Steve Smith visibly sick after training session

Smith’s lingering concussion saw him miss the entire ODI series and comes after he missed three innings in the Ashes last year

Steve Smith missed the ODI series in England. Picture: Getty Images

Steve Smith flies to the UAE late Thursday Australian time with teammates and opponents from the England series amid concerns about his health.

Smith missed the entire one day series after being struck in the head by a throw down from new assistant coach Trent Woodhill last Thursday.

He passed a number of concussion tests, but is understood to have been ruled out again after completing a training session that involved sprints and a spell facing bowlers.

Access to training sessions in the UK was strictly controlled but it is understood that Smith vomited after the session.

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Smith was reported to have “ticked every box” by coach Justin Langer on Tuesday but the coach said after the net session that the batsman “looks a bit rusty”.

“He was a little bit groggy and just wasn’t 100 per cent, so like any time you’re dealing with a head injury or anything like that you want to be ultra conservative and cautious,” Finch said before the third match overnight.

Australia won a thriller to seal the series two-one on the back of an extraordinary fight back from Alex Carey and Glenn Maxwell who both scored centuries.

It is the second significant concussion for the champion in little over a year, but Cricket Australia told The Australian he had been very close to playing the last match.

Smith was felled by a short ball last August from Jofra Archer at Lord’s in an incident that sent a chill through cricket. He was substituted out of that match and subsequently missed the third Test at Headingley.

Cricket Australia’s head of sports medicine, Alex Kountouris, said they were taking a cautious approach and were now working with medical staff at Smith’s IPL franchise.

“Steve is making progress and working with our medical team through the concussion protocols required to return to play,” Kountouris said.

“Unfortunately, he was not ready to play the final ODI against England. We are working collaborative with his IPL franchise on his return to play from here once he arrives in the UAE.

“The conservative management of Steve through this injury is consistent with our approach to put the player’s welfare first, as we did with him during the Ashes last year.

“That says a lot about the environment within our Australian teams. We are striving to create environments where players trust that our medical team will always put their welfare first and therefore speak openly with them, whether this is about concussion, other injuries or mental health.

“Cricket Australia has strict protocols when it comes to head impacts and concussions and, as we’ve seen over the last 12 months, we’re not willing to compromise on those.

“We have done a lot of research over the last few years to better understand head impacts and concussions specific to cricket, and that has helped up in how we manage our players.

“We place the welfare of the player before the game because we strongly believe that is what’s best for the player.”

Medical staff take a cautious approach to concussions aware of how significant concussion is and equally how dangerous it would be for a batsman to play suffering effects which can include slower movement and thought processes.

Concerns arise for the long term health when a repeat concussion is caused by reduced force and recovery times are slower.

Steve Smith lays on the pitch after being hit in the head by a ball from the bowling of England's Jofra Archer at Lord’s last year Picture: AFP

The batsman passed initial concussion tests in England last year and even resumed batting after a period of rest but deteriorated in the days following.

Cricket Australia said at the time research indicates that 30 per cent of concussions report with delayed symptoms.

“As part of the Cricket Australia concussion protocol, repeated concussion testing of Steve Smith was also performed (Sunday) morning (local time) and demonstrated some deterioration from his testing which is consistent with the emergence of the symptoms he was reporting,” the organisation said at the time.

“On that basis, Steve has been withdrawn from the match by team doctor Richard Saw and the Australia team will lodge an application for a concussion substitute with the ICC match referee in line with the ICC protocol.”

Smith was hit in the neck by Jofra Archer close to the place where Phillip Hughes suffered a fatal blow.

“I started to feel a little bit of a headache coming on last night, probably as the adrenaline got out of my system,“ Smith said the day after the blow.

“I was able to get a good sleep in, which is somewhat rare for me. But I woke up feeling a little bit groggy and with a headache again, so had some tests done, and upon some further assessments (it was) deemed to be a mild concussion.

“We did a test this morning here at the ground, did one last night and results changed slightly and unfortunately that and how I’m feeling have contributed to me being ruled out for the rest of the Test match.

“With the tests I’ve done and how I’ve woken up today I think it’s the right decision. The doc’s had a pretty close eye on me since I came off the field yesterday, and I’ve been assessed and asked a lot of questions over the last 20 hours or thereabouts, and unfortunately I’ve declined in the way I’ve felt over that time.

“I didn‘t have any real pain in my neck yesterday when I touched it or when anyone else touched it. Today I do have a bit of pain there, whether that’s some swelling or what I’m not sure. Perhaps that’s leading to me having a headache and feeling a bit groggy.”

Smith said later he woke up feeling like he had a hangover.