Cricket has long way to go to protect players against concussion
Doctors still powerless to stop batsmen playing on after being struck, writes Tim Wigmore at Lord’s
In the moments after sustaining a harrowing blow to the neck from Jofra Archer, Steve Smith wanted to continue batting. Smith told Australia’s team doctor Richard Saw: “I feel fine and I’d like to continue,” a team spokesman later said. But Saw was adamant that he should go off anyway. Smith reluctantly agreed.
To anyone who observed how Smith fell to the floor after being hit, dropping his bat and taking off his helmet immediately, the notion that he should resume his innings unabated seemed absurd. And yet, for most of cricket’s history, batting on in such circumstances has been the norm.
Indeed, too often it still is. The introduction of concussion substitutes in Test cricket, introduced from Aug 1, indicates a newfound awareness of the risks of head injuries within the sport.
Yet, despite this landmark rule change, a culture that is blase about blows to the heads still permeates much of the cricketing world.
In 2017, Bangladesh’s Mushfiqur Rahim was hit on the head by a searing bouncer from South Africa’s Duanne Olivier. As Bangladesh did not have a team doctor, it fell to South Africa’s doctor Mohammed Moosajee to recommend that Rahim leave the field for his own safety. Rahim defied the advice, and – looking palpably discomforted – batted on for another 40 minutes, facing 10 more bouncers, before being dismissed. Only then did Rahim go to hospital for further tests.
Against England in the World Cup, Afghanistan’s Hashmatullah Shahidi was hit on the head by a 92mph bouncer from Mark Wood. “The ICC doctors came to me, and our physios, my helmet was broken in the middle. They told me just, ‘let’s go’. I told them I can’t leave my team-mate at that moment,” Shahidi said, disturbingly, after the game.
In this context, Smith leaving the field was a sign of progress. While he eventually agreed with the decision, Australia – unlike most other countries – do allow a doctor to withdraw a player from the field.
But, despite the introduction of concussion substitutes, there are still no rules that doctors can mandate players to leave the field when they want to stay on, largely because only three Test countries always travel with their own doctor.
Before Smith returned to the field, he underwent a modified Maddocks assessment – answering a series of routine questions about everything from where the game was being played to who bowled the last ball and what happened. Smith passed the test, his words displaying no adverse impact from the blow, but the team doctor decided that he should go off anyway as a precaution.
Once Smith was off, he then underwent a SCAT5 test, which is common throughout sport and used to evaluate potential concussions.
Australia’s officials also put Smith through two further tests: the CogSport concussion test, which measures cognitive functions against a baseline; and a balance test, which entailed standing on one leg while closing his eyes to make sure he did not fall over. These tests took about 20 minutes, and Smith was ready to bat around 10 minutes before the wicket of Peter Siddle.
Despite these tests by Australia, Smith “should have stayed off for his own safety and gone to hospital for a scan”, Derek Wyatt, a former England rugby union international who works for the Brain Campaign Charity, told Telegraph Sport. Wyatt also said that all professional cricketers should be scanned in the off season to check for signs of damage in their brains.
Permitting concussion substitutes in international cricket is an important step in protecting players: essentially, the measure means that players will know they will be replaced if they are concussed, and so should make them less inclined to try and play on with a concussion. But the sport’s journey to better protecting its players remains far from finished.
For all the focus on head injuries in rugby union – and, increasingly, football, which still does not permit concussion substitutes despite repeated calls from the sport’s players’ union – cricket still has major issues to address. In an investigation by The Telegraph into the risks of injury last year, Peter Brukner, who worked with Australia from 2012 to 2017, highlighted three main areas to address: concussion substitutes; the need for a standard head-injury assessment; and the lack of full-time team doctors among most Test nations. The last two of these issues remain.
There also remain concerns about helmet safety. Although it probably would not have protected him, Smith did not wear a stem guard – he tried them in the nets two years ago but found them uncomfortable – on his neck. The International Cricket Council is working on a project with the England and Wales Cricket Board and Loughborough University around improving the quality of neck protectors to better protect players, and establishing a gold standard so that players know what the safest option is. Depending on the results, the ICC board could eventually mandate that all players wear such helmets in international cricket.
Such steps, building on recent work, are wholly welcome. The blow sustained by Smith was just the latest example of cricket’s need to be vigilant in protecting players from head injuries and their aftermath.