For most of her career, Jen Kish was known as one of the best and most fearless female players in rugby sevens. She captained Canada’s women’s team to an Olympic bronze medal at the 2016 Rio Olympics. And, she also endured more than 30 concussions with only five of them formally diagnosed.
“Your brain health should always be a top priority because I can tell you right now, there is no amount of accolades or Olympic medals that ends up being worth your brain health,” Kish told the audience at the 2024 Concussion in Sport Symposium, “I have to say, I never in a million years would have ever thought that statement would come out of my mouth because I have always had the mindset of, I don’t care what my retired life looks like. As long as I achieved my dream, I wanted the Olympics and trying to be the best in the world. I was wrong, naive and shortsighted.”
Kish has pledged her brain to science to help researchers understand the impact of repeated trauma, particularly on women’s brains. Her story is one of thousands across Canada each year. An estimated 200,000 sport-related concussions happen annually in this country, part of a North American total likely exceeding two million.
And while headlines often focus on professional athletes, the problem stretches far beyond the elite level. Children and teens in organized sport, university athletes, weekend warriors are all at risk.
Dr. Keith Yeates, a professor of psychology, pediatrics and clinical neurosciences at the University of Calgary, has been studying concussions for more than three decades. His research and advocacy have helped shift the way we understand and treat this injury.
One of the most important changes, Yeates says, is moving away from the old “cocoon” approach, which means isolating someone in a dark room until symptoms pass. “Rest until better is not the best strategy,” he explains. “We now know that getting people active within a day or two — back to school, work. I think that’s just made a massive change because it wasn’t just about the rest, but it led us to realize we really need to do the research in terms of trials to find out what works.”
This shift didn’t happen overnight. For too long, concussion protocols were based on expert opinion rather than rigorous data. As more clinical trials emerged, researchers realized they could speed recovery and improve outcomes by encouraging early, gradual activity.
The psychological side of concussion
While much of the science has focused on the biological effects of brain swelling and inflammation, and neural damage, Yeates’s recent work looks at something less visible: the psychological readiness to return to play.
Even after symptoms resolve and a player is medically cleared, fear of re-injury, anxiety about long-term effects, or doubts about whether they’re truly recovered can linger. “If you don’t deal with that psychological preparedness, you’re missing the boat,” says Yeates.
Some athletes avoid activity altogether, afraid of triggering symptoms. Others push too hard, too fast; what Yeates calls an “all-or-nothing” behaviour. Surprisingly, both tendencies can exist in the same person. “They aren’t mutually exclusive,” he notes.
In a study of adolescent athletes that is being prepared for publication, Yeates and his team found that female athletes reported higher levels of fear avoidance, more all-or-nothing behaviour, expectations of longer recovery, and lower psychological resilience compared to their male peers. These factors may help explain why recovery times are often longer for girls and young women, even when accounting for injury severity and access to care.
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The reasons aren’t fully understood. Biological differences, hormonal factors, and biomechanics may play a role, but psychological responses clearly matter. And, Yeates adds, it’s not about blaming one approach over another: “It’s just different. It seems to predict how quickly they’re cleared to return to sport medically, and then the question becomes like, what’s driving that?”
Why early care matters
The most important step, Yeates says, is simply getting athletes to report their symptoms. There’s strong evidence that the quicker you get somebody into care, the faster their recovery, he explains.
Early intervention allows for a controlled re-entry to sport and reduces the risk of a second concussion, which used to be most common in the first week or two after injury. Slowing down the return-to-play process has prevented many of these repeat injuries.
Coaches and parents also play a key role by setting realistic expectations. Quickly is relative. Two to four weeks for recovery is typical, says Yeates. If athletes know that upfront, they’re less likely to get anxious at the three-week mark.
Acknowledging that concussions can be frightening is part of the process. Fear and uncertainty are normal, and talking about them openly can help athletes get back to their sport and perform better when they do.
SIDEBAR: Beyond sport
Although sports often drive concussion research, Yeates points out that many concussions happen elsewhere: to victims of intimate partner violence, people experiencing homelessness, older adults, and young children. Lessons learned in sport medicine could help these groups, too.
The future of concussion care
On the horizon, Yeates sees promise in new diagnostic tools, especially point-of-care biomarker tests using blood or saliva. These wouldn’t replace clinical judgment, but could offer quick, objective data to help confirm a concussion and track recovery.
He also predicts growth in neuromodulation techniques and psychological interventions — approaches that are relatively inexpensive and can be paired with biological treatments.
But there’s a hurdle: funding. Concussion research in Canada has taken a hit in recent years as public health priorities have shifted. Without sustained investment, Yeates warns, progress will slow. “The squeaky wheels tend to get the grease. We need to be squeaky wheels, we need to be advocates… we need to get also parents and coaches and kids and athletes involved in advocacy as well.”
One urgent funding need is to maintain Canada’s world-class concussion management guidelines. “The best kind of guidelines are what we now call living guidelines,” he says. “They’re continually being updated rather than a guideline that’s written and then 10 years later, [it’s] updated and then everything that’s happening in between doesn’t get reflected.”
The message for athletes and parents
Despite the risks, Yeates stresses that sport offers immense physical and mental benefits. “Concussion doesn’t mean you shouldn’t take part. Learn how to prevent it, how to recognize it, and seek care if it happens.”
Most people recover fully. The key is not to ignore symptoms. “The worst thing you can do if you think you have a concussion, is not tell anybody and just see if it gets better. That’s not necessary these days, and it’s actually very counterproductive.”
For Jen Kish, that’s a lesson learned too late to avoid the lasting effects she lives with now. But her openness, and the research it inspires, may help the next generation of athletes make different choices.
As Yeates puts it: “It’s not just about getting you back to sport, it’s about getting you back well.”