Return to Health

The Fragility of Gladiators: Examining the Handling of Injuries and Pain in the NFL


Kirk Irwin/Getty Images

Habiba Adnelly Youssouf
June 26, 2023


Sports have always captivated our imaginations, serving as a thrilling display of human athleticism, skill, and determination. However, beneath the surface of this seemingly glamorous world lies a dark side that demands our attention – the issue of player safety, and the handling of pain and injuries.

In the world of professional football, where the relentless pursuit of victory often consumes the spotlight, there are moments that jolt us into realizing the fragility of the players who entertain us each week. One such moment arrived on that fateful Monday night, January 2, 2023, during a crucial week 17 matchup between the Buffalo Bills and the Cincinnati Bengals. The game came to an abrupt halt when Buffalo Bills safety Damar Hamlin collapsed on the field, his body succumbing to cardiac arrest. As I watched the scene unfold from the comfort of my living room, a surge of fear and shock washed over me. The distress etched on the faces of the players and staff mirrored my own. It was a chilling reminder of the complexities of player safety.

That moment sparked a series of introspective questions within me, and perhaps within all of us: Why was this the first time a game had been halted indefinitely (and ultimately canceled) due to a catastrophic injury? Has the league done enough to prioritize the well-being of its players, especially when it comes to the management of injuries and pain? Are we all complicit? Why do we love violence so much? What has to change? These questions became the catalyst for this deep dive into the management of pain and injuries in sports and most specifically in the NFL.

In this series, we will explore the complexities of player safety, including the societal fascination with violence in sports, the implications of the current culture surrounding injuries in sports, and the legal battles that arise from player injuries. We will also delve into the role of the NFL Players Association and the collective bargaining agreement to understand the various forces at play.

In recent times, we’ve witnessed the word “soft” or “weak” thrown around carelessly, targeting, for different reasons, athletes like Ben Simmons, Naomi Osaka, Simone Biles, Zion Williamson, and Anthony Davis, who have faced their fair share of criticism. But as we gain a better understanding of the toll the game takes on these individuals over time, both physically and mentally, perhaps we should move away from these sorts of labels, which are used as insults, and start adopting a softer approach to sports.

Of course, this doesn’t mean eliminating physicality altogether; it’s an intrinsic part of the game. I, too, fell in love with football and basketball because of the raw physicality they embodied. The bone-crunching collisions on the field and the fierce battles in the paint were exhilarating. Growing up in the southwest of France, rugby captivated me precisely because of its physical nature. However, just because something has been done a certain way in the past doesn’t mean it must continue unchanged. We evolve, we learn, and we strive to find better, safer approaches. As Maya Angelou famously said, “When you know better, you do better.” It’s time we apply this wisdom to the realm of sports.

To that end, consistency in applying rules that protect players, regardless of a player’s fame, reputation or style of play, or the game’s score, is crucial. Rules should not be applied arbitrarily, no matter who is on the receiving end or how costly the call might be for the guilty team. That is if the league is serious about fairness and safety. Rule changes are adopted every off-season and although some may prioritize entertainment or financial considerations if they make sports safer and allow athletes to have better post-retirement lives, it’s a trade-off worth making. More often than not, however, these needs are in conflict with each other, and rule changes respond to one at the expense of the other. Safety should always be at the forefront, and although things have gotten better in recent years, there is still a long way to go, as illustrated by the reactions to the newly-adopted changes to the kickoff rule. Athletes deserve safe conditions and fair treatment, regardless of the risks associated with their sport.

We have learned from the struggles of athletes in the past, where abusive behaviors were often tolerated. It’s time to break the cycle and create a safer and more nurturing environment for today’s athletes. Injuries and pain should not be glorified, and the well-being of athletes should be prioritized.

The handling of concussions in professional sports, particularly in the NFL, has been a contentious issue. Recent cases involving Miami Dolphins quarterback Tua Tagovailoa and New England Patriots wide receiver DeVante Parker have once again raised concerns about player safety and the effectiveness of the league’s concussion protocols.

In 2022, there was an 18% increase in reported concussions compared to the previous year. Tua Tagovailoa suffered two consecutive concussions within five days. The initial concussion, which occurred during a game against the Buffalo Bills, was reported as a back injury by the team. However, the team’s social media team referred to it as a “head injury” before deleting the tweet. The NFL and NFLPA conducted a joint investigation and concluded that the protocols were followed, but the unaffiliated neurotrauma consultant involved in the concussion check was terminated by the NFLPA.

The second concussion occurred during a game against the Cincinnati Bengals, on Thursday Night Football, where Tagovailoa was knocked unconscious, with his arms and fingers locked in what is called a “fencing response”, and had to be stretchered off the field. The incidents led to the revision of protocols and the adoption of the “Tua Rule,” which added “ataxia” to the list of symptoms for evaluation. Despite these changes, Tagovailoa suffered another concussion later in the season but was not evaluated during the game. He reported concussion symptoms the next day and remained in the concussion protocol until February 2023.

Tagovailoa used that time away from football to meet with multiple doctors and specialists, from which he reportedly received assurance that he was not more at risk from concussions than any other player nor at higher risk for chronic traumatic encephalopathy (CTE), which not all experts agree on, and although he admitted to contemplating retirement, he ultimately decided to keep playing and took up jiu-jitsu to improve his falling skills. The Dolphins renewed their commitment to him by picking up his 5th-year option, which all but assures that he will be the starter when the 2023-2024 season starts, but there are still significant concerns about what those repeated injuries, and the high potential for future head injuries, might mean for his future on and off the field.

The aforementioned “joint investigation” concluded with the following statement: “The Protocol exists to establish a high standard of concussion care for each player whereby every medical professional engages in a meaningful and rigorous examination of the player-patent. To that end, the parties remain committed to continuing to evaluate our Protocol to ensure it reflects the intended conservative approach to evaluating player-patients for potential head injuries.” Nice words. In practice, though, the handling of DeVante Parker’s head injury during a Monday Night Football game against the Arizona Cardinals highlighted that the league seems to have a loose definition of the phrase “conservative approach”. Despite showing signs of being injured, and despite the efforts of his teammate, fellow wide receiver Nelson Agholor to attract the attention of the officials and stop the action for moving forward, it was the opposing team’s head coach who threw the challenge flag to review the play, ultimately leading to Parker’s removal. A joint investigation into the matter ultimately concluded that there had been “no violations of the concussion protocol” and that “(T)he parties (were) satisfied that the player would not have participated in another play even if the Cardinals had not challenged the play”. Many fans and observers remained skeptical of the findings, and why wouldn’t they? Watching those events unfold in real-time and over and over again since, are we really to believe that Parker was not going to play that next snap if that flag had not been thrown? Even if we accept that everybody did what they were supposed to do, it took way too long and the optics are nauseating.

These incidents highlight the need for stricter and consistently applied concussion protocols in the NFL. All parties involved, including players, need to be more committed to player safety. For players, it means being even more active in their own protection and that of their brothers, even if it goes against what they have always done and what they have always been taught. It is necessary to implement more stringent protocols and ensure their proper implementation to break the cycle of mishandled concussions.

Not all injuries are created equal and some don’t necessitate immediate care and extra caution, but there is still a need to err on the side of safety and do more rather than less. What I mean by that is that, in the wake of the debacle that led to the adoption of the Tua Rule, more players were removed from play after suffering a hit that could lead to concussion when they did not exhibit overt symptoms, like Miami Dolphins’ back-up quarterback Teddy Bridgewater and Los Angeles Chargers quarterback Justin Herbert, to their dismay and annoyance, and to the surprise of many spectators.

While some argue that it is overkill, I find it encouraging. After the blow to the ribs from New York Jets’ cornerback Ahmad “Sauce” Gardner, which caused the back of Bridgewater’s head to hit the ground, the QB seemed to stumble, which is considered a sign of ataxia, and a spotter alerted the sideline. Herbert’s head snapped back after a hit to the head dispensed by San Francisco 49ers linebacker Dre Greenlaw and he took a knee before getting up. While they were both able to stand up on their own and did not appear to struggle, the nature of the hits they received and the brief signs they showed triggered the activation of the concussion protocol. They were both removed from the game, evaluated on the sideline, and passed the concussion protocol. Herbert, who did not display any of the signs on the protocol’s no-go list was allowed to return to play after missing three plays. Bridgewater, however, was ruled out, as per the “Tua Rule” and missed the remainder of the game. The protocol as it is currently written, worked as intended, and, in my book, that’s what a “conservative approach” might look like, if it is done consistently. Neither player displayed concussion symptoms later, thankfully, but had that been the case for Herbert, would it have still felt unnecessary to remove him from the game to be evaluated or would the same people who considered it overkill then have been outraged that he wasn’t ruled out like Bridgewater? Concussions are unpredictable by nature, symptoms can manifest later, and we now have more knowledge that the long-term consequences of repetitive head trauma (whether a concussion is diagnosed or not) can be severe. It is crucial for the league and teams to prioritize player safety over immediate results, regardless of the score or implications of a game. It is an imperfect process, with imperfect rules and people, but as long as we commit to learning from each experience and putting safety first, we can and will do better.

This is especially true for concussions but it needs to be true for any injuries, and the NFL with all its means, reach, and influence, can be a force of change for good in this arena.

What happened to Damar Hamlin is called commotio cordis, “an extremely rare, serious medical condition that can happen after a sudden, blunt impact to the chest”, according to the American Heart Foundation. “If the physical blow hits during a narrow window in the heart rhythm, it can disrupt the heartbeat and cause sudden cardiac arrest.” Although there are fewer than 10 cases reported per year, it mostly affects young male athletes under the age of 20. As rare and as improbable as this condition is, it doesn’t mean that we should stop talking about it because Hamlin recovered. What saved Hamlin was the efficacy, quickness, and abilities of the first responders on the sidelines to use CPR and an automated external defibrillator (AED) on-site, which is one of the benefits of playing in a league that has the means to provide these life-saving resources to its employees. Beyond its extraordinary nature, this incident highlighted the need to ensure that CPR training and AEDs would be more widely available in schools and sports clubs across the US because as it turned out they aren’t and it is costing lives. Hamlin has made it his mission, and along with U.S. Representative Sheila Cherfilus-McCormick and American Heart Association CEO Nancy Brown went to Capitol Hill, in Washington, D.C. to help introduce new bipartisan legislation called “Access to AEDs Act”, this past March. “The Access to AEDs Act will help ensure that schools are just as prepared and trained to respond in a time of crisis as those on the sideline in an NFL game,” said Hamlin, during his address. He added: “Every kid should have the same access to a life-saving emergency response that I did, should they need it. Around the world, people have come together to focus on this need, and I’m amazed and encouraged by what we can do together.” On March 27th, 2023, the NFL announced the launch of The Smart Heart Sports Coalition, which is a collaboration between the NFL, NBA, MLB, MLS, NHL, NCAA, the American Heart Association, American Red Cross, Korey Stringer Institute, National Athletic Trainers’ Association, and Damar Hamlin’s Chasing M’s Foundation, “will work to advance the adoption of lifesaving policies for student-athletes across the country”, as per the NFL. Whether it is more common injuries such as a torn ACL or a concussion, or rarer conditions like commotio cordis, the effort to protect the health and the lives of athletes of all ages will have to be a common endeavor.

The media’s role in shaping the narrative surrounding injuries and concussions is also vital. It is crucial for sports media to recognize its influence and responsibly address these issues. By reframing the discussion and promoting a culture of player safety, the media can contribute to the necessary changes within the sports industry and in society as a whole. It is essential to view injuries and pain not as byproducts of the game but as issues that demand attention. We should value the physical and mental well-being of athletes, reshaping the narrative and creating a healthier future for sports.

Stay tuned for part two of this series, where we will delve deeper into the societal fascination with violence as entertainment and examine the broader implications of the current culture surrounding injuries in sports. We will explore the challenges faced by athletes, the need for a change in attitudes, and potential solutions to protect players while preserving the essence of competitive sports.

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Habiba Adnelly Youssouf is a writer and blogger with a communications, event planning and public relations background. She has experience working in sports marketing, publishing and with non-profit organizations such as the Alzheimer Society of Canada. She is driven by a strong will to empower and uplift others, fight against injustices and disrupt the status quo. An absolute
music and sports lover, and a bookworm, Habiba is equally passionate about mental health, criminal justice reform, sports law, social justice, and advocacy. Born in Moscow, Russia, to Chadian parents, she was raised in France, where she also studied and started her professional life, before moving to Toronto, Canada, in 2009, where she still resides. Her blog is

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