Tua Tagovailoa Suffers Another Concerning Concussion:-
Miami quarterback to a Tung of voo unfortunately just suffered another really concerning looking concussion once again displaying that abnormal posturing fencing like response on the field with his hands.
Visual Signs of Brain Trauma:-
With Tua here in the third quarter against the bills now everybody saw him take this hit it was pretty apparent when he was on the ground we saw his body in once again a similar rigid kind of posturing response after this clear concussion he’s been ruled out with a concussion so let’s talk about what happened last year let’s talk about what we’re seeing here explain visually what’s going on and just what this might mean with Tua Health going forward this of course was what we saw last season when Tua had his concerning concussion and you know when we see something visual .
The Fencing Response Explained:-
Like this obviously it looks very concerning this doesn’t necessarily mean that it was a more severe concussion or a more severe head injury but when we see these outward displays we know for sure that there has been this clear and obvious brain trauma whenever somebody gets a concussion one of the common things we can see from an external sort of sign of a concussion that you can visually observe is going to be abnormal posturing meaning abnormal contraction or flexion of the limbs or the muscles because of this increased motor tone that’s being abnormally fired from our brain as a result of that brain trauma the fencing response is the most classic thing.
Mechanism of Tua’s Injury:-
We’ll see where one arm sort of gets extended outward in this fencing position which is thought to be reactivation of this primitive reflex that we have when we’re little it gets reactivated within our brain within the brain stem and that was similar to what we saw here with Tua we saw this abnormal posturing with his right hand where those muscles were contracted not because he’s volitionally doing.
Brain Trauma During the Hit:-
It but because there’s been enough.Brain trauma that it’s activating those neural Pathways it’s activating those circuits abnormally to cause that contraction this seizur likee response this was the play where it happened and there’s no real mystery about the mechanism of course this is a situation that no matter how much you try and train.
Posturing Response and Further Impact:-
Teach an athlete you know we heard all this stuff about Tua learning how to fall whenever you lower your head his eyes are closed he’s clearly trying to brace for impact gets this direct axial load compressing into the top of his head combined with this rotation where his head gets knocked off to the side brain stem the brain are going to get rotated and twisted imparts clear Force into the brain to cause this head injury no mystery here with mechanism now next we’ll talk about what we saw on the field this time with that motor activation .
Additional Signs of Brain Trauma:-
What’s happening in the brain as this hit occurs right all of tu’s momentum is carrying him forward into the bills player as he makes contact there’s this sudden abrupt stop where right there his brain wants to continue moving the brain stem wants to continue moving forward but you’ve hit this rigid object and so the helment the skull stops the brain continues to move and all of that energy.
Immediate Medical Response and Rule Out:-
Gets imparted into the actual cells within the brain you then get this rotational component and what happens to actually cause the concussion and cause the brain injury is a whole sequence of things there’s actual rotational sheer forces that can damage that can tear the neurons you get this widespread sort of brief activation and then release of neurotransmitters as all that energy is being transferred into the skull thinking .
Like that brain you know bouncing back and forth within the skull the combined component here of that rotational twist can put additional stress on the brain stem which we theorize might be part of how and why we see those external posturing responses because a lot of those reflexes are centered within the brain stem one of the first things we can observe then with the posturing is we see his right lower extremity the right leg is planer flexed that foot is pointed downward.
The ankle’s pointed downward along with a little bit of this inversion that’s not what happens when you’re just completely limp and unconscious that’s going to be from muscle activation again centering within the brain coing down and affecting that right lower leg and now from this angle we can see not only do you get that initial axial load into the head but then as he falls his head is going to smack against the turf which is going to cause another insult to the brain it might have been part of why we saw that posturing sort of response.
Understanding Recovery After Multiple Concussions:-
So as we keep playing through here initially we’re going to see his body again that right lower leg we see how it’s tensed up we see that ankle pointed downward we’re going to start to see the right hand go into that awkward flexed position with his hands being rigid similar to what we saw happen last year and then as he’s trying to kind of roll over again we see that rigid firing of the hands the arms are coming up towards the head in that sort of protective response and then as he continues to try to get up here we even see some changes in the left hand as he’s working to sort of regain conscious push himself up we see how that left hand is awkwardly extended backwards .
Again showing all these external signs of that brain overactivation those reflexes being reactivated as a result of this significant brain trauma when we saw him coming off the field all ad mid it looked like he still didn’t really have a clear sense of was or where he was I’m glad we saw him ruled out right away there was no question we see those visible signs it doesn’t matter what your exam shows it doesn’t matter if Tua says he’s completely asymptomatic you see that visible evidence of that tonic posturing on the field you’re automatically done and he still seemed to me to be pretty dazed now just because again we saw that severe outward display of the brain trauma that doesn’t mean that this is going to be a multi-week multi- we you know prolong super long recovery what matters more so in how slow or how quickly you’re going to go with the recovery .
Yes you have the Baseline five steps with the NFL protocol but also you’re going to consider the individual athletes history Tu it having undergone serious head injuries like this before I would expect they’re going to be more conservative with him in no way would this like disqualify him from being able to continue playing football there’s not a set number of concussions that we keep track of there could be some athletes who get disqualified after one concussion and others who might have five six seven or eight it really depends more on how you respond to each of them and what your residual symptoms are now Tua could look at this and say goodness clearly there is something about his brain that seems to be more sensitive to these impacts and this one I don’t know if it’s just having a sensitive brain but I think anybody who takes a hit .
Like that is going to be at risk of a head injury so I don’t think this is something where we can say boy clearly Tua is more at risk this really does just feel a bit more like bad luck we don’t know of anything that would say man the fact that he’s had now multiple outward displays of this posturing means there’s something inherently wrong with his brain I presume a long time ago they’ve done some brain Imaging and they probably haven’t found anything structural or we probably would have heard about it or he might have been disqualified so just because we saw this happen another time .
Assessing Tua’s Future in Football:-
I don’t think means that Tua is done with his football career however each time that this happens you have to start asking those questions more and more again nobody knows what the number is where you would say this is too much it’s not safe you’re probably going to get multiple opinions you’re going to see how long his recovery is if his recovery and symptoms are prolonged for many weeks a month plus that might make them more cautious and make him say yeah I might think about stepping away from football but if in a week he feels great totally asymptomatic runs through the protocol just fine I don’t really see a reason where he can’t come back and play but what if it happens a third time what if it happens a fourth time those are all the discussions that you have to involve the athlete you have to involve multiple.
The Uncertainty of Brain Injuries:-
Specialists you have to involve all the interested parties to help make that educated decision but there’s nothing black and white about saying it happened again to his career is over yes with each subsequent time you start worrying more and more about that long-term brain health but right now there’s no way of proving visibly what we see today and how that is going to affect down the road just from what we see on TV so concerning absolutely hopefully Tua doesn’t have any sort of internal brain trauma of course that’s always a possibility brain bleeds internal sort of trauma with you know subdural hematomas epidural hematomas could have a neck injury.