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A faster return isn’t always a safer one. We sit down with physiotherapist Kosta Ikonomou to unpack why musculoskeletal injuries spike two to three times after a concussion and how to build a recovery plan that restores performance, not just symptom reduction. From elite level athletes to everyday patients navigating concussion rehab, Kosta shares hard-earned lessons on testing, training, and the psychology of change.

Kosta is a clinical specialist physiotherapist with over a decade of experience in sports medicine and concussion. He has worked in acute neuro hospitals and specialized concussion clinics, treating persistent symptoms. In sports, Kosta collaborated with Chelsea Football Club Academy, Olympic GB diving, Vancouver Bandits Basketball (CEBL), CIS rugby, and ice hockey teams.

Beyond a Physiotherapy degree, Kosta holds a Master's in Sports Medicine from University College London, a FIFA Sports Medicine Diploma, and certifications in Vestibular Rehabilitation and visual-vestibular postgraduate training for concussion rehabilitation from Duke University. His research findings on the effects of fatigue on the vestibular oculomotor screen was presented at BASEM in Leeds in 2018 and the 2023 Concussion Consensus statement in Amsterdam.

We break down the modern assessment toolkit—VOMS, force plates, reaction time training, neurocognitive scores, and cervical motion mapping—and why baselines matter when pressure mounts. You’ll hear how to test under fatigue to expose hidden deficits in reaction time and visual motor speed, and why neck strength is a keystone that only works when vestibular and ocular systems are trained alongside it. We get practical about exercise timing too: relative rest for 24–48 hours, then progressive aerobic work that raises brain-derived neurtrophic factor (BDNF), stabilizes the autonomic system, and reduces fear-based immobility. For sedentary listeners, microdosing workouts and “never miss twice” habits create momentum without flare-ups.

We also zoom out to the culture of concussion care: the gap between North America and Europe in awareness and access, the role of rule changes in rugby, and how youth and grassroots programs need better education. Throughout, the theme is consistent—return to performance requires objective data, deliberate progressions, and a team approach that meets people where they are. If you’re an athlete, a parent, a clinician, or someone rebuilding life after impact, this conversation gives you clear steps and smarter standards for safer returns.

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