NFL Week 4 Takeaways: Inside the NFLPA Investigation and Concussion Protocol

More on the Tua Tagovailoa fallout and a Q&A with the NFL’s chief medical officer. Plus, why the Eagles are worthy of being unbeaten, and Saquon Barkley fills in at QB.

There’s a way to boil down the Tua Tagovailoa flashpoint to its essence, and I think I found it. Just answer this question: If Tagovailoa’s head bounces off the turf, and he stumbles as he did against Buffalo, and the Dolphins are up, say, three touchdowns in the fourth quarter against a nondivision opponent, is he still going back in the game? My guess is no. And, thus, it sure looks like competitive factors contributed to a decision that’s supposed to be made on medical factors alone.

Anyway, we covered a lot of this in my column Friday, but there’s a lot more to dive into. First and foremost, I wanted to update you on the NFLPA’s investigation (and then get you information from the NFL’s side of it). Here’s some insight into the union’s effort …

Tagovailoa's injuries have already prompted changes to the NFL's concussion protocol.  :: Rich Storry/USA TODAY Sports

• First, the union’s reason for opening the investigation, I’m told, was simple: It didn’t believe Tagovailoa should have reentered the Buffalo game. And it wanted to know why he was cleared.

• The second concern was that, while the NFL and Dolphins maintained Tagovailoa was checked all week, the call to put him back into the game against the Bills kept him out of the concussion protocol. Had the protocol been initiated with Tagovailoa, it would have been difficult for Miami to get him cleared for Thursday’s game against the Bengals. Which begs the question: Was there any intention by the Dolphins to keep Tagovailoa available for Thursday’s game?

• The union was also incensed that the NFL twice went on the record saying protocols were followed before the investigation even got off the ground.

• Another central question: How did Tagovailoa’s back injury play into this? Was it there before the game? Was he treated for it? And how was he cleared to return in that time frame when it came to the back injury?

The effort to get answers led the NFLPA to exercise its right, on Saturday, to fire the UNC (unaffiliated neurotrauma consultant) that worked the Dolphins-Bills game. In interviewing him, union officials found he didn’t understand that his job wasn’t just to run down a checklist. It was, really, to work with the team doctor to make a decision for the care of the player being evaluated. So that served as the first salvo here, with the union’s investigation expected to wrap up in the next seven to 10 days or so.

And with that in mind, we touched base with NFL chief medical officer Allen Sills with a few questions. Here are his answers (and if you just want football this morning, scroll down).

Sports Illustrated: Let’s start with the basics—how hard is it to diagnose a concussion in-game?

Allen Sills: As a practicing neurosurgeon, I would tell you that we often struggle to identify whether or not a concussion has occurred because we lack objective tests for a concussion. And what I mean by that is, our diagnosis of concussion is still very much dependent on self-reported symptoms. We obviously do have some objective neurologic findings, where we’ll check, for example, cranial nerves, and we’ll check memory and we’ll check balance. Those items, when they’re abnormal, make the diagnosis easy. There are difficult situations where all of the objective neurologic findings are normal, and we have to rely on symptoms. And those are difficult situations for all clinicians.

SI: Do you think there’s been progress on self-reporting?

AS: The data tells us that we’ve made a lot of progress in that area. If you look at the last several seasons, we’re now approaching 40% of all concussion evaluations that have some component of self-report, meaning that the player themselves acknowledged or endorsed symptoms or either asked for the evaluation. And so that, I think, represents an enormous amount of progress from what we might have seen 10 or 15 years ago. Certainly, we want to continue to make that progress.

SI: Why does the team doctor take the lead, per the protocol, when it comes to determining whether gross motor instability was neurologically caused?

AS: The reason the protocol was written that way several years ago was that gross motor instability, again, is a nonspecific sign that can be recognized on video. And it’s important, then, once it’s seen that the player gets a concussion evaluation and a determination made on was the instability due to a brain injury? Or was it due to another type of injury? Was there an orthopedic injury or other injury that caused the player to stumble or lose balance in a way that looked like it could have been a brain injury but in fact reflects something else? The team doctor’s role in that is the team doctor is the one who knows the player. They know the history, and they know whether that player had a preexisting injury.

SI: Are you confident that team doctors aren’t making decisions for competitive reasons?

AS: I have absolute confidence in our team physicians across the league, from my own interactions with them and my direct observations in all of the games and practices that I attend. They are men and women who are leading physicians in their communities. They go through a very careful selection and vetting process. And we always have to remember that their ultimate authority is to their state medical licensing and regulatory boards, and everything they do in their practice has to conform to the highest standards of practice of medicine within that jurisdiction. I can’t speak to what happened many years ago, Albert, but I can tell you that since I’ve been with the league for five years, I’ve never seen nor heard of any interference in any way from any coach, general manager, owner, any other individual on the club side from any of our teams. I am confident that our physicians operate in a fully independent manner.

There is some good that’ll come from this. The league and union are reworking the concussion protocol, and the biggest change will come with the aforementioned section on gross motor instability—the union and league have agreed that, as part of the revised policy, any player showing gross motor instability after a hit to the head will immediately be done for the day, regardless of whether there might be another reason for it.

And that, to me, is the good that comes from situations such as these—they’re high profile (and don’t think the NFL missed that the story made the A block of Good Morning America on Friday) and often force change.

As for what it means? I figured we’d check in with a couple of high-profile lawyers who represented players in the NFL concussion case that led to a billion-dollar settlement. I asked both a simple question: What should be the impact of what happened to Tagovailoa on Thursday night?

“I think that the whole gross motor thing is deceptive in some ways—it means that there is an assessment,” said Philadelphia-based attorney David Langfitt, who’s also the son of a neurosurgeon. “There’s an assessment of symptoms, and I think that when something like that happens to a guy like Tua, he’s out and he stays out. And you wait. You wait a week. You have him assessed over a long period of time. If it’s seven days, it’s seven days. If it’s 14 days, it’s 14 days.

“But the idea that there would be more subjective analysis of gross motor, that’s taking it from an individualized neurological standpoint, and I don’t think that that’s adequate. I think it’s got to be a ‘When in doubt, sit them out’ approach. That will insulate the neurologist or his designee from any kind of second-guessing by coaches, trainers, executives, owners, that sort of thing. I think that you have to insulate the neurologists.”

“What happened with Tua could’ve killed him,” added Miami-based attorney Brad Sohn. “You hope something that reckless never happens again, but this was more like the 500th time it happened. I’m just trying to do my part to avoid 501. Concussion protocols need to have teeth and consequences. Right now, I see neither. I know we can do better and just hope we will.”

I will say it’s unfortunate that a lot of times it takes events such as Tagovailoa’s unfortunate five-day stretch to force change. But at least it feels like more change is coming, and we probably won’t have to wait more than a few days to see it.

---

Reddick and the Eagles could be 10-0 when they host the Packers over Thanksgiving weekend :: Eric Hartline/USA TODAY Sports

The Eagles are a worthy final undefeated team. The really interesting thing is that only one other team even made it to 3–0—which is probably a good sign for the balance of the league. Either way, Philadelphia is 4–0, and while I’m not ready to crown Jalen Hurts & Co. the league’s best team, this is also no fluke. And that’s why it interested me to hear what Hurts said to his teammates after they came back from a 14–0 deficit to beat their old coach Doug Pederson and the Jaguars 29–21 at Lincoln Financial Field on Sunday.

“We’re damn good,” he said. “Damn good.”

Why did he say it? I sought out one of Sunday’s stars, edge rusher Haason Reddick, and asked, and Reddick affirmed, it wasn’t just that the Eagles won. It was how they won.

“He was saying it on the fact that we started off 14–0 in the first half and how we rallied back to get the W at the end of the day,” Reddick said. “That shows you the type of team we have. Nobody ever wavered. We never flinched. When we saw the scoreboard said 14–0, ain’t nobody was arguing or bickering, nobody was screaming, yelling at each other. We just all looked at each other, All right, buckle down, and it’s time to go. Let’s go do what we do; let’s go play football the way we know how to play football. And let’s just show people who we are.”

And, as Hurts said, what the Eagles are right now is a damn good team, which was proven out in an undeniable way over the past three quarters of Sunday’s game.

Here are the numbers from the second, third and fourth quarters …

• The Eagles outgained the Jaguars 325–123.

• The Eagles had 22 first downs to the Jaguars’ eight.

• The Eagles rushed for 194 yards on 42 carries (4.6 yard average).

Then, there was a defense that flashed very real playmaking ability, forcing five turnovers to take the bite out of the Jaguars’ offense. There was a spectacular pick from James Bradberry. There was also a pair of strip sacks in the fourth quarter from Reddick, the homecoming free-agent signing from Carolina, who grew up in Camden, N.J., and starred down the street at Temple.

The last sack, which came right after the offense failed to convert a fourth-and-3 to put the game away, drove the dagger into the Jaguars. Like his first strip sack, Reddick set up Jawaan Taylor with one from his arsenal of pass-rush moves. On this one, specifically, the right tackle was on his heels, and Reddick got aggressive.

“I had used one of my better moves and then I just decided to go with a bull-rush,” Reddick said. “I was able to see the quarterback stepping up into the pocket, getting ready to make the throw. I just used my hand to swipe at the ball, and it came out and I was able to get the forced fumble for us to have a walk-off sack. But something like that, that doesn’t happen without the other men on the field. They played hard today. We played hard today.”

The question now becomes how far the Eagles can take this before a crew of cranky old guys (1972 Dolphins) get to pop the bottle for the 50th consecutive year. And the schedule shows the Eagles have a chance to be 10–0 when the Packers come to town on Thanksgiving weekend—Philly plays the Cardinals, Cowboys, Steelers, Texans, Commanders and Colts between now and then.

Maybe they will get there. Maybe not.

“When you look at it on paper, it looks damn good—it looks great,” Reddick said. “But it doesn't mean anything if we don’t come out here every week and show who we are. When things got rocky, we fought back and we showed that, and we came home with the W. We got the W and we showed exactly who we are.”

Which is a team that’ll be tough for anyone to deal with from here on out.

---

Obviously it’s hard to like how the Giants got there—because it happened due to injury—but the team going to Saquon Barkley at QB in a pinch was pretty fun. The truth is New York just ran wildcat plays it had in the bag, so it’s not like the coaches were ready and raring for the former No. 2 pick to take five-step drops. Really, this was a creative solution to an unusual situation after Daniel Jones’s ankle acted up on him, and Tyrod Taylor suffered a concussion. But it was also a fun look at what most teams plan for in these sorts of circumstances, which we rarely get to see.

On top of all that, for Giants coach Brian Daboll, it was another opportunity to create more opportunity for a player he really, really likes.

“No doubt about it, he’s been great, and I’ve said this multiple times—since I’ve met him, he’s been great in just how he’s gone about his business, how he’s practiced, how he’s studied, what he does off the field, how he is in the building with people,” Daboll told me soon after the game. “And he knows how much confidence I have in him and we have in him. He’s himself and he’s done everything we’ve asked him to do and he’s shown great leadership.

“And he’s a really good player. You can tell that. I could tell that first day of OTAs when I saw him. This guy can f---ing play. He’s talented.”

In this circumstance, when Taylor went down, Daboll called up offensive coordinator Mike Kafka on the headset and simply said, Let’s go with the Saquon plays. Those brought Jones back on the field as a decoy split out. The Giants closed out their last scoring drive with three plays out of the wildcat, then brought Jones back under center on their next possession just to hand the ball off.

And while that part was funny and quirky, the Giants got the serious part taken care of, too, beating the Bears, 20–12, to move to 3–1.

So maybe Daboll’s rebuild … really isn’t a rebuild?

“All we’re trying to do is work our asses off, not get too high or too low after outcomes of games, focus on the things that we can do during the week to help us, and if we do those things during the week, then they know that I can live with whatever results we get,” Daboll said. “I might not like them all the time, but I just think their mindset is to keep battling, keep fighting, give as much effort as we can give and then get it to the fourth quarter and make the plays that we need to make.”

Barkley certainly made enough Sunday with 146 yards on 31 carries, and he answered the bell when his team needed him most.

---

I can’t imagine how demoralizing a play such as Patrick Mahomes made Sunday night is for a defense. Imagine you’re already struggling with Mahomes. You fumble the opening kickoff, he hits Travis Kelce two plays later for a touchdown. You kick a field goal to answer, but Mahomes drives 79 yards in 12 plays and converts three third downs to make it 14–3. And then as he’s driving the field again, finally, you create a negative play inside the 5-yard line, dropping Jerick McKinnon for a 1-yard loss, and maybe you can hold him to a field goal, and then, this happens …

I mean, it almost looks fake. https://t.co/P0ZLrECZaq

— Albert Breer (@AlbertBreer) October 3, 2022

On the play, Mahomes escapes Patrick O’Connor coming free into the backfield, spins to take Devin White, one of the best defensive players on the planet, out of the play, as White has him hemmed into the sideline. He then draws safeties Keanu Neal and Antoine Winfield in toward the pylon, and flips the ball over their heads to tailback Clyde Edwards-Helaire for the touchdown.

Chiefs 21, Bucs 3. Game over (effectively).

“I was able to use my speed, my little bit of speed, to get around the edge there. I was gonna run for it, but they kind of flew around me,” Mahomes told reporters afterward. “I realized I wasn’t going to make it and I saw Clyde, so I kind of flicked it up to him.”

He makes it sound easy, of course. But few have the gift he does, to see the field the way he can, with the full complement of athletic gifts to weaponize that vision—and all of it was on display on this particular play.

We should all appreciate what we’re watching here, which is a young quarterback that’s so spectacular, and is growing now as a distributor of the football (he found eight different receivers for catches Sunday night, with three different guys scoring touchdowns). He and his offense are something to watch now, so …

Imagine what this’ll look like once they get a little more time working together.

---

The Packers-Patriots game is the rare win-win in the NFL. And I know that sounds kind of like a cop-out, but here’s why I believe it …

• The Patriots have been trying to find their offensive identity for months, and it sure looks like they’re landing on it now as a physical, downhill-running team with a big offensive line (populated with three guys topping 335 pounds) and hard-charging tailbacks. They ran for 167 yards on 33 carries Sunday against the Packers, with Damien Harris (18 carries, 86 yards, TD) and Rhamondre Stevenson (14 carries, 66 yards) splitting carries. And that, in turn, allowed the team to insulate rookie quarterback Bailey Zappe after Brian Hoyer went down, and get Zappe looking, well, pretty good. So here’s to the Sunday success of much-maligned offensive coaches Matt Patricia and Joe Judge. They came in with a plan, stuck to it, and had a first-year, fourth-round quarterback ready to go toe-to-toe with Aaron Rodgers (well, sort of). They deserve credit for that, and the result of going through it might be a better situation for starter Mac Jones.

• The Packers really need young receivers Romeo Doubs and Christian Watson to make strides, and we saw some Sunday. The former dropped what would’ve been a game-winning touchdown and had a bad early fumble, but Rodgers kept coming to him down the stretch—Doubs had four catches for 46 yards in the second half and overtime, and scored the game-tying touchdown near the end of regulation. As for the latter, the Packers are continuing to find ways to get Watson the ball as he weathers the adjustment going from the FBS (North Dakota State) to the NFL—he took an end-around for 15 yards Sunday and had a catch (and three targets) for eight yards. With both guys, the talent is very, very apparent. And if they turn the corner in the coming weeks, the Packers should be just fine on offense.

---

The Raiders really showed something Sunday. Their first win for Josh McDaniels was going to come, one way or the other (though it’s good it happened this week because going to Arrowhead without a win for Monday Night Football next week might’ve been a recipe for 0–5), after they lost their first three in the final minutes to the Chargers, Cardinals and Titans. What, to me, sticks out on this one is one thing McDaniels said to the press in the postgame.

“We kind of had the mindset we wanted this to be a physical game and leaned on Josh and the running game a little bit more than what we have and really established that,” McDaniels said. “Our goal was to try to make it that kind of game and make it a fourth-quarter game.”

And they were able to do that rushing for 212 yards on 38 carries, while Denver had only 85 yards on 21 carries. So McDaniels and his staff deserve credit for the plan here, and leaning on Josh Jacobs to execute it—it should be one that travels well the rest of the year. But there’s a flip side to that, too.

The Broncos were held under 105 rushing yards for the third time in four games, and now Javonte Williams is hurt. Traditionally, Russell Wilson has had a pretty physical, consistent run game alongside him, and he’s struggled some when everything is on the passing game to make an offense go. So this could be interesting over the next few weeks, and starting with a pretty desperate Colts team coming to Denver on Thursday.

---

Mike Vrabel and his staff are doing a really good job in adverse circumstances. The last two weeks the Titans have weathered big comebacks from the Raiders and Colts. And while I still have reservations on the ceiling for the team, Sunday showed, again, through the Tennessee run game, and through the team’s resiliency, hallmarks of the program that Vrabel and Jon Robinson have built.

Vrabel said postgame about the offense, “It wasn't perfect, but that did look more like our running game.” Derrick Henry rushed for 114 yards and a touchdown on 22 carries. And on defense, the Titans got a Joe Schobert forced fumble (Kristian Fulton covered it) and a game-clinching Denico Autry sack to close out Indy’s last two possessions.

Without Taylor Lewan, Harold Landry and A.J. Brown, among others, it’s hard to imagine Tennessee being quite what it was the past couple of years. But that doesn’t mean they’ll be an easy out, either.

---

The Wisconsin and Colorado job openings only shines the spotlight brighter on Carolina. I still think Matt Rhule can win in the NFL. But it’s at least interesting that you’ve got this coach who’s going to be at the top of every college list—and his candidacy for those jobs probably rides on his pro team coming undone. Why?

Well, with those two, plus Arizona State and Nebraska open, it’s fair to assume that the athletic directors in question will want to fill their jobs by or around Dec. 1, which is right when LSU, USC, Notre Dame and Oklahoma made their hires last year. The trouble with that, of course, is that it’s between the Sundays of Week 12 and Week 13 of the NFL calendar, and no one will be waiting for a job candidate who may or may not be available when you get to … January.

If Rhule bounces back from 1–3 and wins, all the speculation evaporates.

If not, things could get awkward.

---

Pickett likely will get his first NFL start in Week 5 against the Bills :: Philip G. Pavely/USA TODAY Sports

We’ve got your quick-hitting Week 4 takeaways. And we have them now …

• Just a note here—Sills and the NFL health-and-safety staff have a meeting set for Tuesday in London with the medical staff of every Premier League team, as well as the league itself. They’ll be sharing findings and data. Obviously, concussions will be one area covered. I believe playing surfaces will also be discussed at the summit.

• Mike Tomlin’s a really sharp football coach, and so I have to think the leader of the Steelers was waiting to turn to No. 1 pick Kenny Pickett until he felt like he could go to him for good. So while he said, “We’ll deal with next week, next week” at his presser in regards to who starts at quarterback (Mitchell Trubisky or Pickett) … it’s really hard to see him turning back now. It’s a safe bet Pickett’s starting next week.

• Zach Wilson, after a shaky start, had a really nice finish against those Steelers. One of the Jets staff’s favorite plays from him Sunday? A checkdown to Michael Carter, mostly because it was a sign Wilson is starting to take the layups the offense gives him, which is what the coaches have been working on with him through spring and summer. We’ll have more on that in the MAQB later this afternoon.

• The Cowboys improved to 3–1 with Cooper Rush at quarterback. One, congrats to Dallas—winning three in a row with your starting quarterback on the shelf isn’t easy. Two, Rush just made himself a ton of money. I’ll bet, off this little stretch, he gets offers for backup jobs and cashes some pretty nice checks, too.

• The Bengals’ offensive line took another step Thursday night against the Dolphins.

• Chris Olave’s going to be a top-10 receiver by the end of the year—he was an absolute monster (four catches for 67 yards and a TD) for Andy Dalton in Dalton’s first start as a Saint against the Vikings.

• The Falcons have somehow rushed for 200 yards in two of their four games. Which is eye-opening when you consider their lead back, outside of Swiss Army knife Cordarrelle Patterson, is fifth-round rookie Tyler Allgeier.

• The Browns are going to kick themselves for that one. They probably should be 4–0. Instead, they’re 2–2, with the Chargers, Patriots, Ravens, Bengals, Dolphins, Bills and Bucs on the slate between now and Thanksgiving weekend.

• Carson Wentz’s passer ratings Week 1–4: 101.0, 99.6, 71.0, 56.6. So things aren’t going in the right direction.

• We’ve got one heck of a Monday nighter on tap for 8:15 p.m. ET.