Nearly six weeks after sustaining a concussion, Dolphins quarterback Tua Tagovailoa is expected to begin practicing this week, putting him on track to play at home next Sunday against the Arizona Cardinals if he gets through the week without any issues.
While the Dolphins hope he can play against Arizona, that decision cannot be made until two doctors authorize that he’s able to go through the final stage of concussion protocol. When the Dolphins decided to play Tagovailoa on injured reserve, that assured he would be sidelined for at least four games, by league rule.
Tagovailoa can begin practicing with the team as early as next Wednesday; the Dolphins would have 21 days to activate him once he begins practicing. How long would Tagovailoa need to get ready to play before appearing in a game? “I think whenever he’s cleared to return to play, we’ll just see how that process plays out,” offensive coordinator Frank Smith said Thursday in response to that question. “But the way he is, I’m sure it’ll be nose to the grindstone, here we go, and making sure that he can be ready to go for whatever the timeline is.
“He’s been great in the process and is trying to play, just his energy so whenever that happens we’ll make sure that we do the right things and his return to play is all handled appropriately.” On Friday, Dolphins coach Mike McDaniel declined to say if Tagovailoa would practice next week, but that has been the expectation because he hasn’t had symptoms and because the feedback from doctors has been positive. “Everything has been the same,” McDaniel said Friday. “There’s been no negative; everything has been positive each and every day.” The Dolphins decided to be especially cautious after Tagovailoa sustained the fourth, and possible fifth concussion of his life on Sept. 12 against Buffalo.
He was able to attend a Disney on Ice event the day after the concussion, but the team – in consultation with medical experts – concluded that he would benefit from being sidelined for more than a month. Sitting Tagovailoa for an extended period was a necessary decision, according to concussion experts and a study on how the brain responds after concussions. Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation, said: “It’s a myth the brain recovers in a week. Symptoms go away, and it functions OK, but on a cellular level all brains need weeks to physiologically recover.” A study by Roberto Vagnozzi and colleagues that used advanced imaging — “proton magnetic resonance spectroscopy” — suggests that brain metabolite ratios do not return to normal by Day 15 after a concussion, but do return to normal by Day 30.
Even after three weeks, those ratios are not completely back to where they were before brain trauma, suggesting it was sensible to sit Tagovailoa for at least a month, especially considering his history of concussions. Also, studies also have suggested that the risk of a severe brain injury increases for a short time after a first concussion, and the results of a second concussion within that short period could be dire.
Several neurologists have told The Miami Herald that if Tagovailoa sustains another concussion this season, he very likely would need to sit out the remainder of this season. If he finishes this season healthy but sustains a concussion in future years, he likely would be sidelined for an extended period, those neurologists say. Evan Packer, managing partner of the Brain and Spine Center of South Florida, told the Miami Herald recently that an extended absence would follow any future Tagovailoa concussions and “the length of time would be greater and greater.” Tagovailoa remains in the NFL’s five step concussion protocol system because injured reserve rules do not allow him to practice, the final step of clearing protocol, before his 21-day practice clock begins.
Phase 4 of concussion protocol is noncontact training drills: “The player is encouraged to continue cardiovascular, strength and balance training, team-based sports-specific exercise and participate in non-contact football activities.” Phase 5 is full football activity/clearance: “The player is finally cleared by the club doctor for full football activity involving contact.
The player must be examined by the independent neurological consultant assigned to his club.” If the neurological consultant agrees with the club physician that the player’s concussion has been resolved, then the player can participate in practice and contact without restriction.
The Dolphins will need to clear a spot on the 53-man roster to activate Tagovailoa. In Tagovailoa’s absence, Tyler Huntley will make his third consecutive start for the Dolphins on Sunday at Indianapolis (1 p.m, Fox). Tim Boyle is expected to be the backup.
Skylar Thompson, who started the first game in Tagovailoa’s absence, is listed as questionable for Sunday’s game and continues to be bothered by an injury affecting his ribs and chest.