Three Sides to the Head Injury Conversation

It was 4^th and 4 and the quarterback was scrambling for a red zone first down. His team was down three scores, but Tua Tagovailoa was trying to keep his Dolphins in the game. Tagovailoa’s collision with Buffalo’s Damar Hamlin knocked him out of the game, and perhaps changed his team’s fortunes. Tagovailoa was diagnosed with his third confirmed concussion.

Photo credit: AP Photo/Lynne Sladky

Sports fans who aren’t neuroscientists saw that awkward posture of his arms and fingers, commonly called fencing, and knew he wasn’t well. His doctors would use that fencing response as one part of their diagnosis. Fencing, if you’ll allow a simplistic medical explanation, is a reaction that occurs when a blow impacts the brainstem.

A lot of ink and pixels have been spilled on his career, and the long-term prospects of his health, after seeing Tagovailoa’s arm in the air, his fingers fixed and rigid, after watching the Dolphins medical staff rushing to his side once again. Even considering the many steps the NFL takes with protective rules for quarterback safety on game day, and the many steps a team logically takes to preserve their leader throughout the week, three confirmed concussions in such a short span of time seems like a lot for the 26-year-old. And if you’re skeptical, you wonder how many other TBIs the guy might have suffered that aren’t discussed, that weren’t diagnosed. What might all of this ultimately mean for him?

That’s something Colts tight end Kylen Granson, who is also 26, is thinking about. He’s made headlines at the beginning of the season for his choice to wear the new Guardian Cap, those bubble shaped, soft-shelled pads worn over the regular football helmets. The idea behind the extra gear, of course, is to reduce the risk of concussions and other head injuries. Granson offered his Instagram followers a thoughtful explanation behind his decision to wear the extra padding, and to promote them for others.

Guardian Caps. Photo credit: Ric Tapia/Getty Images

He talks not just about the big hits, but the accumulated series of smaller impacts the brain takes over the course of a game, a long season, and a player’s career. The comments to his video are a bit mixed, of course, but largely complimentary. Most coming from a ‘take care of yourself,’ angle, with a few variations of a ‘you’re being a good role model’ theme as well. A few of the negative ones are as reductive as, ‘these things look goofy.’ Granson discusses that in his video, too. His premise remains, essentially: Why wouldn’t I do everything I can to protect my livelihood, and my future?

Photo credit: Icon Sportswire / Getty

Photo credit: Mykal McEldowney/IndyStar / USA TODAY NETWORK

If it seems like a novel idea, remember that players are coached to concentrate not on the future, but the next snap. It’s the one-play-at-a-time, one-game-at-a-time mentality. As fans, we might think about a full season. Winning is everything, even at the expense of the most basic human level of self-preservation. Just look at the language we use surrounding game day. He’s fighting for yardage. It’s a war. He sacrificed his body.

Rhetoric like that has made it easy for us to think about old school athletes and say things like, “They just didn’t know about head injuries back then,” with more than a little cognitive dissonance.

The truth is we’ve just never taken brain injuries as seriously as we should. Players sometimes got knocked silly, that’s all. What could be more dismissive than that?

Medical research, popular media, and even the NFL have come around to the very real concerns. Retired athletes are leading the charge on this front.

New research published in JAMA Neurology may have one of the largest surveys of former NFL players ever undertaken. The survey tabulated responses from 1,980 former professional football players, and a third of them, 681 of them, said they believed they had CTE. More than 230 reported experiences of suicidal thoughts; 176 reported a diagnosis of Alzheimer's disease or other forms of dementia (Grashow, et al., 2024).

The study’s authors dutifully point out there’s still a lot we must come to understand about the brain, it’s injuries and long-term prospects. 

For fans, Granson’s appeal to safety and his desire to be a positive example for others should resonate.

“Football is a game … but it’s not worth putting my life, putting my family’s life at risk … If I can do the same things on the field, and be safe at the same time, why would I not want that? As a fan, why would you not want that? Some of your best players could play for longer and protect their health.”

Research isn’t conducted in a two-minute drill, and important new breakthroughs have to be understood, accepted and implemented to be effective. But, in the meantime, why wouldn’t players who take such great pains to improve their craft and maintain their bodies to peak performance – with a whole life ahead of them after they put away the pads – do the same for their brains?