Tua Tagovailoa is nearing his return after dealing with a concussion that kept him out for a while. Now, everyone is on edge.

The star quarterback for the Miami Dolphins was last seen during a game in a vulnerable position after experiencing at least his third concussion in two years. This week, he returned to practice and was fully cleared to play against the Arizona Cardinals on Sunday.

Following his most recent concussion, Tagovailoa became aware of the intense discussions surrounding his health, future, and career—many voices, including those of former players in the NFL, suggested he should step away from football. However, he is not listening to them, claiming he is unaware of what others say about his situation.

“I appreciate your concern, I really do,” Tagovailoa mentioned in a recent press conference when asked about these sentiments. “I love this game, and I love it to the death of me. That’s it.”

Those words are quite haunting.

Tagovailoa, now 26, certainly dislikes being a prominent example of concussion hazards. While he brings great energy to Miami’s offense—with the potential for deep passes to speedy receivers like Tyreek Hill and Jaylen Waddle—it is his next big hit that raises the most questions.

It could even be a minor hit, considering how he fell during his last game on September 12, bumping into Buffalo Bills safety Damar Hamlin in a collision that was only moderately intense by football standards.

He is aware of the reality: the more concussions one suffers, the higher the risk of additional ones. Tagovailoa has discussed this with medical professionals in recent weeks, but he still hasn’t reached a conclusion about his future risks.

One would think that it must be daunting for any player with multiple concussions to think about the risk of developing chronic traumatic encephalopathy (CTE) or other lasting brain issues.

“I think the brain is – there’s just a gray area when it comes to that,” Tagovailoa said. “If you do know that you’re going to get long-term disease from it, or you’re not, I just think there’s a lot of uncertainty with it. For me, this is what I love to do. This is what makes me happy, and I’m going to do it, that’s it.”

But still: How many concussions are considered too many? How does that contribute to risk?

“I don’t know if there’s a magic number, but the number that’s always been mentioned as far as I know is three or more in a short time,” told Dr. Julian Bailes, a prominent neurosurgeon with Endeavor Health in suburban Chicago, to YSL News Sports.

“So, three or more in a brief period has always made me pause. It’s essential to take time off to let it heal. Additionally, there’s the matter of susceptibility, as the threshold for getting a concussion lowers.”

As Tagovailoa suggests, there is uncertainty regarding his situation, especially since he recovered well from his injuries in 2022; he completed the full 2023 season without any concussions. However, the sight of him falling again this season instantly reminded many of his previous setbacks. After taking sufficient time off, Tagovailoa maintains he was symptom-free the day after his last concussion and has been practicing for five weeks while on injured reserve. He is now fully cleared to play.

For Tagovailoa, the last steps in the NFL’s gradual return-to-play protocols involved clearance from both the Dolphins’ medical team and an independent neurologist.

However, Tagovailoa’s situation transcends the question of whether he can play right now. According to Allen Sills, the NFL’s chief medical adviser, there is no scientific formula to measure the risk of concussion, even when considering a player’s history. Each individual case is unique because various factors—like the number of concussions, length of symptoms, and circumstances surrounding the injury—must be accounted for.

“Then it’s a best guess,” Sills explained to reporters. “A guess at what someone’s future risk of concussion might be.”

If a player is medically cleared, the NFL or the NFL Players Association will not recommend retirement. The ultimate choice rests with the player, who can be influenced by family or advisors. Tagovailoa mentioned that after his last injury, he didn’t think about leaving the sport. Even though he talked about his future with his family after his concussions in 2022, he only sought input from his wife, Annah, this time.

As Sills stated, “patient autonomy” plays a crucial role in the process of gathering feedback from doctors regarding a player’s long-term risks. The league’s primary aim, he added, is to ensure compliance with return-to-play protocols to facilitate healing without influencing a player’s decision about his future.

But what happens if the “patient’s voice” is flawed? Misguided? Naive? Self-centered? Misled? When someone has experienced a brain injury—and there’s scientific ambiguity in assessing the damage—perhaps that voice represents a significant problem in the decision-making process.

Interestingly, Tagovailoa noted that the Dolphins placed him on injured reserve for at least four weeks to “protect myself from myself,” recognizing that his competitive nature would push him to return quickly. However, Dolphins coach Mike McDaniel explained that the decision was based on medical advice recommending an extended recovery period for the quarterback.

Regardless, it is clear that Tagovailoa’s determination remains unshakeable Or completely bold.

Someone posed a hypothetical question about how he would respond if doctors advised a longer recovery period following another concussion.

“I believe it depends on how that individual feels,” Tagovailoa stated. “If you feel ready to play, then go ahead.”

It was notable how nonchalant he was in discussing this question, given the serious implications.

“I think this issue is being highlighted now because of my situation two years ago in the sport,” Tagovailoa added. “I regret that it has come to this, but we don’t view boxers or hockey players the same way. It’s just that due to the significant impact of my situation, it’s becoming a bigger topic in this league.”

After Tagovailoa’s situations in 2022, the NFL altered its protocols in response to public perception, particularly after the quarterback was not diagnosed with a concussion following a hit during a game against Buffalo (it was labeled a neck injury) and later suffered a concussion just days later after his head hit the ground in Cincinnati. The NFLPA dismissed the independent neurotrauma consultant who assessed Tagovailoa after the initial incident, a decision that initiated the protocol changes.

Nonetheless, Tagovailoa is mistaken if he believes the attention on his case is not part of a broader context. The focus on concussions has ramped up long before he joined the league in 2020.

Dr. Bailes, who has been at the forefront of concussion research for two decades, collaborated with Dr. Bennet Omalu, known for identifying CTE, to present findings to the NFL. He has concerns for Tagovailoa, particularly because there is still much to learn about possible risks. As Bailes noted, a significant advance in concussion research will occur when doctors can diagnose CTE and similar degenerative brain conditions in living individuals.

“I send my best wishes to him; I hope everything works out,” commented Bailes, who serves on the advisory board of the Chuck Noll Foundation for Brain Injury Research. “I hope he can continue playing safely, perhaps by sliding more often rather than running and putting his head in danger to gain additional yards.”

Tagovailoa recognizes the importance of making better choices, asserting that he can play more wisely – despite the fact that his habit of running without restraint has been a key aspect of his play style since high school. He has opted not to wear a Guardian Cap, which is extra foam padding over the helmet aimed at lessening impact from hits. Instead, he is using the top-rated helmet for quarterbacks, the VICIS ZERO2 MATRIX ID QB, which the league claims is as safe or safer than one with a Guardian Cap.

Tagovailoa has also conveyed a wish to remain available for his team, which, notably, signed him to a substantial four-year, $212.4 million contract extension in August. His contract features $167.171 million in guarantees, suggesting that his decision to play isn’t solely driven by financial concerns.

However, when he reflects on the long-term risks, Tagovailoa seems to have a particular oversight.

“How much risk do we take every morning driving to work?” he pondered. “There’s always the chance of a car accident. Life itself is full of risks… Every time we gear up, we are all accepting the possibility of injury, whether from a concussion, a fracture, or something else. Just getting out of bed wrong could twist an ankle. Risk exists in everything, and I’m prepared to play the odds.”

The trouble is, some bets carry far higher stakes.

This article has been updated with the latest information.