Tua Tagovailoa concussion: what is the NFL’s five-step concussion protocol?

Thursday Night Football didn’t go at all to plan for the Miami Dolphins on September 12. Not only did they suffer a heavy 31-10 defeat at the hands of the Buffalo Bills, but quarterback Tua Tagovailoa was forced out of the game with another concussion.

What happened to Tua Tagovailoa against the Bills?

On a first down in the third quarter, Tagovailoa’s helmet slammed into Damar Hamlin’s body and his head banged off the turf. It became immediately clear something had gone wrong for the Dolphins star, who raised his closed fist in the air, something characteristic of the involuntary - and somewhat alarming - “fencing response,” common occurrence after some type of brain injury.

Players from both teams signalled to the sideline for assistance and the 26-year-old remained on the ground for two minutes before getting up and gingerly walking off the field.

After the game, head coach Mike McDaniel said Tagovailoa was “in good spirits,” but revealed the Dolphins would in no way be taking any chances with their quarterback, who previously suffered two confirmed concussions in the NFL in 2022.

One incident two years ago, also against the Bills in Week 3, led to a change in the league’s concussion protocol, which determines when it’s safe for the player to return to the field.

Tagovailoa took a hit that left him visibly shaken, which the Dolphins called it “back injury” at the time. He returned to the game but four days later, during a Thursday Night Football matchup with the Cincinnati Bengals, the quarterback was sacked and again showed a “fencing response”.

The NFL’s current concussion protocol

For an NFL player to return to the field after a concussion, they now have to go through five-step process, which culminates with the team physicians and independent neurological consultant deciding whether the player is ready to play again.

Step 1 - rest and recovery “until his signs and symptoms and neurologic examination” are at " “baseline status”

Step 2 - Light aerobic exercise

Step 3 - Continued aerobic exercise and introduction of strength training

Step 4 - Non-contact football

Step 5 - Full clearance to play, agreed upon by team physician and independent neurological consultant

When will Tua Tagovailoa play again for the Dolphins?

“The furthest thing from my mind is what is the timeline,” McDaniel said after Thursday’s game, which suggests Tagovailoa’s return is unlikely to be any time soon.

“We just need to evaluate and just worry about my teammate, like the rest of the guys are.

“We will get more information tomorrow and take it day by day from there. My thought was concern. I was just worried about my guy. Not something you ever want to be a part of, you hope not to.”