MIAMI - Dolphins quarterback Tua Tagovailoa is set to make his return to the football field on Sunday night against the Pittsburgh Steelers (8:20 p.m. ET, NBC), just over three weeks after sustaining a highly publicized concussion and in the wake of an NFL investigation that produced swift policy change.
Tagovailoa said Wednesday he lost consciousness when he was sacked and hit his head on the ground late in the first half against the Bengals in Cincinnati on Sept. 29. He does not remember being carted off the field.
Tagovailoa was briefly hospitalized for the concussion but flew home with the team that night. He was kept off the football field for the next two weeks.
The incident came four days after Tagovailoa hit his head on the ground when shoved after throwing a pass in a Week 3 matchup against the Buffalo Bills. He stumbled on his way back to the huddle and was evaluated for a concussion at halftime, but he was allowed to return to the game after it was determined a previously reported back injury caused the stumble. The NFL amended its concussion protocol after reviewing the situation.
Meanwhile, the Dolphins, who opened the season with three straight wins, have since lost three in a row.
"There's things you can do in the locker room to keep the guys encouraged, to keep the guys motivated," Tagovailoa said Wednesday. "But it sucks. As a competitor, I want to be out there with the guys. I want to be able to go out there and help our guys win games.
"And that's a terrible feeling that I could only watch from the sidelines."
Tagovailoa also missed three games last season because of a rib injury, and when he returned, the Dolphins lost their next three. That scenario taught him a lesson.
"I just gotta be myself. I'm not the savior of this team," Tagovailoa said. "I don't just come in and we start winning games. It's a team deal.
"The defense gets us stops, the offense goes and puts points on the board, and the defense can help put points on the board, as well as special teams. So for me, I just look at it as coming into this week and just be myself. Don't try to force anything. Don't try to make plays that aren't there -- just give our playmakers the ball and let them go to work."
That's a critical realization for Tagovailoa, who said throwing the ball away to avoid a hit is not something he has done well in the past. Dolphins coach Mike McDaniel said he has spoken with Tagovailoa about learning when to concede a play and move on to the next.
That will be just one of the storylines Sunday night as Tagovailoa returns to a team and a league that have changed as a result of his injuries. He needs to regain his early-season form if the Dolphins are to stay in contention in the AFC East, and teammates have been encouraged by what they've seen over the past couple of weeks. But Tagovailoa's return is about more than wins and losses, it's also about the protocol he has cleared and the concussion policy that has changed. -- Louis-Jacques
What were the concussion protocol steps Tagovailoa had to clear to return to the field?
Tagovailoa went through a five-step process before returning to the field after sustaining a concussion. This is what it looks like, paraphrasing from the return-to-play portion of the protocol:
Phase 1: Rest, and then limit -- or avoid -- physical and cognitive activities if they aggravate symptoms. Introduction of limited stretching and balancing work and moving to light aerobic exercise.
Phase 2: Gradual progress toward cardiovascular exercise, dynamic stretching and more balance work. Neurocognitive and balance testing can be administered. If the results are interpreted as back to baseline (pre-concussion) levels, Phase 2 is satisfied.
Phase 3: Increased cardio exercise to mimic sport-specific activity, along with supervised strength training. The player can practice with the team, doing sports-specific exercises, for 30 minutes or less.
Phase 4: The player can advance to non-contact football activities such as throwing, catching and running. Another round of neurocognitive and balance testing is administered to confirm results remain at baseline.
Phase 5: A club physician must clear the player for full football activity, including contact. Then, an independent neurological consultant (INC), assigned to the team by joint agreement between the NFL and NFLPA, must concur with the team physician that the concussion has resolved. At that point, the player is clear to play in his team's next game. -- Seifert
When was Tagovailoa allowed to participate in all football activities, and what has he done on the practice field?
Tagovailoa was cleared to participate in football-specific activities on Oct. 12 and fully cleared concussion protocol on Oct. 15. In the three practices before he was cleared, Tagovailoa took individual reps during position drills but ceded starter and backup reps to Skylar Thompson and Teddy Bridgewater, respectively, during team drills. McDaniel said he was impressed by how intently Tagovailoa was able to focus throughout practice despite his hands-off role.
This week, Tagovailoa returned to the starter's workload. -- Louis-Jacques
What have Tagovailoa's teammates seen from him in the past two weeks?
Tagovailoa has been present throughout the Dolphins' facility for the past two weeks, in meetings and in the locker room -- where teammates say he has been his typical self.
"Just to have him back out there, his energy, his leadership, the way that he's able to have fun playing this game throughout it all, man, it's just amazing," wide receiver Tyreek Hill said. "It's always fun to have your brother back out there on the field."
Tight end Mike Gesicki said Tagovailoa took plenty of mental reps while he was out and said he "didn't skip a beat" when he returned to practice. -- Louis-Jacques
Tua Tagovailoa throwing at Dolphins practice for the first time in two weeks— Marcel Louis-Jacques (@Marcel_LJ) October 12, 2022
He also did some downfield throwing during the portion of practice open to the media - roughly 25-30 yards pic.twitter.com/6ivEYaGLKE
What should expectations be for Tagovailoa's return?
McDaniel said he doesn't expect to see any rust from Tagovailoa and joked the left-handed quarterback didn't start throwing with his right hand during his time away from the field. The Dolphins can't afford to ease him back in terms of a simplified game plan -- not on the heels of a three-game losing streak while the rest of the AFC East kept winning.
The Steelers own the league's third-worst pass defense through six games, so Miami's path to victory will likely include Tagovailoa throwing the ball frequently. -- Louis-Jacques
What has changed in the NFL policy since Tagovailoa's concussion?
The NFL and NFLPA targeted the specific clause of the protocol that allowed Tagovailoa back on the field after he stumbled against the Bills in Week 3 but came back to play in the second half. Moving forward, players who demonstrate ataxia -- uncoordinated body movement caused by an injury to the brain -- are diagnosed with a concussion and prohibited from returning to the game.
Like all players who suffer a concussion, they must pass through all phases of the protocol before being cleared to play in a future game.
Previously, players who stumbled the way Tagovailoa did against the Bills would be examined to determine the cause. If the source was neurological in nature, the player would be prevented from returning. In Tagovailoa's case, multiple doctors attributed it to back and ankle injuries he had suffered earlier in the game.
The new protocol doesn't require game doctors to make the distinction between neurological or other causes. All such instances are now an immediate "no-go." - Seifert
What happens if Tagovailoa gets another concussion?
That would obviously be a serious and worrisome circumstance, but in terms of the NFL/NFLPA protocol, nothing would change. He would have to pass through all of the same phases in order to be cleared for a return to the field. - Seifert