The NFL updates its concussion protocol after Tua Tagovailoa injury, but a culture change is still needed

• Miami Dolphins player Tua Tagovailoa was injured in a game against the Cincinnati Bengals.
• A number of former NFL players are taking to social media saying the NFL failed him.

The video of the Miami Dolphins quarterback Tua Tagovailoa lying on the field during a game against the Cincinnati Bengals earlier this month,with his hands locked above his face — a sign of potential brain damage — was sickening.

For Chidi Ahanotu, a former NFL defensive player, it was an abomination. As the 12-year NFL veteran spoke, he started to cry.

"What happened to Tua, it's just absolutely horrendous and unforgivable insofar as where we are today," Ahanotu told Insider. "All the work, and all the deaths, and all the suicides, and all the suffering we've seen."

The 51-year-old Ahanotu, who said he continues to experience cognitive deficits like memory loss from his time in the NFL, is one of 4,500 former players who sued the league a decade ago over its concussion policy and practices, resulting in a massive settlement.

"If this was any other business, it would be shut down by the government," Ahanotu, who played for the Tampa Bay Buccaneers, the Miami Dolphins, and others, said.

On Saturday, The NFL and NFL players union agreed to modify the league's concussion protocol. As a result of an investigation into what happened to Tagovailoa, the league and union agreed to add the term "ataxia" to the list of issues that bar a player from returning to the field. They defined ataxia as "abnormality of balance/stability, motor coordination or dysfunctional speech caused by a neurological issue."

The provisions around ataxia are the latest steps the NFL has taken to tighten its concussion policies, which are are tougher than they were a decade ago. Yet the league's macho culture still pushes players to risk injuries that can cut short lives, medical experts, advocates, and former players say. Players often want to protect their pride, and the NFL wants to protect its business. Without a culture shift, there will be many more Tagovailoas.

"Nobody cares. The NFL doesn't care," Ahanotu said. "Well, it's not that no executive at the NFL cares, but the culture, this caveman mentality, it needs to change."

The NFL didn't immediately reply to Insider's request for comment.

Criticism of the Dolphins leadership and the NFL's culture around player safety is growing.

"To be honest, it's business as usual," Jonathan Martin, a former NFL offensive tackle who played for the Miami Dolphins and the San Francisco 49ers in the 2010s, told Insider.

Martin's NFL run wasn't always easy. During his time with the Dolphins, Martin was subject to harassment by fellow players, a 2014 report found. After leaving the league, Martin was arrested in 2018 for a social-media post that police deemed threatening. The charge was dismissed in 2021 after Martin took part in a diversion program.

Martin now believes he has chronic traumatic encephalopathy, or CTE, a degenerative brain condition associated with blows to the head. He has agreed to donate his brain for CTE research. "You're the labor if you're a player, for better or worse," he said.

The NFL changed its policies, but safety still doesn't appear to be the top priority

The saga began when Tagovailoa suffered a punishing hit during a Sunday game against the Buffalo Bills. The 24-year-old stumbled around, a sign of a concussion. He was put back in the game shortly after a medical assessment, a decision many disagreed with. Four days later, the Dolphins played Tagovailoa against the Cincinnati Bengals, when he sustained another hard hit and was taken off the field on a stretcher.

In video of the game Thursday, Tagovailoa showed signs of "decorticate posturing," a condition that could indicate severe brain damage, said Toufic Jildeh, a doctor at Michigan State University's Health Care Sports Medicine.

The players' union has since dismissed a doctor who OK'd Tagovailoa's return to the game after his hit on Sunday, per reports.

Brain health is a concern for many former players because successive hits over a career are cumulative, making a diagnosis like CTE more likely.

Several NFL retirees have taken to social media to demand action.

"In no sport should an athlete display this kind of neurological behavior and compete again in 4 days (let alone later that day). Someone must be held accountable. #Tua," former NFL linebacker and Fox Sports commentator Emmanuel Acho tweeted.

But should the responsibility extend beyond medical experts? What about the coaches with years of experience witnessing bad hits? What about NFL leadership?

Reporters on Thursday asked the Dolphin's head coach, Mike McDaniel, whether the team should've done anything differently. He said "absolutely not." McDaniel also told a reporter that the quarterback watched a movie with him on their flight home Thursday night and was laughing and in good spirits.

The NFL and the players' union released a joint statement on Saturday, saying that the investigation into the handling of Tagovailoa's situation is ongoing. Both parties said updates to concussion protocols are required.

'There is too much concentration on winning'

Tagovailoa told reporters that "adrenaline kept him going" after the bad hit on Sunday. But can you trust the judgment of someone who just sustained a potentially brain-damaging hit? A former New England Patriots player Rich Ohrnberger says no.

"Very thankful today for the Patriots' trainers/medical staff for the way they handled my concussion in 2011. I was out on my feet, they took it seriously, and I spent the year on [injured reserve list]. They saved me from myself. I would've rushed back if they let me. They didn't. Prayers for Tua," he tweeted.

Martin, the former NFL player, said he understands the motivations at play.

"The incentive is to get your best players on the field," Martin said. "The NFL is a business. If you have to deal with long term liabilities on a balance sheet, like ongoing disability payments, that affects your bottom line. At the end of the day, the NFL owners are apex capitalists."

Indeed, the NFL is a giant money-producing machine. In 2021, the league's 32 teams generated revenue of $11 billion. And NFL commissioner Roger Goodell wants the league to be generating $25 billion by 2027.

"There is too much concentration on winning, making money, fame, and denial," said Karen Zegel, the cofounder of StopCTE.org, a nonprofit in memory of her son, Patrick Risha, who died by suicide in 2014. Studies of his brain revealed CTE from high school and college football. "Tua Tagovailoa will never be the same."

Safety has costs: Key players sitting out for weeks or longer could mean lost games, which could put coaches' careers in danger. It could also potentially lower viewership when a star like Tagovailoa is on the sidelines.

The NFL has made some important changes over the years in how it handles concussions. The league unveiled an updated concussion policy in 2011 and has made changes since then. In 2018, the NFL made some of its rules stricter to protect players who could have sustained concussions. The league works with a board of independent and NFL-affiliated physicians and scientists to make these policies.

According to Jildeh, the sports-medicine doctor, the NFL should be lauded for its work to reduce and better handle concussion — but he noted there are calls for more stringent, data-driven policies when a player is injured.

"The concern is that these return-to-play protocols have many loopholes, which can be manipulated for an expedited return to play when the athlete is not fully rehabilitated from injury," Jildeh said.

Ahanotu, who spent most of his career with the Buccaneers, said that many of the changes to the NFL's protocols only came after retired players contacted the NFL or filed suits against the league.

"This suffering of families and loved ones and children and, and parents — this doesn't have to happen. I mean, this is a dangerous, violent sport, but we can be smarter," Ahanotu said. "I hate that I have to be the bully on this, but it's because I care so much. Like, what the hell is going on?"

This article was originally published on October 4.