BUFFALO, N.Y. (WIVB) — It was a stunning moment in Thursday night’s game between the Miami Dolphins and Cincinnati Bengals when Dolphins quarterback Tua Tagovailoa was slammed to the ground after taking a sack. His head hit the turf and his hands and arms immediately seized up.

Tagovailoa was taken off of the field on a stretcher.

The scene took place just four days after Tagovailoa suffered an injury following a hit from Bills linebacker Matt Milano in the first half on Sunday’s game. Many observers, including UB Concussion Management Clinic Director Dr. John Leddy, believed the hit resulted in a concussion. However, Tagovailoa was allowed to return to the game, even after stumbling to the ground in the seconds after the hit. The Dolphins said Tagovailoa was evaluated and the fall was caused by a back injury. The NFL Players Association began investigating the claim on Sunday.

Thursday’s follow-up injury is raising questions about the NFL’s concussion protocol and if the Dolphins followed it or not.

The NFL’s protocol states that an independent neurological consultant evaluates the player in the training room right after the injury, including asking questions about symptoms and observing behavior.

“They say he passed the questions and the physical examination. I guess the point that most people … are concerned about is that the initial observance of his behavior suggested that he was concussed,” Dr. Leddy said. “Even if he cleared up in terms of his symptoms, the protocol to protect him would have been to take him out of the game.”

In the seconds following his hit to the head on Thursday, Tagovailoa’s arms and hands went into what is known as the “fencing response,” which usually indicates a severe concussion or a “stunning” of the brain and spinal cord. This can happen when someone is knocked unconscious.

“It’s involuntary, but it’s one of the signs that we look for, much like the unbalanced gait he had four days earlier,” Dr. Leddy said. “The point is, even if he said he had no symptoms and he had a fairly normal neurological examination after that first hit in the Bills game, his initial behavior suggests he had a concussion.”

Dr. Leddy said that this type of injury can slow his recovery considering that this would have been his second head injury in four days.

“Given what happened to him within four days of one another, he’s now at risk for having a much more complicated and delayed recovery from this second injury than he otherwise would have had he been protected the first time,” Dr. Leddy said. “Instead of missing a game or two, he’s at risk for missing multiple games and maybe large parts of the season.”

Dolphins head coach Mike McDaniel said postgame Thursday that Tagovailoa had been diagnosed with a concussion at University of Cincinnati Medical Center, but nothing more. He additionally said that they had been testing him daily throughout the week beforehand.

The NFLPA tweeted shortly after the injury: “Player health and safety is at the core of the union’s mission. Our concern tonight is for Tua and we hope for a full and speedy recovery. Our investigation into the potential protocol violation is ongoing.”

Tagovailoa did fly home with the team in the hours following the injury, which Dr. Leddy was not concerned about. It is still unclear how much time he will miss.

Tagovailoa said in a statement on Twitter on Friday: “I want to thank everyone for all of their prayers and support since the game last night. It was difficult to not be able to finish the game and be there with my teammates, but I am grateful for the support and care I’ve received from the Dolphins, my friends and family, and all of the people who have reached out. I’m feeling much better and focused on recovering so I can get back out there on the field with my teammates.”

You can watch the full interview with Dr. Leddy above.

There was a storm of reaction to Tagovailoa’s injuries on social media. Western New York high school football referees say they have a protocol to follow in an effort to increase concussion safety for the youngest athletes.

“Parents should be confident to know that they’re going to make sure that their young boy or girl, regardless, suffers a head injury, that all conditions will be taken before they can even be considered to participate,” Michael Binkowski, president of the Western New York certified football officials, told News 4.

Ten years ago high school football protocols were introduced across the region. Officials say any athlete who gets hit in the head and shows concussion symptoms is sidelined.

Local football parents say they get nervous when their children take the field, but they trust the school protocol. Mary Faracca’s sons played before the protocol was in place.

“There weren’t all of the steps in place like there are now. Now you get hit in the head, and they start you on the protocol and they test you right away and there’s no messing around,” Mary Faracca, former Williamsville East football parent, said.

Other parents say the protocol works in high school sports.

“It almost seems that at this point in time high school protocols are stricter than NFL protocols,” Robert Murphy, a current Williamsville East football parent, said.

Aidan Joly joined the News 4 staff in 2022. He is a graduate of Canisius College. You can see more of his work here.

Tara Lynch is a Buffalo native who joined the News 4 team as a reporter in 2022. She previously worked at WETM in Elmira, N.Y., a sister station of News 4. You can follow Tara on Facebook and Twitter and find more of her work here.