By Louise Rachlis
It’s hard not to discuss the timely topic of concussions without the name Sidney Crosby coming up.
“He was the face of the NHL and now he is 10 months out from his second concussion and has yet to play,” says concussion expert Dr. Kristian Goulet. “That really exemplifies the need to be cautious when you return from the first concussion.”
Dr. Goulet and Dr. David Mai provide sport medicine services with a specialty in concussions for paediatric and adult patients at the Pediatric Sports Medicine Clinic of Ottawa and the Eastern Ontario Concussion Clinic.
The first of their kind in Ottawa, both clinics located at the ActiveCare Sport Medicine Centre in Kanata were established to offer the most comprehensive and up to date treatment for a wide variety of pediatric and adult sports injuries.
Dr. Goulet says that the effects of concussion are cumulative, meaning the more concussions you get worse off you are more likely to be.
“You are more likely to get another concussion if you are still
symptomatic from the first. That second concussion is also more likely to be much worse than the first.”
In Boston at the Pediatric Sports Medicine Clinic at the Children`s Hospital, he would often see kids with three, four, six and eight months of symptoms, “and the majority of those kids took a second hit while they were still symptomatic from the first hit.”
“Treating childhood sport injuries and preventing future injuries is my passion,” says Dr. Goulet, who trained at the clinic in Boston and was present for the launch of their Concussion Clinic. “I’m familiar with the most cutting edge treatments and am eager to apply this experience in Ottawa.”
He is currently writing up a paper in association with the Sports Legacy Institute (the Brain Bank). “This organization gets the brains from NFL players after they die. What these brains show is that multiple concussions can cause a condition like Alzheimer’s.”
When he speak to parents or children about concussions, he gives specific examples - such as the fact that only 0.03% of minor hockey players go on to play professional sport - to show the importance of protecting their brains.
“I have been very impressed with the parents of the kids I have seen thus far. The parents understand that the vast majority of kids’ future is with their brain and the parents are happy to be
conservative regarding returning their sons or daughters to sports after obtaining a concussion.”
The goal of the clinics is to help young athletes return to their discipline as quickly and safely as possible, as well as to educate parents and patients to help prevent future injuries, says Dr. Goulet, who founded the OPSMCO and EOCC after completing a Pediatric Sports Medicine Fellowship at Harvard University.
Dr. Goulet is originally from Ottawa and played junior hockey in the area. He did a Sports Medicine Fellowship at Harvard University where he was the head team physician for the Northeastern Huskies Men’s Varsity Hockey program.
The EOCC is the first clinic in Ottawa dedicated exclusively to the treatment of children up to 18 years of age with concussions.
“The clinic uses the most up to date management techniques to get children back to sport as quickly and safely as possible,” says Dr. Goulet, who also places a large focus on concussion education and prevention. “The clinic uses both conservative measures as well as the latest medicinal interventions.”
Baseline and post concussion neurocognitive testing (IMPACT) are available, says Dr. Goulet, one of a select few Certified IMPACT Consultants in Canada, meaning he has been trained to properly administer and interpret the IMPACT test. “We also offer physical therapy on site designed to treat current concussions, such as vestibular therapy, and to prevent concussions in the future.”
The PSMCO is modeled after the Sports Medicine Clinic at the Children’s Hospital Boston and Harvard University.
They specialize in all acute sporting injuries, muscle strains and ligament sprains, all types of joint pain, “Little League Elbow,” “Little League Shoulder,” and many other conditions.
Dr. David Mai completed his Family Medicine Residency, Emergency Medicine training at the University of Western Ontario and Sport Medicine Fellowship at the Fowler-Kennedy Sport Medicine Clinic.
He currently oversees the medical care of the varsity athletes at the University of Ottawa.
“Over the past 10 years, several international bodies have come together to bring together all the tools physicians were using,” says Dr. Mai. “Consequently, there are many more tools available for managing concussions than there were a decade ago. As the program director for the University of Ottawa Sport Medicine Training program and the chief physician of the University of Ottawa Sport Medicine and Physiotherapy Centre, I teach my students the best and latest way to treat concussions.”
Dr. Mai sees patients of all ages for primary care concussions and sport and exercise related conditions. Many family doctors refer patients to him, from older people who have slipped on a sidewalk, to children who have had a schoolyard accident. “It’s the whole gamut of the population.”
He says that now all athletes and the general public can now get the kind of treatment that only elites got years ago. “What we’ve learned can be applied to any level of athlete. Health care in Canada does not discriminate.”
Physiotherapy can also help, says physiotherapist Matthew Claxton. He describes the example of a 15-year-old boy who was recovering from his second concussion in two years. “He came into the clinic one afternoon looking horrible. He indicated that he was suffering from a terrible headache after math class. We were able to reduce his headache by about 90 per cent through heat treatments and appropriate neck stretches.”
The boy left the clinic “much happier,” says Claxton. “We all had a sense of how much his headaches were due to poor posture and neck strain in class compared to the cognitive functioning required for math.”
“Concussion occurs from impact of some sort which rattles the brain - but that also means strain to the muscles of the neck,” he says. “Therefore, physiotherapy can help with the pain and loss of movement associated with a whiplash type injury.
Further, he says, “whiplash-type injuries not only cause neck pain but often headaches. Concussions cause headaches, and physiotherapists can help sort out if the patient’s symptoms are neck-related or brain-related which helps us determine how much activity is safe as their recovery proceeds.”
Physiotherapists can provide exercises to address visual disturbances, imbalance and dizziness. “By determining the dysfunctions producing the patient’s symptoms, we can provide patients with short term goals during their recovery,” says Claxton. “Giving the patient a goal to focus on reduces the frustration often associated with the imposed rest required during concussion recovery.
“We also have objective measurements to help us gauge their recovery. This can be a big boost to a patient’s morale during what is often a very frustrating experience.”
All are at the ActiveCare Sport Medicine Centre,
1108 Klondike Rd., Unit 4 Kanata, tel. 613-595-0222.
.
kanata@acpottawa.ca www.concussioncentre.com
If you or someone you know is interested in learning more about concussions, Dr. Goulet or Dr. Mai are available to give presentations free of charge to groups of 40 or more. Contact Dr.Goulet@yahoo.com or dmai@uohs.uottawa.ca .
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