In a Game Built on Violence, No Player Is Safe

A couple of hours after the Miami Dolphins quarterback Tua Tagovailoa was so violently thrown to the field that he lay contorted in a way associated with brain injury and had to be carted off the field in a stretcher, he was released from the hospital and flew home with his team.

Speaking to reporters before departing, Coach Mike McDaniel said watching his quarterback down on the field was “an emotional moment” but then expressed relief “that he didn’t have anything more serious than a concussion.”

For those who have pushed the N.F.L. to take a more aggressive posture toward head injuries, the words rung discordant with the messaging from the league that, especially after a $1 billion settlement with former players with cognitive defects from the game, it was taking the problem seriously.

“I don’t think this guy gets it,” Chris Nowinski, a co-founder of the Concussion Legacy Foundation and a frequent critic of the league, wrote on Twitter.

“A concussion is a traumatic brain injury & posturing suggests brain stem injury,” Nowinski said. “It’s pretty high on the list of serious medical consequences of football.”

Already, Tagovailoa was drawing renewed scrutiny of the N.F.L.’s problem with head hits and concussions. His injury Thursday, in a game against the Cincinnati Bengals, was the second time in a week that Tagovailoa appeared to sustain a head injury; after the last one, in a game against the Buffalo Bills on Sunday when he was helped to the sideline by trainers, he returned to play 30 minutes later, infuriating former players.

The injury Thursday provoked more concern.

“Truth be told Tua should probably never have been playing,” said Emmanuel Acho, a former linebacker and now an analyst on Fox Sports. “He displayed neurological trauma last week, we disregarded it, labeled it a ‘back injury’ & let him back in the game. Now, the whole world watch as he lay on the field helpless. When will we put player safety FIRST!”

On a conference call with reporters on Wednesday, Jeff Miller, the league’s executive vice president for communications, public affairs and policy, said that “every indication” was that the league protocols had been followed by the team’s doctors and the league-affiliated neurologists at the game. But by then, the N.F.L. players union had begun an investigation into the Dolphins’ handling of Tagovailoa’s earlier injury. The process can take weeks.

Under the league’s concussion protocols, players displaying instability after a hit are evaluated by both the team doctor and an independent neurologist, who is hired by the team but not on its staff. Together, they determine whether a player can return, with the team doctor having the ultimate say.

The league has reported concussions are trending downward, to 187 in 2021 from 275 in 2015.

Yet legal experts have questioned whether they are fully documented, and as long as the team doctor can make a final ruling, the protocols are only as good as the willingness to follow them.

“These measures are no different than when Big Tobacco was telling people for years that they put filters on cigarettes and made them safer,” said Brad Sohn, a lawyer who has represented numerous current and former players who have sued the N.F.L. “The concussion protocols have a loophole big enough to drive a truck through.”

Aside from the concussion protocol, the N.F.L. has sought to address head injuries with better helmets and regulations and a marketing campaign de-emphasizing head hits.

Yet reminders of the inherent violence of the game are constant.

The N.F.L. has built itself into the most-watched league by marketing brutality, speed and power in game-size nuggets. The league and its broadcast partners celebrate hard tackles during games and in endless highlight reels. Players have become millionaires for their willingness to put their bodies on the line in pursuit of victory.

Still, as doctors have exposed the ravages of repeated head hits, public opinion has turned. More parents are pushing their sons into soccer and baseball. Scholastic football programs have shrunk and even shuttered.

Fearing a shrinking pipeline of new players and fans, the N.F.L. has spent hundreds of millions of dollars to assuage nervous parents that the game can be made safer.

At the professional level, though, risk of serious injury is part of the calculation for the multimillion-dollar salaries and potential fame.

As McDaniel put it, “That is not part of the deal that anyone signs up for, even though you know it’s a possibility in football to have something that you have to be taken off on a stretcher.”

The players union, like the league, is conflicted on the issue, since its members are dependent on the incomes they earn as a result of the league’s riches and many players willingly rush back to the field when their bodies are telling them they shouldn’t.

“Player health and safety is at the core of the union’s mission,” the union said on Twitter on Thursday night, adding that it hoped Tagovailoa would have “a full and speedy recovery.”