With Winter Olympics underway, UB concussion experts discuss head injuries

With all eyes on the ongoing Winter Olympics and the recent Super Bowl, it’s an opportune time for UB’s concussion experts to discuss how the university’s researchers have changed concussion treatment worldwide, what parents and athletes need to know about the condition and where the field is headed.

The most recent episode of the UB Medicine Podcast, which was released last week, focuses on the science of concussion care and features John J. Leddy, clinical professor of orthopaedics and director of the Concussion Management and Research Center at UBMD Orthopaedics and Sports Medicine, and M. Nadir Haider, assistant professor of orthopaedics. The podcast was moderated by Allison Brashear, vice president for health sciences and dean of the Jacobs School of Medicine and Biomedical Sciences.

For more than two decades, Leddy and UB colleagues including Barry Willer, professor emeritus of psychiatry, have been developing and studying prescribed aerobic exercise to speed recovery in individuals who’ve had a concussion. They have consistently demonstrated that individualized physical activity starting a few days after concussion provides the best evidence-based care for evaluating and managing sport-related concussions. Their Buffalo Concussion Treadmill Test assesses a patient’s ability to tolerate physical activity following a concussion. Their recommendations were included for the first time in the Sixth International Conference on Concussion in Sport, held in Amsterdam in 2022.

In the podcast, Brashear, noting that the NFL reported that concussions increased during the 2025 season compared to last year, said that concussions are a concern not just for professional athletes but also for anyone who plays a sport. 

Leddy said parents watching their kids from the sidelines should know the most common symptoms of a concussion: headache, dizziness, problems with balance, blurred vision and not processing information quickly.

“If you think your kid is different for some reason, even if they are denying it, take them out of that sport or activity and have your pediatrician or family doctor examine them,” Leddy said, “and if they’re complaining of severe headache or if they’re vomiting, take them to the ER.”

He added it’s a misconception that the individual has to lose consciousness in order to have a concussion. “They don’t have to be knocked out to have a concussion,” he said. “In fact, most kids are not.”

Brashear asked Leddy to discuss the Buffalo Concussion Treadmill Test, which he and colleagues at UB developed and which was officially incorporated into the international concussion guidelines in 2022.

Leddy said he was treating UB’s athletes in the 1990s when he noticed the standard of care then, which was essentially to refrain from most physical activity, didn’t seem to be helping them. So he applied an approach to concussion patients that’s being used in cardiac rehabilitation.

“In cardiac rehabilitation, you identify a heart rate at which you can safely exercise your heart so you don’t get angina or a heart attack,” he said. He began working with Willer to apply those principles to the brain.

“We developed a treadmill test that we put the patient on and we took them up to the point where their symptoms went up more than mildly, took that heart rate, took a percentage of that and gave them that to go home and train at. And lo and behold, we found that the athletes who did that versus those who didn’t got better faster,” Leddy said.

Over the next few decades, that research is what ultimately changed the standard of care, from restrictions on physical activity to the understanding that in order to recover from a concussion, the patient will recover more quickly with individualized prescribed exercise that keeps the heart rate below the point where symptoms worsen more than mildly. The UB work led to the updated international recommendations published in 2023.

More recently, Haider has developed similar recovery regimens for people for whom the treadmill isn’t an option. “In patients with significant balance problems, we said ‘OK, instead of the treadmill we can use a bike,’” he said. And for people in underserved areas, for example, who don’t have access to treadmills or cycle ergometers, Haider and UB colleagues developed the March in Place test, a graded exercise intolerance test that doesn’t require exercise equipment.

Leddy’s focus now is on identifying objective markers to determine when a concussed brain has recovered.

“Our clinical skills are good, but research shows that even when someone looks like they’re recovered and they’re back to school, they may have abnormalities of motor control or brain blood flow or autonomic function that haven’t fully recovered, even though they feel fine,” he said. “We’re investigating salivary biomarkers of concussion because the key point is when is the brain recovered. Sometimes that’s a tough decision for a clinician to make. The field is moving toward more objective biomarkers.”

UB researchers are also interested in finding less expensive methods of ruling out other kinds of brain injuries in concussed patients. “Approximately $400 million a year is spent on concussion health care just in 12-25-year-olds,” Haider said, “and out of this, approximately 40% goes to the ER just to rule out that this is nothing more than mild traumatic brain injury. I think research has to focus on identifying cheaper alternatives to rule out more moderate forms of brain injuries.”