Dr. Karen Johnston had something of a Newton's apple moment
during a mountain bike excursion a few years ago. While
completing a difficult uphill climb, Johnston, a neurosurgeon and
the director of the concussion program at the McGill University
Sports Medicine Centre in Montreal, grew tired and tumbled off
her bike. She dusted herself off and was able to pedal several
miles back to her car, but by then she had a headache and felt
tired--classic symptoms of a concussion. "I only realized it
after the fact, and I didn't suffer from anything significant,"
she says. "But it made me appreciate how easily this injury can
The same point is made by the many woozy NHL players who have
trekked to her office in the bowels of the athletic center at
McGill. Thanks to a groundbreaking research program and her
treatment of stars such as New York Rangers center Eric Lindros,
Johnston has become the authority for hockey players who suffer
head injuries. "There's no question whom the players trust," says
former Ranger Nick Kypreos, who has appeared with Johnston at
several concussion education seminars since his career was cut
short by the injury in 1997. "She's taking it upon herself not
only to treat guys but to educate them as well."
Johnston has worked with a virtual All-Star team of concussion
victims. Lindros, who suffered his eighth concussion in January,
has been a frequent patient; his 2001 trade from the Philadelphia
Flyers to the Rangers wasn't completed until she gave him a clean
bill of health. Last summer Rangers goalie Mike Richter retired
on Johnston's recommendation after suffering for months from
postconcussion syndrome. In December, New Jersey Devils
defenseman Scott Stevens went to Montreal for an exam after being
plagued by mysterious flulike symptoms for weeks. Johnston told
him he was suffering from postconcussion syndrome, and Stevens
hasn't played since early January. The CFL's Montreal Alouettes
gave her a championship ring when they won the 2002 Grey Cup.
Johnston is revered as much for her independence (she's not
affiliated with any league or team) as she is for her expertise.
After getting a Ph.D. in neuroscience in 1987 and a medical
degree four years later from the University of Toronto, Johnston
worked as a brain surgeon and was director of neurotrauma at
McGill University Health Centre. Her interest in concussions was
at first purely research based, but by the late '90s she was
treating injured McGill athletes and helping groups such as the
Canadian Academy of Sports Medicine and the International Olympic
Committee draw up concussion safety guidelines.
March 29, 2004
In 2000 Johnston wrote the McGill Concussion Protocol, the first
comprehensive program for diagnosing, treating and rehabilitating
concussion victims. Until then, loss of consciousness had
traditionally been the benchmark for judging the severity of a
concussion. Johnston's protocol is based on research indicating
that symptoms after the fact--headaches, nausea, dizziness and
cognitive troubles that mark postconcussion syndrome--are better
indicators of how badly the brain has been affected. "Concussion
is a functional injury rather than a structural one," Johnston
says. "If athletes aren't knocked out, they might not even
realize the symptoms they're having are related to a concussion."
Johnston's rehab regimen is based on the idea that, as she says,
"you have to create an environment for the brain to heal itself."
That means an ultracautious approach: Athletes are forbidden from
strenuous physical activity--no skating, weightlifting or even
stationary bike riding--until they've been free of symptoms for
an extended period. "Most athletes try to push through brain pain
like it's an orthopedic injury," she says. "That usually just
makes things worse."
Though concussion treatment remains an art as well as a science,
Johnston and her McGill colleagues are pioneering the use of
cutting-edge technology that someday could make measuring
symptoms as easy as reading an X-ray. On standard MRIs and CAT
scans, concussed brains generally appear normal, with no scarring
or visible trauma. Johnston's clinic has developed a functional
MRI that can measure a patient's brain activity while he or she
performs tasks such as taking a written neuropsychological exam.
Though it's just a research tool for now, Johnston foresees a day
when the functional MRI is used to assess when concussion victims
are fully recovered and ready to return to action.
Though she still holds the neurology post at McGill, Johnston
decided last summer to concentrate more on her sports medicine
practice. "I'll be able to look back and say I think I made a
difference," she says. "How many people get a chance to do that
in their lives?"