Tua Tagovailoa’s Injury Exposes The NFL’s Priorities

Tua Tagovailoa in the huddle before the NFL game against the Cincinnati Bengals

Miami Dolphins quarterback Tua Tagovailoa leads the huddle before the NFL game against the Cincinnati Bengals on Sept. 29, 2022, in Cincinnati.

Miami Dolphins / AP
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The nightmare scenario played out in slow motion, to an audience of millions. On Sept. 25, after 24-year-old Miami Dolphins quarterback Tua Tagovailoa’s head hit the ground hard on a tackle, he seemed unable to walk straight. Tagovailoa returned to the game after a brief medical evaluation and led his team to victory. Afterward, Dolphins coach Mike McDaniel told reporters that “his legs got wobbly because his back was loose,” an explanation Tagovailoa himself also gave in his postgame press conference. The claim was met with widespread skepticism across the TV shows, podcasts, and Twitter threads making up the sports-talk ecosystem. Chris Nowinski, a former college football player and founder of advocacy group the Concussion Legacy Foundation, called on the Dolphins to keep Tagovailoa out of the next Dolphins game four days later.

“If Tua takes the field tonight, it's a massive step back for #concussion care in the NFL,” tweeted Nowinski. “If he has a 2nd concussion that destroys his season or career, everyone involved will be sued & should lose their jobs, coaches included. We all saw it, even they must know this isn't right.”

But on Thursday, there was Tagovailoa, on the field for a game against the Cincinnati Bengals. A league spokesperson told reporters that “every indication from our perspective” showed that Tagovailoa had passed the required concussion protocol, an assessment overseen by union-appointed and team-employed physicians. The NFL Players Association has since terminated the doctor who handled Tagovailoa’s diagnosis Sunday, according to NFL Network reporter Tom Pelissero.

In the second quarter, as Tagovailoa scanned the field for a receiver, a defender grabbed him and threw him down. His head smacked the ground hard, again. A camera close-up captured the terrifying sight that followed: His body seized up, arms bent stiff and fingers flexed and twisted in what medical professionals call a “fencing response,” a sign of a brain injury. He was carried off on a stretcher and shuttled to the hospital, seemingly felled by the sort of repetitive brain trauma the NFL claims it is trying to limit.

What happened to Tagovailoa seems to have violated the tacit agreement that upholds the sport’s tenuous place as America’s national pastime.

Outrage echoed across the football world — near universal condemnation that reflected a cultural shift that has been sweeping the sport in recent years. As scientific research has revealed the game’s true cost to its players’ health, fans have had to reckon with the guilt of knowing that the violence they continue to cheer on is ruining lives. What happened to Tagovailoa seems to have violated the tacit agreement that upholds the sport’s tenuous place as America’s national pastime: an unspoken acknowledgment that while football’s dangers can never be eliminated, viewers can at least trust that the most extreme risks have been mitigated.

A decade ago, football faced an existential crisis. In 2011, thousands of retired players filed a class action lawsuit claiming that the NFL was responsible for their brain injuries — the two sides would reach a $765 million settlement. Youth participation then declined for the first time in history as more parents sought to keep their kids out of the game. Politicians in some states proposed bills banning the sport before high school, although none passed. Television ratings for NFL games dipped. A growing number of players, including a few stars, announced retirements in the prime of their careers, some citing concerns over health risks. In a book I wrote about football around that time, I wondered aloud whether football’s place as America’s most popular sport was in jeopardy.

But the sport withstood those years of reckoning. Today, it remains as popular as it’s ever been and has even grown more profitable — last year, the league secured an 11-year, $11 billion deal with Amazon for the rights to broadcast its weekly Thursday night game, a recent addition to the NFL schedule that many players opposed. When I started watching football in the ’90s, games only took place on Sunday or Monday, guaranteeing players at least five or six days of rest. Adding an additional game day to the calendar gave the NFL another package to sell at the expense of player recovery time. That Tagovailoa’s injury happened on just three days of rest underscores who bears the cost as the league profits.

The NFL’s response to concerns over head injuries has helped it regain lost ground by showing its capacity to evolve beyond its traditional standards for violence. It has adopted rules aimed at reducing the game’s most brutal collisions and protecting players who show symptoms of brain trauma. Certain hits that target a player’s head are now penalized. When a player appears to suffer a brain injury, the concussion protocol, now a feature of the game at every level, authorizes an independent third-party physician to issue the diagnosis rather than the team doctors, who had previously been in charge of the decision and might feel pressure to keep a player in a game.

Now anxious fans watch players step into a tent on the sideline to undergo the approximately 20-minute evaluation that will determine whether they will be allowed to return to the game. Those deemed to be concussed are barred from participation until they pass a neurological exam. The process is intended to eliminate the possibility of “second impact syndrome,” which can occur when a person suffers a concussion before having healed from a previous concussion, and carries the risk of permanent brain damage or death. That Tagovailoa was ruled fit to play has drawn fresh scrutiny of current standards and whether they are strict enough to prevent players from facing unnecessary danger.

Even beyond this case, though, the scientists who research football collisions have warned that these new policies do little to reduce the primary cause of the long-term degenerative brain damage that scores of former players have experienced: an accumulation of subconcussive hits, unavoidable in a sport that fundamentally involves moving and toppling bodies through force.

Remaining a fan, therefore, has required a moral compromise. I accept that the players face an unavoidable risk — but with certain conditions. I can tell myself that, at least, these athletes know what they are getting into, and can opt out if they determine that the physical risks outweigh the financial rewards. I can find comfort in seeing how much the game has changed over the last two decades, with the most vicious hits becoming rarer, replaced by an increasing emphasis on the game’s finesse elements, including speed, anticipation, and ball-hawking skills. I can appreciate that norms are shifting, that a head injury now draws a more urgent concern once reserved for broken bones and torn ligaments.

Teammates gather around Dolphins quarterback Tua Tagovailoa after an injury during the game against the Bengals on Sept. 29, 2022, in Cincinnati.

Teammates gather around Dolphins quarterback Tua Tagovailoa after an injury during the game against the Bengals on Sept. 29, 2022, in Cincinnati.

Emilee Chinn / AP

I played football before the paradigm shifted. Back in my gridiron days, in the lawless ignorance of the late aughts, my college teammates took pride in playing through a concussion. The upperclassmen indoctrinated freshmen with the secret trick to staying on the field after a dizzying collision.

The summer before each season, we would all take a test that measured our memory and concentration — repeating a string of words in reverse order, for example. If anyone suffered a possible head injury in a game, we’d have to take the test again on the sideline. If our score fell significantly below the mark set in the summer, it was a sign that we'd probably had a concussion.

So my savviest teammates intentionally tanked their baseline score. The lower the bar, the better their chances of passing the test even when their brain function was sputtering from a big hit. Those of us too cowardly to attempt the trick praised and admired our more courageous comrades for putting the team’s success before their own well-being — for exhibiting the toughness that stood as the sport’s highest virtue. At the time, none of us knew the magnitude of the risk those teammates were taking.

American culture, and the uniquely American sport it prizes, incentivizes the very mindset that compelled Tagovailoa to suit up on Thursday.

A decade and a half later, we know better. And now that the true stakes are clear, those willing to play the game are increasingly people without other pathways to upward mobility. During my three years embedded with middle school football players in the mid-2010s, I witnessed kids sacrificing their bodies because football talent remains a highly valuable commodity — and represents an early lesson in capitalist labor practices. Private high schools and venerable universities aren’t sending scouts to scour the country for up-and-coming trumpet players or engineering prodigies. American culture, and the uniquely American sport it prizes, incentivizes the very mindset that compelled Tagovailoa to suit up on Thursday, all to entertain people like me.

Tagovailoa plays a game where risk of debilitating injury is inherent, the stakes changing by only a matter of degree. He knows that especially well because in his final year as a college player in 2019, as his star was rising to new heights, he suffered a severe hip injury that threatened to derail his professional prospects. After his recovery, the first two years of his NFL career got off to a rocky start, with underwhelming performances that didn’t live up to the millions of dollars his team had invested in him. He came dangerously close to earning the most denigrating label in sports: a bust. Then, this season, it finally all came together, and over his first three games, he seemed to have turned a corner, meeting the expectations hanging over him in a sport filled with disappointments and a long line of replacements. Leave it to a player to decide whether to play through injury, and there’s only one answer that will preserve their livelihood.

As a fellow football veteran of Pacific Island descent, I felt immense pride watching Tagovailoa’s ascent. I confess that I pay good money to access the premium NFL television package, which grants me the luxury of watching a split screen of up to four games at a time every autumn Sunday. I still love football and probably always will. Watching Tagovailoa get hurt was a reminder of the harm I help subsidize and continue to justify to myself, even as I know that my favorite sport can never ensure its players’ long-term well-being.

After the game, the Dolphins were quick to announce that Tagovailoa was awake, smiling, and in “good spirits.”

The NFL players’ union announced an investigation into whether the league or the team had violated the concussion protocol by allowing him to play. What happened has made headlines because it was an outlier, an egregious case with millions of witnesses. But this alleged isolated incident is actually the inevitable outcome of systemic indifference — a deep-seated acceptance that football’s violence is ultimately part of its appeal. I can hold the belief that Tagovailoa shouldn’t have played four days after he was knocked woozy, while still continuing to consume a sport where players bang their heads together on every play. I don’t want to see anyone suffer a severe brain injury on my television screen, but I still cheer on routine hits that contribute to damage that might not become clear for years.

On Thursday, Tagovailoa’s injury exposed the seams of a carefully constructed delusion. If he had not been allowed to play, I could have maintained my fantasy that the game is still morally defensible. But the price I have to pay as a fan is the duty to grapple with my complicity in a sport that requires its players to pay a much higher price. ●