DeVonta Smith, Lane Johnson, and how the NFL’s concussion protocol has evolved

Eagles wide receiver DeVonta Smith, grappling with the unpredictable fallout of a recent concussion, won’t play in the team’s game Sunday afternoon against the Tampa Bay Buccaneers.

The Eagles on Friday officially ruled out Smith but listed right tackle Lane Johnson, who is also recovering from a concussion, as questionable. They were injured on different plays during a 15-12 victory over the New Orleans Saints last Sunday.

An NFL player’s path to back to the starting lineup is dictated by the league’s return-to-participation protocol. The five-step process has received renewed attention following multiple high-profile concussions, and a spate of unsettling reminders about the neurocognitive problems that many former players develop later in life.

On its website, the NFL details the phases that athletes must progress through before they can step back onto the field.

Players who suffer concussions are initially instructed to avoid strenuous physical or cognitive activities that might aggravate their symptoms. A gradual buildup is supposed to follow, all under medical supervision: cardiovascular exercises, stretching, and strength-training lead to noncontact practices with the team.

The injured player is required to undergo physical and neurocognitive testing, according to the league; an independent neurological consultant and the team’s physician must agree that the player’s concussion symptoms have resolved before he can participate in a full practice or a game.

“Player health and safety is the NFL’s highest priority,” Brian McCarthy, the league’s chief spokesperson, wrote in a recent email to The Inquirer, “and we continue to implement strategies to reduce concussions and remove head impacts as part of a concerted effort to make the game safer.”

The NFL’s game-day concussion protocol faced intense scrutiny in 2022 when Miami Dolphins quarterback Tua Tagovailoa suffered two concussions in the same week. The second of those concussions caused Tagovailoa’s hands to jut out in a fencing position, a reaction sometimes observed in victims of traumatic brain injuries.

Following Tagovailoa’s injuries, the league and the NFL players’ union agreed to new rules, which call for players who show signs of balance, motor or speech problems following a possible head injury to be removed from a game. The union also fired an independent neurologist who had evaluated Tagovailoa.

Earlier this month, during a Thursday Night Football game against the Buffalo Bills, Tagovailoa, 26, suffered another concussion, and again displayed a fencing position as he lay on the field.

The Dolphins placed the quarterback on injured reserve, meaning he would miss at least four games.

The NFL adopted its concussion protocol in 2011, after years of downplaying the potential health risks of concussions and sub-concussive hits.

In 1994, then-NFL commissioner Paul Tagliabue dismissed concerns about football-related head injuries as a “journalist issue,” a remark for which he later expressed regret.

That same year, the league assembled a Mild Traumatic Brain Injury Committee, which went on to publish more than a dozen papers about its research in the medical journal Neurosurgery.

Concussions were portrayed as rare, minor health events in the committee’s papers, one of which claimed that 92% of players who suffered concussions were able to return to practice in fewer than seven days.

The NFL has since replaced the MTBI committee, and acknowledged a link between repeated head trauma and neurodegenerative diseases.

Earlier this month, an Inquirer investigation, The Final Penalty, examined the toll that concussions and sub-concussive hits have taken on members of the 1980 Eagles, the first team in franchise history to appear in a Super Bowl.

The newspaper spoke with a dozen of that team’s 22 starters, and with relatives of two who have died, and found that 12 of the 14 developed a range of cognitive problems after retirement — from memory loss and depression to personality changes and movement disorders.

Former Eagles running back Wilbert Montgomery said that he was diagnosed with Parkinson’s disease in 2022, while former right tackle Jerry Sisemore said that he has been diagnosed with a form of dementia.

“It’s sad when you talk to your teammates, and you both end up crying,” said Sisemore, 73. “You can’t remember the good things that you should remember. We kind of knew what we were getting into — but not really. We were so stupid.”

Three members of the 1980 team — Guy Morriss, Frank LeMaster, and Max Runager — were found to have had the brain disease chronic traumatic encephalopathy.

A new study, published Monday in the medical journal JAMA Neurology, found that 34% of nearly 2,000 former NFL players believe that they have CTE, which can be diagnosed only after a person has died.

The research, conducted by Harvard University’s Football Players Health Study, showed that the average age of former players who believed that they had CTE was 54; 25% of those players also reported having had suicidal thoughts in the previous two weeks.

A day after the Harvard study was released, former Green Bay Packers quarterback Brett Favre announced that he was recently diagnosed with Parkinson’s.

Favre, 54, disclosed his illness while testifying before a U.S. House Ways and Means Committee hearing on welfare reform. (The NFL Hall of Famer has been embroiled in a scandal over millions of dollars of misspent welfare funds in Mississippi.)

Following Favre’s revelation, former Minnesota Vikings quarterback Tommy Kramer, 69, wrote in a post on X that he was diagnosed more than a year ago with dementia.

Smith, the Eagles’ slender wide receiver, suffered his concussion during the fourth quarter of the team’s game against the Saints. He caught a short pass from quarterback Jalen Hurts, and was corralled by a pair of Saints defenders, who began to push Smith backward. A third Saint, defensive tackle Khristian Boyd, then struck Smith from behind with such force that Smith’s helmet was knocked off his head.

The NFL has since fined Boyd $4,600.

Johnson, 34, suffered his concussion earlier in the game, during the first quarter, and was observed vomiting on the sideline. It marked the fourth time that Johnson had suffered a brain injury during his 12-year career.

In 2022, after his third concussion, Johnson told reporters that he had vomited and experienced difficulty remembering some plays.

He insisted, though, that he wasn’t worried about his health.

“Brett Favre had about 38 [concussions],” Johnson said at the time, “so I think I’ll be OK.”