Elite sportspeople desire and expect that they can control every situation. But when it comes to head injuries, sport must take the decision out of their hands, or face devastating consequences.
Steven Smith’s Terrifying Return
Late on day four of the 2019 Lord’s Ashes Test, Australia’s star batter Steven Smith was flattened by a lightning-fast Jofra Archer bouncer that hit him on the side of the neck.
He lay prone and unmoving for a few minutes. With memories of the death of Phillip Hughes from a similar incident fresh in the memory, not least in the Australian memory, those minutes passed sickeningly slowly.
As he unsteadily regained his feet, there was a sound unlike any other – the sound of exhalation from thousands of people who hadn’t realised they were holding their breath.
The replays were, and to this day are, simultaneously unwatchable and unmissable. As was what happened next.
At the fall of the next wicket, Smith walked back through the Long Room and out to the middle. But this was not the imperious Smith of a few minutes ago.
He managed to thrash a few fours, but he simply did not react to the full, straight ball that dismissed him LBW. It was as though he had frozen.
Smith has since said that he was physically unable to do what his cricketing instincts told him to do. Put simply, he was no longer fit to play.
Archer did not bowl during Smith’s brief second stint at the crease. Smith thus did not have to face truly fast bowling, which requires absolute concentration and reduces reaction times to fractions of a second.
It is barely an exaggeration to say that, had he done so in his sub-par condition, he could have died.
Team Doctors Are In An Impossible Position
In the cold hard calculus of top-level sport, a player is fundamentally an asset.
The job of a team’s coaching and support staff is to enable that team’s assets to perform at the highest possible level.
The job of a doctor is, in the broadest terms, to care for their patient.
But when it comes to head injuries, those two tasks can come into conflict. Consider the unenviable position of Australia’s team doctor Richard Saw when assessing Smith.
He first did so when Smith was still lying prone on the Lord’s turf. This was presumably to ensure there was no immediate threat to life or loss of physical faculty.
But once Smith was in the dressing room, it then fell to Dr Saw to carry out a head injury and concussion assessment. And here’s where the conflict emerges.
Dr Saw is a highly qualified and oft-published expert in sports medicine. He has written specifically about head injuries and concussion in cricket. Nobody is questioning his professionalism.
But he is employed by the Australian men’s cricket team, who benefit from having their star player available to them against their fiercest rivals. Justin Langer and his staff almost certainly do not put overt pressure on their medical staff, but they don’t have to.
Concussion cases are notoriously difficult to assess. The symptoms are not uniform, and there is often a lag between the impact occurring and those symptoms emerging.
Even an unimpeachable professional like Dr Saw is likely to experience an unconscious bias to clear a player for a return to action purely by virtue of being the doctor to a team.
Then there’s the pressure from the player. Elite players are used to playing through pain, and in any case concussions often don’t hurt straight away. How would a player know to say anything other than, “I’m okay”?
Now consider that a player’s ability to assess their own condition may be affected by the very thing they’re trying to assess.
If given any sort of choice, a player is going to want to return to action. A team is going to want them to return to action. And we have seen that a team doctor ruling on a player who is a borderline case may well clear them to return to action.
Would a doctor employed by cricket’s governing body the International Cricket Council (ICC), and thus entirely independent of either team, err on the side of caution in such cases?
It’s high time we found out. Let doctors be doctors.
Players Don’t Know Best
Aside from Smith, between May and September of 2019, Hashim Amla of South Africa, Hashmatullah Shahidi of Afghanistan and Darren Bravo of the West Indies all continued playing after being hit hard on the head, though Bravo like Smith was later substituted.
Hashmatullah even told doctors who urged him to leave the field: “I can’t go, you know, my team need me.”
It is dangerous to call this bravery. And it is too harsh to call it stupidity.
Rather, it is an obvious consequence of the heady cocktail of competitive instinct and fear of being seen as weak – and, perhaps, a failure to educate athletes about what they’re dealing with.
Let’s Remember What We’re Talking About
A concussion is when a blow to the head means your brain rapidly moves back and forth inside your skull. Sometimes, your brain hits the inside your skull.
When your brain repeatedly hits the inside of your skull., it becomes becomes inflamed, and the areas of function that the brain controls can begin to suffer.
And sometimes, if an impact does not lead directly to a concussion, that can be even worse.
A University of Stirling study showed that repeated non-concussive head impacts, such as heading a football, significantly reduced performance on memory and cognition tasks even within 24 hours.
While these impairments soon faded, chronic brain injuries are not so easily overcome.
We have seen in the tragedies of Jeff Astle, Nobby Stiles and the Charlton brothers, and the early retirement of Andy Wilkinson, that football like cricket has a serious question to answer on head injuries.
For cricket, it is ensuring that the doctor assessing a player’s fitness to play after head injury is entirely free to make a medical decision.
For football, it is whether the game is willing to continue risking its players’ ability to function as independent human beings rather than severely limit heading.
For both, continuing to believe that ‘Players know best’ is not just wrong, but potentially lethal.