Kosta I. Transcript

My name is Kosta Ikonomou. I’m a physiotherapist specializing in sports medicine and concussion.

First, I want to thank Concussion Box for letting me participate in their initiative to raise awareness and educate those who are kind of going through a concussion journey or have someone in their life who they’re supporting.

Over the past decade, I’ve worked and witnessed kind of the evolution of concussion research and treatment approaches. So, I’m very happy for the opportunity to share my insight with you all. The moment that sparked my passion for this field–it was during the university softball game where I was working on the sidelines as part of the medical team as a student. One of the players got a concussion, but what struck me was her unexpected emotional response, which kind of really deviated from the typical headache symptoms that I was, kind of, aware of. And from that point forward, kind of my journey into the realm of concussion started. After pursuing a career though working in physiotherapy, you sort of find yourself in the vestibular therapy as well. My master’s degree was in sports medicine from UCL in London, England, where my research topic was in, in concussion. And most recently, I had the privilege to present my research at the 2023 Concussion Consensus Statement in Amsterdam.

In my clinical practice, I come across two types of concussion patients. First, there are the acute patients who respond well to appropriate advice and education, which kind of just creates the optimal healing environment for their brains. The most significant change in treatment over the past decade has definitely been the recognition of exercise as a crucial element in recovery. Older consensus statements suggested that exercise might be helpful. But the latest one clearly states that exercise definitely easing recovery. And still to this day, I’m still shocked and surprised to get phone calls, or individuals telling me that the advice that they’ve gotten is to almost confine themselves in a dark room and rest.

So second, the majority of patients I do tend to see experience persistent symptoms. These individuals may struggle for months or even years after the initial incident. And their recovery journey can be challenging and multi-faceted. Each concussion is unique and therefore a comprehensive approach is necessary. For myself, I examine various factors, such as the vestibular system, cardiovascular system, cervical spine, sleep patterns, mood, ocular, motor system, and kind of their behavioral strategies that they have developed. And by understanding individuals’ needs at that time, I develop a tailored plan that initiates their path for recovery, really focusing on those avenues. And it can be an uphill battle. It actually is a very, you know, difficult injury to go through. But I always say it is a recoverable injury. And adversity has a way of shaping us, and often individuals emerge from this experience stronger than before.

So, I’m just going to share a story in my experience working with a concussion patient. This particular case involved a 45 year old woman who had been in a car accident two years prior. She came to see me. She presented dizziness as her primary symptom, along with fatigue, headache, difficulty concentrating, and heightened sensitivity to motion. These symptoms severely impacted her ability to engage in daily activities, such as kind of socializing, household chores, hanging out with friends. So over the time, she developed these patterns that initially served her well. But ultimately, now she is stuck in this perpetuated cycle of symptom escalation, fear based avoidance pattern. So to begin a recovery, it was essential to calm her nervous system down first and establish a sense of safety and grounding within her body. Grounding techniques played a significant role in this phase. We then focus on rebuilding our confidence in her neck through range of motion exercises, strength, enhancing body awareness and kind of just core coordination. Simultaneously, together, we gradually introduced exercise, kind of focusing on what she enjoyed doing. And kind of teach her body to be okay with exercise as a stress and teach her that stimulation is not dangerous to her anymore.

You know, she had increased self-confidence, and she kind of realized that her body was over protecting at times, so this was a key milestone for her journey. And although her recovery spent, you know, almost a year, she, you know, it was definitely a success story. And the main thing is, she took control of her symptoms rather than allowing her symptoms to control her.

So for those currently recovering from a concussion, my general advice is seek out an evidence-based practitioner who understands the various subdomains that may be affected by a concussion. These professionals will guide you through the recovery process and provide targeted rehabilitation strategies. And if you are experiencing persistent symptoms, I urge you to kind of identify what you may be avoiding now. And I would say tackle the low hanging fruit first. So engage in regular exercise, even if it’s if you start as simple with like a small walk, stretching, kind of anything to get your body moving. Gradually train your body to handle, you know– exercise is a stress– but you must handle that stress before you handle the others. Additionally, prioritize hydration, maintain a healthy diet, establish a consistent sleep schedule. So, that means kind of go to bed around the same time, wake up around the same time. Practice good self-care habits.

Last, work on managing internal stress. We all have kind of stress in our lives. So it’s important to seek support, identify and address any subconscious or unresolved stressors from your past. Because our bodies and minds are interconnected and addressing all these aspects is crucial for recovery.

So to friends and family members supporting some other concussion recovery, I offer this advice to you: be patient and ask them what do they need at that moment. It may be a simple gesture like a hug, providing space, offering quiet time, or engaging in an activity that the individual may enjoy. This could really make a significant difference. So, your support plays a vital role in their healing journey.

For myself, like working with concussion patients, something that consistently surprises me, but I’ve gotten used to is that no two concussions are the same. There are some kind of patterns and kind of unique trends. But like every individual brain is different. We have, you know, it’s been shaped by our experiences, our lifestyles or development or developmental patterns. So, interestingly, any previous injuries or condition often becomes more pronounced after concussion. For example, like if somebody had, you know, some motion sensitivity as a child, for example, for some reason it can become more prominent post concussion. So this is why like concussion is like the threshold of injury. So, the higher individual’s physical, mental and emotional resilience, the milder their symptoms may be when they do or if they do have a concussion.

So last, I just want to say I’m grateful for the opportunity to share my insight and experiences with you today. Concussion recovery is a difficult journey with kind of various timelines for recovery, but with evidence based approaches, tailored rehabilitation plans, and a strong support system, individuals can emerge stronger and more resilient.

So, again, thank you to Concussion Box for continuing to increase awareness, educate others and provide the necessary tools for successful recovery.