Explaining the NFL's latest concussion controversy and policy change

The NFL is once again under fire over concussions.

After Miami Dolphins quarterback Tua Tagovailoa sustained a pair of big hits, the second of which left him needing to be carted off the field, the league and its players' union opened an investigation and said it would review its concussion policy.

Over the weekend, the investigation findings were released and the league announced it would change a key element of its concussion policy, effective immediately.

Now, all eyes are watching closely to see how officials handle concussions as the NFL heads into the sixth week of its season.

Looking to catch up on the latest? Read on.

Why's this happening now?

The hits on Tagovailoa sparked the latest concussion conversation.

First, in a Sept. 25 game against the Buffalo Bills, Tagovailoa was pushed to the ground and his head hit the turf. Afterward, he stumbled and needed help steadying himself, leading many viewers to believe he'd been concussed. But he returned to the game after a medical evaluation, and team officials later attributed Tagovailoa's wobbliness to a back injury he'd sustained a few plays earlier.

Then, four days later, Tagovailoa returned to the field for a Thursday night game against the Cincinnati Bengals. He was sacked and his head hit the turf again; immediately afterward, his fingers and arms were flexed unnaturally in what appeared to be a "fencing response," a telltale sign of traumatic brain injury.

After Tagovailoa's injuries, many viewers – including former players and concussion experts – criticized the decision to allow the quarterback to return to play.

"We are all outraged by what we have seen the last several days and scared for the safety of one of our brothers," said JC Tretter, the president of the NFL Players' Association. "We need to figure out how and why the decisions were made last Sunday to allow a player with a 'no-go' symptom back on the field."

What is the NFL doing about it?

The NFL and its players' union conducted an investigation and released the findings last weekend. The league also announced a change to its concussion policy.

The investigation showed that the NFL's concussion protocol had been followed in evaluating Tagovailoa, who did not show concussion symptoms either during his mid-game medical evaluation on Sept. 25 or in the days that followed before the Thursday game. Instead, Tagovailoa's unsteadiness was attributed to a back injury he'd sustained on an earlier play.

But the league and union also acknowledged that "the outcome in this case was not what was intended" when its concussion protocol was drafted.

Now, the policy has been changed. The revision concerns ataxia, the medical term for the poor muscle control associated with concussions that can appear as unsteadiness or slurred speech. Going forward, any player who is diagnosed with ataxia will not be allowed to return to the game. Previously, players could return if there was another explanation for a moment of instability, like how Tagovailoa's stumble was attributed to the back injury.

The new policy has already come into play: During the Dolphins' game Sunday, an independent certified athletic trainer (also called an "ATC spotter") reported seeing the team's backup quarterback, Teddy Bridgewater, stumble after being hit on the first snap of the game. The report triggered the new clause of the concussion policy, and Bridgewater was pulled from the game. He's now in concussion protocol alongside Tagovailoa.

Is there any connection to this week's controversial "roughing the passer" calls?

For those who didn't watch this past weekend: A pair of questionable "roughing the passer" penalties raised eyebrows and caused some to wonder if the league had asked referees to more strictly penalize quarterback tackles in the wake of the Tagovailoa incident.

The first was a Sunday flag against the Atlanta Falcons' Grady Jarrett for tackling Tom Brady of the Tampa Bay Buccaneers. The other came Monday night against the Kansas City Chiefs' Chris Jones, whose strip-sack of Las Vegas Raiders quarterback Derek Carr was overturned by the penalty.

The roughing-the-passer penalty is designed to keep defensive players from tackling quarterbacks in dangerous ways. But many felt the tackles had been appropriate and wondered if there was a connection between the calls and the Tagovailoa incident.

On Tuesday, The Associated Press reported that the NFL had not issued any directive to referees, but that the topic will be discussed next week at a meeting of team owners in New York. (Even if any changes to the rule are proposed, they would be unlikely to take effect until next season.)

"When you do it right, I don't believe you should be punished for it," Jarrett said this week on an Atlanta sports radio program. "Hopefully something can come from this and a change can happen but at the end of the day, I would hope that some conversation would be had."

Statistics show that roughing penalties are down from last season. In 2021, there'd been 54 such penalties through Week 5; this year, there've been only 29.

What does research say about how long players should sit out after a concussion?

Concussion recovery times vary widely. More severe concussions — like the kind that can cause a player to stumble or lose consciousness altogether — take longer to recover from.

Over the weekend, the NFL's top medical official said that players diagnosed with a concussion miss a median time of 9 days.

That's in line with current concussion research. Studies vary, but many have found a "return to play" timeline within that timeframe for elite male athletes like NFL players.

Professional athletes generally have quicker concussion recovery timelines than non-athletes, said Christopher D'Lauro, a cognitive neuroscientist at the Air Force Academy, who called the NFL's nine-day median "a good number."

In his 2018 study of concussions among cadets at the military academy, D'Lauro and his colleagues found that men returned to play more quickly than women, and "elite athletes" – meaning players on the school's NCAA Division I teams – returned to play more quickly than non-athletes.

The male athletes had the shortest recovery periods, just 20 days, while female non-athletes needed double the recovery time, they found. Women athletes and men who weren't D1 athletes were somewhere in between. (Other studies have found that professional athletes recover even more quickly than college players.)

Several factors help explain the difference in recovery times between NFL players and an average person, D'Lauro said.

For one, even a healthy brain is an energy-intensive organ, and concussions can cause an abnormal increase in brain activity. Athletes are better poised to absorb that energy hit, D'Lauro said. "If you're a normal person and you get a concussion, you don't have much energetic expense capacity to spare when compared with an athlete who is training year-round," he said.

The other major variable is around-the-clock access to medical care. "They have certified athletic trainers, they have doctors, they have physical therapists who are monitoring them and progressing them through the protocol at an appropriate rate," he said.

Returning to the field too soon after a concussion can be dangerous. Research has shown that people who experience a concussion are more likely to have a future concussion, and some studies of people with multiple concussions have found that the subsequent injuries can cause worse symptoms.

While medical professionals have made major strides in identifying concussions, diagnosis can still be a challenge, D'Lauro added. There is no single test that can unequivocally identify concussions, unlike infections like strep throat. "You go take your kids to the pediatrician, and they do the rapid strep [test], it's like — you're good or you're not," he said. "There's nothing like that for concussions. It's all clinician judgment, so it is pretty hard."

Research shows that even a single concussion is associated with an increased risk of brain disorders like Parkinson's disease and dementia.

And research shows that repeated hits to the head — not just concussions – can increase the risk of developing the degenerative brain condition CTE, which has been found in many former NFL players.

Copyright 2022 NPR. To see more, visit https://www.npr.org.