What is the concussion test in cricket?

Why was Steve Smith substituted in the second Ashes Test? What are the rules for a head injury in cricket? What happens in other sport?

Updated - August 25, 2019 12:12 am IST

Published - August 25, 2019 12:02 am IST

Australia’s Steve Smith falls to the pitch after being hit in the head by a ball off the bowling of England’s Jofra Archer (unseen) during play on the fourth day of the second Ashes Test between England and Australia at the Lord’s on August 17, 2019.

Australia’s Steve Smith falls to the pitch after being hit in the head by a ball off the bowling of England’s Jofra Archer (unseen) during play on the fourth day of the second Ashes Test between England and Australia at the Lord’s on August 17, 2019.

The story so far: Australia’s Steve Smith, batting on 80, was floored by a bouncer from England pacer Jofra Archer in the first innings of the second Ashes Test in London on August 17. Smith was hit on the back of his neck close to his head at a spot that was not protected by the helmet, and fell down immediately after taking the blow. Dazed, he had to leave the crease. Although he came back to bat later in the innings (he eventually got out on 92), he was withdrawn from the game and was substituted by Marnus Labuschagne who batted in the second innings. Labuschagne was the first ever “concussion substitute” and in fact, the first ever substitute player to bat in a Test innings.

What are the new rules on ‘concussion substitution’?

Following the death of Australian cricketer Phillip Hughes, who was hit on the head by a bouncer in a Sheffield Shield (Australian domestic cricket tournament) first class match in 2014, there had been several calls for “concussion substitutes” who could replace injured players and also bat in the game.

After a two-year trial in domestic cricket, the International Cricket Council (ICC), in July 2019, approved player replacement in the case of concussion or suspected concussion in all formats of international and first class cricket worldwide. The rule, implemented since August 1, 2019 says that following a medical determination by a team representative in the case of an on-field concussion, the injured player will be substituted by a like-for-like replacement approved by the match referee.

In Smith’s case, Labuschagne was the like-for-like replacement as a middle-order batsman at the exact same position as Smith’s (No 4 in the Australian batting order). The ICC rules also specify that in case a like-for-like replacement is not available, the match referee may choose not to allow a substitute under the circumstances. Substitutes of this kind are only allowed if there are injuries due to concussions.

What is a concussion? How are concussions medically determined?

The 4th International Conference on “Concussion in sport” held in Zurich in 2012, came up with a consensus statement. It defined concussion as “a brain injury... that may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head”. Concussion is also termed as a “mild traumatic brain injury” and temporarily affects brain functioning. Its symptoms could include loss of consciousness, memory loss, headaches, difficulty with thinking, concentration or balance, nausea, blurred vision, sleep disturbances and mood changes.

Concussions tend to bring about a rapid onset of temporary impairment of some neurological functions, and could resolve spontaneously or evolve over a number of minutes to hours. Most concussions resolve in a short period (a week to 10 days).

The ICC has recognised that “concussion is a potentially serious injury that may have both short (increased musculoskeletal and brain injury risk) and long-term (chronic traumatic encephalopathy, dementia and mental health issues) health risks”, and therefore “requires a conservative management approach”.

Do other sports also follow a protocol?

While several sport have had concussion protocols in place in recent years, the ICC’s concussion management guidelines follow the Berlin Concussion Consensus, which sets the benchmark for such guidelines. A number of various sporting bodies representing various disciplines have instituted specific concussion-related protocols and guidelines within the settings and rules of their sport. These include American football, Australian football, basketball (organised by the National Basketball Association, or NBA), ice hockey, rugby, football among others.

The guidelines look at ways to assess if the player has suffered a concussion and to grade the injury quickly and offer immediate remedies. They also include the need for a graded return to play based on the symptoms suffered and the scale of the injury. The ICC says a player must be immediately withdrawn from the field of play if he/she is seen to suffer from typical concussion symptoms and diagnosed appropriately by a trained medical official. The player should also be tested for structural brain injuries if he/she suffers signs of serious brain injury.

The ICC’s guidelines also mandate that a typical graded return to play for cricket would include these steps — 24 hours relative rest, light aerobic exercise, light training, full training and being cleared to compete (via a formal medical clearance). If at any of these stages, the symptoms return, the player drops back an exercise level. In case the symptoms persist for three weeks or more, the player will be subject to a neuropsychological assessment and tested for structural brain damage.

Other sports also follow such graded testing and return protocols. Besides these, the NBA, for example, has instituted mandatory education of concussion knowledge to players, coaches and medical staff.

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