Tua Tagovailoa and concussions: It's really time to rethink tackle football for kids | Opinion

Tua Tagovailoa and concussions: It's really time to rethink tackle football for kids | Opinion

Updated: 3 months, 1 day, 18 hours, 42 minutes, 30 seconds ago

Tua Tagovailoa and concussions: It's really time to rethink tackle football for kids | Opinion

3 minute readplay

Show Caption

Hide Caption

How Tua feels internally with Dolphins after his head injury dominated the sports world

USA TODAY Sports + NFL insider Safid Deen shares details on the current status of Tua's relationship with the Dolphins.


This week, many experts in the field of concussion are gathering in Amsterdam for the 6th International Consensus Conference on Concussion in Sport. Because of the pandemic, this is the first international gathering since Berlin 2016 — Paris 2020 was canceled — for which I was a participant. At the conclusion of the conference, a very small selected group called the “Concussion in Sport Group,” commonly referred to as the CISG will author a consensus paper and disseminate it worldwide. 

The gathering was initially held in 2001 in Vienna with the goal to foster research, education, identification, training, treatment and management of concussions. Much has changed since that initial meeting, and even more so since the last meeting in Berlin in 2016. Based on research studies, prior CISG consensus statements have made recommendations that have dramatically improved how we address concussions. For example, we no longer tell those with who have sustained concussions to stay in a dark room and wait until their symptoms subside. Instead, we know active rehabilitation helps recovery.

We also know that recovery from concussions is not typically a 7-10 day process. In September 2021, research from the DOD-NCAA Care Consortium was published that found that it takes an average of 28 days for the brain to fully heal from a concussion.

The need to not rush back from concussions was never more evident when Tua Tagovailoa of the Miami Dolphins sustained two injuries within a five- day window, the second of which led to an on field “fencing” response likely due to seizure. 

With regard to long term effects of concussions, particularly chronic traumatic encephalopathy the CISG has consistently stated that there is no causal relationship. However, recent developments have created doubt.

Over the past few months however, research has come out that, I believe, should make everyone pause. One of the main authors from the Concussion in Sport Group and organizer of the conference, Dr. Paul McCrory, was forced to resign when it was discovered that he plagiarized at least 10 articles — since retracted —from the British Journal of Sports Medicine and another 38 are being further examined. McCrory has repeatedly claimed that there is no evidence linking repeated concussions to CTE and that discussion of that is based on fear and “neuromythology.”

Additionally, a new study from the University of Glasgow found that former international rugby players shown to be at higher risk for neurodegenerative disease.

The most compelling research on the link between football and CTE has always come from Boston University. Many in the CISG have repeatedly stated the research was biased due to selection issues.  However, a recent study applied The Bradford Hill Criteria — first created 1965 by Sir Austin Bradford Hil to show smoking causes lung cancer — and found that repetitive head injuries were a definitive cause of CTE.  The Bradford Hill Criteria is a nine-category framework for analyzing environmental exposures & harms and defines and when to move from "association" to "causation."

These developments led to the National Institute of Health to acknowledge a causal link between contact sports and CTE.

Four years ago I had the privilege of testifying before the New York State Assembly about a proposal to ban youth football in New York. At that time, I wrote that it was premature for public policy to ban one particular sport or activity at that stage, with the research still undecided.  The evidence presented to me over the last few years makes me pause and ask myself what significant detriment will there be to playing flag football before the age of 14? If advocates for tackle say it’s to curb things such as obesity so that kids don’t stay glued to technology, then where were their voices during the pandemic when sports were shut down and kids were home on their tables, phones or laptops?  And why is it that the compelling evidence is not good enough?  If one argues it has to do with selection bias, an argument can be made about who supports, financially and otherwise, the research that shows that CTE is not caused by repetitive head impacts.

As a clinician who has spent his entire 25 year career in brain injury, I always felt that it was important to collect the data, let the science lead us, make informed decisions, and engage in a robust, civil discourse. Doing so would lead to good public policy grounded in hypothesis confirming scientific findings. Since I wrote my piece in 2018, much has changed.  New evidence has emerged, and I believe that overall risks now outweigh the benefits. Each of us has only one brain and it is the most important aspect to our entire well being. I believe those involved in consensus statements need to not only include new scientific evidence, but to also include those with whom they disagree with to participate in the drafting of the consensus statement. In light of the plagiarism and recent evidence, I believe the CISG needs to re-examine itself and its mission.  It is important for the greater good of the international community that we take care of, especially those of the young, to get this message right.

Mark Herceg is founder and clinical director of Head Strong Diagnostics, LLC. He is former commissioner of the Westchester County Department of Mental Health and past chair, New York State Concussion Task Force. Herceg is also a fellow of the Sports Neuropsychology Society, clinical assistant professor of the Department of Rehabilitation Medicine at Zucker School of Medicine at Hofstra University and assistant professor at the School of Public Health of New York Medical College.