Cheers rang out in anticipation when a rare three-way playoff started on the final day of the Kyushu Grand Sumo Tournament in Fukuoka in November.

But the packed sumo arena went silent as Takayasu slammed his head into the chest of Abe, his opponent, who jumped to the side, and fell to the dirt.

After his loss, Takayasu could not move. As the spectators and the national TV audience watched in concern, the maegashira No. 1 put his hands on his forehead and his head wobbled dizzily back and forth.

Takayasu struggled to get to his feet and finally managed to rise, but needed assistance to descend from the ring.

What was noticeably absent and alarming was that no doctor was at ringside to evaluate him for telltale signs of a concussion or other injury.

Senior sumo officials who served as judges had a woozy Takayasu remain nearby instead of heading for the dressing room.

He had to wait for the results of the next bout in the playoff and the possibility that he might have to climb back into the dohyo for a deciding bout.

A wrestler who claims two straight bouts would win the three-way playoff, the first in 28 years. 

In the ensuing match, Abi, maegashira No. 9, defeated ozeki Takakeisho to claim his first career title on Nov. 27.

But if Takakeisho had won, Takayasu would have had to wrestle again, which could have had grave consequences for the 32-year-old veteran.

Kazuo Isayama, a neurosurgeon who has a long history of working as a ring doctor for combat sports, including leading the Rizin Fighting Federation, which holds contests combining mixed martial arts and kickboxing, said Takayasu’s symptoms suggested he suffered a concussion.

“In combat sports, it is a standard to declare a ‘no contest’ when a combatant suffers a serious injury during a match,” he said. “Takayasu should have never been allowed to fight again that day. He could have ended up with a life-threatening condition if he could not get up even after a light clash in another bout in the playoff.”

A medical report submitted to the Japan Sumo Association said Takayasu was diagnosed with traumatic cervical syndrome, a biological and neurological condition of the cervical spine and nervous system caused by neck trauma. He reportedly will require at least a month to recover from the injury, according to the diagnosis.

The JSA, which runs six tournaments a year, does not have a protocol for treating injured wrestlers. It does not assign medical staff to stand ready next to the dohyo during the 15-day competitions.

It is unclear whether the JSA has ever considered setting concussion or other injury-related protocols for the tournaments. No explanation has been provided for not offering such a safeguard.

It is not uncommon for heads to violently collide at the initial charge and wrestlers to be slapped so hard in the face and head that they have difficulty rising and walking.

Ura, maegashira No. 3, could not move for a while after he was thrown out of the ring and landed on his back and hit his head on Jan. 10, the second day of the New Year Grand Sumo Tournament.

Ura struggled to crawl back into the dohyo, which stands about 60 centimeters above the floor, to bow to the victor before leaving the ring first, which is customary for the losing wrestler. 

But Ura then wobbled. Sumo ushers ran to him to hold him up from both sides. Ura bowed and walked unsteadily to a wheelchair in a passageway to help him leave the arena.

Spectators at the Ryogoku Kokugikan in Tokyo sent him off with warm applause.

On the internet, however, many questioned sumo officials’ handling of Ura’s injury.

“Why was there not a doctor to check on him?” said one post. “He should have been taken out on a stretcher,” said another.

Also in the New Year Grand Sumo Tournament in 2021, a junior class wrestler suffered a concussion when his head was hit at the initial charge.

But he was forced into a rematch by a referee and sumo officials as the face-off was ruled improper.

The decision drew fire from critics who raised concerns about the obviously impaired wrestler.

In the Spring Grand Sumo Tournament in March that year, another wrestler in a lower division was thrown to the dirt and hit his head violently as he fell. He was taken to a hospital by ambulance and died one month later. It is unclear whether the injury and his death were related. 

In the incident, it took a doctor more than five minutes to arrive at the dohyo to evaluate the injured wrestler, causing an uproar about the JSA’s approach to safety.

Ryogoku Kokugikan, the venue in Tokyo that hosts three tournaments annually, has a medical clinic that is also open to the public. But it is located hundreds of meters from the ring and requires taking an elevator to arrive at the site.

The JSA has begun taking safeguards against injuries. Workshops have been held for referees and officials to educate them on responding to emergencies. It also set up a panel to study conducting training sessions that lessen wrestlers' susceptibility to injuries.

But a system requiring medical specialists to be on hand to treat injured wrestlers does not appear to be on the horizon.

Shorter wrestlers are prone to head injuries because they often charge with their heads down to improve their chances of toppling taller opponents.

Wrestlers are thought to momentarily exert a kinetic energy equivalent to 1 ton when they clash at the initial charge.

The violent impacts have even worsened in recent years as wrestlers increasingly bulk up and weigh more than in the past. The average weight in the top makuuchi division now exceeds 160 kilograms.

The most well-protected athletes in Japanese sports are said to be those in rugby.

For example, up to four doctors stand ready during each match of the Japan High School Rugby Championship. Rugby players who suffered head injuries are cleared to return to the pitch only after completing a multi-tiered recovery process.

Isayama called on the JSA to institute a head injury protocol obliging injured wrestlers to undergo continued medical analysis, in addition to treating them as soon as they are injured on the dohyo.

“If things are left as they are now, a serious accident can occur,” he said.

(This article was compiled from reports by Ryusaburo Matsumoto, Kenichi Hato and Kensuke Suzuki.)