Tua Tagovailoa, fencing, and NFL procedure explained

Some people who witnessed the terrifying injury want to know why Tagovailoa was playing just four days after his rapid comeback Sunday sparked an NFL investigation.

Tua Tagovailoa slumped to the ground Sunday, his legs shaky and unable to move to the huddle. Then, on Thursday night, he was stretchered off the field after another impact forced his head to crash forcefully onto the grass and his hands to freeze.

The Dolphins said that the third-year quarterback was aware and moving all of his limbs. He was brought to the University of Cincinnati Medical Center but was later discharged and is scheduled to rejoin the squad in Miami.

"It was a terrifying experience." He was assessed for a concussion and is now in the concussion protocol, according to Dolphins coach Mike McDaniel.

Some people who witnessed the terrifying injury are wondering why Tagovailoa was playing just four days after his rapid comeback Sunday spurred a joint investigation by the NFL and NFL Players Association.

Many former players blasted the decision to let Tagovailoa play against Buffalo and start against Cincinnati.

"Player health and safety is vital to the NFLPA's purpose," the NFLPA stated on Twitter. "Our thoughts tonight are with Tua, and we wish him a healthy and swift recovery." The inquiry into the possible procedure breach is still continuing."

According to NFL executive vice president Jeff Miller, the assessment typically takes a week or two.

"Every indication from our standpoint is that it was," Miller said on Sunday of the club and its medics adhering to concussion protocol. "I know the player, coach, and others have discussed this." And we are currently doing that evaluation. So we'll respond with a proper answer to that inquiry, something in which we're interested."

Before the game, Chris Nowinski, CEO of the Concussion Legacy Foundation and former Harvard football player, tweeted: "If Tua plays tonight, it's a big step back for concussion treatment in the NFL." If he suffers a second concussion that ends his season or career, everyone involved, including coaches, will be sued and may lose their jobs. We all witnessed that, and they must realize something is wrong."

HOW DID TAGOVAILOA GET PERMISSION TO RETURN ON SUNDAY?

Tagovailoa seemed dazed after taking a strong hit from Bills defender Matt Milano late in the first half, which the club initially described as a head injury. He just missed three snaps before returning after halftime. Tagovailoa and the team said his instability after the impact was caused by a back ailment, and he was not in concussion protocol. He was iffy to play on Thursday, but he did.

WHAT CONCUSSION PROTOCOL DOES THE NFL FOLLOW?

A player who displays or reports symptoms or signs of a concussion or stinger is placed in procedure.

Independent certified athletic trainers (ATC spotters) observe the athletes on the field throughout each game. If officials witness an impact to the head, they call a timeout and the player must be taken from the game, inspected, and evaluated. Team trainers, coaches, or physicians, teammates, NFL game officials, sideline unaffiliated neurotrauma consultants (UNC), or booth ATCs can also commence the process.

A team physician and UNC conduct a six-step examination of every player in concussion protocol to establish the severity of the ailment and whether or not they are fit to return to the field. The final phase is a neurological assessment that includes a cervical spine exam, range of motion/pain evaluation, speech evaluation, gait observation, eye movements, and pupillary exam.

If any of the criteria are positive, inconclusive, or suggestive of a concussion, the athlete is led to the locker room.

A team physician and UNC do a comprehensive neurological evaluation and complete NFL Standardized Concussion Assessment Tool in the locker room.

If the results are abnormal, the player is not allowed to play again, is evaluated on a regular basis by a medical team, and has a neurological test.

After Cleveland Browns quarterback Colt McCoy had a helmet-to-helmet hit in a game and returned without being checked for a concussion, the league implemented the procedure in 2011. The Browns claimed that the hit went unnoticed by the team's trainers because they were caring to other players, and that no one informed them of it. McCoy was diagnosed with a concussion following the game.

WHAT EXACTLY IS FENCING RESPONSE?

"When a person receives an impact severe enough to induce traumatic brain damage, such as a concussion, their arms typically move into an awkward posture," according to healthline.com.

Tagovailoa looked to assume that posture, his fingers flexing uncomfortably in front of his facemask as he lay on the grass for many seconds.

According to healthline.com, "the fencing reaction is frequently observed when a player gets knocked down or knocked unconscious during full-contact sporting tournaments such as football, martial arts, boxing, rugby, and hockey."

Last December 17, it happened to Los Angeles Chargers tight end Donald Parham during a Thursday night game against Kansas City. After being diagnosed with a concussion, Parham was taken on a stretcher and sent to a hospital for observation.

WHAT HAPPENS NEXT FOR TAGOVAILOA?

The extent of Tagovailoa's concussion is unknown, but the fact that he was allowed to fly with the squad is positive. Before he may return to the field, he must go through a five-step process. The fifth stage consists of a full practice session followed by clearance from the team physician. He will then be assessed by an impartial neurological expert.