2022 Dolphins: Our coach is cooler than yours

Kenny F'ing Powers

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I made the same point in post 486. I don't get why this is so hard. All stakeholders (coaches, trainers, med staff, owners?) should have a say in ruling a player out, but not clearing a player. That is a significant difference.
Fair. As long as the doctor gets to have a say on 3rd and goal. Because everyone should have a say.

This is really fucking stupid. There's a procedure in place for concussions. The entire team - and all the COACHES - keep their fucking hands OFF the process. Medical professionals make the call. Because we could all see how a coach being able to overrule a doctor about a players availability is a fucking horrible idea.

We have mountains of material by Belichick saying, "I dont know his gametime status, I'm not a fucking doctor." Because that's the right response. Now, when another coach relies on that same process - relying on the professionals - it's his fault? This is exactly why BB defers so hard to the doctors.

Someone's job should be on the line, but it ain't McDaniel.
 

riboflav

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McDaniel didn't say what BB typically says. McDaniel doubled down last night and tripled down today saying Tua had no head issues last Sunday. BB would never say that and your example proves that. But that said, you are misrepresenting what I am saying. No one says the doctor can override a 3rd and goal situation. No one is saying that a coach should clear a player to play especially against a doctor's evaluation.

EDIT: To be clear for the third time, no one is saying a coach can OVERRULE a doctor or med staff on clearing a player to play.
 
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riboflav

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Jesus this thread wants so hard to whataboutism instead of dealing with what actually fucking happened this week right in front of their eyes. Just deal with the situation. And that said, I'm willing to concede there's a legit disagreement and have tried my best to engage on that. But again the whataboutism hypotheticals... how does one even begin to argue that shit in good faith?
 

Kenny F'ing Powers

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McDaniel didn't say what BB typically says. McDaniel doubled down last night and tripled down today saying Tua had no head issues last Sunday. BB would never say that and your example proves that. But that said, you are misrepresenting what I am saying. No one says the doctor can override a 3rd and goal situation. No one is saying that a coach should clear a player to play especially against a doctor's evaluation.

EDIT: To be clear for the third time, no one is saying a coach can OVERRULE a doctor or med staff on clearing a player to play.
Cool. So when a player has some incentives to reach for playing time and a coach decides to ignore his medical staff to "play it safe", I'm sure there won't be any issue.

They don't need to be involved with the medical process. Ever.
 

riboflav

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Cool. So when a player has some incentives to reach for playing time and a coach decides to ignore his medical staff to "play it safe", I'm sure there won't be any issue.

They don't need to be involved with the medical process. Ever.
I'm not sure how this is a response to what I have written.
 

riboflav

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Maybe you're saying McDaniel who said he is 100 percent confident that Tua was fine on Sunday and did not suffer a head injury was way off base for involving himself in the medical process of Okaying Tua to return to play on Sunday and then again on Thursday? I mean his words. McDaniel actually said as much. Which is it? Coaches can say with confidence that a player is good to go but can never rule a player out?

Also: We should consider the player's desires and his contract incentives!
 
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riboflav

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It is not lost on me that on this board in V&N when a company has a major issue in accounting or audit or wherever department, the response tends to be uniform that the CEO is ultimately responsible and should have known better even if that is not their area of expertise or their specific background and they should be fired too. But when it comes to sports this board contorts itself in many ways to absolve many in positions of power and responsibility to blame outside influences or the system at large for what occurred. In V&N so many times people in power should be fired for acting unethically, immorally, etc. but in sports? Hey, everyone else is would do it also, so shut up.
 

sodenj5

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Maybe you're saying McDaniel who said he is 100 percent confident that Tua was fine on Sunday and did not suffer a head injury was way off base for involving himself in the medical process of Okaying Tua to return to play on Sunday and then again on Thursday? I mean his words. McDaniel actually said as much. Which is it? Coaches can say with confidence that a player is good to go but can never rule a player out?

Also: We should consider the player's desires and his contract incentives!
McDaniel keeps doubling and tripling down because he’s confident that Miami followed the protocol to the letter of the law and that he trusted the experts that are 100x more qualified than him to do their job.

We have not heard anything to the contrary yet other than speculation. In fact, anything that we have heard thus far has confirmed what McDaniel has said.

If the review shows negligence on the behalf of the training staff or the independent neurologist, that’s a different story, but it still doesn’t make Mike McDaniel an accomplice in some shady act to put Tua in harm’s way.
 

DJnVa

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Jesus this thread wants so hard to whataboutism instead of dealing with what actually fucking happened this week right in front of their eyes. Just deal with the situation. And that said, I'm willing to concede there's a legit disagreement and have tried my best to engage on that. But again the whataboutism hypotheticals... how does one even begin to argue that shit in good faith?
You are acting like the ONLY questions in the football world about this are in this thread.
 

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McDaniel keeps doubling and tripling down because he’s confident that Miami followed the protocol to the letter of the law and that he trusted the experts that are 100x more qualified than him to do their job.

We have not heard anything to the contrary yet other than speculation. In fact, anything that we have heard thus far has confirmed what McDaniel has said.

If the review shows negligence on the behalf of the training staff or the independent neurologist, that’s a different story, but it still doesn’t make Mike McDaniel an accomplice in some shady act to put Tua in harm’s way.
In the moment, I stated that I thought how Miami handled this was criminal. But thinking about McDaniel's role in this, it occurred to me that he spent the days before the game observing Tua in meetings and on the practice field. If Tua were impaired in any way, he couldn't have thought that Tua presented a better chance of winning the game on Thursday than Bridgewater if Teddy were given all the reps with the first team. And, at the very least, if Tua were showing signs of distress, he would have realized that he needed to give Bridgewater some portion of the first team reps, because it was likely that he'd be needed at some point in the game. As far as I know, neither of those things happened, so I have to believe that McDaniel not only accepted the judgement of the medical staff, his interactions with Tua last week gave him no reason to even consider disputing what they told him about his starting QB's condition.

In short, seconded.
 
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Shelterdog

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McDaniel keeps doubling and tripling down because he’s confident that Miami followed the protocol to the letter of the law and that he trusted the experts that are 100x more qualified than him to do their job.

We have not heard anything to the contrary yet other than speculation. In fact, anything that we have heard thus far has confirmed what McDaniel has said.

If the review shows negligence on the behalf of the training staff or the independent neurologist, that’s a different story, but it still doesn’t make Mike McDaniel an accomplice in some shady act to put Tua in harm’s way.
What have we heard that confirms that he did not receive a concussion on Sunday?
 

sodenj5

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Nothing. I’ve seen no meaningful information one way or the other
Besides the fact that a team of professionals examined him, said he didn’t, and then evaluated him all week for symptoms leading up to Thursday.
 

EvilEmpire

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It is not lost on me that on this board in V&N when a company has a major issue in accounting or audit or wherever department, the response tends to be uniform that the CEO is ultimately responsible and should have known better even if that is not their area of expertise or their specific background and they should be fired too. But when it comes to sports this board contorts itself in many ways to absolve many in positions of power and responsibility to blame outside influences or the system at large for what occurred. In V&N so many times people in power should be fired for acting unethically, immorally, etc. but in sports? Hey, everyone else is would do it also, so shut up.
There is uncertainty as to what occured last Sunday. Some people trust the doctors who evaluated Tua last Sunday and presumably during the practice week more than what they saw on TV.

We don't know if McDaniel acted unethically or immorally.

That is not the bad faith posting you and others imply with your rants.
 

JimD

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Ok, so let's play the game and say that Tua did not suffer a concussion on Sunday and it was a 'back issue'. How was he cleared to play so quickly after he literally couldn't stand on his feet at one point? Seems pretty risky to let him resume playing absent more comprehensive testing, no?
 

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Besides the fact that a team of professionals examined him, said he didn’t, and then evaluated him all week for symptoms leading up to Thursday.
Well actually we don’t know that they evaluated him for symptoms this week because he wasn’t in the protocol. Haven’t seen anything saying he got an mri or other testing after the game either. I Haven’t even seen confirmation that the team of specialists said he didn’t have a concussion (maybe it’s out there, I just haven’t seen it)-all we know for sure based on the protocol and the statements that they followed the protocol is that the team doctor determined he did not.

But sure he didn’t receive a concussion last week when he got hit in the head and showed signs of a concussion and it was great work all around by the Dolphins organization to put that guy back out there this week. To bad he just had a career threatening injury-what can you do?
 

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Besides the fact that a team of professionals examined him, said he didn’t, and then evaluated him all week for symptoms leading up to Thursday.
And this is how the NFL keeps the farce of "concussion oversight" on its feet. As others pointed out upthread, the protocols are a fig leaf that will only catch guys whose concussions rate a "Holy Shit" on the severity scale--observable, persisting symptoms. After that, it's pretty much all on Tua. Following the first event, he (a) wasn't concussed, (b) had subjectively experienced but not observable symptoms that he's had so many times before he didn't identify them as being related to concussion, or (c) lied. As long as they players approach the evaluation with a response bias to stay on the field, they make it easy for the NFL to keep up the masquerade (and it's not my intention to "call out" Tua here, it's more of an occupational culture thing).
 

mauf

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Seems to me the key questions are:

1. Who cleared Tua to return to the game on Sunday?

2. Was that person (or group of people) given all of the relevant facts?

I’m particularly interested to know whether the independent neurologist saw the video of Tua stumbling, or whether he/she relied on a description of that from someone else, such as a team doctor or trainer.
 

BigSoxFan

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Ok, so let's play the game and say that Tua did not suffer a concussion on Sunday and it was a 'back issue'. How was he cleared to play so quickly after he literally couldn't stand on his feet at one point? Seems pretty risky to let him resume playing absent more comprehensive testing, no?
And why was a 3rd QB activated if Tua was all set?
 

Van Everyman

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Seems to me the key questions are:

1. Who cleared Tua to return to the game on Sunday?

2. Was that person (or group of people) given all of the relevant facts?

I’m particularly interested to know whether the independent neurologist saw the video of Tua stumbling, or whether he/she relied on a description of that from someone else, such as a team doctor or trainer.
Disagree. The problem here is that concussions can take up to multiple days to reveal themselves – and the league protocol allows the medical teams to ascribe symptoms to the possibility of another injury they can’t rule out. Hence, Tua stumbling around on the field and holding his head on Sunday was ascribed to his back injury.

I’m sorry, but anyone with half a brain knows the likelihood was that Tua was concussed Sunday. Everything after that was simply ass covering to get him back out on the field – from the medical team (“We found no symptoms of a concussion in the aftermath and his back injury explains what we saw”) to the coach (“I’m not a doctor and followed the medical team’s advice which told me it was a back injury”) to the league (“We have a protocol in place designed by doctors that was followed”). Every one of them failed.
 

Cotillion

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In the moment, I stated that I thought how Miami handled this was criminal. But thinking about McDaniel's role in this, it occurred to me that he spent the days before the game observing Tua in meetings and on the practice field. If Tua were impaired in any way, he couldn't have thought that Tua presented a better chance of winning the game on Thursday than Bridgewater if Teddy were given all the reps with the first team. And, at the very least, if Tua were showing signs of distress, he would have realized that he needed to give Bridgewater some portion of the first team reps, because it was likely that he'd be needed at some point in the game. As far as I know, neither of those things happened, so I have to believe that McDaniel not only accepted the judgement of the medical staff, his interactions with Tua last week gave him no reason to even consider disputing what they told him about his starting QB's condition.

In short, seconded.
except the part where they activated their 3rd string QB for the game. They knew he had some problem or concern about Tua for something.
 

Shelterdog

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Seems to me the key questions are:

1. Who cleared Tua to return to the game on Sunday?

2. Was that person (or group of people) given all of the relevant facts?

I’m particularly interested to know whether the independent neurologist saw the video of Tua stumbling, or whether he/she relied on a description of that from someone else, such as a team doctor or trainer.
Based on the actual protocols it appears that independent neurologist doesn’t get to diagnose a concussion, s/he only gets to consult with the team doctor who makes the final call. It’s the team doctor and the team doctor alone who makes the call.
I think we can infer that the medical staff were at least aware of the stumbling and decided to accept the explanation offered by Tua that is was because his back spasmed (McDaniel discussed that in the press conference after Sunday). My guess is that Tua didn’t show other signs of a concussion, and the medical staff either believed or perhaps more accurately decided to accept Tia’s explanation for the gross motor instability-at which point there’d be no reason to treat him as having had a concussion.
 

mauf

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Based on the actual protocols it appears that independent neurologist doesn’t get to diagnose a concussion, s/he only gets to consult with the team doctor who makes the final call. It’s the team doctor and the team doctor alone who makes the call.
I think we can infer that the medical staff were at least aware of the stumbling and decided to accept the explanation offered by Tua that is was because his back spasmed (McDaniel discussed that in the press conference after Sunday). My guess is that Tua didn’t show other signs of a concussion, and the medical staff either believed or perhaps more accurately decided to accept Tia’s explanation for the gross motor instability-at which point there’d be no reason to treat him as having had a concussion.
Of course the team medical staff was aware of the stumble; it’s the only reason they would’ve had Tua checked out. In my view, if the team’s medical staff showed an independent neurologist the video of Tua stumbling and he/she said “yup, that looks consistent with a back injury rather than a concussion, and he checks out fine” that’s a lot different than if they simply related the story to him/her (“he tweaked his back, which made him stumble as though he was woozy, so we’re bringing him to you out of an abundance of caution”).

As you can probably tell, I suspect the latter. So many experts have said that Tua’s stumble looked like a tell-tale concussion symptom that I find it hard to believe a neurologist who saw that video would have cleared Tua to return to the game based solely on a brief examination. An independent neurological review is only an effective safeguard if the neurologist has all the relevant facts presented to him/her, and the protocols should require the team’s medical staff to ensure that’s the case.
 

Shelterdog

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Of course the team medical staff was aware of the stumble; it’s the only reason they would’ve had Tua checked out. In my view, if the team’s medical staff showed an independent neurologist the video of Tua stumbling and he/she said “yup, that looks consistent with a back injury rather than a concussion, and he checks out fine” that’s a lot different than if they simply related the story to him/her (“he tweaked his back, which made him stumble as though he was woozy, so we’re bringing him to you out of an abundance of caution”).

As you can probably tell, I suspect the latter. So many experts have said that Tua’s stumble looked like a tell-tale concussion symptom that I find it hard to believe a neurologist who saw that video would have cleared Tua to return to the game based solely on a brief examination.
I agree with you with the one quibble that the neurologist doesn’t technically clear Tua-it’s the team doctors call (not sure what happened here of course) and the team doctor is under the protocol is permitted to say (assuming no other evidence of a concussion) that an either a concussion or an orthopedic cause could have led to the stumble, we can’t confirm it was a head injury, so he’s clear to return.
 

mauf

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I agree with you with the one quibble that the neurologist doesn’t technically clear Tua-it’s the team doctors call (not sure what happened here of course) and the team doctor is under the protocol is permitted to say (assuming no other evidence of a concussion) that an either a concussion or an orthopedic cause could have led to the stumble, we can’t confirm it was a head injury, so he’s clear to return.
Do we know why the protocol gives final say to the team doctor? It’s easy to say that it’s because the protocols are a farce, and maybe that’s true. But it could also be out of a recognition that the team doctor will always have superior information to a consulting specialist, and therefore shouldn’t be able to delegate accountability for the ultimate decision to clear a player.
 

catomatic

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In the moment, I stated that I thought how Miami handled this was criminal. But thinking about McDaniel's role in this, it occurred to me that he spent the days before the game observing Tua in meetings and on the practice field. If Tua were impaired in any way, he couldn't have thought that Tua presented a better chance of winning the game on Thursday than Bridgewater if Teddy were given all the reps with the first team. And, at the very least, if Tua were showing signs of distress, he would have realized that he needed to give Bridgewater some portion of the first team reps, because it was likely that he'd be needed at some point in the game. As far as I know, neither of those things happened, so I have to believe that McDaniel not only accepted the judgement of the medical staff, his interactions with Tua last week gave him no reason to even consider disputing what they told him about his starting QB's condition.

In short, seconded.
I don’t dispute any of this but, why then, did they add a 3rd QB to the Gameday roster for the first time, this season? Might that betray some consciousness of doubt about Tua’s condition?
 

Remagellan

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except the part where they activated their 3rd string QB for the game. They knew he had some problem or concern about Tua for something.
Well, even if they believed that he just had a back issue, a team might take that step. If Mac's recovery from his ankle issue really did allow him to play this weekend, the Pats for sure would have both Hoyer and Zappe active for the game. If a QB has a lingering injury (and has to play four days later!), a team is going to take precautions to ensure they are not going to be caught short at the most important position on the field.
 

BigSoxFan

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I don’t dispute any of this but, why then, did they add a 3rd QB to the Gameday roster for the first time, this season? Might that betray some consciousness of doubt about Tua’s condition?
I mean, back spasms can be rather unpredictable…
 

gammoseditor

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To me there are two issues.

1) Did he suffer a concussion on Sunday? I think it’s overwhelming likely that he did but I’m not 100 % certain. If he didn’t then the Thursday injury sucks but it is no one’s fault.

2) If he did suffer a concussion on Sunday then someone fucked up. I don’t know who and reading up on it there seem to be a lot of opinions on who to blame but I am having trouble finding facts.
 

Van Everyman

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I mean, back spasms can be rather unpredictable…
But concussions are super easy to predict and diagnose.

I hate this whole “Doctors cleared Tua to play bc they ruled out a concussion” line of thinking. They did not rule out a concussion because, unless I’m missing something about concussions, you can’t definitively rule them out within a few days much less a few minutes of head trauma. Tua was allowed back on the field Sunday because his doctors foolishly concluded his stumbling around wasn’t related to his head injury. Which again, you can’t conclusively.

If I know that as some schlub fan, certainly McDaniel knows that as a professional football coach. Yet he (like a lot of coaches I’m sure) allowed his franchise player to go back out there anyway and then again on Thursday. Perhaps he felt even more pressure as a young coach with a toxic owner.

This is an institutional failure – but it’s also one where certain individuals who made conscious choices that out the player’s health at risk failed too.
 

BigSoxFan

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But concussions are super easy to predict and diagnose.

I hate this whole “Doctors cleared Tua to play bc they ruled out a concussion” line of thinking. They did not rule out a concussion because, unless I’m missing something about concussions, you can’t definitively rule them out within a few days much less a few minutes of head trauma. Tua was allowed back on the field Sunday because his doctors foolishly concluded his stumbling around wasn’t related to his head injury. Which again, you can’t conclusively.

If I know that as some schlub fan, certainly McDaniel knows that as a professional football coach. Yet he (like a lot of coaches I’m sure) allowed his franchise player to go back out there anyway and then again on Thursday. Perhaps he felt even more pressure as a young coach with a toxic owner.

This is an institutional failure – but it’s also one where certain individuals who made conscious choices that out the player’s health at risk failed too.
Sorry, was being sarcastic. Definitely on your side of this argument.
 

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Do we know why the protocol gives final say to the team doctor? It’s easy to say that it’s because the protocols are a farce, and maybe that’s true. But it could also be out of a recognition that the team doctor will always have superior information to a consulting specialist, and therefore shouldn’t be able to delegate accountability for the ultimate decision to clear a player.
I don’t think that’s known and I don’t have a string view about what the “right” answer is to who should be accountable there. I do think it’s kind of striking that the NFL often highlights the role of the independent neurologist in pr and media events but then quietly let’s the team doctor make the final call. Interestingly the protocols make clear that the team doctor alone conveys the result to the player and suggests that the discussions between the neuro and the team doctor be held away from the player (it says they should have a “private”’discussion)
 

leftfieldlegacy

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I agree with you with the one quibble that the neurologist doesn’t technically clear Tua-it’s the team doctors call (not sure what happened here of course) and the team doctor is under the protocol is permitted to say (assuming no other evidence of a concussion) that an either a concussion or an orthopedic cause could have led to the stumble, we can’t confirm it was a head injury, so he’s clear to return.
If you watch the Judy Battista video tweet with Dr. Sills (NFL Chiel Medical Officer) that was posted earlier (#485), you will hear him directly contradict your statement about the team MD getting final say. Dr. Sills said that each of the physicians (neuro + team doc) examine the player independently and both must clear him before he is allowed to return to play. Additionally, he said that Tua was examined everyday after last Sunday until the the game on Thursday to maintain his playing status. So, there is something amiss here. If the written policy you quoted states the team doc has final say but the NFL Chief Medical Officer says otherwise then there seems to be confusion in how the protocol is being implemented. Personally, I'm not sure how anyone can watch that video from last Sunday and think that Tua was not at least mildly concussed. I think it's possible that he might have recovered quickly enough to pass the evaluation in the locker room and subsequent assessments during the week. Dr. Sills was emphatic about thouroughly investigating every aspect of this case, but after all, this is the NFL so who knows how deeply they want to look.
 

Shelterdog

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If you watch the Judy Battista video tweet with Dr. Sills (NFL Chiel Medical Officer) that was posted earlier (#485), you will hear him directly contradict your statement about the team MD getting final say. Dr. Sills said that each of the physicians (neuro + team doc) examine the player independently and both must clear him before he is allowed to return to play. Additionally, he said that Tua was examined everyday after last Sunday until the the game on Thursday to maintain his playing status. So, there is something amiss here. If the written policy you quoted states the team doc has final say but the NFL Chief Medical Officer says otherwise then there seems to be confusion in how the protocol is being implemented. Personally, I'm not sure how anyone can watch that video from last Sunday and think that Tua was not at least mildly concussed. I think it's possible that he might have recovered quickly enough to pass the evaluation in the locker room and subsequent assessments during the week. Dr. Sills was emphatic about thouroughly investigating every aspect of this case, but after all, this is the NFL so who knows how deeply they want to look.
I’ll take a look at the video. You would hope that whatever the protocol says a team doctor wouldn’t send a player back if the neuro thought a concussion happened and I’ll give them the benefit of the doubt and assume that no one saw signs of a concussion on Sunday. I certainly agree that it seems pretty likely that Tua didn’t show (or complain) of any symptoms either during the game or during the week. Where I keep getting caught up on this is the conclusion made by the doctors that the stumbling was caused by the back injury; it seems impossible to me that you could rule out a concussion-and if there’s a possible concussion you would think he should be held out of the game, put on the full protocol, etc
 

soxhop411

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The official investigation regarding the decision to clear Dolphins quarterback Tua Tagovailoa remains pending. For now, however, the NFL Players Association has decided to take action.

Per a source with knowledge of the situation, the NFLPA has exercised its prerogative to terminate the Unaffiliated Neurotrauma Consultant involved in the decision to clear Tua to return to action.



The concussion protocol provides that players who demonstrate gross motor instability may return only if the team physician, in consultation with the UNC, determines that the instability did not have a neurological cause.

Although specific findings have not been made regarding how and why Tua returned, the union lost confidence in the UNC, given that the impairment of the player was obvious. Based on the available video, Tua should not have returned.

Ravens coach John Harbaugh made that point on Friday, as tactfully as he could.

“I couldn’t believe what I saw last Sunday,” Harbaugh said regarding Tua clearly wobbling and later returning to the game. “It was just something that was astonishing to see. I’ve been coaching for 40 years now, college in the NFL, almost 40, and I’ve never seen anything like it before. I couldn’t believe what I was seeing.”
https://profootballtalk.nbcsports.com/2022/10/01/nfl-players-association-terminates-unaffiliated-neurotrauma-consultant-involved-bills-dolphins-controversy/
 

RIrooter09

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Besides the fact that a team of professionals examined him, said he didn’t, and then evaluated him all week for symptoms leading up to Thursday.
One of those professionals was just terminated. Maybe they’re not infallible after all.
 

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I’d be curious to hear more informed medical views but I was speaking to a doctor earlier today (not a radiologist or neurologist) and he was firmly of the view that you can’t begin to properly diagnose a concussion without an MRI. If you accept that then the NFLs protocol for same game returns is not effective because it doesn’t require (and it doesn’t seem that Tua ever received let alone received on Sunday) an MRI
 

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I’d be curious to hear more informed medical views but I was speaking to a doctor earlier today (not a radiologist or neurologist) and he was firmly of the view that you can’t begin to properly diagnose a concussion without an MRI. If you accept that then the NFLs protocol for same game returns is not effective because it doesn’t require (and it doesn’t seem that Tua ever received let alone received on Sunday) an MRI
Neuropsychologist here. Depends on what you mean by "properly diagnose." You can get a very good idea of what's going on--certainly well enough to make a play/no play decision in real time--through observables and the player's self report IF the docs are competently "observing" and the player is being forthright, and this is how most concussions are diagnosed in a GP's or pediatrician's office. Absent an MRI, you could probably move beyond clinical signs/symptoms if you wanted to do some quick performance testing in the tent to compare with baseline testing, although I have no clue as to whether or not they do that (although If they do and Tua's numbers were within acceptable range, I assume the team and league would be eager to report that).
 

DaveRoberts'Shoes

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I’d be curious to hear more informed medical views but I was speaking to a doctor earlier today (not a radiologist or neurologist) and he was firmly of the view that you can’t begin to properly diagnose a concussion without an MRI. If you accept that then the NFLs protocol for same game returns is not effective because it doesn’t require (and it doesn’t seem that Tua ever received let alone received on Sunday) an MRI
I hesitate to even wade into the enormous and frequently gray area around concussions but I’ll put in my limited knowledge on this. As a sports medicine orthopedic surgeon I have spent plenty of time on sidelines and in training rooms and the diagnosis and prevention of concussions has come a long way. Back when I was playing it was “follow my finger left and right… you’re not vomiting and you can stand up, go back in”. When I first stated training (2000)… it really hadn’t changed much. Since then high schools and colleges have implemented neuropsychometric testing (the ImPACT test is a relatively well-known example) in which player take a test before the season which is nominally supposed to give a baseline for their ability to focus, concentrate, answer basic questions quickly… all stuff which can be affected by a concussion. If a player has or is suspected of having a concussion they have to re-take the test and be back at or close to their baseline before they are allowed to go back in. This was huge, as you now have hard data to go on before allowing someone back in - it’s not like a player can just say they don’t feel dizzy or have a headache which may or may not be true and they can go right back in. I don’t know how the NFL game day protocols work, but the impact and other tests are usually administered via computer so that may or may not be feasible within the constructs of halftime of an NFL football game. As for the whole MRI thing, you can absolutely diagnose a concussion without an MRI. The MRI can give you additional data within the constructs of halftime of an NFL football game. As for the whole MRI thing, you can absolutely diagnose a concussion without an MRI. The MRI can give you additional data such as significant Adema but it is by no means mandatory to have one in order to make the diagnosis of a concussion. Therefore, I don’t think that not having an MRI of the brain was the failure here. Clearly whoever evaluated him either screwed up or is being made the scapedog in this case.
 

radsoxfan

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One of those professionals was just terminated. Maybe they’re not infallible after all.
Screwup or scapegoat, maybe we will never know for sure. But not surprised at all he/she was fired.

To be clear, my previous posts supporting McDaniel in no way were meant to imply doctors are infallible. I can't tell you how many egregious mistakes I see every day from docs, it's fairly shocking (not to scare people :)).

The point is that there is no reason to think McDaniels would somehow be expected to know better than the doc or should have the responsibility of stepping in when highly trained people are doing the medical eval. He wouldn't even begin to know what he doesn't know about the situation or what mistakes he could be making.
 

Shelterdog

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Thanks to the doctors. The scary possibility to me (in lay terms) is that Tua seemed fine, had no observable symptoms, passed his baseline tests etc but still had significant brain trauma that for is not detectable without, for example, an MRI or other advanced tests (and that because of the unibserved injury Tua was at a greater risk). Is the possibility I’m discussing a real medical thing?
 

radsoxfan

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I’d be curious to hear more informed medical views but I was speaking to a doctor earlier today (not a radiologist or neurologist) and he was firmly of the view that you can’t begin to properly diagnose a concussion without an MRI. If you accept that then the NFLs protocol for same game returns is not effective because it doesn’t require (and it doesn’t seem that Tua ever received let alone received on Sunday) an MRI
Odd thing for a doc to say, 100% not true at all.

Brain imaging studies are almost always normal in concussions. No one would ever report a head CT or an MRI as positive for a concussion. They would just say "normal" or "no bleed and no fracture".

If there is clinical concern for something worse than a concussion, it's common to get a head CT rule out a skull fracture or head bleed. MRI would be rarely done in this setting, even on pro athletes, if the head CT is normal. It's rarely going to show anything.

It's honestly all still a very gray area of medicine. When most people get diagnosed with a concussion, it's just the "likely" scenario. If you go to the doctor after a head injury and have a headache, nausea, etc and nothing else is wrong... they'll tell you that you had a concussion. They're probably right, but they don't know with any certainty (which is why the anecdotal things about person X,Y,Z missing a concussion are sort of silly... it's often subjective). They have some more recent tests that DRS mentioned to help but by no means are they perfect.

There are a few objective findings supporting a concussion such as posturing, amnesia, wobbly gait, that make it pretty clear your "bell got rung" pretty badly. Absent that, it's still pretty hazy and sometimes even the most educated docs are just making their best guess.
 

Harry Hooper

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Is it possible that players are deliberately tanking {in terms of response times or whatever} when taking the baseline test so that they will not fail the mid-game test later?

Addendum: according to this sheet from Bismark Public Schools, it takes 30 minutes to administer the ImPACT test. Doesn't seem like they're taking that long in the blue tent on the sidelines during NFL games.
 
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P'tucket rhymes with...

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The Coney Island of my mind
Is it possible that players are deliberately tanking {in terms of response times or whatever} when taking the baseline test so that they will not fail the mid-game test later?
Oh God, we hate people who think like you. More substantively, it would be difficult to do so credibly. I don't use imPACT or whatever the league might be using, but most of these things are sufficiently sensitive (and in some cases include specific validity indicators) to catch someone trying to game the test. When individual differences and test norms for something like measured response times vary in terms of msecs, it's difficult to pull off.
 

Shelterdog

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Odd thing for a doc to say, 100% not true at all.

Brain imaging studies are almost always normal in concussions. No one would ever report a head CT or an MRI as positive for a concussion. They would just say "normal" or "no bleed and no fracture".

If there is clinical concern for something worse than a concussion, it's common to get a head CT rule out a skull fracture or head bleed. MRI would be rarely done in this setting, even on pro athletes, if the head CT is normal. It's rarely going to show anything.

It's honestly all still a very gray area of medicine. When most people get diagnosed with a concussion, it's just the "likely" scenario. If you go to the doctor after a head injury and have a headache, nausea, etc and nothing else is wrong... they'll tell you that you had a concussion. They're probably right, but they don't know with any certainty (which is why the anecdotal things about person X,Y,Z missing a concussion are sort of silly... it's often subjective). They have some more recent tests that DRS mentioned to help but by no means are they perfect.

There are a few objective findings supporting a concussion such as posturing, amnesia, wobbly gait, that make it pretty clear your "bell got rung" pretty badly. Absent that, it's still pretty hazy and sometimes even the most educated docs are just making their best guess.
Thanks. I’m sure I misunderstood what he was saying-I think his point was in the case of a head injury you would want the imaging to assess the scope of fractures, bleeding and the like and you would always always want to do the scanning but perhaps I was confusing what is a necessary diagnostic tool with what are the steps one would take to in caring for a patient. (Based on our discussion he would certainly agree that you might be able to say someone who had had a head injury, was knocked out, had amnesia and vision problems had had a concussion without needing a scan)
 

radsoxfan

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Thanks. I’m sure I misunderstood what he was saying-I think his point was in the case of a head injury you would want the imaging to assess the scope of fractures, bleeding and the like and you would always always want to do the scanning but perhaps I was confusing what is a necessary diagnostic tool with what are the steps one would take to in caring for a patient. (Based on our discussion he would certainly agree that you might be able to say someone who had had a head injury, was knocked out, had amnesia and vision problems had had a concussion without needing a scan)
Imaging sometimes is a part of the workup to rule out something worse, but CT is better to see fractures and bleeds than MRI.

So if there is imaging at all, almost certainly CT only.
 

sodenj5

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One of those professionals was just terminated. Maybe they’re not infallible after all.
No one said they’re infallible. I said they’re more qualified than Mike McDaniel to make a medical decision.