for pain. “He’s 10.5 on a scale of 1 to 10,” he said.

He also knows Tagovailoa’s intense desire not to let anyone down.

“It’s just that competitive spirit in him and his obligation he feels to his team,” Passas said. “Because in football, they all work hard together and you get this bond that you establish with everyone where it becomes family. Tua is a big family guy, and he never, ever wanted to disappoint his family.”

Passas said he cried and prayed during that Thursday night game last month, waiting for any updates after the commercial break, which seemed to take hours. Passas now trains younger children to play the position, and in the past two years since Tagovailoa’s concussion struggles, parents of course have asked him about Tagovailoa. He hopes the man he calls a “brother” eventually will have some kind of clarity.

“Sometimes I just hope that he reconsiders thinking about his future,” Passas said. “Now that he has a boy and a girl and a wife. It’s not like high school [when] you can just go home to Mommy and Dad. … I just think he has so much more to offer, not only to his family but the people around him.

“He believes that God has a path for him, and I’m just going to believe in what path God has for him. That’s what I pray for is that God has the right path for him and sends him in the right direction.”

DR. DAN DANESHVAR, chief of the division of brain injury rehabilitation at Harvard Medical School, said he never officially clears a concussed athlete who participates in contact sports. He approaches it as a conversation about risk.

If a person is cleared, he said, they might think they’re completely fine to go back and engage in the high-risk activities that prompted the concussion. Some athletes, Daneshvar said, are never completely back to normal after a brain injury. There is always risk, he said, because every brain is different.

“We know that hits to the head, getting hit in the head a lot, is not good for you,” he said. “But if someone’s completely back to their baseline in terms of symptoms, then they’re more likely to get back toward that green[-light] side.

“Now, for someone like, like Tua — I’ve never evaluated him, so I can’t say for sure what’s going on with him, his brain and him overall in terms of his recovery — but with someone who it appears with hits that are associated with less and less force or higher frequency is getting symptomatic head impacts, is getting concussions in response to these lower-force hits, that makes me think that they might never get back to that green level where there’s going to be low risk for future problems. And that’s kind of how I approach conversations with the athletes.”

CTE is the pall looming over tackle football, but concussions, Daneshvar and Bailes said, are just part of the overall picture, a sliver of the total amount of brain injury an athlete has experienced.

Junior Seau and Mike Webster, former NFL stars who were found to have CTE (chronic traumatic encephalopathy) after their deaths, had no reported concussions in their careers.

Daneshvar said helmet-sensor studies have shown that on average, a college offensive lineman diagnosed with one concussion probably has experienced more than 300 hits to the head that were the same force or greater than the one that gave him the concussion. All of those hits, he said, are what increase the risk of CTE.

Bailes, who has served on concussion committees from Pop Warner football to the pros, said that, in his three decades of work, he has been tasked with telling more than 100 football players they needed to retire. He bases that decision on factors such as how old the player is, how long they’ve been playing, what position they played and their style of play.

Quarterbacks, for example, aren’t susceptible to as many repetitive blows to the head as a lineman. But Tagovailoa’s calculus is adjusted by the way he plays. “Instead of sliding,” Bailes said of the latest concussion, “he went headfirst … and his neck flexed to the side kind of violently.

“So that style of play, the total number of concussions, that doesn’t tell the entire tale because it’s a bit of a surrogate of the exposure they’ve had.”

He weighs personal circumstances and the wishes of the family. He weighs the risk-reward benefits, especially with younger people who have smaller bodies.

“I have made many high school players who are 130 pounds with long skinny necks retire,” he said. “What more do they have to gain by playing monetarily? [Can they] make a career, make a name for themselves, get a college scholarship and maybe that’s their only way out sort of thing. … With a knee injury, maybe it’s more straightforward. With the brain, there’s a lot of factors to consider.”

DEEP IN JT DANIELS’ Instagram is a photo of him with Tagovailoa when they were high schoolers playing 7-on-7 football together. They once had similar dreams of being NFL quarterbacks, and Daniels’ journey took him from USC to Georgia to West Virginia to Rice. Now he’s retired from football because of concussions.

His decision to let go came in a doctor’s office in Houston late last year. Daniels had suffered what he believed to be his fourth concussion in November 2023. It wasn’t even from a big hit, he said. Daniels was sacked and came up feeling a bit dizzy, but he had felt that way after hits before and not been concussed. So he kept playing, but “wasn’t in the best of head spaces.” He remembers getting hit again — on second down, he thinks — and at some point was living that old battered quarterback saying: If you’re seeing triple, throw it to the guy in the middle.

He threw a touchdown on third down at the end of the first half. And that was it. The training staff saw him walking awkwardly, he said, then noticed that his eyes “weren’t adjusting.” He was pulled into the training room, was ruled out for the second half and began to feel progressively worse in the days that followed.

Weeks later, his eyesight was still so bad that he had to arrange a ride to see his doctor at the Houston Medical Center. He had been staying indoors mostly, because when he’d see something moving too fast, he’d get a sharp head pain. The loss of visual acuity was causing him to sometimes see one picture in his right eye and a different one in the left.

It wasn’t the first time he had kept playing after a concussion. In high school, Daniels said, he got “knocked loose” early in a game and played all four quarters. That concussion forced him into a dark room for a few weeks.

The worst concussion he ever had was when he was in a game against Utah, he said. Daniels said he had more memory issues with that one.

Doctors would tell him there were risks if he kept playing, but after each concussion, his recovery seemed to take longer and the symptoms were more pronounced. The vision problems this past winter were jarring. “When you literally need someone to come pick you up every single day or you have to Uber everywhere … that alone is a pretty big deal,” he said.

So he asked his doctor what he should do, if he should keep going. He said the recommendation was a “strong no.”

Daniels said his symptoms have abated and his vision is back to normal. He is now a graduate assistant at the University of West Georgia, but there’s still a natural void.

“I played football pretty much every month of the year since I was 5 years old,” Daniels said. “It was hard for my mom and dad. This is the first year they didn’t watch me play football, and my grandpa as well. We talk all the time about it.

“There’s definitely a level of sadness. There is absolutely a level of relief. Everyone that goes on the field, at least to some extent, acknowledges the potential significant harm that could come across you. And for most people, that’ll never happen, right?”

IN 2012, WHEN more than 1,000 former NFL players sued the league for failing to protect them from head injuries, Dominic Raiola was asked whether someday he would do the same. Raiola, then a longtime center for the Detroit Lions, said he couldn’t imagine himself at 40, in a rocking chair, pondering suing the NFL.

“I have so much fun playing the game, I really don’t worry about it,” Raiola said then. “It’s common knowledge that people are going to suffer. Memory loss is going to come. You’re hitting every time you step on the field. I am ready for it. It’s worth it — totally worth it. This is the best job in the world. I would never trade it for anything.”

Raiola is 45 and retired now. In an interview with ESPN earlier this month, he said he remembered one concussion in his 13-year NFL career. It was in a game against Arizona. He played the whole fourth quarter with it. Raiola watched film of the game later, and the average person would never know he was concussed.

But after the game he kept asking for teammate Kyle Vanden Bosch, who wasn’t around because he was on injured reserve with a torn ACL. He also had to call his neighbor to give him a ride home because he couldn’t drive.

“To me it was part of the game,” Raiola said. “You can call it ignorance; you can call it what you want. But I guess I was never going to blame the NFL. Or blame concussions.”

He said nowadays, he probably wouldn’t have gotten through that last quarter because of the expanded coverage of the NFL and all the eyes that are on the game. Raiola said that he thought that was a good thing but that he probably wouldn’t change anything he did.

Raiola, who went to the same high school as Tagovailoa — St. Louis High in Honolulu — said football was a way to provide for his family. He was good at it and did everything he could to be the best at it, so that’s what he did.

He said his mind still feels sharp. There are moments when he forgets something, but he doesn’t think that has as much to do with concussions as it does with being 45.

“There might be a day where I don’t know where this thing could go,” he said. “But I do think you got to take care of yourself. You got to be healthy, you got to be active. You do the things that keep you moving. My kids tease me all the time about lifting weights, and I got to get my farmer’s walk in every day.

“I’m going to run this race until the wheels fall off. That doesn’t mean being reckless. It just means to keep going.”

Raiola said Tagovailoa’s recent concussion gave him pause. Raiola has two sons who are quarterbacks. Dylan, a freshman, starts for Nebraska, Dominic’s alma mater, and Dayton is a junior at Buford High in Georgia.

He says he thinks about the health of his sons both on the field and when their playing careers are over. He’d never ask them to tough it out; he said that’s not his race to run. He said the family dealt with concussions with daughter Taylor, a former outside hitter for the TCU volleyball team. She suffered two of them.

Raiola said he was thankful his sons aren’t run-first quarterbacks. He tells his sons to build up their neck muscles the way he did in college and the NFL. That, he believed, helped sustain him through his career. And Daneshvar said there were some studies that suggest stronger neck muscles might help decrease the force of a head injury.

Still, Raiola will worry like any other parent.

“There’s going to be a time when they go get that first down, and it’s scary,” he said.

“I’d be lying to you if I didn’t say it was scary watching [Tua], especially because it’s his third one. But man, if he’s going to take the necessary steps to make a return, I admire that too.”

FORMER MIAMI DOLPHINS quarterback Don Strock says he figures he had four major concussions during a 15-year NFL career that included backing up Bob Griese and Dan Marino. Unlike Tagovailoa, the violent hits Strock suffered did not play out in front of millions in Thursday night showcase games.

In Strock’s day, the concussion protocol went something like this: A trainer would come and wave a finger in front of his eyes. He’d administer some smelling salts and ask Strock how he was feeling.

“I think I can still go,” Strock would say.

Strock is 73 and still lives in South Florida. He said he’s doing OK all these years later. But he attends Dolphins reunions and notices some of his former teammates who aren’t the same.

“They keep saying that concussions are down,” he said. “That’s what I keep reading in the newspaper. But it’s a physical game. It’s going to happen every game at some point.”

A few months ago, Strock said the excitement in South Florida was palpable. The Dolphins, who have been searching for a franchise quarterback since Marino retired in 2000, were coming off another playoff season, and this time, their quarterback was healthy.

Over the summer, Miami signed Tagovailoa to a four-year, $212.1 million contract extension. Shortly after that, the Dolphins extended McDaniel, too.

A few months later, the mood is different.

“There’s an uneasiness down here right now,” Strock said.

He’s not sure he would play again if he were Tagovailoa. Strock remembers that concussion, hip injury and broken nose Tagovailoa sustained at Alabama. He says he thinks about what has happened to the quarterback since then.

“It’s going to be a call for him and his family,” Strock said. “I have a good idea of what my wife would say.”