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NFLPA initiating investigation into Tua’s concussion protocol


YoloinOhio
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31 minutes ago, Rochesterfan said:

Everyone here is overlooking one major thing.  There is one person to blame for this issue and one person only - Tua - the player.

 

Look the NFL and NFLPA agree the protocol was followed - then the idiot Tretter - who “SUCKS” as a leader comes out with his weak response that the NFL and the UNC are at fault, but they can not tell you anything they did wrong other than the team doctor did not examine his back - Bullcrap.

 

The 1st issue here is a player (and it has been stated many times by other players) had a baseline testing that he did poorly enough on that he could pass it in game even with a head injury.  Therefore the UNC in doing his work is already at a disadvantage because he has a baseline that is false.

 

The 2nd issue is if the player lies about the injury or any symptoms- so in this case as they are asking about the injury while watching the film and Tua states that Nope - it was not my head it was my lower back - the players know the loop hole and he passed the mental part because his baseline was low - then the 2 best ways to diagnose a concussion on site and quickly have been gamed by the player and it is not the first time it has happened.

 

The UNC and team doctor have a responsibility to protect the player, but the player has a direct responsibility to themselves to be honest and helpful in an exam and the doctors can only do so much.

 

I started out reading this and saying "Blame The Victim Going Down in Aisle 2", but this a valid point.  If the players are going to "game the system" by deliberately messing up their baseline testing and lying about the locus of their pain, they do have responsibility.  Maybe not "one person and one person only", but definitely significant responsibility.

 

I still think "the player states his earlier back injury was aggrevated by that hit, causing gross motor instability and the need to be helped off the field" should require a detailed back exam.  If the physician feels the only valid diagnostic tool for him is an MRI, then that's where the player should go. 

 

Question: when you say "and it has been stated many times by other players" are you referring to statements about Tua, specifically, fudging his baseline testing, or just general comments?

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31 minutes ago, The Wiz said:

So basically the Miami staff made up the back injury so they didn't have to test him for concussion while they even listed him out with a "head injury" when he came out of the game.

 

The claim is that Tua had previously reported a back injury earlier in the game, so it wasn't "made up" entirely (allegedly)

 

Maybe I'm naive, but one of the things that stuns me (HA!) is (taking the "aggravated a back injury reported earlier" at face value) the lack of apparent concern for an aggravated back injury that supposedly caused that degree of motor impairment/instability because I heard that and was thinking "dude if that's true you better ice that player out until you figure out what's going on with his lower back or the next hit might have a wheelchair with his name on it"

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42 minutes ago, Beck Water said:

 

C'Mon Man.  We know you're a physician.  We all know you like to shade stuff to "win" in an argument.

 

Physical exam is a lost art, but it still exists and is still useful.  A dozen templates or more for back exam as taught to medical students exist.  A good PT can watch a patient move, ask them to move their trunk and legs in various ways, and have a damn good idea exactly where the problem is.  I have a back injury from a fall off a scaffold years ago and my favorite PT asked me to walk, turn, and move my legs in various ways (while I wasn't experiencing pain at the moment) and pinpointed the locus of the injury.

 

The player collapses when he stands and walks and has to be assisted off the field.  He attributes this to a previously reported back injury which has worsened with a subsequent hit.  Most of us look at the aftermath of that play and think concussion causing ataxia.  These guys are saying "nope, not concussion, back injury."

 

So then you have an alleged back injury worsened by a subsequent hit to the point of causing gross motor impairment and requiring the player to be assisted off the field.  Isn't that serious stuff too?  Shouldn't physicians of integrity that we would all want treating us conduct whatever tests and examinations are needed to determine that the injury won't be potentially further aggravated and place the player's long-term motor abilities at risk with continued play? 

 

Get an xray and ping the radiologist on call to read it.  If you really think all that physical exam for diagnosis stuff is just poppycock, just pull the guy and send him for an MRI if that's what you feel you need.


you are conflating several issues.  
 

People are dragging the med staff for missing an obvious concussion.  In doing so they are mocking the “back injury” explanation yet also up in arms that no “back exam” was done.  There really isn’t such that is significant in the patient I described above.

 

also, you can lecture about the list art of physical exam (it’s certainly not lost in my practice, but thanks for the helpful hints), but no spine or ortho spine doc is going to make a spot diagnosis of any specificity in an acute on chronic injury.  Many won’t see a consult until MRI is in erecord for them to view.

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2 minutes ago, Mr. WEO said:


you are conflating several issues.  
 

People are dragging the med staff for missing an obvious concussion.  In doing so they are mocking the “back injury” explanation yet also up in arms that no “back exam” was done.  There really isn’t such that is significant in the patient I described above.

 

also, you can lecture about the list art of physical exam (it’s certainly not lost in my practice, but thanks for the helpful hints), but no spine or ortho spine doc is going to make a spot diagnosis of any specificity in an acute on chronic injury.  Many won’t see a consult until MRI is in erecord for them to view.

 

But what people are saying is Tua should have been sent for a MRI on his back considering the signs on the field; not sent back into the game.

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44 minutes ago, Beck Water said:

 

I started out reading this and saying "Blame The Victim Going Down in Aisle 2", but this a valid point.  If the players are going to "game the system" by deliberately messing up their baseline testing and lying about the locus of their pain, they do have responsibility.  Maybe not "one person and one person only", but definitely significant responsibility.

 

I still think "the player states his earlier back injury was aggrevated by that hit, causing gross motor instability and the need to be helped off the field" should require a detailed back exam.  If the physician feels the only valid diagnostic tool for him is an MRI, then that's where the player should go. 

 

Question: when you say "and it has been stated many times by other players" are you referring to statements about Tua, specifically, fudging his baseline testing, or just general comments?


 

Just in general.  Several former players have talked for years about how the majority of players all “game the system”.  It is well known amongst the players and the NFLPA - so if the NFLPA truly cared - that would be the first place to fix the system.  They even point to rookies and younger players that did not know failing concussion protocols because of it.

 

It is not victim blaming - the player is the most important piece of the equation and they have to be honest for the protocol to work and if they lie about symptoms and purposely game the baseline testing then they made everyone else’s job nearly impossible.

 

I do not know if Tua “gamed” the system, but if he didn’t and he did not have any concussion symptoms and he passed the mental testing repeatedly - then we are all speculating on a concussion based solely on the GMI.  
 

Do I think he had a concussion and should have been held out - yep, but I also understand based upon the previous protocol- if everything checked out - why you allow him back in.  He passed the testing he needed to, gave a ready made excuse, and cleared through.  
 

 

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8 minutes ago, UKBillFan said:

 

But what people are saying is Tua should have been sent for a MRI on his back considering the signs on the field; not sent back into the game.


He would have to go to the hospital for that.  He had no neuro deficit and was moving appropriately so they sent him back out.  
 

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15 minutes ago, Mr. WEO said:


you are conflating several issues.  
 

People are dragging the med staff for missing an obvious concussion.  In doing so they are mocking the “back injury” explanation yet also up in arms that no “back exam” was done.  There really isn’t such that is significant in the patient I described above.

 

also, you can lecture about the list art of physical exam (it’s certainly not lost in my practice, but thanks for the helpful hints), but no spine or ortho spine doc is going to make a spot diagnosis of any specificity in an acute on chronic injury.  Many won’t see a consult until MRI is in erecord for them to view.

 

As soon as Tua puts his hands up to his helmet when his head hit the ground that's a concussion. Have seen it so many times, and that's the almost default reaction by a player in that situation...

 

The fact they ignored that is pretty wild. 

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7 minutes ago, Mr. WEO said:


you are conflating several issues.  
 

People are dragging the med staff for missing an obvious concussion.  In doing so they are mocking the “back injury” explanation yet also up in arms that no “back exam” was done.  There really isn’t such that is significant in the patient I described above.

 

also, you can lecture about the list art of physical exam (it’s certainly not lost in my practice, but thanks for the helpful hints), but no spine or ortho spine doc is going to make a spot diagnosis of any specificity in an acute on chronic injury.  Many won’t see a consult until MRI is in erecord for them to view.

 

I’m explicitly not doing this.  I’m explicitly taking them at their word, and saying OK, so Tua’s physicians don’t believe the gross motor instability and need for assistance off the field was caused by concussion, but instead was caused by motor issues caused by aggravating an earlier back injury.  What is best medical practice in this case?

 

 If you believe you have a patient who has an aggregated back injury that just caused gross motor instability, and you personally believe a physical exam is of no value and an MRI is indicated for diagnosis, do you send them for an MRI?  Or do you say “nothing to see here, return to play”?

 

My point is that I believe even if the Dolphins physicians honestly believed that Tua did not have a concussion but instead, had aggravated a previous back injury to the point where he fell and required assistance to leave the field - isn’t that a matter you should follow up by whatever means necessary to make a determination that a player who just aggravated back injury that had just caused gross motor instability can, in fact, safely return to play?  

 

Is that what you’d do?

 

Is that what you’d want a physician treating your child or close family member to do?

 

I don’t think I’m conflating several issues at all.  I think you’re dodging on addressing the issue I’m trying to raise here.  

 

My point is that taken at face value, the Dolphins claims make no sense.

 

 

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16 minutes ago, UKBillFan said:

 

But what people are saying is Tua should have been sent for a MRI on his back considering the signs on the field; not sent back into the game.

 

I don’t know about “people”, but I’m specifically saying, if the Dolphins physicians honestly believed that the GMI Tua exhibited was in fact caused by aggravating an earlier back injury - if we take that at absolute face value - then shouldn’t the Dolphins physicians conduct whatever examination and testing they believe is relevant to a back injury causing those symptoms?

 

If WEO is correct that no physician would rely upon a physical exam and X-ray to diagnose that but would require an MRI, then pull him and send him out of stadium for an MRI.  If a physician/PT feel that x-ray and physical exam are enough to rule out issue that could be worsened by RTP, then do that.

 

But don’t do nothing - no exam, no X-ray, no MRI - and tell me these are physicians acting with utmost integrity that I would want treating me and mine, Dr Sills.  That’s (IMO) into Diggs pithy “don’t piss on me and tell me it’s raining” territory.  Either they knew those were symptoms caused by concussion and they let him slide through the “other cause” loophole, or they honestly believed those were symptoms caused by aggravating a previously reported back injury, in which case they should pursue examination or testing relevant to a back injury causing GMI

 

Either or, but not neither.

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1 hour ago, UKBillFan said:

 

Though the point of the protocol is to protect the player from both themselves and the franchise. There is an understanding that the player may want to re-enter the game, and value it over his health. There is an understanding a franchise may want a player to re-enter the game, and value it over their health, especially if they're under pressure. The protocol is supposed to protect from this. It's farcical that Tua claimed to have a back injury yet no one checked his back.


 

Agreed, but that is not on the UNC - that is on the team doctor.  
 

We also do not know what was said.  Did he say like a stinger that it flared and stopped or was that a Dolphins code for getting out of concussion protocol.   
 

I think you can easily lay blame at the team doctor, but I do not think they can lay blame at the one person the NFLPA could blame - the UNC.

 

The biggest piece though is if the player stated he had any symptoms, headache, light sensitivity, woozy feeling, etc.  The UNC holds him out.  If the player is hell bent on getting back in and lies about all of that and gamed the baseline testing and many former players have stated they do - for the express reason of getting out of protocol and getting back - isn’t that the primary issue the NFLPA should be addressing.

 

Players - including Tretter could be part of the solution to the issue rather than being a part of the problem and then blaming others for the problem.

 

 

 

 

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40 minutes ago, Beck Water said:

 

I’m explicitly not doing this.  I’m explicitly taking them at their word, and saying OK, so Tua’s physicians don’t believe the gross motor instability and need for assistance off the field was caused by concussion, but instead was caused by motor issues caused by aggravating an earlier back injury.  What is best medical practice in this case?

 

 If you believe you have a patient who has an aggregated back injury that just caused gross motor instability, and you personally believe a physical exam is of no value and an MRI is indicated for diagnosis, do you send them for an MRI?  Or do you say “nothing to see here, return to play”?

 

My point is that I believe even if the Dolphins physicians honestly believed that Tua did not have a concussion but instead, had aggravated a previous back injury to the point where he fell and required assistance to leave the field - isn’t that a matter you should follow up by whatever means necessary to make a determination that a player who just aggravated back injury that had just caused gross motor instability can, in fact, safely return to play?  

 

Is that what you’d do?

 

Is that what you’d want a physician treating your child or close family member to do?

 

I don’t think I’m conflating several issues at all.  I think you’re dodging on addressing the issue I’m trying to raise here.  

 

My point is that taken at face value, the Dolphins claims make no sense.

 

 


on first blush I would have put him in the concussion protocol.  But what I would do is beside the point here.

 

I am commenting on how they seem to be defending their decisions, and others’ response to this.

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Okay, so the Fins managed to circumvent the existing protocol to allow Tua to re-enter the game.  I don't care about that.  Congratulations.

What pisses me off, is that if he has a back injury, that's SO severe that it causes him "gross motor instability", how the F%$%^& can ANY medical professional w/ good conscience (& ability) allow him to subject himself to more potential (possibly permanent) damage/injury?

If you truly are prioritizing player safety that's absolutely appalling and needs to be penalized & not allowed to continue.

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Ever since they have started talking about an "independent spotter" all i can think is the massive unintended consequences that could arise.  You have violent hitting on every play.  Now they're going to allow some yahoo up in a booth to watch a screen and determine who has to leave a game? No way, that should be determined by a doctor.  They blew it with Tua, but this is a massive overreaction.  You're going to have some big playoff game or a Super Bowl where Mahomes, Allen, Brady, Hurts, etc. are going to be pulled from a game because some spotter *thinks* the guy looks shaky.  How do we even know that the spotter at the game yesterday didn't have money on the Jets?  Ok Teddy, take a seat.   

There should be video evidence for starters AND the player should be checked by a real doctor and cleared to come back in the game if he's deemed to be ok.  

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2 hours ago, Big Blitz said:

The Dolphins have set back the sport of football 10 years

 

 

This guy isn't wrong 

 

 

In the end - blame the organization you cover.  

This rule is too damn much. If these dudes want to scramble their brains then I'm cool with it.

 

I have a problem with team doctors and medical experts lying and betraying their obligation.

 

These doctors should advise the players. Let them make their own health decisions. By no means should they be able to force the player out.

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On 10/9/2022 at 11:12 AM, Beck Water said:

 

I’m explicitly not doing this.  I’m explicitly taking them at their word, and saying OK, so Tua’s physicians don’t believe the gross motor instability and need for assistance off the field was caused by concussion, but instead was caused by motor issues caused by aggravating an earlier back injury.  What is best medical practice in this case?

 

 If you believe you have a patient who has an aggregated back injury that just caused gross motor instability, and you personally believe a physical exam is of no value and an MRI is indicated for diagnosis, do you send them for an MRI?  Or do you say “nothing to see here, return to play”?

 

My point is that I believe even if the Dolphins physicians honestly believed that Tua did not have a concussion but instead, had aggravated a previous back injury to the point where he fell and required assistance to leave the field - isn’t that a matter you should follow up by whatever means necessary to make a determination that a player who just aggravated back injury that had just caused gross motor instability can, in fact, safely return to play?  

 

Is that what you’d do?

 

Is that what you’d want a physician treating your child or close family member to do?

 

I don’t think I’m conflating several issues at all.  I think you’re dodging on addressing the issue I’m trying to raise here.  

 

My point is that taken at face value, the Dolphins claims make no sense.

 

 

The biggest problem is that the standard of care is not the same in the outpatient setting as it is on the sideline.

 

if a QB injures his shoulder, and is structurally intact on the sideline, and wants to go back in after a block, I PROMISE they are not doing enough imaging to fully diagnose the problem. 

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Tua reportedly will begin throwing today...does not specify if he will start Sunday but it's unlikely as the timeline to progress through the protocol is too lengthy

 

https://profootballtalk.nbcsports.com/2022/10/12/report-tua-tagovailoa-to-throw-in-wednesday-return-to-field/

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