With Tua Tagovailoa’s future and health on the line, Dolphins must exercise ultimate caution

It was the scene none of us wanted to see: Tua Tagovailoa incapacitated on the football field after another collision and blow to the head.

But there we found ourselves late Thursday night, watching in fear of the Miami Dolphins quarterback’s well-being as medical personnel tended to him after his third-quarter scramble and collision with Buffalo Bills safety Damar Hamlin. Immediately, memories and mental images of Tagovailoa’s 2022 concussions rushed back.

The heart-stopping fear that his family members must have experienced at that moment is hard to fathom. But everyone from current to former NFL players, fans and anyone in between sympathized.

Tagovailoa eventually was helped to his feet, and he limped off the field under his own power. Just before the quarterback reached the sideline, Dolphins coach Mike McDaniel had a brief word with his player, “I told him he’s the starting quarterback of his family, and to ‘Go in the locker room, take a deep breath and I’ll see you soon.’” With that, McDaniel kissed Tagovailoa on the head and turned him over to the trainers, who ushered him to the locker room for evaluation.

.@KayleeHartung provides an update on Tua Tagovailoa. pic.twitter.com/hiEnuq9ISC

— NFL on Prime Video (@NFLonPrime) September 13, 2024

McDaniel’s emotions were impossible to hide for the remainder of the game and during his postgame news conference. McDaniel immediately fielded questions about how the Dolphins would approach Tagovailoa’s recovery, but he said only that he expected Tagovailoa to go through extensive evaluations on Friday, and that the Dolphins would then approach the situation and the quarterback’s care “one day at a time.”

Now faced with how to handle their quarterback after a third known concussion in three seasons, Dolphins leadership finds itself in an extremely difficult position. It must wait to learn how this latest concussion will impact the 26-year-old quarterback and then grapple with the decision of when/if he should return to the field.

The Dolphins and their doctors no doubt will work hard to avoid a repeat of 2022, when Tagovailoa seemingly was allowed to return to action prematurely and then sustained at least one other concussion. (Those decisions sparked a joint investigation by the NFL and NFL Players Association’s medical examiners.)

If you recall, it was Week 3 of that 2022 season when Tagovailoa sustained a blow that left him stumbling and struggling to maintain his balance after an injury that the Dolphins classified as a back injury, although something about that diagnosis always felt off. Tagovailoa started the following game before eventually sustaining a sack that caused his back and back of his helmet to hit the ground. Tagovailoa’s body involuntarily went into the fencing response before he was taken off the field on a stretcher. Then in Week 16, Tagovailoa sustained another concussion and missed the final two regular-season games and Miami’s playoff game.

If the Dolphins learned anything from that Week 3 and 4 sequence, it’s that medical exams and league-mandated protocols aren’t always as all-encompassing or as foolproof as one would hope. So this time measures that may even seem extreme are required as they navigate this latest brain injury recovery with their quarterback.

Almost immediately after Tagovailoa’s injury Thursday night, social media erupted with opinions from former players, including Hall of Fame tight end Tony Gonzalez, who covered the game for Amazon Prime, and fans who suggested that Tagovailoa should retire — never playing football again. The risk of the quarterback returning to action and suffering another (and possibly more devastating) concussion seems to far outweigh the rewards of a continued playing career, they believe.

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It’s not so simple, however. How do you tell a young man that he’s unfit for work? How do you tell him that he can no longer live his dream?

Tagovailoa certainly has proved he’s capable of playing at an elite level. He led the NFL in passing yards last season and had gotten off to another prolific start in Week 1. But his injury history suggests that his body isn’t designed to hold up under the rigors of this violent game.

There’s a fine line between supporting a player while allowing him to live his life and make his decisions and protecting a player from himself. Determining where that differentiating line falls is painfully complicated and perhaps impossible to determine.

Tua Tagovailoa led the NFL in passing yards last season and was the league’s leader through Week 1 of this season. (Jasen Vinlove / USA Today)

It’s an unenviable position for the Dolphins, who earlier this summer agreed to a four-year, $212.4 million contract extension with the quarterback. The deal is the last thing on anyone in the organization’s minds at this time. Protecting and supporting a member of their family in hopes he returns to full health and maintains the ability to lead a quality life tops their priority list.

The Dolphins can’t abide by the usual return-to-play concussion protocol, which entails daily monitoring and benchmarks and a gradual ramp-up of physical activity and potential clearance for game action by the end of the same week.

It seems like the Dolphins’ doctors should mandate extensive and the most sophisticated testing possible to learn as much about Tagovailoa’s brain and recovery process before they let him set foot anywhere so much as a treadmill. The problem is that concussion-related brain damage is often difficult to detect even with the most modern forms of technology. But extreme care is needed, even if the quarterback is no longer exhibiting concussion symptoms.

For now, it’s far too early to know what the recovery timeline looks like. McDaniel said Friday that he didn’t even know if the Dolphins would place the quarterback on injured reserve (a minimum of four games) to ensure he doesn’t attempt to rush back.

“I literally will not know any sort of anything either way, because, again, that’s how we’re operating, as though we know nothing — because we don’t,” the coach said. “The driving force behind any sort of move — let’s say playing anytime, let’s say IR, whatever those things are — the absolute most important opinion is that of the most important person in this whole equation: Tua. His opinion of what he wants to do with his life and his career, coupled with the experts in neuroscience — those are the driving forces behind those actions. … I’m not hiding anything. I’m being as transparent as I absolutely could. I have zero idea what any sort of timeline is, and I’m actually extremely motivated to be in the gray, because I’m extremely motivated to do right by, you know, the person that we’re talking about. I know that’s not an ideal way to do business, necessarily. But this is more than business.”

McDaniel added, “Literally all I’m telling Tua is, ‘Everyone is counting on you to be a dad this weekend,’ and then we’ll move from there.”

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If Tagovailoa does ultimately decide he wants to continue playing and doctors allow it, then the Dolphins must do everything possible to protect him, which means bringing him along at a painstakingly slow pace to help guard against setbacks, and perhaps making him wear a Guardian Cap in games over his already specialized helmet. But that’s just the start.

They have invested in him heavily at this point. His contract features $167 million that is guaranteed for injury, including $43 million that has been paid this year. Even if the team forced him to retire for medical reasons, it would owe Tagovailoa the remaining $124 million of guaranteed money on his contract. If he chooses to retire on his own, he would forfeit that money, unless he and the team reached an injury settlement. So, the only move is to exercise patience and support.

McDaniel explained, “I look at Tua as a family member of mine,” and his sentiments are shared by those within the Dolphins’ organization. So for now, the necessary moves are to ensure the well-being of the man takes precedence over any football matters. Then, eventually those decisions will come.

If only there was a way to guarantee that the Dolphins quarterback never has to endure a similar episode in the future.

(Top photo of Mike McDaniel kissing Tua Tagovailoa as he exits the field: Megan Briggs / Getty Images)