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In the world of sports, concussions have become one of the most discussed and debated topics due to the serious long-term effects they can have on brain health. Athletes, parents, coaches, and healthcare professionals are becoming more concerned with how to manage concussions and when an athlete should consider stepping away from their sport, particularly after multiple injuries. This is not just a question of health, but also one of career and life trajectory.
A recent example that has reignited this conversation is the case of NFL quarterback Tua Tagovailoa, who sustained his third career concussion on national television. The incident led to an outpouring of opinions from fellow athletes, medical professionals, and fans, with some calling for him to retire.
For athletes at the professional level, retirement means potentially walking away from millions of dollars and the life they’ve known since childhood. Similarly, for high school or college athletes, the consequences of multiple concussions could mean losing scholarships or career opportunities.
However, the decision to retire after multiple concussions is not as simple as just counting the number of injuries. Understanding the mechanism of a concussion, the risks involved, and the path to recovery are essential in making an informed choice.
The most essential factor in deciding whether to end a sports career after multiple concussions is understanding the injury itself. Not all concussions lead to permanent damage, and not all of them result in chronic traumatic encephalopathy (CTE) or other neurodegenerative conditions. In fact, many concussions resolve fully, and the individual returns to their pre-injury level of function.
It’s essential to note that although concussions can present differently in each person, the pathophysiology—the cellular changes and disruptions—are the same across the board. Typically, everyone experiences similar issues during the first two to four weeks after a concussion, such as energy deficits within brain cells, inflammation, and disrupted neural connections. According to research, not everyone recovers from concussions. Around 27% of concussions resolve on their own within that time, meaning the brain returns to normal functioning without long-term effects.
However, the real concern lies with the 73% of individuals who don’t experience this spontaneous recovery. In these cases, certain networks of nerve cells—critical for functions like memory, balance, and cognitive processing—underperform, while others work harder to compensate. This imbalance often leads to symptoms such as headaches, dizziness, fatigue, and cognitive fog. What’s more, even if symptoms aren’t immediately noticeable, there are often signs that a trained specialist, such as balance disturbances, visual tracking problems, sleep irregularities, and coordination deficits, can objectively measure.
When these networks are left dysfunctional, the brain’s cells are more vulnerable to producing harmful free radicals, consuming too much glucose, and accumulating misfolded proteins—factors that can contribute to long-term neurodegeneration.
To make an informed decision about whether an athlete should continue their career after multiple concussions, a thorough neurological evaluation is critical. A doctor specializing in concussion management will assess multiple domains of neurological function, including autonomic function, emotional regulation (affect), cognition, vestibular function, vision, oculomotor control, sleep, and musculoskeletal coordination.
In my practice, the concussion evaluation I perform consists of over 150 distinct examinations and diagnostic procedures. These range from simple tests, such as assessing limb coordination and reflexes, to more advanced techniques, like video head impulse testing, neurocognitive assessments, and force plate posturography. These tests allow us to measure balance, eye movements, and postural control, often affected by concussions.
This extensive evaluation takes approximately three hours and is designed to assess the integrity of the various brain networks affected by concussions. Performing these tests and collecting the data is just the first part of the process. In reality, anyone can be trained to administer these tests. The real value lies in the next steps: interpreting and explaining the data to the patient.
Interpreting the results of a concussion evaluation requires years of specialized training. To properly understand the implications of the findings, clinicians often undergo clinical fellowships under concussion experts, followed by years of experience treating thousands of patients with varying concussion presentations. Individuals should insist that their doctor provide them with comparable normative data for their age and sex. At a minimum, the doctor should present data measuring their symptoms, cognitive function, balance, vestibular function, vision, oculomotor function, sleep, and emotional status.
The third decision-making component is explaining the results in a way that the patient and their family can understand. They should take time to explain all normal and abnormal data points. It’s not enough to tell someone their brain function is abnormal; the patient and their family deserve to know what that means for their current and future health.
Here is where the most important factor comes into play: just because the brain shows signs of dysfunction does not mean that the damage is irreversible. In my opinion, no athlete should consider ending their career solely based on initial evaluation results. If dysfunction is detected in brain networks or other body functions, the next step is often a therapeutic trial aimed at rehabilitation.
Concussion rehabilitation, when done correctly, can help restore normal brain function. In fact, based on my team’s published research, we found that approximately 90% of our patients who had been experiencing concussion symptoms for over two years showed significant improvement after rehabilitation. This data passed critical peer review, demonstrating that proper concussion care can yield tangible, positive outcomes.
If an athlete improves after rehabilitation, they should feel empowered to make a free and informed decision about their future. They may choose to continue their athletic career or pursue another path that poses fewer risks to their brain health. Either way, they are making a choice that is not dictated by lingering concussion symptoms.
In my professional opinion, an athlete should only consider retiring after multiple concussions when all rehabilitation efforts have been exhausted and their symptoms persist despite intervention. If an athlete still experiences significant neurological dysfunction after a dedicated rehabilitation period, continuing their athletic career poses unnecessary risks to their long-term brain health.
However, if they recover, the decision is no longer bound by their injury. They can decide to continue their passion for sports, knowing the risks, or explore other life opportunities. Recovery allows them the freedom to choose rather than being forced into retirement due to persistent symptoms.
Ultimately, the decision to retire is deeply personal and should be made with a comprehensive understanding of the injury, the athlete’s neurological health, and the potential for recovery. With the proper care, many athletes can recover and make their decisions from a place of strength rather than fear.
