Experts Explain Football Players' Scary 'Fencing Response' After Big Hits
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AFTER MIAMI DOLPHINS quarterback Tua Tagovailoa took a sack from the Cincinnati Bengals' lineman Josh Tupou during the 2022 season, Tagovailoa raised his hands before his face mask and appeared to stiffen his fingers.
It was a gruesome moment for anyone watching the game—and quite possibly the first time you may have witnessed what experts refer to as "fencing response."
The same thing happened to Los Angeles Chargers tight end Donald Parham the season prior. In both instances, experts say the NFL players were exhibiting fencing response, a reflex that can occur after a head injury.
“It is widely believed that an observed fencing response is associated with brain injury,” says April Krowel, Ph.D., a licensed clinical neuropsychologist at The Brain Center. “And, this could be experienced whether it’s the first or fifth time.”
Tagovailoa was later diagnosed with a concussion. His display of the fencing response followed another incident a few days earlier where Tagovailoa was hit on the back of the head during a game and was evaluated for a concussion but returned to the field. NFL guidelines don’t specify a timeframe for recovery and returning to a game following a concussion.
Repeated head injuries, often experienced by football players, boxers, and other athletes, can cause long-term problems, such as concentration and memory issues, mental health conditions, headaches, physical impairments, and an increased risk for dementia.
The injuries might also cause chronic traumatic encephalopathy (CTE), a brain disease that’s tied to certain changes in the brain and can only be diagnosed after death, according to the Centers for Disease Control and Prevention. Demaryius Thomas, a former NFL player who died in 2021 at age 33, reportedly had CTE.
Multiple head injuries that occur close together can potentially cause second impact syndrome (SIS), also known as repetitive head injury syndrome. It refers to situations where someone sustains a second brain injury before recovering from the first, says Rami Hashish, Ph.D., DPT, founder of the National Biomechanics Institute. “While SIS is commonly a fatal condition, even when it’s not, it’s thought to result in long-term impairments or disability.”
Here’s a closer look at the fencing response and the signs of a concussion.
What Is the Fencing Response?
The technical term for the fencing response is Asymmetric Tonic Neck Reflex (ATNR). It’s a “primitive reflex” in babies that’s part of the development of muscle tone, hand-eye coordination, and one-sided body movements, Krowel says. It usually stops after a baby reaches about four months old.
“The reflex can also be activated after significant force is applied to the brain,” says Hashish, adding that the term “fencing response” is used because the position mimics the position of a fencer. “One arm is flexed, the other arm is extended, and the head is turned towards the extended arm.”
It’s believed that the fencing response is triggered in brain injuries that result in soft brain tissue hitting the skull’s hard bone, Krowel says. “This causes bruising of the gray matter and temporarily shuts down higher brain functioning as the brainstem takes over.”
This can result in the unnatural position of the arms, which usually lasts for a few seconds after the impact, she says.
What the Fencing Response Tells Doctors About a Head Injury
Concussions can’t be visualized on MRI or CT scans, so doctors use a variety of indicators and symptoms to diagnose them. The fencing response is one of these indicators, Hashish says.
Doctors diagnose concussions by evaluating vision, reflexes, coordination, balance, memory, the ability to recall information, and observation, according to the Mayo Clinic. Imaging tests, like a CT scan, may be used if doctors suspect that the injury has caused bleeding or swelling in the skull.
“Research has determined that the fencing response is an overt indicator that a brain injury has occurred and it is believed to be a worse injury compared to times when there is no fencing response,” Krowel says.
One animal study showed that the fencing response occurred in 66 percent of head injuries and that the response signaled a moderate brain injury, rather than a mild one, even if a mild concussion makes someone lose consciousness.
Signs You Might Have a Concussion
It’s estimated that up to 3.8 million sports-related concussions happen in the U.S. every year. Concussions are caused by blows to the head, a fall, or a violent shaking of the head and upper body. According to the Mayo Clinic, concussions can affect brain function and cause a variety of symptoms, including:
Headache
Ringing in the ears
Nausea and vomiting
Burred vision
Confusion
Memory loss
Dizziness
Loss of consciousness
Slurred speech
Forgetfulness
Dazed appearance
They can also lead to anxiety, depression, irritability, and sleep problems, Krowel says. Someone might display the fencing response momentarily right after the impact to the head.
Concussion symptoms can be subtle and may resolve within a few hours or days, which makes diagnosing the injury difficult. And, just because someone doesn’t show symptoms doesn’t mean the brain has fully covered, Hashish says.
“Understanding of brain injury is still developing,” he says. “So, because there is this somewhat incomplete understanding, it’s better to be safe than sorry and not risk someone’s life or livelihood over a game or two.”
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