NFLPA initiating investigation into Tua’s concussion protocol

[leh-nerd skin-erd]

43 minutes ago, YoloinOhio said:

 

Sometimes, with all the questions swirling as to who should have done what, who said what to whom, and against what one thinks is absolutely in their best interest, it’s just a good thing to have someone who cares enough about you to say “Sorry…no can do.”. 
 

All the people involved here and Tua didn’t have that person in his corner. 
 

[Beck Water]

1 hour ago, Saint Doug said:

Based on the NFL’s definition of “ataxia”, which btw is correct, Tua still wouldn’t have been pulled out of the Bills game. Per NFL, ataxia has to be secondary to a neurological problem, which everyone on the Dolphins denied and said the imbalance was due to a “back problem”.

 

I'm really glad to hear someone else say this.  At best, there is ambiguity in the definition where some would define it as a symptom or series of symptoms, and some would define it as the same symptoms but in the absence of a skeletomuscular injury (eg a balance break due to a knee buckling from torn ligaments)

 

Which kind of seems to get us back where we started

 

1 hour ago, Saint Doug said:

One thing can definitely learn, based on the response, is that Tua did indeed had a concussion. 

 

Please say more here.

 

 

1 hour ago, Saint Doug said:

I’m not as concerned they didn’t examine his back. That was not their job, which was to determine if he had a concussion or not. Regardless of what was going on with his back, even if there was a positive exam finding, Tua still could’ve been diagnosed with a concussion. That is, I don’t think concussion is a diagnosis of exclusion. 

 

Respectfully disagree in part.  Of course, you're correct concussion is not a diagnosis of exclusion (although, apparently it has been functionally used as such? and I'm not sure the term ataxia fixes that?). 

 

It was the job of the UNC and, during the concussion exam, the team physician and trainers to determine whether Tua had a concussion or not, we agree there.

 

Where we may disagree, is that after determining that Tua did NOT have a concussion based on clearing his exam and persuading them that his ataxia was caused by his back injury....it was By Damn the head trainer and team physician's responsibility to examine Tua's back and determine whether he would be at risk for worsening the injury and whether he could protect himself and function, if he returned to the game

[Beck Water]

1 hour ago, YoloinOhio said:

 

 

BOOM!  Bravo, Tretter!  The exact point that needs to be made - if you're going to say "OK, UNC, this isn't your turf,  it's not a neuro problem" but you don't examine the player to determine the extent of the injuries on the body parts that are supposed to be responsible for his "gross motor instability" -  how can you credibly look anyone in the eye and say the Dolphin team physicians acted with "absolute integrity" and "those are the people you would want caring for you"?

 

The Dolphins team physician and their trainers have a responsibility to assess the player overall, not just whether or not he has a concussion.  Hell to the No do I want a physician or trainer who doesn't see it that way caring for me!

[Beck Water]

1 hour ago, Mr. WEO said:

What “back exam” are people expecting they would have done in the tent?  Short of a visible or palpable vertebral subluxation, a player with an intact neuro exam isn’t going to show much on a “back exam”

 

They weren't in the tent for all this, Bright Eyes.   Tua was taken to the locker room. 

 

It's my understanding that all 32 NFL stadiums now have pretty good xray equipment with high-res digital imaging which can transmit images instantly to a radiologist on call.  Some have CT scanners as the NFL has a pilot program using CT scan to screen for concussion, but I couldn't quickly find out if Hard Rock is one. 

 

Only 2 have MRIs.  Hard Rock is not one of them.

Edited October 9, 2022 by Beck Water

[JoPoy88]

1 hour ago, Mr. WEO said:

What “back exam” are people expecting they would have done in the tent?  Short of a visible or palpable vertebral subluxation, a player with an intact neuro exam isn’t going to show much on a “back exam”

I was more referring to in the locker room at halftime. I know they can’t do much in the tent.

Edited October 9, 2022 by JoPoy88

[Mr. WEO]

12 hours ago, Warcodered said:

Probably not as in depth a one as they could do in the lockeroom where he actually went.

 

12 hours ago, newcam2012 said:

I mean they did go into the locker room at halftime. I doubt the Miami medical staff examined and evaluated his back. I have seen no such evidence. It's my best guess the medical staff used the halftime to get their crooked story straight so Tua could play. Also, the days between their next game vs Cinci Tua was questionable due to a back injury. They keep the lie going which makes it even worse. 

 

11 hours ago, JoPoy88 said:

I was more referring to in the locker room at halftime. I know they can’t do much in the tent.

 

Back injuries are assessed typically with MRI.  Few diagnoses are made on physical exam.  It's not like an extremity injury.

11 hours ago, Beck Water said:

 

They weren't in the tent for all this, Bright Eyes.   Tua was taken to the locker room. 

 

It's my understanding that all 32 NFL stadiums now have pretty good xray equipment with high-res digital imaging which can transmit images instantly to a radiologist on call.  Some have CT scanners as the NFL has a pilot program using CT scan to screen for concussion, but I couldn't quickly find out if Hard Rock is one. 

 

Only 2 have MRIs.  Hard Rock is not one of them.

 

 

see above

[UKBillFan]

Back injuries can cause paralysis. Surely a complaint of a back injury which causes the player to stumble should be assessed and, if the stadium doesn’t have the facilities to do this, then he should be withdrawn from the game abd taken to the nearest hospital or medical centre for this to happen? Not have a response of “well, we can say it’s not his brain so it’s fine”?

 

Honestly, I’d be as angry about this if it was any other team who acted this way, including the Bills. Or if we had made one less blunder and won the game. This isn’t about winning or losing - this is about player safety and the clear lack of care they have in Miami.

Edited October 9, 2022 by UKBillFan

[RunTheBall]

This is very simple and people are getting lost in the weeds, which is exactly what the NFL wants. The Dolphins deliberately used the loopholes in the NFL concussion protocol to allow an obviously concussed player back onto the field in order to win their Super Bowl against us.

 

Patients are not protocols. Protocols serve to remove any critical thinking from the caring of patients and are useful in some circumstances where you want to act quickly and not have to think under pressure  (such as ACLS, Difficult Airway, Trauma Resuscitation).  The Miami docs and coaches used the protocol as cover to deny what they knew to be true (he had symptoms of a head injury walking off the field) and hide behind it to get Tua back on the field. Disgusting on so many levels.

 

There should be severe consequences to everyone involved for allowing Tua to be placed in a potentially life threatening situation by playing 4 days later and suffering a second concussion, but there won’t be.

[ehfeuh57]

That is a very broad summary to an investigation.

 

I thought we were going to have verbatem what was discussed between the Team Doctors the UNC and the Head Coach with timestamps.

 

I feel like we're missing a lot here. Almost like the NFL wanted a "move along now" ending.

Edited October 9, 2022 by DrDare

[The Wiz]

7 minutes ago, DrDare said:

That is a very broad summary to an investigation.

 

I thought we were going to have verbatem what was discussed between the Team Doctors the UNC and the Head Coach with timestamps.

 

I feel like we're missing a lot here. Almost like the NFL wanted a "move along now" ending.

That's the NFL version of "total transparency"

[Nextmanup]

12 hours ago, Beck Water said:

 

They weren't in the tent for all this, Bright Eyes.   Tua was taken to the locker room. 

 

It's my understanding that all 32 NFL stadiums now have pretty good xray equipment with high-res digital imaging which can transmit images instantly to a radiologist on call.  Some have CT scanners as the NFL has a pilot program using CT scan to screen for concussion, but I couldn't quickly find out if Hard Rock is one. 

 

Only 2 have MRIs.  Hard Rock is not one of them.

Great use of the term "Bright eyes."

 

I had an immediate flash to Planet of the Apes, which I enjoyed.

 

 

 

[Motorin']

57 minutes ago, DrDare said:

That is a very broad summary to an investigation.

 

I thought we were going to have verbatem what was discussed between the Team Doctors the UNC and the Head Coach with timestamps.

 

I feel like we're missing a lot here. Almost like the NFL wanted a "move along now" ending.

That's exactly what it seems like. Something tells me they're not going to get what they want.

[Rochesterfan]

14 hours ago, YoloinOhio said:

 

 

14 hours ago, syhuang said:

 

 

13 hours ago, Beck Water said:

 

BOOM!  Bravo, Tretter!  The exact point that needs to be made - if you're going to say "OK, UNC, this isn't your turf,  it's not a neuro problem" but you don't examine the player to determine the extent of the injuries on the body parts that are supposed to be responsible for his "gross motor instability" -  how can you credibly look anyone in the eye and say the Dolphin team physicians acted with "absolute integrity" and "those are the people you would want caring for you"?

 

The Dolphins team physician and their trainers have a responsibility to assess the player overall, not just whether or not he has a concussion.  Hell to the No do I want a physician or trainer who doesn't see it that way caring for me!

 

1 hour ago, RunTheBall said:

This is very simple and people are getting lost in the weeds, which is exactly what the NFL wants. The Dolphins deliberately used the loopholes in the NFL concussion protocol to allow an obviously concussed player back onto the field in order to win their Super Bowl against us.

 

Patients are not protocols. Protocols serve to remove any critical thinking from the caring of patients and are useful in some circumstances where you want to act quickly and not have to think under pressure  (such as ACLS, Difficult Airway, Trauma Resuscitation).  The Miami docs and coaches used the protocol as cover to deny what they knew to be true (he had symptoms of a head injury walking off the field) and hide behind it to get Tua back on the field. Disgusting on so many levels.

 

There should be severe consequences to everyone involved for allowing Tua to be placed in a potentially life threatening situation by playing 4 days later and suffering a second concussion, but there won’t be.

 

 

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.

 

If “Tretter” and the NFLPA really and truly want to fix the concussion issue they can, but it requires the Players to be honest and do he baseline and in game testing honestly.  Idiots like Tretter are looking for blame and they found their scapegoat in the UNC they fired for no cause.  If the NFLPA truly “found” something done wrong and outside of protocol - they would be shouting it from the rooftops - instead they fired the man because he was belligerent to them during the interview process.

 

There was a loophole and now that loophole will be closed and players will begin looking for the next way around the loophole.  As has been stated - staying down longer to prevent GMI issues - limping or adding some other action if they think they are a bit wobbly to make it appear to be something else.

 

The only facts we have are Tua got knocked on his Butt and smacked his head - he told the team and the UNC he had no symptoms and he could pass the mental testing at the facility.  He got through the rest of the game and then the weekly practice with according to Tua - no signs or symptoms and passes any additional testing that was part of the NFL follow in case of delayed symptoms.  Therefore he was cleared for Thursday Night.

 

The person at fault and the person to blame - Tua - he could have stopped it at any point by being honest.

 

 

 

 

Edited October 9, 2022 by Rochesterfan

[Nextmanup]

Folks need to understand that the "back injury" was fabricated once someone read the fine print in the concussion protocol.  They caught the provision about exhibiting signs of head trauma, and how that means you can't return to the same game, period.

 

So the head trauma was was re-defined as a "back injury".  It's the only way they could get him in the game without being categorically in error.

 

Of course the story doesn't make sense or check out; it's all a lie.

 

The problem for the Dolphins is that it's not a particularly well thought out lie, nor particularly compelling.

 

 

 

[The Wiz]

Just saw this, old news I'm sure.

 

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.

 

Love all the comment in that tweet also relating "back injuries that cause vertigo symptoms hence his head shaking" from the Miami fans.

Edited October 9, 2022 by The Wiz

[UKBillFan]

10 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.

 

If “Tretter” and the NFLPA really and truly want to fix the concussion issue they can, but it requires the Players to be honest and do he baseline and in game testing honestly.  Idiots like Tretter are looking for blame and they found their scapegoat in the UNC they fired for no cause.  If the NFLPA truly “found” something done wrong and outside of protocol - they would be shouting it from the rooftops - instead they fired the man because he was belligerent to them during the interview process.

 

There was a loophole and now that loophole will be closed and players will begin looking for the next way around the loophole.  As has been stated - staying down longer to prevent GMI issues - limping or adding some other action if they think they are a bit wobbly to make it appear to be something else.

 

The only facts we have are Tua got knocked on his Butt and smacked his head - he told the team and the UNC he had no symptoms and he could pass the mental testing at the facility.  He got through the rest of the game and then the weekly practice with according to Tua - no signs or symptoms and passes any additional testing that was part of the NFL follow in case of delayed symptoms.  Therefore he was cleared for Thursday Night.

 

The person at fault and the person to blame - Tua - he could have stopped it at any point by being honest.

 

 

 

 

 

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.

[Beck Water]

1 hour ago, Mr. WEO said:

Back injuries are assessed typically with MRI.  Few diagnoses are made on physical exam.  It's not like an extremity injury.

 

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.

[Beck Water]

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?

[Beck Water]

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"

[Mr. WEO]

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.