Leading Concussion Expert Wins Stockton Kimball Award

Published June 15, 2022

John J. Leddy, MD.

John J. Leddy, MD ’85

story by dirk hoffman

John J. Leddy, MD ’85, clinical professor of orthopaedics and one of the foremost world leaders in the diagnosis and treatment of concussion, has received the 2022 Stockton Kimball Award for outstanding scientific achievement and service.

“Dr. Leddy’s decades of seminal research to establish clear guidance and recommendations for treating concussions are a testament to his status as a leader in the field and his drive to continue this work in the future.”
Senior associate dean for faculty affairs

Leddy is also a clinical professor of rehabilitation sciences in UB’s School of Public Health and Health Professions. 

As a primary care sports medicine physician, Leddy provides the best evidence-based evaluation and treatment practices to patients with concussion and post-concussion syndrome. As a scholar, he conducts clinical and physiological research on these conditions.

His primary research interest is the investigation of the basic mechanisms of the disturbance of whole-body physiology in concussion and how to help to restore the physiology to normal to help patients recover and safely return to activity and sport.

Leddy is currently also medical director of the UB Concussion Management Clinic, and director of outcomes research in the Department of Orthopaedics. He also serves as concussion consultant to the Buffalo Bills football team and Buffalo Sabres hockey team.

Unwavering Translational Clinical Research Feted

In presenting the award, Allison Brashear, MD, MBA, UB’s vice president for health sciences and dean of the Jacobs School of Medicine and Biomedical Sciences, noted Leddy “has over many years contributed significant service to his profession and to the academic mission of the university and Jacobs School.”

“He fulfills the criteria for the Stockton Kimball Award with a professional career of consistent academic accomplishment and recognition, identification with Buffalo of his accomplishments, concern for and contributions to the progress of UB and the Jacobs School, and a career that exemplifies excellence in its broadest sense,” she said.

With the recognition of the medical and functional risks of traumatic brain injury (TBI) — it has been the unwavering translational clinical research led by Leddy that today is relied upon for best practice treatment in the United States and around the world, Brashear noted.

“As a primary care sports medicine physician, Dr. Leddy provides the best evidence-based evaluation and treatment practices to patients with concussion and post-concussion syndrome,” she said. “As a scholar, he conducts clinical and physiological research on these conditions.”

Studies Led to New Direction for PCS Recovery

Leddy’s research has had a broad scope and impact. He has published in the fields of orthopedics, sports medicine, physiology, nutrition, concussion and post-concussion syndrome. He has 153 papers published or in press, with many in high impact journals, and several reviews and book chapters.

He also has more than 190 invited podium or other oral lectures or presentations at national and international conferences, and an extraordinary number of invited presentations locally and regionally — just in the past 10 years he has made more than 60 presentations at UB and area colleges, schools, hospitals, and to community and professional organizations.

Leddy’s reputation in his field and service to his profession are confirmed by his editorial roles for several journals and grant reviews for national and international organizations. He has made over 190 invited presentations, has co-edited two journal special issues on concussion and brain injury, served on editorial boards, and as ad hoc reviewer for scores of journals.

It was in 2004 that Leddy collaborated on a study that would launch a career-long interest when he investigated head injuries and symptoms of concussion of children and adolescents in schools.

In 2006, his work on concussion injury began to gain notice among others in his field after he co-authored a study with his collaborator Barry S. Willer, PhD, professor of psychiatry, on management of concussion and post-concussion syndrome (PCS) and suggested a promising new direction for helping patients recover from PCS.

PCS symptoms include headaches, dizziness, fatigue and loss of concentration and memory, among other symptoms. A new concept in the latter study was the presentation of a clinical model suggesting that concussion evolves to become a mild traumatic brain injury after PCS has developed, representing a more severe form of brain injury.

Developed Buffalo Concussion Treadmill Test

In 2010, Leddy was senior first author on a groundbreaking study of the sub-symptom threshold exercise training for post-concussion syndrome. This study was the first to demonstrate that treatment with controlled exercise was a safe program that appears to improve PCS symptoms when compared to no-treatment baseline, and showed that a randomized controlled study was warranted to support development of new treatment guidelines.

Leddy followed that study in 2011 with an assessment of an exercise treadmill protocol that proved reliable for identifying patients with worsening concussion symptoms.

The Leddy team also established the Buffalo Concussion Treadmill Test (BCTT) to use in acute concussion and in PCS. The Buffalo Concussion Treadmill (and Bike Test) has become the prototype method for assessing exercise capacity in athletes in recovery from concussion. 

The BCTT, Bike Test, and the “Buffalo Protocol” for exercise evaluation and rehabilitation for sport-related concussion are used throughout the world to manage concussed patients.

Leddy’s work has already moved the needle in the clinical area of brain injury rehabilitation. The value of the test is to diagnose physiologic dysfunction in concussion safely and reliably, and to help quantify the clinical severity and exercise capacity of concussed patients. Initially, the test was used in those with prolonged symptoms to establish a safe aerobic exercise treatment program to help speed recovery and return to activity.

The BCTT was consistent with world expert consensus opinion on establishing physiologic recovery from concussion, in large part based upon Leddy’s contributions to the field.

“Under his directorship and directly resulting from Dr. Leddy’s and Dr. Willer’s research, the UB Concussion Management Clinic is the first center in the United States to use a standardized treadmill test to establish recovery from concussion and to use exercise in the rehabilitation of patients with prolonged concussion symptoms,” Brashear noted.

Paradigm Shift in Concussion Treatment

Leddy’s early research was a paradigm shift from what then was the standard approach for managing post concussive symptoms — strict, and sometimes prolonged, physical and brain rest until all symptoms resolve. His work is noteworthy in its emphasis on understanding the metabolic and neurophysiological changes that drive post concussive symptoms and how aerobic exercise may reverse those effects.

In 2016, Leddy’s team reported a follow-up study investigating why some female athletes with PCS have reduced exercise capacity that may reflect altered brain cardiorespiratory control due to altered cerebral blood flow.

Searching for a physiologic and metabolic correlate for their observations, their results showed that, indeed, some PCS patients have exercise intolerance due to abnormal cerebral blood flow that may be the result of an altered brainstem sensitivity to carbon dioxide. Moreover, this study suggested that normal cerebral blood flow and exercise tolerance may be “biomarkers” of recovery from concussion.

That year, Leddy received the American Medical Society for Sports Medicine’s (AMSSM) Best Overall Research Award for determining predictors of recovery from concussion in adolescents.

Leddy’s senior-authored later study reported data suggesting that aerobic exercise prescribed to males suffering from sport-related concussion also hastened recovery and had the potential to prevent delayed recovery.

In 2018, Leddy led a clinical trial on the safety and prognostic utility of exercise testing using the BCTT in acutely concussed adolescents, which showed that the degree of early exercise intolerance after sport-related concussion was important for prognosis.

The Leddy team received a Clinical and Translational Science Award pilot study award that resulted in a 2019 publication in JAMA Pediatrics of the first randomized clinical trial (RCT) to show that individualized subsymptom threshold aerobic exercise treatment prescribed to adolescents during the first week after sport-related concussion speeds recovery and may reduce the incidence of delayed recovery.

This was confirmed in a follow-up RCT published in Lancet Child & Adolescent Health in 2021 that showed for the first time that early exercise treatment significantly reduced the incidence of delayed recovery in adolescents following sport-related concussion.

Collaborator on Nutrition and Exercise Studies

Over the years, Leddy has collaborated on projects ranging from the nutritional and metabolic correlates of food reinforcement, eating disorders, and exercise effects on cognition in normal subjects.

He is a physician with UBMD Orthopaedics & Sports Medicine, and a consultant to the National Institutes of Health on sport concussion research.

Leddy received his medical degree from UB in 1985 and joined the UB faculty in 1990.

He completed an internal medicine residency at New England Deaconess Hospital and Harvard University and was a faculty development fellow in primary care sports medicine at UB.

Leddy is a fellow of the American College of Sports Medicine, American College of Physicians and the American Medical Society for Sports Medicine. In 2021, he was a recipient of the SUNY Chancellor’s Award for Excellence in Scholarship and Creative Activities.

“Dr. Leddy’s decades of seminal research to establish clear guidance and recommendations for treating concussions are a testament to his status as a leader in the field and his drive to continue this work in the future,” said Suzanne G. Laychock, PhD; senior associate dean for faculty affairs.

“Dr. Leddy’s work represents the best of what we as an institution are about — answering challenging clinical issues that touch the lives of our most vulnerable, with hypothesis-based, boundary-breaking methodologies informed by science and patient need,” she added. “Dr. Leddy exemplifies a model scholar physician who is critical to fulfilling the promise of team science.”

Award Honors Former Medical School Dean

Leddy was recognized June 7 during the Jacobs School’s Faculty and Staff Recognition Awards celebration.

He will deliver the Stockton Kimball Lecture in 2023.

The award and lecture recognize an outstanding scholar and researcher who has also contributed significantly to the school. It is named in memory of Stockton Kimball, MD ’29, dean of the medical school from 1946 to 1958.