Miami Dolphins quarterback Tua Tagovailoa is returning to NFL action for Week 7, having passed the concussion protocol following a head and neck injury in Week 4.
Dr. Vernon Williams, who has worked with the Los Angeles Rams as team neurologist, tells Newsweek about the recovery that a player needs to go through after suffering a concussion and why it is "risky" to return to full-contact games.
He said that while there is no "recipe" for returning to action, there are a number of examinations and tests a player needs to pass to be considered ready for a collision sport again.
Dr. Williams, who is a sports neurologist and founding director of the Center for Sports Neurology and Pain Medicine at the Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, said: "There's no 'recipe' or fixed time frame for [Tagovailoa's] return to action.
"It will be based on his full recovery from the standpoint of symptoms and objective examination/testing. He will have to have demonstrated his ability to tolerate exertion and perform physically and cognitively.
"I'm sure all stakeholders understand the need to be as safe and considerate as possible regarding his return. But the truth is that there will be some degree of risk associated with participation in collision sport, as there is with any and every athlete (and not limited to football).
"The goal is and should be to minimize that risk and to avoid any unnecessary and significant increase in risk by returning prior to a complete return to normal clinical function—as best as can be evaluated and tested with current assessments."
Dr. Williams said that each player's recovery, both mentally and physically, would be different after suffering concussion.
He warned that some athletes can be "unaware of deficits in neurological function" which makes it so risky for them to return to sport when they think they are feeling fine.
The neurologist sus: "Concussion and patient/athlete signs, symptoms, and experience varies dramatically from person to person and even within an individual (from one concussion to the next).
"While headache is the most common symptom, other issues experienced may include additional physical (neck pain, dizziness, visual complaints), cognitive (difficulty with focus/concentration, word-finding, speed of mental processing), emotional (anxiety, depressed mood, mood swings), sleep (insomnia, hypersomnia, fragmented sleep/frequent awakenings) or other symptoms.
"The take-home message is that of variability in terms of number and severity of symptoms. It can be very different from person to person.
"In other cases, people feel fine and are unaware of deficits in neurological function. Sometimes it's only after examination or testing that we know the brain hasn't fully recovered."
The treatments available for concussion has evolved in recent times and gone are the days that waiting for injury to sort itself out, have now gone.
Dr. Williams continued: "Treatments used to be limited to 'watchful waiting'—essentially waiting for symptoms to improve/resolve.
"Concussion management is evolving/changing and now involves aggressive management of symptoms (treatment for headaches, neck pain, etc., targeted and symptom-specific therapy for balance/dizziness, and/or visual symptoms, optimizing sleep, quieting the autonomic system with meditation and breath work exercises, and controlled exertion/exercise as a prescription for hastening brain recovery).
"In addition, there's increasing interest and use of various neuromodulation techniques— such as transcranial magnetic Stimulation to facilitate brain recovery after concussion."
When returning to play in a collision sport, there are a number of indicators to look out for that could show that an athlete has not fully recovered, despite tests showing they are fit and well enough to step back onto the field of play.
Dr. Williams continued: "Concussion can manifest in multiple ways. Sometimes, recovery is faster for some symptoms than for others. Any athlete who suffers a concussion should be mindful of improvement/recovery in all of their symptoms.
"We expect this and it happens for most people. But persistence of some symptoms doesn't mean they have a 'new normal.' The most exciting thing we're learning regarding the brain is that the brain can change. Even after significant injury, it can recover and improve.
"We call it neuroplasticity. And it involves the ability to reinforce connections and increase communication/activity for improved function. It can be done through training and various kinds of neuromodulation."