Kosta Ikonomou  00:00

Athletes risk of injury after the get cleared to play, there's a two to three times risk of getting a musculoskeletal injury. So that means, like an ankle injury, hamstring injury, you know, blow an ACL or something like that, put them more at risk, and now they're out even more. And depending on what level you play, you're, you know, involved in, that's hundreds of 1000s of dollars every time at the end of the year, you get this sheet that says how many missed games we've had and how much that cost the team. So as you, as a as a clinician, you want that to be as low as possible.

 

Dr. Ayla Wolf  00:42

Welcome to Life after impact, the concussion recovery Podcast. I'm Dr Ayla Wolf, and I will be hosting today's episode where we help you navigate the often confusing, frustrating and overwhelming journey of concussion and brain injury recovery. This podcast is your go to resource for actionable information, whether you're dealing with a recent concussion, struggling with post concussion syndrome, or just feeling stuck in your healing process. In each episode, we dive deep into the symptoms, testing treatments and neurological insights that can help you move forward with clarity and confidence. We bring you leading experts in the world of brain health, functional neurology and rehabilitation, to share their wisdom and strategies. So if you're feeling lost, hopeless or like no one understands what you're going through, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact

 

Dr. Ayla Wolf  01:43

Kosta Ikonomou, thank you so much for joining me for the life after impact podcast. Thank you so much. Really excited to be here. Yeah, you are a physiotherapist specializing in working with elite athletes with concussions and doing a lot of concussion rehabilitation. Why don't you give us a little bit of background on how you ended up in that space?

 

Kosta Ikonomou  02:06

Yeah. So I've been a physio for about 10 years now. I

 

Kosta Ikonomou  02:13

did, I started one did one degree. I did my kinesiology degree in Vancouver, Canada, and that's where I kind of got into just the whole space. I ended up

 

Kosta Ikonomou  02:25

going to London, England to do my physio. And then upon returning, I had always promised my parents, as long as you return back to Canada, study for your exams, get get certified, here you can go anywhere else in the world, they said. So I was like, Great, I'll come back to Canada.

 

Kosta Ikonomou  02:44

While I returned, I there was, it was right around 2015 if you remember, like the concussion movie just come out. There's this kind of, this uptick of the kind of the media starting to talk more about it. So I ended up going to work at the British Columbia's first concussion clinic. So it was a dedicated concussion clinic. It was modeled after the Pittsburgh model. So it was kind of an opportunity. I just got went into there, and that was my first introduction into concussion so and

 

Kosta Ikonomou  03:24

as a physio, I knew how to treat the neck. And then as the years went on, I ended up, you know, certifying myself in vestibular rehab

 

Kosta Ikonomou  03:35

for two years I was working at the concussion clinic, and then I really wanted to get into some research. So I ended up back to England, and I did my Master's at UCL in sports, sports medicine. And my research was on in the concussion space. I had some my research published looking at the the

 

Kosta Ikonomou  03:56

effects of exercise on visual motor speed and the voms it had. So it just kind of morphed into that.

 

Kosta Ikonomou  04:06

After my master's, I started working again, more in elite sport. I worked for a Chelsea Football Club in the academy. I worked for some Olympic athletes, and then back to Vancouver I came where the last seven years, I worked clinically, specifically treating concussions, but also people with persistent concussion symptoms. And then one of my travels and sports was been in professional basketball in the cebl so a very dual kind of

 

Kosta Ikonomou  04:40

clinical presence I have my clinical work and my sports work.

 

Dr. Ayla Wolf  04:46

Yeah, absolutely. And then are there any differences that you have noticed when you're working with maybe these different patient populations in terms of what you have to do differently or adjust differently when you're working.

 

Dr. Ayla Wolf  05:00

With an athlete versus kind of the general public in terms of concussion rehab.

 

Kosta Ikonomou  05:06

So in clinic, you know, the majority of your concussions are going to come from car accidents. Is a big portion of that. And now your patients, who do suffer, you know, go through with a car accident kind of experience. There's a lot of, you know, other factors that play into that, in the sense of one, it never wanted to. It's something that suddenly happened to them so emotionally, there is a lot,

 

Kosta Ikonomou  05:34

there's a big part of that that is a toll on them, and with that now their life was kind of completely turned upside down. They weren't kind of going out there with the sense of so an athlete who's playing a sport knows there's a bit of a relative risk to whether they're playing a contact sport, so they already have that expectation. So emotionally, we have two very different kind of starting points. One is a,

 

Kosta Ikonomou  06:03

you know, I play a certain sport, there's a certain risk that I'm aware of, and these things happen. And in the sporting world, we have, you know, there's protocols in place. There's, you know, they get their care really quickly, their referrals really quickly. So they and they already come from a level of their kind of exercise and sense of fitness is already, you know, at a certain level. So their drop of, you know, when they do sustain a concussion,

 

Kosta Ikonomou  06:38

they're able to get themselves up a little bit quicker when we deal somebody in clinic again. So we have that part where they weren't expecting. This is an unexpected, unfortunate event that happened, whether maybe it was a fall, you know, or a car accident, and now this has completely derailed their life, right? So now it's

 

Kosta Ikonomou  06:58

and when we're talking about. It's affecting their work. It's affecting their

 

Kosta Ikonomou  07:05

their family life, their social life. So with this, I think, like I said, the starting point, expectation is a big, big difference. The access of care is a big difference. The level of fitness is a is a difference. You know, we have somebody who's bat, who's an athlete, their balance system is going to be quite high already, where somebody maybe

 

Kosta Ikonomou  07:31

who who wasn't as physically active, and now somebody who hasn't been now, our big barrier is trying to get them to be active. So it takes a little bit more.

 

Kosta Ikonomou  07:42

I think there's a bit more steps in you know, clinically, we have to take in consideration more things that are that are happening to the patient. But from an objective sense, a concussion is this almost retreated, the same, essentially, right?

 

Dr. Ayla Wolf  07:58

Well, I think you make a very good point where the clinician really needs to meet the person where they're at. And you can't necessarily treat a high level basketball player in their 20s, the same as somebody who's 70 years old and was just in a car accident. And so as a clinician and a therapist, you have to be able to kind of structure your entire neurological exam probably a little bit differently in terms of your expectations of where somebody's balance system is, and also kind of the level at which you come in and try to maybe tone the autonomic nervous system with exercise. So I think you bring up a good point that as somebody working in both of those worlds, you have to be very flexible and adaptable to really, completely different populations.

 

Kosta Ikonomou  08:46

Everybody presents differently, and everyone's experience, and everybody's kind of how they grew up, and how where they're at in their life is completely different, and this all plays a role.

 

Dr. Ayla Wolf  09:02

Yeah, and can you talk a little bit, maybe, about the the technology that use, or kind of what has changed in your examination of people over the years from 2015, to now, as far as assessing the vestibular and ocular motor systems? I mean, the voms test is not a whole lot of technology involved. But since then, we've, we've also got a lot of additional computerized balance testing and a lot of cool tools that are out there these days.

 

Kosta Ikonomou  09:29

Yeah, so I still use the voms. I feel that it is, you know, these kind of call them analog tests give you some good information, because it's all about the feedback you get from the patient. More and more technologies are coming out. For example, just one of the assess. So we do use like an impact, like a neurocognitive test, something like this can give you some good information both on their symptom score, sleep, their visual, motor speed and cognition. But you have to, there's no one test. So that's why we have a battery of tests that we kind of use.

​

The voms is a great sideline tool to see if you are in a somewhere where you're not in a in, you know, a clinical setting. But now there's a, I believe it's got, like you would have, like psyched analytics. They've just rebranded neural flex. They're called now. So that is one technology we have now, instead of you balancing on foam, you know, we have force plates. We have things that look at sway,

obviously our, you know, our joint position says our head test I just chatted with it's not a plug. It's neck care. I think it's called, it's like a Bluetooth device that I know is very big there in America, which is very cool product gives you a great kind of a 3d visual of how well your neck is moving.

​

So a lot of this stuff has gone from, I think, 2015 where we just had a laser taped onto somebody's head, to actual something that is, you know, a bit more looks a little bit more professional. We have the reaction time boards have definitely gotten, you know, cheaper the first came out. They're very expensive. So every The thing is, I look back at 2015 I look now and whether you how you assess, we're still going to assess the neck, we're still going to look at the balance system. We're still going to look at the visual system, and we're still going to look the autonomic system. I think what we understand now is the interplay between all of them, and we have a which is better. So in a sense, has my, maybe my assessment has gotten a little more, you know, it looks more like a new iPhone now, I guess a little bit newer, but it is still the it's still the same, essentially, right.

 

Dr. Ayla Wolf  12:13

You're still testing all the same things. Just have a little bit more refinement of the metrics and the objective data. Yeah, exactly, yeah, amazing. And then, when somebody is in their recovery process, at what point do you try to bring in exercise as a therapy? You know, is there a certain kind of like symptom threshold that you want reduced, or are you doing that right away? Kind of, where do you see exercise and that kind of training kind of brought in and in this process,

 

Kosta Ikonomou  12:45

we know, and that's the work done out of Buffalo from John Letty, that the faster we get people into, you know, aerobically building their aerobic capacity produces a hormone called Brain dervived, neurotrophic factor helps bathe the nerves, helps increase that brain healing part gets oxygen, blood flow to the brain. So all of that stuff is what we want now, even in the athletic population, after 24 hours to 48 hours, where we have our relative rest, which is one thing that really changed from, you know, in the beginning, say, 2015 whereas, like, dark room, don't rest. Now in the sports medicine world, we like to call it relative rest, which is like kind of you can putter around a bit, you can go for a light walk, you know, don't cocoon yourself up. But there's really good research, and that states that, you know, the quicker we get everybody moving, the better it is for their recovery.

​

Now, When you have an athlete, they can't wait to get back to exercising. Clinically, I find, you know, if somebody's super dizzy, you know you have to also respect their symptoms of where they're at, right? You can't just say, Just sorry. You have all these symptoms. I'm not going to make you rush on a treadmill because, because then that, we're going to just trigger more of a fear, fear response to exercise. So you have to, you know, respect the symptoms, respect what the patient's experience is right now, and really meet them where they're at. But the end, the goal is to, if they were exercising Great, then we know where we need to get them back to if they weren't as active, there's bit of a challenge of like, we're gonna have to get you at least meeting. So the North American guidelines of 150 minutes of moderate activity, of aerobic a week a week, so there's about 30 minutes of walking.

​

And continuous. So there's challenging ways. If they're, you know, you don't, you don't need to always go in a treadmill. There's a, you know, a bike is probably really great, because we can take out the vestibular system a bit from there where they're not moving. So that's always a good start. So I would say, start there, start moving as soon as possible. And if it's not aerobically, some form of movement is okay. Maybe it's like, really, you know, Hatha Yoga, like something really kind of light body movement. It's always your what we don't want is to let the body adapt or kind of build this fear response to symptoms. So I think that's the so the sooner we break through that. And always reminds me, you know, when you say the things like, when you fell fall off your back, everyone's like, You got to get back on your bicycle, right? So there's, there's a there's a bit of that, but we're not pushing people to the deep end. We are doing we are being a bit, you know, cautious,

 

Dr. Ayla Wolf  16:09

yeah, and I do think it is difficult when you have a patient that comes in who is not used to exercising. They've been relatively sedentary for kind of their that part of their life, and then they get a concussion, and then you start to realize the importance of getting them moving and toning that autonomic nervous system. But they're like, Well, I've never I'm not active. So it's like, what are your kind of tools and strategies for communicating with somebody like the importance of movement and exercise when maybe that isn't a big part of their life, even prior to the concussion.

 

Kosta Ikonomou  16:45

Yeah, I mean, concussions one of the hardest injuries anybody will go through, and it is especially hard for somebody who you know hasn't had that the activity level in the past, because to kind of get your yourself out of the kind of the symptom rut, you almost have to become the healthiest version of yourself. And that is, you know, it takes a bit of, you know, some motivational interviewing. There's the patient has to meet, has to be ready for it as well. You I usually end up starting with, okay, if exercise is kind of this daunting task, and I get it, there's it can be, especially when you haven't been exercising and, you know, walking 20 minutes is a lot is, you know, it seems like a mountain for some individuals. So then we're really focused on, what are some healthy habits? And really break it down to, okay, let's make better, you know, nutritious food choices, hydrating well. Do we have a regular sleep pattern? Are we doing kind of our lifestyle, healthy habits? And then we're kind of slowly, you know, short term goals, bringing in that exercise piece.

 

Kosta Ikonomou  18:07

And that's where we, I steal this from, actually, some of the athletes I work with the, you know, what we do in a season is we call, we call micro dosing. So we These athletes are playing so many games, they're Oh, we want to get them exercising. But how do you exercise some during? How do you get an athlete to exercise and maintain fitness when they're already playing so many games and travel, traveling so much? So what we do is we, we do a micro dose. So essentially it is like three exercises, like six minutes, but like for every single day. So after practice, you'll see a lot of professional athletes will go in the weight room and they'll lift weights after practice. And that is, it's a compounding interest kind of thing. So I same, I use that same principle to patients who are experiencing, you know, persistent symptoms or have not gotten into exercise, is we're going to do a little bit and but we're going to do a little bit every day, and it's going to be, it going to come into a habit, and you'll see the slowly increase it over time.

 

Dr. Ayla Wolf  19:25

Yeah, that's such a great point that you make in terms of the complexity of the brain injury, kind of putting people in a situation where they now do have to really dig deep and say, Okay, I'm going to have to become the best, healthiest version of myself in order to heal from this, which might mean, you know, okay, I didn't used to exercise, but now I have to make that a priority in my life. Or maybe my diet wasn't that great, but now I have to be extra careful about how much sugar I eat, or, you know, things like that. And you know, in my book, I think I made the statement that concussion recovery is a participation sport. You know, it really takes, it's a team sport. It takes a lot of people to help people, but it also takes that participation level of saying, Okay, I guess it's time to make some some lifestyle changes here as part of that recovery. It's not just take, you know, put a cast on it and wait six weeks

 

Kosta Ikonomou  20:19

and it's hard, and because now you're doing that with a headache, with some symptoms, right? But I've always also like the atomic habits book, where he talks about, I'll steal the coat. Never missed twice. So I always tell people my patients like, all right, you didn't do your exercise one day, or you had kind of a down day, that's okay, but we're going to make sure the next day you're not going to miss twice. So I really like that for my patients as well.

 

Dr. Ayla Wolf  20:53

Yeah, so you certainly do a lot of, like you said, kind of motivational interviewing, and really pay attention to just the mental hurdles that people have to overcome as part of the recovery and changing some of those lifestyle habits.

 

Kosta Ikonomou  21:08

Yeah, it's a big, big factor. And why? If you should have a team around it, so somebody who's really good on the Exercise Front, some you should be seeing, maybe a counselor, psychologist, somebody or somebody who can help you with that piece, somebody who can help you with the symptom, piece of, you know, maybe your concussion trigger to migraine you need, you know, or a good neurologist, a good doctor. So, you know, like you said, you mentioned that you need a team its a team sport,

 

Dr. Ayla Wolf  21:38

yeah, yeah. And you started off the conversation by saying that initially in your career, you're like, I'm really good with necks, and then you had to learn about vestibular rehab. But bringing it back to the neck, I know that neck strengthening is such an important component, even in concussion recovery for athletes, but I also find that with a lot of my patient population of people that were in car accidents, that causes a lot of whiplash injuries, damage to the ligaments, and so do you include, like, a lot of neck strengthening in your program with those people as well?

 

Kosta Ikonomou  22:12

Yeah, it gets this is where it becomes the concussion recovery becomes very complex. So I feel I've seen a lot of individuals who will only treat the neck and kind of miss the vestibular part of it, but actually patients are have a stiff neck, have neck pain because they haven't tackled their vestibular because their neck is just constantly guarding because they're dizzy. So it's, it is that kind of fine balance of you got to treat the neck and but also treat the other. Are kind of like the other, the other aspects, the eyes and then and the and the balance system. There's parts where, you know, patients early on become very symptomatic, so turning kind of increases their symptoms and makes them dizzy, so they end up kind of learned this learned behavior of not turning their neck, not so now in turn. Now you're dealing with neck stiffness, neck tightness. Obviously everybody says like then the stress and anxiety holding their shoulders, their traps get tighter. So there is this perpetual, kind of down, downward slope.

 

Kosta Ikonomou  23:27

But getting the neck moving, I think, is really important early on, telling patients that you know you're not causing damage. I think, yes, you went through this whiplash mechanism, but now you know, pain becomes a protective mechanism. Your pain is not You're not causing damage because you're moving your neck right. So within your tolerance, say that I feel it is okay, but anything makes you wince, you know, okay, back off a little bit. But you need to get into that comfortable moving your neck, because later on in your A hab, we're gonna have to do some vor, which is the everyone's least favorite head shakes. And in order to train that system, we're gonna have to go at 120

beats per minute. Otherwise you're just doing smooth pursuits. So you got to get comfortable moving it, because to tackle that other part, it's got to be a big bear. So definitely the neck, and then we've, you know, it plays a role into everything. It's a bit of a domino effect.

 

Dr. Ayla Wolf  24:37

Yeah, absolutely. And I definitely see those people when they walk in the office, and you can tell with just the way that they walk, that they are terrified to move their head. And so yeah, usually my first question is like, let's talk about dizziness, because you know, is this why you're walking so stiffly? Is it because you're afraid that if you turn your head, you're going to have a moment of vertigo or disequilibrium or, I think that so often, people kind of get used they might not even be aware that they're holding their head as stiffly as they are. They're kind of unconscious about those behaviors, until you can, like, bring that awareness to it and then start to practice different exercises that involve kind of safely moving and turning the head and walking, and, like you said, being more comfortable with those movements and not afraid of causing more damage or bringing on an episode of dizziness.

 

Dr. Ayla Wolf  25:32

In terms of the work that you do with athletes, I imagine, like you said, you know, a lot of athletes, they just want to get back to the game. And so if anything, I imagine that sometimes you're having to hold people back a little bit and say, Hey, even if your symptoms are a lot better, we still need to maybe kind of do this, like reintroduce movement and activity in sport gradually. So what are your parameters around that whole concept of, kind of getting people safely back in a game where there may be a potential for another head injury, especially,

 

Kosta Ikonomou  26:08

yeah, so in the you know the athletic population, they want to get back to play as quickly as possible. And I do as well. And I always tell the athlete, I'm not here to hold you back. I'm here to get you back safely, because the worst thing that can happen is that we haven't gotten all those subsystems up to where your baseline is, and you get another concussion, and now we're dealing with, you know, higher symptom burden, you know, prolonged symptoms and you know, longer return to play the next time. So this is where one of the things has changed in the sport world is we take baseline data as much as we can, because that's the one thing as clinicians helps us. So the more data we have of their preseason better we know. Okay, this is where we need to get to, because the coach is going to you will go. And this happens to me all the time.

​

I want to have a meeting with the coach to tell him this players, you know, still not where he needs to be. He kind of beelines, ignores me, and goes right to the player and goes, How are you feeling? And then the player just goes, Yeah, I'm good coach, and he just looks at me, he's like, he's on but we need to have a bad, objective data to show and we know that athletes risk of injury after the get cleared to play, there's a two to three times risk of getting a musculoskeletal injury, so that means, like, an ankle injury, hamstring injury, you know, you might, you know, blow an ACL or something like that, put them more at risk, and now they're out even more. And depending on what level you play, you're, you know, involved in, that's hundreds of 1000s of dollars every time at the end of the year, you get this sheet that says how many missed games we've had and how much that cost a team. So as you, as a as a clinician, you you want that to be as low as possible. So making sure that you have data on their balance system, their reaction time, their neurocognitive scores, you know, their neck strengths, which you know a lot of that is tested in the big clubs, they use kind of these isometric tests, and we get like feedback on that, but also knowing Your athlete, and knowing that when you clear them, you don't clear them to play. You clear you return to performance. So you want to be able to return them to a level where they were performing hard, and you almost have to again. There's that, like we talked about, kind of the our persistent patients will retire to tell them what's the healthiest version of yourself, where the athletes are like, we're going to push you harder than we did before you were injured to see you know, and that's kind of how

​

We kind of navigate that there's a lot of other, you know, I think in sports, certain sports, there's the pressure from, you know, agents, stakeholders, you know, fans, coaches, which makes it hard so on certain decisions. We see that in the NFL a lot,

 

Dr. Ayla Wolf  29:43

right? Yeah, absolutely. It's like you're actually kind of seeing almost the economics of it from a medical perspective, and yet you really just want to do what's best for the individual in terms of safely getting them back to performance at the right time. But the whole, the rest of their influences are kind of in opposition of that. That could I imagine be very difficult?

 

Kosta Ikonomou  30:05

Yeah, so it makes probably the biggest the outside noise and the outside pressures is the hardest part of a athlete recovery when it comes to concussion or any injury. Whereas what I love about working clinically is I can just call set me and the patient, and we can just kind of take our time and, you know, get them where they want to go. And, you know, there's, there's no outside noise for it. So,

 

Dr. Ayla Wolf  30:34

yeah, yeah, exactly. And so you mentioned that there's this increased incidence of other types of musculoskeletal injuries, if people get a concussion and then go back into performance. And are you seeing those as a result of maybe some residual vestibular ocular reflex issues, or reaction time issues or balance issues, like, do you kind of, can you kind of trace that back to maybe some of the original issues they were dealing with from the concussion that then translated into them being more susceptible to these other future injuries.

 

Kosta Ikonomou  31:09

Yeah, I was just referencing what, what the data shows, the research is showing. And I think a big part of that is Yes, from underlining, you know, we are kind of, our goal was to get them asymptomatic, but now it's, you know, we know are the proprioception and kind of their coordination is, if we don't challenge that or get that up to speed, their body mechanics, especially under fatigue, is going to be an issue. And that's where you roll your ankle, you know, other ligament injuries, things like that. So that's where that comes from. And we got to think it's, it's, yes, we can train, you know, each aspect individually, but then we got to do it all, you know, put it all together and challenge the athlete, kind of, you know, in a in a game setting where some individuals might not do that, or might not have the time or the pressure, and that's when, then the athlete is, you know goes back and is at risk. But it's also the their capacity, depending how long they've been out for. So if an athlete's been out for we know that their cardio doesn't fall off, you know, till after two weeks. But if an athlete's a little bit longer, we know that we got to get them up their cardiovascular but from working in clinic, I'll tell you that their reaction time athletes reaction times is not trained back to, you know, where it should be. It's a big thing we see from, you know, one of our clinics, we used to get athletes to come in more for like kind of second opinions and their and their reaction time was really bad. And now if your reaction time is off, I would assume it just makes sense that you're going to be more at risk of getting another injury. So I think that's where the research is showing up for that is their coordination reaction time is not where it should be.

 

Dr. Ayla Wolf  33:19

Yeah, and there's so many aspects involved in reaction time, from your ability to make rapid saccade eye movements and to also kind of engage the appropriate muscles, which is often almost on an unconscious level, those like vestibular, spinal reflexes. And so I can imagine that if you're only basing somebody's ability to return to performance on a symptom level and not on kind of a level of, how are they presenting? From a neurological exam standpoint, you could kind of miss those deficits that are still there and send them back out, and then they're set up for kind of potentially these future injuries.

 

Kosta Ikonomou  33:58

Yeah, and it's again, where we should be. Also, I think testing, I mean, our athletes, I want to see how they are under fatigue, right? So it's, it's watching them at the end of practice, at the end of that, and just kind of been putting through a bit of a battery and see how they respond.

 

Dr. Ayla Wolf  34:17

Yeah, yeah, absolutely. I mean, your, your entire kind of nervous system can change based on whether you are rested and energetic versus at the end of a day when you're tired. So that makes perfect sense. What are you kind of are there any projects you're currently working on from either a research perspective or kind of sports perspective?

 

Kosta Ikonomou  34:38

Yeah. So right now I've, I'm in London, England, so I am just kind of getting integrated into the kind of London system here, and really hoping to do a bit of research with some of the rugby clubs. So right? I'm more in the development stages, and especially the.

Just really interested in the you know, I think how we treat in North America is completely different how we treat concussions in Europe. It's almost like, I want to say how I think the the appetite of a concussion is a bit more aware in North America, so people are just bit more aware of concussions. There's more concussion clinics. There's more, you know, concussion care insurance companies kind of are, kind of will help some individuals who are, you know, have experienced where in Europe, it's less, I would say. So I'm really interested in seeing, like, kind of building some services out here, building kind of the kind of the educational stuff.

​

I'm not sure why, but there it is. Is definitely different. I'd say it reminds me, just to hear that things are almost five years behind, is that there's some clinicians who are really good, actually, that I've met some who are doing great work. And there's good research coming out of here, especially, you know, University of both are kind of leading in the research, in the sense of the saliva. There's, you know, some good work out of where I did my master's, out of the ich doing some good work. There's just not, as, you know, as many as it feels like in North America, I can go, there's a lot of people doing research, you know. So I've been to a lot of conferences down in the States. And it seems, you know, it is people want to, you know, figure this out and evolve it, right, and where I think it I think it's not the clinicians. I think it's just the attitude towards a concussion from a population standpoint, like you said in Australia, I think that's how it is in the UK. And, you know, I've worked in football there and soccer, and I can tell you, the parents pressure of, oh, my kid doesn't have a concussion is, is there where I whereas I think parents are more concerned. I think my kid has a concussion in, you know, in Canada, where, where I've also worked. So it's more of that sense, but there's some really good work happening, really good clinicians, and more and more picking up here.

 

Dr. Ayla Wolf  37:28

Yeah, yeah. So that public awareness piece is huge in terms of recognizing the seriousness of it and the need to actually take that time off and treat it seriously, and then in terms of the current sports teams that you work with, do you still go back to Vancouver, or are you you said you're currently working with some of the local teams there?

 

Kosta Ikonomou  37:48

Yeah. So the C, E, B, L, the Vancouver bandits were a summer league, so that kind of kicks off in May, May, June. So see so right now, taking a month by month right now, and trying to get involved a bit with, you know, with some rugby clubs out here. But so technically, I'm in my offseason. So this is where actually my shift focus is more towards treating patients. But yeah, then my sport shift is in the summer.

 

Dr. Ayla Wolf  38:20

So now I don't know much about rugby. Have they changed rules over the years to try to create more safety parameters?

 

Kosta Ikonomou  38:31

Yep, they've changed their rules. They have a now, a minimum of like, almost like to, like a stand down time. So do you experience a concussion, or you they take you off, and there's a minimum timeframe where you have to be out before you go back in 

I think there's, you know, the entire leagues, they're doing a really good job. They've, we know that certain contact sports, we can't change the risk of a concussion, but what we can change is the rules. So there is, like, some tackling rules that they've changed. We saw that in ice hockey, where the band blindside hits. So we they were allowing, you know, players that just come across the ice and just hit people without seeing them. So at least they said that concussion rate was going so high up that, you know, the NHL was like, okay, no blindside hits. Let's make sure if you're going to hit somebody or make contact, it's going to give the opportunity of somebody to dodge it. So even a rule change like that have made a big difference. So there is, I think, from there are making rules to, you know, decrease the amount of concussions, the risk is still there. Obviously, it's a contact sword, and then they're trying to, again, it's the, you know, you got to have a strong, strong neck plays. Rule, you know you're going to be doing your almost, your prehab into the season for for that. But I think really, whereas the challenge is at the lower levels, where you know, you're the grassroots level, where it's, you know, it's a parent who's coaching, you know, the kids rugby match, there's no there's no esthetic therapist, there's no physio, you know, so maybe they're actually one another parent as a doctor, you know, that's usually how like the team cares. I think that is a challenge that wrote that

have, I know there's great programs in Canada and North America, where southern America, where, you know, there's mandatory education on concussions for coaches if you're going to go. So I think that's coming again. There are some programs here as well, but yeah, so it's definitely the struggle for them there.

 

Dr. Ayla Wolf  40:58

Sure, sure, a work in progress.

 

Kosta Ikonomou  41:00

Sorry, I was gonna say this is like an evolving injury. The more we as the years, the more we learn more and more about it. And I think things just change. So as we, like we treated how things have changed in 2015, into now, I think we're going to continue to see a change.

 

Dr. Ayla Wolf  41:16

Yeah, absolutely. And so for people in the UK, where can they find you in your clinic?

 

Kosta Ikonomou  41:23

So right now, so I do a lot of my stuff is online. So I do a lot of online consultations. I do have in clinic. I do I'm in kind of the Notting Hill area. So I do have a website people go to that. I have a newsletter that I send, kind of all about brain health. Send out monthly so but, and then, yeah, people are more than welcome to reach out to me on social happy to respond. Answer questions. Excellent. Well, I can put all that contact info in the show notes. And then, what is your your website? So my website is akesosportsmed.com

 

Dr. Ayla Wolf  42:10

so Akeso is okay,

 

Kosta Ikonomou  42:13

yeah, it's the goddess of healing. So it's my Greek background.

 

Dr. Ayla Wolf  42:20

Yeah, love it. I was gonna, I was gonna ask you where that name came from. I assumed there was meaning to it, all right, the goddess of healing. I love it.

 

Dr. Ayla Wolf  42:33

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