Concussions are an unavoidable part of playing football. But in the National Football League, new rule changes, concussion protocols and equipment have done little to address the key question surrounding concussions; not how to prevent a player from ever having one, but how to properly manage their playing time once they do. 

In a primetime Thursday Night Football game between the Cincinnati Bengals and the Miami Dolphins on Sept. 29, the league’s profoundly flawed concussion protocol was on full display. 24-year-old Dolphins quarterback Tua Tagovailoa started the game just four days after being concussed in a Sept. 25 game against the Buffalo Bills, in which he was allowed to return after a hit left him visibly wobbly as he stumbled back to his feet, shaking his head before collapsing. In that first game, the Dolphins initially released a statement saying that Tagovailoa’s injury was indeed a head injury, but according to the Washington Post, the team quickly reclassified it as a back injury, justifying the star’s return to the game after halftime. 

On Thursday night, the QB was again concussed while being sacked, slamming his head into the turf. He was briefly unconscious, lying on his back with his hands held in front of his face, and his fingers stiff and ominously splayed out. Medical experts said this was a classic case of “decorticate posturing” or the “fencing response,” where brain damage triggers the involuntary reaction, per the Washington Post. Tagovailoa was taken away on a stretcher, and transported to the hospital, where he was promptly released several hours later, and accompanied the team on their flight home.

According to a tweet by NFL Network’s Cameron Wolfe, “Dolphins Head Coach Mike McDaniel said Tua Tagovailoa sat next to him on the plane. They talked about how he was feeling for 15-20 mins, then Tua pulled out his phone to watch MacGruber and they laughed together…” Just over 2 weeks later, on Oct. 23, Tagovailoa had cleared the NFL’s concussion protocol, and suited up yet again. 

The independent doctor who cleared the quarterback to play after his first injury was fired following the game, and an amendment was added to the league’s concussion protocol that requires players exhibiting “ataxia,” or visible abnormality of balance and motor coordination, from staying in the game, according to Forbes. Commenting on the concussion in the Post article, Chris Nowinski, a neuroscientist and co-founder of the Concussion Legacy Foundation, said, “It’s a potentially life-threatening brain injury.” Nowinski’s primary concern is “second impact syndrome,” a condition occurring when someone sustains two concussions within a short period, as Tagovailoa did.

Research shows that experiencing even one concussion increases the risk of developing Parkinson’s disease and dementia, per NPR. And when repeated blows to the head occur, the risk of developing the degenerative brain condition chronic traumatic encephalopathy, or C.T.E., also increases. This can result in anxiety, depression, memory loss, headaches, self-harm and suicidal ideation, and sometimes symptoms don’t reveal themselves until later in life. 

The diagnostic complexity and delayed, unpredictable symptoms of both concussions and consequential brain diseases render the NFL’s simplistic protocols and evaluations almost useless. C.T.E. can only be diagnosed posthumously, and a recent study published in the Journal of the American Medical Association found the disease in 99% of brains obtained from deceased NFL players, some of whom died in their 20s and 30s. The New York Times reports that over 320 former players have been diagnosed with C.T.E.

The NFL has scheduled games on Sundays and Mondays for many decades, but the decision to establish Thursday Night Football, the game in which Tagovailoa suffered his second concussion, only began in 2006. This means that two teams each week play two games with just four days in between, leaving players highly susceptible to second impact syndrome and C.T.E. For Ethan Koler, a 2021 communications and media studies graduate, eliminating Thursday Night Football could be one way to reduce the likelihood of back-to-back injuries like Tagovailoa’s. “The toll it takes on your body clearly isn’t a priority for the NFL since a big reason they don’t eliminate the Thursday night game is due to money and endorsements,” he said. 

According to Insider, the league’s 32 teams generated $11 billion in revenue last season, and Amazon Prime paid the league more than $1 billion this year to broadcast Thursday night games, per the Washington Post. Sam Zyskowski, a 2021 computer science graduate, said, “Removal of Thursday Night Football would be a good option, but wouldn’t touch the underlying culture that runs through football at its core. Hard hits will always be celebrated until we attempt to change the entire culture of the sport, and to do this we have to start at a young age.”

There’s little doubt that situations like Tagovailoa’s will continue to occur, until players, teams, doctors and the league begin treating brain injuries with the same seriousness as bone or muscular injuries.