India’s second Test against Bangladesh may have failed to produce competitive cricket, but it generated a lot of discussion around an important aspect of the game – the concussion rule.

Earlier this year, the International Cricket Council agreed to allow substitutes for players concussed during a match. This means, if a player is unable to compete after being hit on the head, they can be substituted by a squad member who was not a part of the playing XI initially. It, however, has to be a like-for-like replacement: meaning, a batsman cannot replace a bowler or vice-versa.

In the recently-concluded second Test between India and Bangladesh at the Eden Gardens in Kolkata, apart from the pink ball, much of the attention went to this concussion rule.

Visiting batsmen Liton Das and Nayeem Hasan were forced off the field after being struck on the head by bouncers in the first innings. They were replaced by Mehidy Hasan and Taijul Islam. There were a few blows to the helmet in the second innings as well.

Now, since this rule change by the ICC came into effect quite recently (August 1, 2019), there was a fair bit of confusion among viewers regarding the terms of it. The commentators’ insensitive take on the issue only made matters worse.

The first thing that needs to be considered in a concussion case is the fact that it is unlike any other physical injury. A sprain, cut, bruise, ankle twist, muscle pull, a broken bone or any other physical injury is in no way the same as a knock on the head. Phillip Hughes’s unfortunate death in 2014 is an extreme possibility, but a head injury can present other grave dangers too.

The like-for-like aspect is also a talking point, as we saw that Mehidy (primarily a bowler) replaced a batsman and hence could not bowl in the match.

Finally, during the India-Bangladesh second Test, there seemed to be a lack of clarity regarding the determination of a concussion. How do you decide there is an absolute need for a player to be taken off the field? After all, it is not necessary that every time a player is struck on the head it has to lead to a concussion.

This assessment is made by the team physio, who runs on to the field immediately and is the first person to inspect a player after they have been stuck. If the player is taken off, the physio has to submit a detailed medical report to the match referee.

To get an understanding of how this decision is made, got in touch with Abhishek Sawant, the Mumbai Ranji Trophy team physio. Sawant has done his masters in sports physiotherapy, and has been working with the Mumbai Cricket Association for the past three years, and is a Board of Control for Cricket in India-accredited sports science and medicine physio.

As explained by Sawant, this is the procedure a physio has to follow during his interaction with a player who has been struck on the head:

  • Ask the player if they are feeling a lack of consciousness
  • Ask the player if their vision is blurred or hazy
  • Ask the player if they are suffering from blackouts
  • Ask the player if they are feeling like vomiting
  • Ask the player if they are feeling a headache
  • Ask the player about the current match situation
  • Check if the player is saying irrelevant things in general
  • Check if the player is moving clumsily
  • Check if the player is answering questions slowly
  • Check if the player is suffering from memory loss

This is a process that clearly takes time and hence the first couple of sessions at Eden Gardens witnessed slower over rates than usual.

Once the concussion is confirmed and the player is taken off the field, the physio needs to assess the case thoroughly. This is done with the help of the Sport Concussion Assessment Tool 5, referred to as SCAT 5.

The SCAT 5 is essentially a set of questions that a medical doctor asks a patient to determine the gravity of the concussion. If the case is serious, the player must be transferred to the nearest hospital.

Here are the areas the SCAT 5 looks at:

  • Red flags
  • Observable signs of concussion
  • Immediate memory
  • Glasgow Coma Scale
  • Cervical spine assessment
  • Athlete history
  • Symptom evaluation
  • Cognitive screening
  • Neurological screen
  • Delayed memory

One major challenge for a physio in a concussion case is determining whether or not a player is hiding his/her symptoms. Vomiting, memory loss, physical movements, etc, are there for all to see, but what if the player is feeling a headache or suffering from blurred vision and not informing? This is a possibility with the heat of the battle, competitive spirit and adrenaline in play.

“If that is the case, there is nothing a physio can do,” said Sawant. “Players do that at their own risk. They need to understand that the more stress they place on themselves when they are concussed, the more it will aggravate. There are even delayed concussions, the symptoms of which are apparent after 48 hours too. A concussion must be treated immediately, else the effect of it can be long-lasting.”

Clearly, this is an issue that needs to be taken seriously in cricket and the implementation of the protocols is of utmost importance in the modern game, even if some analysts find it to be time-consuming and disrupting the flow of the game.