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What should we make of Tua Tagovailoa’s injury history?

By JAMES RODRIGUEZ

As Tua Tagovailoa approaches his return from fractured ribs, those concerned with his fragility may wonder: Will he miss time again? An adopted adage in sports that many people are familiar with is “the best ability is availability.” How special is a skill set if you are unable to use your abilities because you cannot stay on the field?

Is Tua at risk of joining the injury “What could have been?” list of players such as Bob Sanders, Sam Bradford, and Robert Griffin III. The question may seem significant heading into his second professional season, but this is a player that has an extensive injury history that has resulted in seven games missed between college and the NFL. 

The “injury plagued” title is an unfair designation in my opinion. The focus of this article will be to utilize injury data and provide a review of the anatomy and his medical procedures. Using this information, I intend on presenting the answer to the question about recurrence discussed above. 

Here is a history of Tua’s reported injuries:

  1. March 2018, left thumb fracture requiring surgery
  2. October 6, 2018, sprained right knee
  3. November 10, 2018, left quad contusion
  4. December 1, 2018, right high ankle sprain undergoing TightRope surgery
  5. October 20, 2019, left high ankle sprain undergoing TightRope surgery
  6. November 16, 2019, right hip dislocation with posterior wall fracture requiring surgery
  7. November 25, 2020, left thumb sprain
  8. September 19, 2021, rib fractures

As you can see, that is an extensive list of injuries within a short time frame. Five of the eight injuries involve the lower body and an additional two involve the thumb on Tua’s throwing hand. The rib fractures are his most recent injury that appears unrelated to the others.

For an athlete that is 23 years old, undergoing four surgeries is a lot. Following his rehabilitation, we’re left to wonder what amount of motion or function was regained.

“Loss of motion equals loss of function,” is a common saying used in Physical Therapy. The basis of it is simple. If you lack mobility in one area, it will affect your ability to complete basic functions in another. It is a snowball effect that works itself throughout the body’s kinetic chain. 

For instance, a restriction in your ankle could affect your knee and hip. The same is true vice-versa, as a restriction in your hip can affect your knee and ankle. Range of motion and flexibility are key variables affecting the severity of an injury.

If a hip lacks five degrees of internal rotation, then, when stresses are placed on that joint that takes it to its limits, the resulting force will express its load on other joints or structures. If the force is large enough, a tissue will fail resulting in an injury. Having more motion available gives you a greater opportunity to disperse the force. 

So, are his lower body injuries associated with one another or mutually exclusive? 

The quad contusion is an isolated event that would be painful with minimal long-term effects. In severe cases, a quad contusion could result in myositis ossification, but believe me: if that happened, we would have known about it.

There are limited details regarding the sprained right knee.  He could be seen wearing a brace during subsequent games but did not miss time.

The next three injuries involve surgeries and warrant more in-depth analysis. On two different instances, Tua experienced a high ankle sprain on each lower extremity with a subsequent TightRope surgery.  

Tua underwent this procedure to accelerate his recovery to return to the field sooner. Benefits of the TightRope procedure are that it is minimally invasive and allows quicker weight bearing for rehabilitation.

The procedure provides stability to the injured syndesmosis between the tibia and the fibula where a fracture is typically involved. The strange circumstance in Tua’s case is that there were no reports of fractures occurring. 

Technically, the gold standard for syndesmotic injuries is syndesmotic screw fixation which requires two procedures to plant the screw and then another to remove it. 

Tua was able to return to play and did so effectively completing 24-of-27 passes for 318 yards and four touchdowns. Less than a year later, Tua suffered the same fate on his left ankle. He underwent the surgery the next day and returned to play without missing a game. 

Clinically, it is reported that range of motion is not restricted in the long-term, and short-term returns are better with the TightRope procedure compared to the screw fixation. As a Physical Therapist, I would love to get my hands on each of his ankles to assess the range of motion and joint play to determine future injury risk.

The right hip dislocation with the acetabular posterior wall fracture is the most severe injury that Tua has sustained. John Verros did a great job delving into the injury in The SIS Football Rookie Handbook. 

Unfortunately, we have seen two NFL players, Ryan Fitzpatrick and James White, suffer similar injuries this season. If you watch the replay of each player’s injury, the mechanism is the same.

Due to hip dislocations resulting from a specific mechanism, you can rule the ankles out as a possible contributor. Fortunately for Tua, the hip is one of the most stable joints in the body due to its anatomical structure of being a large ball and socket joint. 

If anything, the past injuries increase the likelihood of future ones. 

Unfortunately for Tua, with the extra stability that the hip naturally provides, it also comes with the consequence of decreased flexibility. Similar to my interest of wanting to assess Tua’s ankle, I would be interested to assess his hip for any restrictions or asymmetries. 

Concerns

The lower-body injuries, in my opinion, are isolated events. An unfortunate cascade of events experienced by an individual within a short amount of time. That does not mean that those injuries do not predispose Tua to more injuries. If anything, the past injuries increase the likelihood of future ones. 

Tua has had three lower-body surgeries that, by definition, are performed to stabilize. That stability will secure the affected areas but potentially at the consequence of other joints or structures. That is my biggest concern regarding the longevity of Tua’s career.

Another area to examine in the future would be to evaluate his play style to determine if it contributed to his litany of injuries. 

Tua is on schedule to return this week and I hope he can excel as well as stay healthy.

 

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