What you can do if you have a concussion

By Dominique Liboiron
This is the final article in a six-part series about sports-related concussions. To date, we’ve covered a lot of information. Because head injuries can have long-term and sombre consequences, we’ll conclude our series by speaking with Codi Isaac, a physiotherapist who specializes in the treatment of concussions.
If you currently have a concussion, this conversation with Isaac will help you. For those of you who’ve had one in the past or if you partake in activities that put you at risk, you will benefit from this article, as well.
Isaac owns and operates Isaac Physiotherapy in Sherwood Park, Alberta. She holds both a bachelor of commerce degree and a master’s in physical therapy from the University of Alberta.
A few experiences came together to influence her decision to specialize in concussions. One occurred years ago while she was attending her brother’s rugby game during which he sustained a head injury. Her brother told his coach that he couldn’t see anything from the horizon down. The coach replied, “You don’t need to see your feet, you just need to see the ball.” Although his coach wanted him to get back in the game, he wisely refused.
The coach’s attitude reflects the outdated view that head injuries aren’t serious.
Isaac explained the other event that fostered her growth as a physiotherapist. “My next-door neighbour’s son had a concussion injury in basketball that left him sitting in his house with all the lights turned off for six to nine months. He missed an entire year of school. It took him a long time to feel normal.” Because of this, Codi asked herself, ‘Something is not right and why can’t anybody do anything? There has to be something to do.’
While studying physiotherapy in university, one of Isaac’s clinical instructors asked her what she was studying outside of class for her own pleasure. It was concussions, a telling answer of where her curiosity and interest was focused. The instructor encouraged her to delve deeper into the subject. This nudged the physiotherapy student onto the path she continues to follow today.
DL: What do you feel the public and athletes need to know about concussions?
CI: They need to know that people get better. An early evaluation and getting the right advice early have a really nice effect on minimizing the effects of the injury and allowing the person to rehabilitate properly. Early identification and early management seem to play a big role in not letting concussions become long, drawn out, difficult scenarios.
Athletes shouldn’t hide it from their bench staff. From an athletic standpoint, I don’t know of very many injuries where you have the capacity to achieve a resolution of the injury within two to four weeks.
A simple ankle sprain can limit your ability to play soccer for up to six weeks. A shoulder separation can limit your ability to play hockey for six weeks. An ACL sprain can be four months or longer if it requires surgery.
You have a serious injury in a concussion, but you also have an incredible capacity to heal and recover. The timeline for being out of your sport, assuming it goes in a normal trajectory, is two to four weeks and you’re back in, in full. There are not very many injuries have that have that kind of timeline. Why hide something like that? If you do the right thing you can recover faster.
DL: Typically, what needs to be done to successfully help an athlete recover from a concussion?
CI: Help the athlete understand that what they do or don’t do matters. Recovery from a concussion, especially a difficult concussion, can be assisted by specific physiotherapy exercises aimed at the individual athlete’s particular injury profile. The athlete is not at the mercy of time or chance.
DL: Sidney Crosby suffered a concussion. What did he do right to recover?
CI: He allowed himself to be guided by the International Consensus of Return to Play Steps. He also had a choice to make on how he was going to handle this injury and he chose to go forward instead of looking backwards. He let the ICRPS be the guidelines for when he was ready to play. It wasn’t an easy process for him. {Note: There are five gradual steps to help athletes safely return to play.}
DL: What does the medical community need to know about concussions?
CI: It’s tough for a physiotherapist to talk to or on behalf of the medical community. There’s so much they’re not taught, both physios and doctors, about concussions.
More and better education is important. It is a real challenge. We all have limited time. Not everybody can take the hours and hours and hours to sift through the information to decide what’s relevant and what’s not.
DL: If an athlete is going to participate in a sport where concussions are perhaps more common, do you recommend the athlete get baseline testing to see what their normal cognitive function is and why?
CI: I do. To take an athlete back to their cognitive function prior to injury is a good target for recovery.
Part of recovery from a concussion is that people start feeling better before their cognitive process returns to normal. You’ve got decreased blood flow and need for glucose that’s been documented in animal studies to last somewhere between two and four weeks, but you feel good. There’s a delay, there’s a gap. Based on how they feel, they may not be fully recovered and they may be susceptible to another injury in that time frame.
If you can have evidence of a cognitive recovery as well then you’ve got another layer of protection. If you have a baseline test you have something that is outside of how you feel.
Isaac concluded our conversation with a message of hope. She said with the right treatment, concussed people can get their life back.
That being said, there is a lack of concussion treatment services in southwest Saskatchewan. Our provincial health care system provides concussion rehab in Saskatoon and Regina, however that’s much too far for anyone with a brain injury. Services in Medicine Hat treat Alberta residents, but options are available for non-residents providing they pay or have medical insurance.
Speaking from personal experience, the best plan is to purchase additional insurance that covers out-of-province treatment. Medicine Hat is close and has some treatment options.
It’s my hope that this series has been beneficial and informative. If you remember one thing from these six articles, it’s that a brain injury must be fully healed before a person attempts to return to play.

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