Combat sports can teach football plenty about short, medium-term effects of head trauma

It's encouraging to see football catch up to the fight game — if you can't stand, or raise your arms, you shouldn't compete. But it's chilling to contemplate that until Tua Tagovailoa's brain injury, the NFL trailed boxing and MMA.

Prior to Tua Tagovailoa's concussion, NFL trailed boxing, MMA in handling head injury

Miami Dolphins quarterback Tua Tagovailoa is examined by training staff after a head injury during a game against the Cincinnati Bengals in September. (Jeff Dean/The Associated Press)

This is a column by Morgan Campbell, who writes opinion for CBC Sports. For more information about CBC's Opinion section, please see the FAQ.

Videos hit social media midway through Wednesday afternoon — Miami Dolphins quarterback Tua Tagovailoa trotting on to the practice field, stretching, laughing, throwing spirals with that slingshot of a left arm.

One reaction: relief.

We hadn't seen Tagovailoa since Sept. 29, when he was carted off the field after getting knocked unconscious during a Thursday night game in Cincinnati. It was his first concussion of the season, technically, though he certainly looked woozy as he wobbled off the field after a blow to the head in a game against Buffalo the previous weekend. Officially, according to the Dolphins, the staggered gait stemmed from a back injury.

Either way, the sack in Cincinnati, in which Tagovailoa's head hit the turf as 345-pound defensive tackle Josh Tupou flung him to the ground, led to two weeks out of the spotlight, and speculation about how he might look when he eventually returned. Wednesday, Tagovailoa allayed concerns about his overall health. Alertness, balance, co-ordination — all there.

But, naturally, other questions arise. Will he play this week?

Zero chance, according to head coach Mike McDaniel.

"When talking about this week and playing, I don't see a scenario," he told reporters Wednesday.  "I do not plan to have him play at all."

So when will Tagovailoa play again?

Unclear. He'll need to pass some tests to clear protocol, and then demonstrate his pre-concussion sharpness. If the team has a timeline, they haven't revealed it.

My question: Why rush?

Contrast Tagovailoa with Juan Macias Montiel, the boxer who lost by TKO to Carlos Adames last Saturday in Los Angeles, now serving an automatic suspension. He couldn't compete again until November 22, and Montiel never hit the canvas. How long would a boxing commission suspend him if he had wound up like Tagovailoa — arms stiffened and raised in front of his face, fingers rigid and contorted?

60 days? 90?

Prior to Tagovailoa's much-publicized concussion, the NFL lagged behind fight sports like boxing and MMA in dealing with head injuries. (Kareem Elgazzar/USA TODAY Sports/Reuters)

A similar timeline would push Tagovailoa's next game into early 2023. As close as we'll get to safety in this sport.

Point is, people who follow fight sports can tell you how intensely big-time football is flirting with tragedy by expecting players to return quickly from concussions. Automatic suspensions linked to the severity of the knockout help ensure that athletes, competitive by nature, and promoters, eyeing the bottom line, can't fast-forward the return-to-competition process.

It's a rare, specific case that mainstream team sports should follow the fight game's example. As it concerns the short and medium-term effects of head trauma, fight sports can teach football plenty.

A month ago, few of us knew the word "ataxia." It refers to a loss of gross motor control, and has become part of the sports lexicon since Tagovailoa's injury, and it's a one-way ticket to the concussion protocol. The Dolphins know. "Ataxia" got second-string pivot Teddy Bridgewater pulled from last week's loss against the Jets, leaving rookie Skylar Thompson to start this week against Minnesota.

If you watched Saturday's boxing card, you saw Adames knock Montiel into a state of "ataxia," and likely didn't complain when the referee halted the bout. Mixed martial arts fights, likewise, are stopped the moment fighters can't defend themselves, because they can't control their limbs, either because of ataxia or outright unconsciousness.

It's encouraging to see football catch up to the fight game — if you can't stand, or raise your arms, you shouldn't compete. But it's chilling to contemplate that until Tagovailoa's frightening, nationally-televised brain injury, the NFL trailed boxing and MMA, two sports with brain trauma built in, on dealing with head shots that render athletes ataxic.

If you've watched a lot of fights, you've seen people lose by knockout, then recover to conduct post-bout interviews, and later field questions at news conferences, conscious and conversant. But still concussed.

Keep those circumstances in mind as you listen to retired NFL quarterback Alex Smith on The ESPN Daily podcast, describing how, as the member of the Chiefs, he passed a sideline concussion screening, only to return to the game and get knocked out.

"The experts cleared me. I passed," he said. "Similarly to Tua, [I] shouldn't have. And I went back in the game."

Fight sport regulations have a built-in recognition that coherent could still mean compromised. If a fighter got knocked out in round two, you wouldn't restart a bout in round three just because they answered questions well. And if they get starched on Saturday, you wouldn't book them for a fight the following Thursday, period. When a fighter suffers a knockout, the subsequent suspension is immediate and automatic, and errs toward sidelining people with underlying brain injuries.

The word "underlying" should concern the folks who still don't understand the stakes.

In May of 2019, I reported from ringside at a thrilling but brutal title fight between Badou Jack and Adonis Stevenson. Late in the final round, Jack landed a thunderous uppercut to Stevenson's jaw. The blow whiplashed Stevenson's head and sent sweat flying; the bout ended in a draw.

Six months later I watched on my laptop as Oleksandr Gvozdyk knocked Stevenson into a coma. 

Hindsight is alway perfect, but I wondered whether Stevenson, then 41, had fully recovered from the punishment he absorbed in Toronto the previous spring. I called a neurosurgeon — Dr. Charles Tator, head of the Canadian Concussion Centre — who explained that brain damage can linger for months, undetectable by CT scans, MRIs and the kind of "what city are we in?" questioning we apply to athletes who have had their bells rung.

"When you take a beating in May and fight again in December, has your brain really recovered?" Tator asked, pointing out that only a radioactive tracer can detect low levels of latent brain damage.

I'm not trying to be alarmist about Tagovailoa, or any other currently-concussed NFL player. And I recognize why the Dolphins might want him back in the lineup the moment he appears ready.

Tagovailoa was Miami's top draft pick in 2020, the quarterback around whom the team is planning its future. Miami also traded for superstar receiver Tyreek Hill, paying him $120 million US over four years. Pairing Hill with the blazing fast, yet sure-handed Jaylen Waddle almost isn't fair. Like Usain Bolt and Yohan Blake on the same relay team. If Tagovailoa is the quarterback Miami imagined he was when they (allegedly) were ready to throw games for the right to draft him, he should put up huge numbers when he returns.

He might come back later this month, and play the rest of this season, maybe the rest of his career, without another incident.

But enough people, suffering enough brain injuries, returning to contact sports before they're fully healed, will eventually yield a result fight fans can tell you about.

Gerald McClelland. Michael Watson. Prichard Colon. Cleveland Denny. Patrick Day. Duk Koo Kim.

Think about the fact that brain injuries happen despite suspensions designed to limit them, and it prompts another question.

What makes a football player's brain different from a boxer's?

The answer? Nothing.


Morgan Campbell

Senior Contributor

Morgan Campbell joins CBC Sports as our first Senior Contributor after 18 standout years at the Toronto Star. In 2004 he won the National Newspaper Award for "Long Shots," a serial narrative about a high school basketball team from Scarborough. Later created, hosted and co-produced "Sportonomics," a weekly video series examining the business of Sport. And he spent his last two years at the Star authoring the Sports Prism initiative, a weekly feature covering the intersection of sports, race, business, politics and culture. Morgan is also a TedX lecturer, and a frequent contributor to several CBC platforms, including the extremely popular and sorely-missed Sports Culture Panel on CBC Radio Q. His work has been featured in the New York Times, the Literary Review of Canada, and the Best Canadian Sports Writing anthology.

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