How the Dolphins handled Tagovailoa's injuries raises questions about player safety NPR's Michel Martin talks with neuroscientist Chris Nowinski and former NFL player Chris Boland about the league's concussion protocol after quarterback Tua Tagovailoa suffered two hits this week.

How the Dolphins handled Tagovailoa's injuries raises questions about player safety

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MICHEL MARTIN, HOST:

Even for fans accustomed to hard-fought games and even brutal contact, the image of Miami Dolphins quarterback Tua Tagovailoa lying flat on his back after a hit during Thursday's game against the Cincinnati Bengals was a sickening sight. This came just four days after another hit on Tagovailoa that saw him stumbling and ultimately falling to the ground. And he's since been released from the hospital. The team says he suffered head and neck injuries. But now many advocates and even fans are demanding to know why he was allowed back on the field after the earlier episode and what happened to what the NFL has touted as its commitment to player safety.

We wanted to know more about how something like this could happen, what should happen and what it says about the treatment of concussions in the NFL. So we called two people who have thought a lot about it. Chris Nowinski is a neuroscientist and the CEO of the Concussion Legacy Foundation. He's also a former college football player and professional wrestler. Professor Nowinski, Mr. Nowinski, thanks so much for joining us.

CHRIS NOWINSKI: My pleasure.

MARTIN: And Chris Borland is a former linebacker for the San Francisco 49ers whose decision to retire in 2015 over concerns about brain injuries sent shockwaves through the sports world at the time. He's now a mental health advocate who, among other things, consults with the Center for Healthy Minds at the University of Wisconsin-Madison. Chris Borland, welcome to you as well. Thank you for joining us.

CHRIS BORLAND: Pleasure to be with you.

MARTIN: So, Chris Borland, I'm going to start with you. As a former professional player, when you saw - I don't know whether you saw this in real time or whether you saw this sort of subsequently, but when you saw what happened to Tua Tagovailoa on the field Sunday, what went through your mind?

BORLAND: Well, I don't watch football. And inevitably, when one of these things happens, my inbox floods with friends and fans sending me the clip. And I watched it. And in the intro, you used the word sickening - and, you know, immediately was just disgusted, one of the most severe fencing responses I've ever seen. And I'd seen the clips - again, sent to me on Sunday - when Tua was likely concussed just four days before playing again. So disturbing, sickening. I also understand the failures of a lot of protocols and policy and the PR around them contrasted with players' desire to play. And, you know, I know how these things can happen from the player's perspective. I know a little bit. Chris Nowinski will know more about, you know, the failures of policies. But just as a human being, when you see that, I was disturbed.

MARTIN: Chris Nowinski, first, would you tell me what fencing is?

NOWINSKI: Well, actually, he had decorticate posturing. So there's two types of posturing, one where your arm sticks out, one where your arm comes close to your chest. And it basically means he had an injury to his midbrain, the deep parts of his brain. And you really only see the decorticate posturing in stroke patients. So it's a sign that really his brain just turned off. And there was a lot of chemical metabolic damage. And he probably had some significant physical damage as well.

MARTIN: I mean, I don't know if you watch football either, but if you saw it or you saw it subsequently, the whole thing taken together, I don't think we can just talk about the Thursday incident because we obviously have to talk about what happened Sunday as well, which is another image that I think was very disturbing to people when he was clearly in some kind of distress and later actually went back into the game. So looking at the whole incident, those two together, Chris Nowinski, what stood out to you?

NOWINSKI: Yeah. It was incredibly frustrating because I predicted it would happen and had a tweet that I put out four hours before the game go viral, saying, I can't believe that the NFL is promoting Tua playing because we all know he had a concussion on Sunday. And the fact that they lied about it all week, I understand, but I never thought they would be dumb enough to actually put him out at risk because you can - you're risking a young man's career. You'd think the Miami Dolphins would want their quarterback playing the rest of the season. So it was a comedy of errors.

MARTIN: Chris Borland, can you talk a little bit more about as a player, what's that like? There's a reasonable expectation that the person has a brain injury is then supposed to make a rational decision about whether he should go back out there or do anything. I mean, I'm just thinking, if you were in a car crash, for example, nobody would tell you to go out and sign papers for a contract or make any other important potentially life-changing decision. What happens when something like this happens?

BORLAND: You highlight a great point. You're asking someone to make a complex decision with a compromised and injured brain. Now, with Tua, there's the added pressure of being the star of the franchise, the player that they're building around. I agree with Chris. I think it's asinine from management's perspective to potentially risk someone you've put so much money and resources into. But it's vital that players are better protected because, if left to their own devices, for a hundred different incentives, we would do anything to get back on the field.

MARTIN: So, Chris Nowinski, who is responsible in this particular incident? Does the NFL Players Association - we called them, by the way, and they did not respond to our query - do they have any responsibility here? And do they have any authority to intervene here?

NOWINSKI: I would argue they have - they don't necessarily have as much authority. I'm an adviser to the Players Association, so maybe I have a conflict. I mean, I certainly always ask for them to do better and try harder and they have been. So I don't know that one. But, I mean, let's be honest. The NFL is the elephant Room, not the NFLPA. The NFL is the one with the authority. The NFL is the one making, you know, standing up there saying, we've got this all under control. And they're the ones now that are caught with their pants down with that - they're definitely not trying hard enough. And they're trying to talk their way out of this and say, you know, we trust the doctor's decision on Sunday and all this. They're trying to tell the whole world, you know, don't trust what you saw. Trust us.

MARTIN: What should happen now? Chris Borland, do you want to start?

BORLAND: Well, Michel, I'd like to go back to the PA question. And I'm unaffiliated. The PA has done a lot of great work. And I think in this isolated incident between Sunday and Thursday, yes, it falls on the NFL. There was warnings over a decade ago during the 2011 collective bargaining agreement about the dangers of playing Sunday-Thursday games. I don't know why the PA coalesced. But I think historically and contextually, they have responsibility here where they could have done better. I think that's tied to the what's-next question. You know, I don't know if there's a call to action for fans. I almost feel bad for fans. There's an inherent risk in this brutal sport, but the way it's horribly mismanaged even puts fans in a bind. I think the NFL must do better. I applaud Chris. What he's done is - has moved the needle and changed things. I think the PA can do much better.

MARTIN: And why did you - said you don't watch football anymore. Is it because you just feel ethically you can't?

BORLAND: Yeah. And it's not for, you know, only because of the dramatic thing we saw on Thursday. It's the NFL actuary in 2014 that 28% of players will have cognitive impairment. It's the brain bank that Chris has been involved with at Boston University. It's many more studies. It's, you know, children playing young. I simply don't think that it's worth it. But I do respect - I'm in Madison, Wisc., right now. I was just at a tailgate with fellow board members ahead of the game. So it's not in protest or anything like that. But to me, I don't think it's worth it. I think a lot of players have paid a steep price. And what isn't told enough is that their families pay a steep price. It doesn't just happen to one person. Living with brain injury affects everyone in your family. So yeah, for me, just not worth watching.

MARTIN: I get it. Chris Nowinski, final thought from you. What do you think should happen? I mean, obviously, look, football remains the most watched sport in the United States. I mean, there are some - for many people, it is a - it's not just a game. It's a way of life for some people. It's a ladder into the middle class. It's their way to improve life for their families into. You know, generations into the future. At least that's how they see it. What do you think should happen now?

NOWINSKI: Well, I mean, on the football side, you know, I don't think Tua should play the rest of the season. They're probably going to roll him out here and we're all going to have to watch with bated breath. They're probably going to overcorrect and punish the Dolphins so that people talk about the punishment rather than what happened to Tua and worry about what happened to Tua.

But I think the biggest question we have to ask is, what role is the NFL playing in our culture, and how are they affecting our kids? And right now, they're setting a horrible example for what a concussion is, what it looks like and how you respond to it. And they're basically putting every athlete in the country at risk because, you know, because they all believe the NFL that you can get up, get hit in the head, fall down, shake your head and you don't have a concussion. That puts everyone at risk.

The bigger problem that I have is that not only are they setting a terrible example that could kill kids, they're recruiting our kids as young as 5 years old to play their game when we know - they've already admitted it causes CTE. And so the idea that they are giving our children CTE on purpose, they're underwriting youth tackle football, they're marketing it, they have a new ad campaign with Peyton and Eli Manning this year, knowing it's going to give our kids CTE is, to me, something we all need to consider. Are they just back to being big tobacco? Is that the role they're playing in our culture right now for the brains of young men?

We have a campaign called Stop Hitting Kids in the Head. Do not let your child get sucked into tackle football before high school under any circumstances, no matter what the NFL markets to you. It's not appropriate. And I think, you know, this is another sort of line in the sand that we have to draw about, who is the NFL in America?

MARTIN: Chris Nowinski is a former college football player, a former professional wrestler. He's now a neuroscientist and CEO of the Concussion Legacy Foundation. We also heard from Chris Borland. He's a former NFL linebacker, and he's now a fellow at the Center for Healthy Minds at the University of Wisconsin-Madison and a mental health advocate. Thank you both so much for talking with us and sharing your expertise and your insights here today.

NOWINSKI: Thank you.

BORLAND: Thank you, NPR, for covering this story.

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