Concussions in Sport and in the Workplace - Dr. Matt Eagles

Dr. Matt Eagles traded his hockey sweater for surgical scrubs after concussions forced him to end his competitive hockey career.  He developed a passion for helping others with brain injuries and is now a Cerebrovascular & Skull Base Fellow at the University of Illinois Chicago.  Tune in to hear Matt share his story and discuss concussions in sport and in the workplace.

Transcript

SSNB Podcast - Matt Eagles (Concussions)-20241213_110210-Meeting Recording
December 13, 2024, 3:02PM
50m 37s

Perley Brewer (Guest)   0:14
Welcome to today's podcast. My name is Pearl Brewer and I will be your host. Today's podcast guest is Matt Eagles. Matt is here today to talk to us about concussions, specifically in sports, but also on the job to set the stage for today's discussion. Health and safety does not just apply to keeping health and safe from the job. It also applies to when we undertake activities at home or participate in sports.
The reality is, statistically more people will suffer injuries off the job than on the job, so today we want to talk about concussions in sports.
Such as hockey and and football, we hear a lot, of course, about football concussions, 2 sports, where the term concussion is is often referred to. But let's start Mac with you telling us about your background and specifically what led you to the field of medicine you're working in today.

Matt   1:08
Alright, thanks so much for having me, Curly. It's, I'm happy to be here and chat about this topic. It's obviously very important to me just for a little bit of background. I I grew up as an athlete. I was a hockey player and and was fortunate enough to play both Majors Union University hockey throughout my career and you know sort of in the the aughts and and early 2010's as was pretty typical I I suffered a fair number of concussions and.
When I was playing in university in my third year, I actually had a concussion that that forced me to step away from the game.
At that time, you know sort of writing was on the wall that I wasn't gonna be a professional hockey player and.
Get interested in things that I I might be able to get passionate about the same way I was about hockey and and medicine was something that piqued my interest that certainly played a role in my decision to step away from sport, competitive sport, contact sport and and sort of safeguard my brain as I knew that I'd probably make in my my my future living with my brain as opposed to my legs.
So as I you know, made that decision to step away from, from playing hockey, I shifted my energies and and started applying myself towards getting into medical school. I was lucky enough to go to Memorial University's medical school in Saint John's, Newfoundland, and then from there my interest in brain injury led me towards the clinical neurosciences. And I think my background as an athlete.
Led me towards a surgical specialty, so I ended up going into neurosurgery and and trained at the University of Calgary.
They're under a section of neurosurgery for seven years and currently right now I'm doing a fellowship at the University of Illinois in Chicago in Suburbascular and Skull based surgery. So that's sort of where I came from and.
You know, feel very fortunate that I've been able to do this, having suffered a number of concussions. I know that some people aren't as lucky and and and take a longer time to recover, but I I do think that my experience with them played a pivotal role in me sort of deciding on on the field that I'd I'd want to pursue.

Perley Brewer (Guest)   3:23
Do you have any idea how many concussions you would have suffered during your career?

Matt   3:27
Oh, I feel bad saying I feel bad. I feel not being able to give you a solid answer because you know, when I was young and even in, you know, as as early as as Adam and and and peewee hockey, it wasn't as well known a concept that.
A.
A hit could cause you to be concussed without being a devastating loss of consciousness or really confused after you know the idea that you might get a little bit of a headache after you get hit and.
If it doesn't go away right away, that that qualifies as a concussion was a bit of a foreign concept, so you know, I I don't really know the the total number. I do know that when I was in university, I suffered 3 concussions in the last 10 months of my career and that was really the impetus for me to walk away from the sport.
And you know, by that time it was the early 2010's and we were getting to be a little bit more familiar with with the problems around concussion and sport. I I think a lot of the things that we were starting to see with patients being patients being diagnosed with CTE.
Air Chronic traumatic encephalopathy, post mortem. What was starting to come about and the field was undergoing a sort of an exponential growth and knowledge. So by that point I knew that things were not good to to continually suffer head injuries over the course of of an athletic career. But but growing up, it was just, you know, you you'd get hit, you'd maybe have a bit of a headache after and not feel 100% but.
The rest of your body seemed to be working OK. There was nothing obvious keeping you from going out and playing. You sort of did it, which is certainly not what I would advocate for young people today. But it was a bit of a we didn't know any better back then.

Perley Brewer (Guest)   5:12
So your last concussion, what kind of symptoms would you have had during that concussion?

Matt   5:17
Oh yeah, so the, you know, the real the worst one I had of those three was the first one. And I remember this well. We were playing in Acadia and I was going around a defenseman and I just kind of got tripped up and went into the boards totally unprotected at top speed and I was knocked out for a very brief period of time. Everything sort of went black. And then I remember coming to on the ice and trying to get.
And I couldn't get up. You know, I don't know if people have you remember watching videos of Scott Stevens when he would, you know, hit somebody in the NHL and and there'd be a bit of a bandy legs on the ice. That's. That's what I felt. And I was very confused for about 1520 minutes. I had a hard time processing language, which I now know from my my training is a condition called aphavia, which is a little bit frightening because, you know, that's a very important part of the brain that that deals with language.
And after about 1520 minutes, I started to clear.
And it took me probably about a week or two to start to feel well enough to attend classes again. I I missed the remainder of that season that that was in January.
Of probably I think January of 2011. And then in the fall of 2011, I came back and played and had two more concussions in the first half of the season of that year. One was in training camp.
You know, just a bit of a stupid play on my part and ended up colliding with a with a teammate and in practise and that's set me out for for a shorter period of time. 'cause it was one of those. I've got some headaches and not feeling well for a couple of days and so it took a couple of weeks.
And then came back and then I was hit pretty hard in Prince Edward Island in in November of that year. And that was again, I I felt the slashing lights, headaches, difficulty concentrating afterwards.
Had a hard time with that third one and getting back into classes and and I I remember that being quite worrisome 'cause as as I mentioned I I sort of saw the writing on the wall in terms of my hockey career at that point and knew that that I had to take school seriously and that was when we decided enough was enough.

Perley Brewer (Guest)   7:35
So personally I've been involved in sports for over 50 years and every time I hear a sports announcer refer to a player possibly having a concussion, they make it sound like it's something very minor that you should almost be able to shake it off. And every time I hear that I, I cringe a bit for our listeners today, Matt, as a as a medical professional.
What did the announcers actually referring to when they see a player that has been hit hard that might have a concussion? So in essence?
What actually happens to the head of player one when he or she gets hit?
In the head by the shoulder of Player 2.

Matt   8:18
That's a great question. I I think it's an important thing to to help people understand so.
Your brain is is actually suspended within your skull and it sort of floats around in a substance called cerebral spinal fluid, and it's not fixed in place. So when you are in motion, you think of the laws of motion and physics, right? When you're in motion, your brain is travelling at the same speed as you are, and there's not a lot you know, for for, especially for young people. There's not a lot of space between the skull and the brain. But there is some.
So if you're in motion at a high speed, whether you're playing, you're running a route in football, or you're skating down the ice in hockey and and then you come to a sudden stop or your head comes to a sudden stop. Well, your brain is still in motion because there is a little bit of suspension there. So. So your brain can actually either rotate and and.
Sort of by like a sheer force to to the neurons or it can go forward and back and actually hit your skull.
And and and suffer what's called a contusion. Concussion is really a catch all term that we use when someone suffers a clinical brain injury. So they have a clinical malfunction with their brain. Something happens to their brain.
That causes it to to function improperly, but we really don't know the severity of it unless we get imaging and and I can promise you that there are some people who are diagnosed with concussions that if they went and got act scan the emergency department, they would no longer have a concussion, concussion, they would have what's called a contusion.
Or a traumatic subarachnoid haemorrhage. There would be radio graphic signs of injury there, but we don't scan everybody because for the most part, people.
Come back to you know normal function relatively soon. You know they get hit, they see stars.
And it goes away after 10 to 15 minutes and they're by all objective measures, normal, right? They might not feel normal, but when you look at them, they're talking, they're awake, they're not drowsy or something where you're really worried that you got to get into a hospital. And most people just say, OK, well, we'll just keep them out of the game for the rest of the day and see how they feel. But Concussion is a very nonspecific term. But I want what I want to relay is it does, it does involve that there's been some sort of functional disturbance with your brain.
Because when that force is applied and your neurons get injured, they release a whole bunch of chemicals called neurotransmitters and. And this just makes your brain kind of go haywire for a second. And that's why people will see the flashing lights or they'll undergo a very brief loss of consciousness or they'll be a little bit confused. And then as those chemicals start to become back and more in back more back into a normal balance.
You know, they those symptoms go away, but the brain was injured and the brain does not like to be injured.
And you know, we do know that repeated brain injuries can cause a long term problem, right? 'cause every time your brain gets injured, it suffers a little bit of a blow, which may be sub clinical. You may not notice it, but your brain remembers.

Perley Brewer (Guest)   11:28
Now in in talking about hits of course, today most hockey players are wearing Kevlar shoulder pads, Kevlar elbow pads. So when we talk about player one, when he get he or she gets hit by a player 2.
If we're talking back at the minor hockey level where they don't have the kind of medical expertise on staff that say an NHL club or an NHL club would have.
What should the coach and all parents look for from the point of view when their son or daughter gets gets hit and seems to get hit hard?
What kind of symptoms?

Matt   12:09
Yeah, you know that's that's an important question, especially for for minor athletes. I think what you have to what you have to be focused on is one, what are they saying? How are they saying they're feeling right? So these are, these are the sort of in between ones you'll know if someone has a serious brain injury. It's not subtle, right?
They're loopy. They're not making sense. They're unconscious for a brief period of time. They're having headaches, nausea, vomiting. That's getting worse. You take them to the hospital. That is an emergency. They need to be seen by medical professionals. Those are not subtle.
You know the ones that we would just play through as kids would be the ones where you come back to the bench, your eyes are, you know, you're seeing stars, your ears are ringing, you've got a headache. Any of those sort of things. If those words come out of the mouth of a young athlete, I think coaches, parents, trainers, whoever's around needs to just say you're done for now. Right. And it's just you have to err on the side of caution. Remember, these are.
We we have societally we've placed a lot of emphasis on what pro athletes are doing.
You know, they've got the concussion spotters in the stands and all sorts of stuff like that in the NFL and the NHL, but but these are professional athletes who are being paid a lot of money to play a sport. Young people are not protected in the same way, right? This is where we really need as a society to take this seriously. So I have very little tolerance for people who will.
Minimise concussions in young athletes because I think that their brains are still developing. We don't want them to suffer head injuries moving forward. We know that that's that's a risk of of all sorts of issues as they as they get older. So I would say anything that raises your Spidey senses at all that there might have been a head injury here whether it's headache, ring in the ears, blurry vision, nausea, just not feeling like yourself.
Then we have to just err on the side of caution.
And one of these things is we're probably gonna over call things.
Because it's hard with a 10 or 11 year old to always get an accurate picture of what's going on, but I think we just need to set the standard that if we're at all suspicious based on a collision that happened and how someone's feeling afterwards that we we just say, you know what you've done not going back today, we'll get you seen by either a family doctor, emergency doctor or some trained medical professional.
At some point before you're playing sports again.

Perley Brewer (Guest)   14:40
So obviously we had a very early age. The brain is still developing.
What age does that continue to? Is there any sort of sense in the medical profession?

Matt   14:50
Yeah. I mean, you really, you know, we know that. So the term I'll use a term that's a bit medical, it's called myelination and what that means is sort of the.
The development of tracks within the brain and nervous system that connect one area to the other. That happens until your early 20s. So your brain develops for for you know, the.
Into early adulthood, we do know that it happens most rapidly.
In re adolescence and adolescence, I mean most rapidly when they're when you're very, very young. But then.
The rapid period ends sort of when you hit puberty and those sorts in that sort of stage of your development.
But it but it continues just at a slower pace until you're in, you're adult. So. So it's it's something to take seriously with with young athletes up until up until early adulthood.

Perley Brewer (Guest)   15:48
So how much more sensitive is a young person's brain?
As you're developing.

Matt   15:57
That's a bit of a catch 22 because you know tissue heals better when you're young, but we do know that young brains are are are very sensitive to any injury because we don't want to disrupt that laying down of path with that normal laying down of pathways. So that's something hard to quantify. But we do know that you know as your brain is developing, it's just very important not to injure it and you know, injure it either with.
Physical trauma, like concussions or.
You know, that's why we're so fussed about alcohol and drugs. Nicotine and young people, because those pathways are still developing and and these sorts of things will will disrupt normal development and may lead to problems down the road, whether that's, you know, behavioural problems, attention problems, psychological or psychiatric problems, it just raises the risk of that.

Perley Brewer (Guest)   16:48
So, was there any sense as to if a, if a young player does suffer an incident of some sort?
As to how long they should be sitting out.

Matt   16:58
Well, you know it's.

Perley Brewer (Guest)   16:59
Is it? Is it good and sorry is it good enough just to ask him a day later? Oh, how you feeling, Jimmy and Jim said. Oh, I'm feeling great.
Should there be extra precautions taken?

Matt   17:12
You know, I I think you have to just err on the side of caution and I would, I would.
Advise our leaders. There's lots of excellent resources. The Canadian resource that I was the most familiar with was from Parachute Canada.
Which was.
Formerly, I think First Canada doctor Charles Tatter, who was the Canadian neurosurgeon most involved with concussion research and education over the last you know quarter century.
Think first was his organisation it it.
Joined with a couple of other organisations to become Parachute Canada. They have some excellent concussion resources. This is a developing field I think to to just say the next day or are you feeling OK and yes and then go back as if nothing ever happened.
That's.
It's probably not appropriate anymore, even if a lot of kids would be OK with that sort of mentality, you'd miss some and that I think that the worry is, is we have to be extra careful with young brains. You know, I I see in professional athletes, sometimes people come back a little bit earlier than the concussion guidelines would suggest. And I think this is a different ball game. And I think that professional athletes, as I talked about before.
They're being well remunerated for what they're doing.
They're adults.
Right. So at some point an adult has to make a decision based on what they think is best for their body and their family. You know, you look at to a taiga iloa who's the quarterback of the Miami Dolphins. Geez, if I was him, I'm not sure if I'd be playing football anymore. But he's making umpteen $1,000,000 a year to play football and I think I have to respect the fact that he's going to say, well, I want to play football and I've suffered these head injuries, but I'm going to accept that risk.
As adults, dealing with young people, they don't have the capacity to make that decision, so we need to be extra cautious. So if if they've suffered what we think is a concussion.
Typically, the minimum that someone should refrain from any high risk activity like full body contact, participation in a hockey game would be about a week. And that's with a graded return to play. Return to sport guidelines that's that's published online, where you have to undergo specific steps without symptoms before you return to your to your sport. I think that's the safest way to go. I will say what's changed.
In the last 10 years has been.
Around the the concept of reintroduction of activity and tolerating a little bit of discomfort throughout a rehab and sort of like rehabbing your brain the same way you would rehab a a joint that had, as opposed to complete rest until your symptom free. There has been some evidence to say, well, maybe you should do a a light walk and just see how you feel or read for 10 to 15 minutes and see how you feel and and gradually train your brain to get back up to full speed.
But but again, this is a an ongoing.
Area of research that we don't have definitive answers for yet. Our best evidence is is what's published in the guidelines.

Perley Brewer (Guest)   20:17
Now you mentioned two or a moment ago when you watched his concussions, that he suffered.
Very obvious, serious symptoms.
Does that not sort of lead a person to believe that you know you have one and and it'd leave you very susceptible to the second one? That that's kind of a long term process and what's he putting himself at risk and keep playing, obviously, you know the money elements there and the careers there, but what do you, you know, when we talk about concussions long term?
What are the consequences for him down the road? The potential ones?

Matt   20:54
Yeah, that's hard. It was hard to watch his last concussion, right? He was unconscious. He had to sort of censor posturing going on, which is where that one arm sticks out reflexively. And, you know, that's an indication that he suffered a pretty significant head injury. And I was certainly uncomfortable with it. And then. And, you know, I would advise him as a medical professional to say, look, it's probably time to hang him up.
But as as we mentioned, he's he's sort of decide he wants to soldier on.
The the Boogeyman for concussions is really.
This condition called CTE or chronic traumatic encephalopathy, which is which is a diagnosis that really can only be made post mortem. Unfortunately, as of yet.
It's similar to other neurodegenerative conditions in that it involves a build up of Tau which is a protein, a misfolded protein in the brain which is likely a response that the brain has.
To repeated injury.
We see Tau in in conditions like Alzheimer's as well, so there there is probably some overlap there.
It's typically characterised by severe behavioural and psychiatric disturbances. If someone gets older, you know you you hear these horror stories of XNHL enforcers who have suffered number of concussions, committing suicide and and you know, having.
Post sport lives characterised by addiction issues and and depression and anxiety, and it's really sad to see and it's it's also hard to predict what somebody's susceptibility to that is. You know, why do some people get it and some people not get it? Or why do even if some people may have it on their, you know, in have those tabled ups within their brain? Why are they not symptomatic from it? And then maybe just found?
Post mortem as opposed to other people who you know in their 30s and 40s are starting to have serious signs of this condition.
We don't really know.
But it's it is scary enough that I would advise people caution if they have suffered concussions before to to try and limit their exposure to head injury.
And we do know that, you know, at least in the immediate post concussive period, you are a much higher risk. So that's why we don't want people coming back to support too early, because until your brain is fully healed, a second impact to your brain can be catastrophic. And we have seen.
Really sad cases of something called second Impact syndrome, which happens to young athletes often, and they get a second concussion within a short period of time of our first concussion and their brain swells like like your leg would swell. But the problem with swelling in the brain is that there's no space for it to go in your skull. It can't swell out. And when the brain swells within your skull, it actually pushes on the important structures that keep you alive, like your brain stem.
And those sorts of things. So it can be a fatal condition and it is really, really scary and A and a good reason to keep young athletes out of sport until they fully recover from a concussion.

Perley Brewer (Guest)   24:11
So when you talk about CT ES and unfortunately not being able to diagnose until after someone's passed away.
Mris, for example, terrific diagnostic imaging tool that that's not able to pick those kind of things up.

Matt   24:25
They're they're working hard on it. I, you know, I know that.
There's actually some research that's been happening at the University of Calgary.
In trying to to find radio graphic markers for these types of conditions, whether it be just for concussion because you know, a concussion may not show up on ACT scan, but there may be something you can see on MRI or CTE, it's it's in the works. It's just not ready for prime time yet and I'm not sure what the. I'm not sure what the time frame would be.
In terms of when it, when it fully becomes available, but it would certainly be helpful not just and not just for CTE, but for neurodegenerative diseases in general, right? It's at some point imaging is gonna get there, I'm sure with the the artificial intelligence boom that we're having right now.
Now neuroimaging and and medical imaging is going to make astronomical leaps forward in the next 10-15 years, and I'm relatively confident that we'll be able to start diagnosing these things earlier. And hopefully if we can diagnose things earlier, we can treat them. And, you know, maybe not totally reverse things, but at least treat them to the point where symptoms become manageable and or slow slow down the progression of these things.

Perley Brewer (Guest)   25:37
So a loaded question for you. What do you think of fighting in hockey?

Matt   25:44
It depends on what hat I'm wearing. If I'm wearing my ex hockey player hat, I have one answer. If I'm wearing a health professional hat, I have a different answer.
It's hard for you know, I love my job. Hockey was my first love and I grew up with it being a part of hockey. I've been in a number of fights myself. Didn't win many of them, but I was in them.
You know, it seems to me from a cultural perspective that it's an important part of the game, but I think that sometimes culture has to change and you know, it's it's putting it certainly puts people at risk enforcers.
At risk, you know, unfortunately, my family was really close with Chris Simon, who passed away not that long ago. And and you just think of the fights that that those really tough hockey players have been in and the blows they've taken their head, it's it's sickening. And then the but the other piece of this and and is what the hockey purist will always tell you as well. You know fighting may increase the risk for people that fight a lot but.

Perley Brewer (Guest)   26:35
Oh.

Matt   26:50
It allows players to self police the game and maybe decreases the amount of cheap shots that you're getting. That may have been true.
When we were seeing a lot more big, big hits in hockey, but the game has sort of changed and I, you know, I think in the last 10 years.
Hockey has become a much less physical game, which the old school hockey purist might scoff at, but I think in terms of a player safety and player health perspective is is a positive development. You don't see as much counter directional contact anymore. You don't as much targeting of the head.
When when players are are hitting one another.
And and the game is great to watch. You know there's an explosion of skill and talent. Guys are doing things in the NHL right now that you just couldn't imagine people being able to survive 20 years ago. Right the way that they handled the puck in, in dangerous areas it it seems, it seems unreal to somebody who grew up playing when Scott Stevens was in the NHL and he went to the middle of the ice at your own peril when he was on the ice.
Now things are different and you know the game is awesome to watch. So I think that eventually fighting will be out of the game. I just don't know when.

Perley Brewer (Guest)   28:04
If you were to watch a game of hockey, what would you see?
That might be done to help better protect the players.

Matt   28:16
That's a good question. I think the the league has in in some ways the NHL has been slow on the concussion issue in terms of recognising the link between concussion and neurodegeneration and and.
Their injury reports in the NHL compared to the NFL are are laughable. You know the upper body injury you know is.
Pretty generic term, but you see upper body injury. It could be anything from a sprained wrist to a concussion. So I think that more transparency would be helpful with injury reports, because then there could be some accountability as to when somebody came back some something and questions would have to be answered. If someone comes back earlier then then what would be recommended for something like a concussion? I do think that.
The way the game has changed in terms of being extremely strict.
About targeting players heads has been a positive development from a health and safety perspective. You know it's it's a hard, it's a hard question to answer because at the NHL level.
Where you people are used to a certain physicality of the sport and don't want to see that completely eliminated. What I do think would be.
Best way to take care of things would be to really protect young athletes.
You know, I I think that.
The old saying of you know, they got to teach them how to hit when they're a novice and Adam and pee Wee, because then they'll know how to protect themselves.
There may be a logic to that, but I don't think the benefit is worth the cost of having kids at that age suffer head injuries so you know I I I don't see any need for counter directional contact in somebody who's younger than 1516 years old, right? So if someone's going to play major junior and and they're playing under 18.
Hockey, and they may be a major junior player down the line, then sure they should. They should maybe be exposed to full body contact hockey before they're before they're put into that.
That environment, but for someone who's in under 16 under 14.
Whatever, whatever age it may be, what's the point, right? Like there's no. There's no need to risk that and.
You're you're putting a lot of kids at risk.
To potentially benefit a few who might make it to that next level and and I think that's that's not correct. We should be focusing on the bottom of the pyramid. Let's make sure we take care of young athletes. Young children make sure their brains aren't at risk.
In as great a number as possible.
So that may be a little unpopular take amongst the the hockey crowd, but I would say I get rid of full body contact until you're you're under 18.

Perley Brewer (Guest)   31:08
Helmets.
Has there been really much progress made from a point of view of of designing a better helmet, whether it's in football, whether it's in hockey, to really help us prevent some of those concussions?

Matt   31:23
You're seeing those guardian caps now in the NFL and and you know, they certainly look funny.
But that's the size of helmet that really is going to be effective. Like you need a substantial amount of cushioning for the brains that your skull can move, right? You what the problem is, like I talked about, you know, one of your earlier questions is if your skull comes to a sudden stop, that brain is still moving. So if you can, if you can delay the point at which the skull stops by allowing it to have some mobility within the helmet.
Pushing mobility. Then you could theoretically decrease the force that's applied to the brain the the problem becomes they're a little bit cumbersome and you look at them and they're, you know, they're kind of funny looking and not everyone's going to want to wear them. And, you know, it's one of these things I I think the best Ave is to make the game so that it says.
You know you can never eliminate risk, but acceptable level of risk as possible.
Helmets are just they're they're part of the solution, but they're not the biggest part of the solution and certainly you're at a much higher risk if you're not wearing a helmet or if you're wearing one of those old Wayne Gretzky Joffe helmets. That's not probably the best thing for your head. But but I I think a targeted approach at at the rules and the way the game is played is going to be more bang for the buck.

Perley Brewer (Guest)   32:45
So when we go back to concussions and and and you receive a concussion, let's say at at the level of a minor hockey.
And then very quickly, you receive a second one is what's a sense. Is there any amount of time it takes the brain to heal?
That guy should be very cautious of or not.

Matt   33:08
You know, I I think that the way that I always look at it and and I've been involved coaching some minor hockey teams during my residency and you know.
Being with my background, I get a lot of questions about stuff like that. I think that a single concussion in a young athlete, you know, you're looking at minimum a week. For me, that's just you got to give a week. You got to prove to me that you're totally back to normal. You can go through all the steps of a graded return to play, return to school. You're functioning normally at school. For young athletes, that's super important.
That that comes first and and then you're you can start talking about getting back into to live action after about a week, a second concussion, you're talking months to for me like second concussion in the same season. You know, if you get one in in the fall, in a hockey season, then another one in, you know, a couple months later, you know I I think you got to be seriously thinking about.
Taking a taking a month minimum and then a third one, you're done for the year. Like there's no, there's no more hockey this season and.
I have to refresh myself on what the exact parachute guidelines say on that, but that's sort of all the all the. The reason the way that I've sort of looked at it.
And a third one in a season, it's time to start talking about do we want to be doing this. And you know, for and for young athletes, the question then becomes, well, you can still play hockey, but maybe you don't play full body contact hockey, you know, you you.
Very few people are going to make a a living out of playing sport and I don't take sport away from people. A lot of what I've been able to accomplish in in, in my academic career I would say is because of some of the lessons that I learned in sport. I think there's a huge value in being a part of a team, you know, as an individual working towards a shared goal as opposed to just being.
You know, worried about your individual goals all the time, so these contact sports, I do think have some benefit.
But we've gotta we've gotta find a way to manage the risk. So if you've had a number of concussions, let's say, but you love playing hockey and you don't want to take that away and say, well, you can't play full body contact hockey, you play a level that doesn't have full body contact, hockey, you get a lot of the benefits of physical activity, team environment, leadership skills, those sorts of things. But but let's let's manage the risk here. Let's let's keep our our eye on the on the long term goal of.
You know, whatever it may be you want to do with the rest of your life.

Perley Brewer (Guest)   35:43
We talked earlier about, you know, football on Tua and his concussions, and I think that really brought a spotlight on football and I was doing some research the other day and and and the NFL especially seems to have done a lot in the last year or two to start to really seriously address this issue.
Is he do you? Based on the knowledge you have, does the NHL taking a a similar approach or are they a little bit behind? There's a group last, there's a group last a week in Boston that studied this issue.

Matt   36:10
I mean I.

Perley Brewer (Guest)   36:15
And CT es in in players that have passed away and and they came out in a not so kind as to you know their thoughts on you know maybe the NHL has not taken this serious enough. What are your thoughts?

Matt   36:27
Oh, I totally agree. I you know, I I think that the group in Boston has has been sort of the the main drivers of this research.
There are all sorts of advocacy groups now. Concussion Legacy Foundation is a is a big advocacy group for this out of the United States and and the NFL really had their feet put to the fire with.
With everything that happened in the early 2010's, I don't know if everyone watched the movie concussion, but that's sort of really caused a caused a big issue with the NFL and and you know.
Legal things do tend to change.
Behaviour and the NFL was was under some significant legal duress and and that's probably a reason why they were more.
Forward thinking than the NHL. You know, the NHL is getting a little bit of heat for this now, and you're seeing lots of sad stories come out, but they they didn't stop, suffer the serious cultural backlash that the NFL did when all these findings about CTE were being made public. So I I would say the NHL still has a ways to go in terms of catching up with with the NFL.
You know, like I mentioned about the injury reports earlier, it's it's just laughable. Hey, A/C, what's what's an upper body injury? What's a lower body injury? You know, you, you may say you're trying to protect the players privacy and you don't want opponents targeting them, but that's the wrong mentality for a sport to have, right? You need, you need to be transparent and make sure that you're taking care of the players. You don't allow other people to target them because if you do, if someone is targeting an injured player or targeting somebody's head, that's just back from a concussion, there should be.
Severe, severe repercussions that that would be.
You know more than just a 2 minute elbowing penalty that somebody might have gotten in the 90s.

Perley Brewer (Guest)   38:13
Now we talk about and we use the term concussion. I've often felt that that's that's a big mistake from the point of view and it almost implies something soft. Is there actually a better term that we should be using to describe when a player gets hit to the head?
And they're taking over. They're taking over the game, and normally we might have called it well, he may have suffered a concussion. What should we be calling these injuries?

Matt   38:30
Well, I mean.
Well, you know it the in reality there are traumatic brain injury and there's a lot of and the literature is there's a, there's a lot of controversy in the literature as to whether you call things concussion versus you call it a mild traumatic brain injury or a traumatic brain injury or or what how you want to name it. But we just need to get the the population to understand that what concussion is a concussion is an injury to your brain, and I'm biassed the brain is my field of interest. So I think it's the most important. We Oregon, we have in our body that allows us to be who we are.
We should protect it, right? And you know when we say someone has a torn meniscus or a torn ACL?
That implies a certain severity of injury. You know that they're going to miss X number of weeks with a torn ACL, and you say, oh, that's a really bad injury.
Well, why don't we say the same? If someone suffers a concussion?
I don't know. It's it's hard to say, but but we just need to have that understanding that a concussion means that you injured your brain and your brain, at least for a small amount of time, is not going to function the way it normally does.
Hopefully it recovers to a state where it's normal or as normal as you can get it based on based on your injury history, but but we should be very, very clear that that's what a concussion is. You have injured your brain.

Perley Brewer (Guest)   39:51
None.
So if you're an athlete and you're listening to her podcast today, and perhaps you've suffered over the the past 1-2 or three concussions or whatever, and and this is a question, you know, you certainly should be able to answer. When do you know it's time to hang up the skates with the cleats or whatever?

Matt   40:15
Yeah, that's a hard question because.
Because there is benefit, you know, I I I still play some men's league hockey. It's one of my favourite things to do, but I think there's a tremendous benefit in getting together with some friends and and playing a sport and gives me it's a social outing and, you know, allows you to be physically active.
But you have to. Everyone's got to have their own sort of risk tolerance. And I think for some people.
That risk may there. Risk tolerance may be higher than others. I do think that if you have a concussion where you feel like it's taking you a long time to get back to normal, or you're not quite normal yet.
You should give serious thought to limiting your risk and maybe instead of playing hockey you find another sport that you can do with other people that is less risky.
Or you play at a lower intensity level, you know, you know, maybe you don't have to play in the top men's league or Women's League in the city, you just.
Get out there and play with people. That's a slower pace.
You know, it's it. Swallow your pride a little bit and and play with the with people who might not be out there as competitive. I know men's leagues can get pretty competitive and and sometimes it seems like you're playing for the Stanley Cup when it's everyone's got to go to work on Monday but anyway it's it's one of these things where everyone's got to make that decision for themselves and it's a good idea to have a discussion with their healthcare provider.
And talk about what's important to them. You know, if you say I. Geez, I'm. I'm an engineer like I can't function at work if I'm having a hard time looking at a computer screen and calculating these different things, well, geez, maybe you should not be playing contact sports and putting yourself at risk of of more head injuries.
So it's hard to know it's it's bit of an individualised decision.

Perley Brewer (Guest)   42:17
Yeah. You talked about having to go to work on Monday.
As it relates to the work environment in your practise and of of medicine and dealing with the brain, have have you dealt with many individuals who've suffered concussions or or brain injuries on the job as such?

Matt   42:35
Well, so as as neurosurgeons, we see a lot of brain injuries. Concussions typically don't make it to us sometimes when we're taking it, when we're at the paediatric hospital in residency, you'll get up, you'll get called about somebody who suffered a concussion and maybe they're just not quite back to themselves yet and you want to watch them overnight.
But in terms of adults, we see a lot of head injuries from work.
And you know, there are people who do risky jobs for a living, right. And there are people who are involved in heavy machinery and have, you know.
Very serious head injuries on the job, which is, which is always really.
Always really sad and and.
And you're you feel awful for them. But in terms of concussions, we we don't treat a tonne of them as surgeons because.
They don't require surgeries, but we do have a very good understanding of what happens in a brain injury, what is the physical things that happen with inside the brain in terms of the brain moving around and how it gets hit and what area the brain might be affected and then what's happening at A at a cellular level when it when a brain gets injured in terms of the chain reaction that gets set set off with those neurotransmitters, neurotransmitters being released and your brain not functioning properly. And the types of symptoms you might have from that so.
I think that neurosurgeons certainly had a role in the discussion around concussion, but also you look at family physicians, emergency room physicians, rehabilitation doctors, physiatrists neurologists.
All you know, allied health professionals such as physiotherapists, these, these people all have a role to play as well because a lot of times they'll they'll be more hands on with managing concussion patients than than a surgeon will.

Perley Brewer (Guest)   44:21
Now when I watch sport and, for example, hockey, football and they they talk about an arm injury or shoulder injury, I often think well we we know so much about those and we know so much about the healing process and and how to get someone back 100%.
How much do we you mentioned we do know a lot about brain injuries, but how much really do we know about brain injuries?

Matt   44:47
Oh yeah. I mean, it's just it's a growth field, right? So there's lots of there's. This is an ongoing area of research. Part of it is it's harder to, it's harder to visibly monitor the recovery that's happening within the brain.
Because because it's hidden from you and it and it's happening at A at a cellular level.
And the function that's lost might not be something that's clinically obvious, right? So there are parts of the brain that.
Aren't obviously important on the outside like to somebody observing someone, but they're very important to that person in terms of how they feel, how they function at a subconscious level. And I think that's what makes it so tricky is, you know, if you have some frontal lobe dysfunction, that could be in, in a quote, UN quote Silent area of the brain where you can walk and talk and sound normal and.
Appear to every observer like you're totally back to yourself, but there can be some subtle changes in your cognitive processing and your behaviours that.
Wouldn't show up unless you did very dedicated neuropsychiatric or or neuropsychological testing, which is just not practical to do for everyone that's suffering a concussion, whether it be at work or in sport. It's it's very intensive and and and.
And really that the benefit of doing it on everybody would probably be a lot of healthcare, healthcare resources spent. So it's hard to gauge progress the same way as it is with your range of motion in a joint.
And your ability to wait there and your ability to stride when you're playing or when you're skating or or whatever be like that, you know the front, the frontal lobe doesn't have a great test for it outside of these very dedicated neuro psych assessments. And I will say that.
When I made my decision to stop playing hockey, I did undergo a very intensive neuro psych evaluation and that weighed into it. So I do think that has a role, especially if you're considering to stop playing. It's just the availability of these tests can sometimes be a little bit limited.
And the typical testing that you do for a concussion in terms of the **** test, like the sideline concussion assessment tool, it it that is a much cruder assessment than than these formal neuro psych tests done by a trained professional neuropsychologist that that is a hours long battery of tests that that gauges how your brain different areas of your brain are functioning.

Perley Brewer (Guest)   47:14
So look, Matt, you've achieved so much to date. Last question, what's next for Maddie goes?

Matt   47:21
Oh, thank you.

Perley Brewer (Guest)   47:21
Any any long term goals?

Matt   47:23
Yeah, well, you know, so we my my family's here in Chicago with me right now. We've got a a wife who is a rheumatologist. She finished her residency training in Calgary at the same time I did. And. And we've got a three-year old, 3 1/2 year old now, daughter, who's just the best part of our world. And we are planning on moving back to St. John's, NL.
Where we went to medical school and practising there. When I'm when I'm done fellowship here in Chicago.
And looking for looking forward to getting back to the East Coast of Canada and and a little bit closer to home, closer to family for for, for us, which will be helpful. And and also just that's where we feel like we belong.

Perley Brewer (Guest)   48:06
Now your father also extremely well known in the hockey circles. What's he up to these days, Mike?

Matt   48:13
Your dad is as I mean. He retired from his job as the Idiot at Saint Thomas. You know, not that long ago. And and he has been keeping busy. He you know, he's a he's a different beast. He likes to. He likes to do triathlons for fun. So he's he actually just went to the world, the World Triathlon Championships in Spain and he comes out and visits us a lot. He's a very involved.
Grandfather and we, you know, we were so thankful that he that he can come out and help us.
Because both of us are are, sometimes we have unforgiving schedules, so we do rely on family help and we certainly wouldn't be able to to make it work. Both of our schedules work without help from people like my dad, my my mother-in-law I've had. We've had my grandmother, my mom, my dad's, my dad's mom. Come out and help us and my mom's sister. It's just it takes a village. But. But we're very fortunate to have family that are that are involved.
In in helping us with with Anne Marie, who is.
It was lots of fun and keeps us on our toes.

Perley Brewer (Guest)   49:18
Well, look, Matt, thank you very much for joining us on today's podcast. We wish you and your family well, certainly a year in the field that there is so much to learn, so much new all the time. But you've certainly provided a lot of a lot of things I think for people to think about whether you're a parent, whether you're a coach or you just have an interest in the topic. Thank you very much. So for our listeners, stay safe.

Matt   49:40
Thank you.

Perley Brewer (Guest)   49:43
We'll see you next week.