What is a “fencing stance” after a head injury?

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With 5:57 to go in the first half of Thursday Night’s football game between the Miami Dolphins and the Cincinnati Bengals, Dolphins quarterback Tua Tagovailoa was sacked and suffered what appeared to be serious injuries to head and neck. It came just four days after Tagovailoa was hit by Buffalo Bills linebacker Matt Milano in Miami’s Sunday win over the Buffalo Bills. It looked a lot like a head injury when Tagovailoa stood up and shook his head, but the team went out of their way to say that Tagovailoa suffered a back injury. The injury against the Bills happened in the first half; Tagovailoa returned to play in the second half.

After the game, the NFLPA said it intended to investigate the Dolphins’ handling of Tagovailoa’s injury.

Many people are wondering about the positioning of Tagovailoa’s hands after the injury in the Bengals game – his hands were spread wide above his head after his head hit the ground.

This is probably referred to as a “fencing response stance”, which is “a clear indicator of the extent of the force of the injury and the location of the midbrain to aid in the identification and the classification of injuries”, according to the National Library of Medicine. This time, the Dolphins released a statement during the game that Tagovailoa suffered head and neck injuries and was being taken to the University of Cincinnati Hospital. Reports indicated that Tagovailoa had movement in all of its extremities.

Unfortunately, Tagovailoa wouldn’t be the first NFL player to suffer head trauma on the field and get into a fencing stance. We won’t post the videos here, but it happened to Pittsburgh Steelers quarterback Mason Rudolph against the Baltimore Ravens in 2019, and it happened to Los Angeles Chargers tight end Donald Parham against the Kansas City Chiefs last season.

Learn more about Healthline’s Fencing Response Position:

The name comes from the similarity to the asymmetrical tonic neck reflex (ATNR), also called the fencing reflex, which occurs in newborns.

It’s when newborns position themselves with one arm bent and the other extended with the head turned towards the extended arm like a trained fencing athlete. This reflex usually stops after the baby is about 4 months old.

This reaction occurs after an injury because it is believed that if a blow strikes the brainstem, it will momentarily reactivate the ATNR.

Doctors use a number of indicators – such as the 15-point Glasgow Coma Scale – to assess the severity of TBI [Traumatic Brain Injury]. For a variety of reasons, including the fact that concussions are not visible on MRI or CT scanshealth professionals are looking for more indicators to make the diagnosis more accurate.

Whether or not the fencing response was seen by witnesses may be part of this evaluation process. If the fencing response is observed after an injury, it may likely be worse than an unresponsive response, since the fencing response is thought to involve the brainstem.

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