Concussions - The Tua Tagovailoa Story

I was recently asked what a fencing posture was by a client who was not a sports fan.
Obviously, the news on Tua Tagovailoa of the Miami Dolphins was news to more than just sports fans. 

For those who do not know, "fencing posture" is an unnatural position of the arms following a concussion. Immediately after moderate forces have been applied to the brainstem, the forearms are held flexed or extended (typically into the air) for a period lasting up to several seconds after the impact.

What happened to Tua Tagovailoa? 

Four days earlier in a game, Tua was knocked backwards and landed on his low back and head. He stood up in a very wobbly manner and left the field accompanied by the team’s medical staff. Less than 20 mins later he was back in the game with the diagnosis of low back spasm. In the fall out, the NFL Players Association fired 2 of its 3 independent medical staff whose had the job to ensure that an injured player was properly evaluated in the case of a suspected concussion injury.

All the current research indicates that symptoms can take up to 24h to appear after a suspected concussion impact. In youth sports, these athletes are removed from play and re-evaluated with no further participation until the next day at the earliest to rule out a concussion. In the world of pro sports, this is much more difficult to manage for some, with much more money riding on the decision. 

We also know that after a concussion it can take at least 5-7 days for the brain’s supply of blood, oxygen and electrolytes to return to pre-injury levels. This is one reason why the return to play process is tagged over 6 steps with each step taking a minimum of 24h. If Tua really did have a concussion in the 1st game, then returning to play 4 days later was too early for the brain’s healing process.

Treating a Concussion: Subjective vs. Objective Findings

Tua’s story of getting hit on a play earlier and having his back hyperextend, as "the cause" for why his back gave out on “the hit” in the next play is a very plausible story. The good news is that in the world of concussion injuries, relying solely on subjective (how are you feeling) questions is not the only deciding factor. A follow up investigation involves evaluating objective tests that can’t be faked to get to a more accurate diagnosis. In addition, having access to baseline/ preseason health scores is also often used as a comparison point.  Without being in the room, I have no way of knowing what process was followed, but the NFL like other profession sports leagues do have strict protocols to be followed. Two people being fired makes you think that something in the protocol was missed.

Yearly Baseline concussion testing assists in the management of concussion injuries to add an additional layer of information that does not rely solely on the "subjective" information from an athlete who may really want to return to play regardless of their actual state. 

Do Pro Athletes get treated differently?

Rowan’ s Law in Ontario was created to help educate athletes, coaches and parents regarding concussion injuries in order to identify and properly manage these injuries and their varying symptoms. At a youth level, this often is led by volunteers with various levels of training. Professional teams have a team of medical staff of Athletic Therapists and Trainers, Physiotherapists, Chiropractors and Sports Medicine Doctors, plus a whole array of equipment and resources at their disposal.

Several years ago, Sports Canada announced that all Canadian National and International level athletes were required to undergo preseason medicals including baseline concussion testing and also having trained concussion medical personal on the sidelines at all practices and games.

But on the other hand, several medical associations were stating that baseline concussion testing was not needed for youth sports where all involved have less concussion knowledge and medical credentials that at professional or national level events.

So yes, pro athletes do get treated differently. 

Why is this? 

Well there are many reasons... knowledge, protection, financial investments, funding, support.... the list could go on. Maybe this is a topic for another blog post. 

The fact of the matter is, we spend a lot of time educating teachers, parents, coaches, trainers and others invovled in youth sports the rationale for yearly baseline concussion tests. This is the most impressionable period and the most significant developmental phase of youth's lives and having the knowledge and data to understand the severity of a suspected concussion injury could singificantly impact the youth's future and their recovery outcome.

Isn't it worth $65 for a Baseline Concussion Test?

What's that old MasterCard commercial.... $50 for hockey tape, $300 for a hockey stick, $250 for a helmet... knowing you protected your child's brain with a Baseline Concussion Test.... priceless. 

How can youth sports organizations and schools prevent the Tua story from happening:

  1. Create a Concussion Policy as mandated by Rowan’s Law
  2. Make baseline concussion testing available to your athletes on a yearly basis 
  3. Ensure adequate concussion training for team volunteers, coaches, and athletes is provided 
  4. Create relationships with local practitioners versed in concussion management to support concussions injuries if they occur. Ideally these relationships with local pracitioners are the same for the baseline concussions tests - allowing for direct access to their scores should a concussion injury be suspected. 

Honsberger Physio+ is involved in all levels of concussion management from baseline concussion testing, educational lectures, advanced concussion training workshops for sports trainers, to in clinic concussion assessment and treatment, as well a planning for return to school, work and play. We can also help your organization map out their own specific Concussion Policy based on the sport and latest research and legal requirements.

Don't let your organization fall behind! Ensure your Concussion Policies and protocols are up to date! You may not know until its too late! 

Click here to learn more about our Individual + Team Baseline Concussion Testing programs. 

Interested in learning more?


Orthopedic Rehabilitation
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