Cupping therapy used by Michael Phelps is effective treatment


Ancient medical practices have been rediscovered by modern day athletes as potential tools to speed injury recovery. Among these is the practice of cupping that was recently in the headlines because of its adoption by the most decorated Olympic athlete, Michael Phelps.

Cupping therapy involves placing of cups that are made of a variety of materials over affected areas. These cups are then used to create a suction that draws increased circulation to the region. The goal is to diminish inflammation, reduce pain and provide relaxation through deep tissue massage.

To better understand how cupping works, it is important to know what happens after an injury. The earliest descriptions of acute inflammation use the terms tumor (swelling), rubor (redness), calor (warmth) and dolor (pain).

Swelling appears immediately to physically restrict the affected area from moving and potentially doing more damage. The redness and warmth are reflective of increased circulation. Pain is an important factor that limits activity of the injured muscle or joint.

Inflammation involves an intense cellular response and a cascade of chemical events at the site of injury. Specialized white blood cells called macrophages are responsible for the cleanup of tissue debris during the healing phase after an acute injury. Increasing circulation to an injured area increases the availability of macrophages.

“In various forms, cupping provides a stimulus that reduces tension in muscle, stretches connective tissue, increases blood flow to superficial tissue and may relieve pain,” states Dr. Craig Denegar, professor and department head of kinesiology at UConn. “As with many traditional treatments there is little research quantifying the benefits however, when properly administered, cupping appears to be safe.”

Cupping may be a good complementary treatment along with standard therapy for injured athletes.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Beware of heat as practice returns


Over six million children will soon be heading out to athletic fields across the country to participate in a variety of fall sports. Unfortunately, practice sessions begin during the warmest months of the year, subjecting these athletes to one of the most frequent causes of death in sports.

Heat-related illnesses are a spectrum of conditions. Muscle cramps and exhaustion are fairly common. Cramps are usually related to poor hydration and electrolyte imbalances. Many athletes have a genetic predisposition to cramping and may require salt supplements.

Heat exhaustion is a sense of fatigue that results when the demand for increased blood flow cannot be met due to dehydration and cardiac failure. This can lead to syncope (fainting) when blood supply to the brain is inadequate.

Exertional heat stroke is a medical emergency that can potentially lead to death in minutes. It involves the escalation of hyperthermia to the point that it leads to cardiac failure and coma. It must be identified and treated swiftly and aggressively.

Treatment of heat-related illnesses involves adequate hydration either orally or intravenously. Heat stroke is treated by immediate immersion into a cold bath. This is followed by emergency transport to a medical center for further evaluation, treatment and observation.

“Acclimatization is the process that allows an athlete’s body to perform in warm climates by gradually increasing the amount of exposure to extreme conditions,” reports Dr. Rebecca Stearns, Chief Operating Officer of the Korey Stringer Institute at the University of Connecticut. “Parents should be sure there is a heat acclimatization and weather policy that is followed by youth sports organizations before allowing their children to participate.”

First aid training for coaches and officials is crucial to identifying heat-related illnesses.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Performance-enhancing drug problem at new level


Among the biggest pre-Olympic stories has been the disqualification of athletes due to widespread use of performance-enhancing drugs (PEDs). Although PEDs have been a part of individual efforts to cheat, the revelation that there was a nationally sponsored program to hide the use of PEDs by Russia has taken this problem to a new level.

PEDs are medications approved to treat specific medical problems and instead are used outside of their approved use to improve athletic performance. These include anabolic steroids, banned supplements, amphetamines and diuretics.

Anabolic steroids, including testosterone, human growth hormone and androstenedione are taken to increase muscle size and strength. This will also result in improved endurance.

Many banned supplements are designed to increase muscle efficiency. Some include creatine, an essential muscle component. Another pitfall of supplements is that they are not FDA regulated and often contain unknown substances that may be banned.

Stimulants include amphetamines, caffeine and some cold remedies. These substances increase heart rate and blood pressure. Oddly, these substances can also have a negative impact on athletic performance.

Diuretics increase kidney function and urine output. This will help athletes lose weight and compete at a lower weight class in some sports. It can also result in dehydration during competition and lead to muscle cramps.

Diuretics have also been used as “masking” agents that dilute urine and make the detection of banned substances more difficult.

“The ability to avoid a positive test while using a PED has become a new science and has led to increasing competition among researchers on both sides of testing,” reports Dr. Jeffrey Anderson, Medical Director of UConn Student Health Services. His conclusions are based on his efforts to make professional and amateur athletics fair.

The incidents involving Russian athletes included a state-sponsored program to replace tainted urine with clean urine from other athletes at the time of testing.

Hopefully, this 31st Olympiad will represent a step closer to fairer play when it comes to PEDs.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Parents should take action to prevent youth concussions

More than 6.5 million children in the United States at the middle school level and younger will be participating in a high-velocity collision sport this year. Early recognition and treatment of children with head injuries can be lifesaving.

Traumatic brain injuries consist of a range of disorders with concussion being the most mild. Typical symptoms including headache, dizziness, confusion and visual abnormalities come on suddenly after a blow to the head.

Sports of the highest concern are football, hockey and soccer since they attract the highest numbers of participants in the fall and winter. This also coincides with the academic year and an injury may impede success in the classroom.

Children are a particularly challenging population given the increased vulnerability of young developing brains and a child’s inability to clearly express symptoms. Underlying medical problems including ADHD and migraine headaches are known to prolong recovery from head injury.

Early recognition of symptoms during a contest requires careful observation by coaches, parents and officials. Athletes who are slow to rise, have a staggering gait, hold their heads or hold onto another player for support after a forceful collision should be pulled from the contest for further evaluation. 

Among the most important steps parents can take to protect their children is to investigate what team they will be playing for. Meet the coaching staff to be sure their goals of promoting good health habits, team spirit and physical fitness are the same as yours. Youth sports are not boot camp and efforts should not be directed to “toughening” the participants.

Recent studies have shown that having a licensed health care professional associated with a team promotes early recognition, treatment and recovery from sports concussion.

If symptoms persist or worsen at anytime, a physician visit is warranted, preferably with someone who has special experience in treating neurologic injuries. 

Parenting a child who participates in a high-velocity collision sport requires effort.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Overuse knee injury affects young athletes

Knee pain affects many Americans. Chronic conditions including arthritis, cartilage damage and ligament tears are common. More striking is when knee pain affects athletically active adolescents. 

The knee is a complex joint consisting of bones, ligaments, tendons and cartilage. It is a weight-bearing joint that allows stable movement in multiple directions. It also provides shock absorption. 

Osgood-Schlatter disease is a painful condition affecting approximately 200,000 adolescents each year in the United States. It is the result of inflammation of the tendon connecting the knee cap (patellar) and the principal weight-bearing bone of the lower leg (tibia).

 The patellar tendon attaches to the upper end of the tibia on a portion of the bone known as the tibial tuberosity. Osgood-Schlatter disease is signified by painful swelling on the tibial tuberosity. It typically occurs in males between the ages of 13-14 and girls between the ages of 12-13.

 It is particularly common in young athletes who participate in sports that require running, jumping and rapid changes in direction. Sports such as basketball, volleyball, gymnastics, soccer and skating seem to have the highest numbers of cases. 

“Osgood-Schlatter disease is the result of a traction where two ends of bone intersect in a skeletally immature person,” reports Dr. Cory Edgar an orthopedic surgeon at UConn who specializes in sports-related injuries. “This is an overuse type of injury and should serve as a sign to rest and modify workouts.”

A common misconception is that Osgood-Schlatter will lead to a fracture or tendon rupture if untreated. It actually will cause chronic pain that will persist until the athlete’s skeletal structure matures.

Acute treatment consists of early diagnosis followed by rest, ice and anti-inflammatory medications. Stretching of the quadriceps muscle is an important part of rehabilitation.

Like other overuse injuries, moderation is key to a successful recovery.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Muhammad Ali displayed fortitude in Parkinson's fight

Muhammad Ali became one of the most recognizable people in the world. His recognition eclipsed the sports world and extended into politics, religion and human rights. His contribution to neurologic sciences may also garner recognition.

Ali was first diagnosed with Parkinson’s Disease in 1984 at age 42. Some experts believe he displayed some early signs of the illness at the time of his last fight against Larry Holmes in 1980. Typically, PD is diagnosed in an older population but a small percentage can be seen in younger adults.

PD is a neurodegenerative disease that primarily affects motor function.

It is the result of a chemical imbalance in an area of the brain known as the basal ganglia. These structures are responsible for the synthesis of dopamine. Dopamine is crucial to allowing for smooth movements. Treatment is based on replacing dopamine with L-dopa, a drug administered in a pill form.

The principal features of PD are a tremor that is most recognizable at rest, a slow, shuffled gait with susceptibility to falling as well as muscular rigidity. Approximately a million Americans suffer from PD and 60,000 new cases are diagnosed each year.

Motor activities to maintain motor function include swimming, yoga, ballroom dancing and ironically, boxing workouts.

Ali’s ability as a high-performance athlete made the loss of motor function particularly striking.

The goal of a boxing contest is to neurologically impair your opponent. Despite this, most neurologists believe that repeated head blows did not play a significant role in Ali’s condition.

Ali approached his disease with uncommon fortitude and acceptance to the point where he set an example for anyone who may be faced with a neurodegenerative disease.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Man vs. mosquito: What the Zika virus means for the Olympics

In 1947, an obscure virus was isolated in a rhesus monkey in the Zika Forest of Uganda. Today, after a recent outbreak in Brazil, that virus threatens the start of the 2016 Olympic games.

The Zika virus was first noted in humans in the 1950s as a result of transmission by mosquitoes. Due to the ease of worldwide travel, infectious diseases previously isolated to specific geographic regions can now spread worldwide.

Mosquitoes flourish in hot climates where there is standing water. This makes countries that do not have adequate sanitation in the form of sewers and drainage particularly vulnerable to diseases transmitted by mosquitoes.

Typical symptoms of Zika are fairly benign and consist of rash, fever and joint pain. The feature that makes Zika exceptionally dangerous is its tendency to attack the nervous system.

The human nervous system is divided into the central nervous system that is made up of the brain and spinal cord and the peripheral nervous system that consists of the nerves as they emerge from the spine and extend to the limbs and organs.

Women of childbearing age are specifically vulnerable since a fetus does not have adequate defenses to fight off this infection since it attacks the developing brain resulting in microcephaly with severe intellectual deficits. The virus can also attack the peripheral nerves in adults causing a paralyzing illness known as Guillain-Barre Syndrome.

Considering the demographics of Olympic participants where approximately 44% are women, many of whom are of childbearing age, hesitation regarding the risk of participation is understandable.

The best preventive measures include the liberal use of DEET-containing insect repellant and avoiding excessive skin exposure. Clothing should also be sprayed with repellant.

Oddly, the biggest competition in this year’s Olympics may the one waged between man and mosquito.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Technology allows amputees to reach athletic potential


The Invictus Games finished up recently in Orlando, Fla. The participants in this multi-sport event were all wounded military personnel. Along with the Paralympics, these events are a tribute to the human spirit and specifically the drive to compete.

Among the athletes facing the greatest challenges are those who have suffered amputations. Battlefield injuries may be the result of explosive devices. Although the torso can be adequately protected, the limbs and the brain are vulnerable to injury. There also have been more amputations as a result of earthquakes and other natural disasters.

Although the most obvious debility is the biomechanical disadvantage of losing an extremity, there are serious potential complications.

After amputation, adequate healing of the remaining stump can be a challenge. The general health of the patient is crucial to healing. Patients with complicating conditions, including diabetes and vascular disease, are more likely to require a longer recuperation for adequate healing.

Another challenge is phantom pain. The nervous system is a network of peripheral nerves that communicate by sending signals to the brain where those signals are recognized and a pattern of limb movement is initiated.

When that network is disrupted after an amputation, the pattern remains in place, creating the often painful phenomenon of a phantom limb.

Research principally conducted by the military has led to the development of modern prostheses consisting of a complex system of hydraulic joints. “New prosthetic limbs are realizing the promise of full functional restoration for patients everywhere,” reports retired United States Army Colonel, Dr. Geoffrey Ling, who is now a professor of neurology at the Uniformed Services University of the Health Sciences in Maryland.

The tragedy of war has prompted technological breakthroughs that allow athletes who have suffered amputations to continue to reach their athletic potential.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Wearable technology for the elite athlete


Wearable technology has already made its way into almost everyone’s life to some degree. Interestingly, Major League Baseball (MLB) has now allowed the use of these technologies to track players’ performance. Using the data provided by these new devices has a lot of implications. 

Smartphones can now track how far and how quickly a person can walk. The Fitbit, Apple Watch, Fuelband and other devices can collect and analyze more data about the wearer’s physiology and sleep habits.

In the case of competitive sports, wearable technology can give an athlete a big advantage in regard to training habits and injury prevention.

Two devices approved by MLB for use during games this season look at different activities. One device is a sleeve that measures stress on elbows. This is specifically designed to collect data that will hopefully decrease the number of Tommy John surgeries that seems to be growing rapidly. The information can help create better coaching techniques and improved arm mechanics at all levels of play.

The other piece of approved wearable technology is a bioharness that monitors heart rate and breathing patterns in real time. These basic physiologic measures can help athletes gain necessary feedback to reach peak performance in stressful conditions.

One area of interest is the field of hydration and electrolyte balance. Specifically, the ability to monitor these parameters and avoid sudden death has become a goal of many scientists.

“The wearable technology industry related to the assessment of hydration status, sweat composition and body temperature has exploded in the past few years,” reports Dr. Douglas Casa, Professor of Kinesiology and CEO of the Korey Stringer Institute at UConn. “As of now we still do not have a valid wearable sensor that can reveal real-time hydration status or provide an accurate estimate of core body temperature. I predict this will change within the next 5 years and will be of great value to the equipment-laden soldier, laborer or athlete who could benefit from this information while training, competing, or working.”

Although many athletes are concerned with the privacy of physiologic data, their concern may be offset by the lifesaving ability this technology can provide.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu 

Athletes, especially women, can fall prey to eating disorders

Eating disorders have become a serious health concern. Athletes are no exception and in fact may be particularly vulnerable to one of these conditions. 

Anorexia nervosa, bulimia nervosa and binge-eating disorder are the most commonly recognized disturbances of eating and weight regulation. The finding that anorexia is associated with the highest mortality rate of any psychiatric disorder emphasizes the seriousness of these disorders.

Young women who participate in gymnastics, cheer and running events are particularly vulnerable. It has been reported that between 15 percent and 62 percent of female college athletes have disordered eating. This wide variation is indicative of how little is known about the prevalence of these conditions.

Another area of confusion is whether an eating disorder developes as a result of participation in a particular sport or if a person with an eating disorder choses a sport that will allow for this behavior. 

The classic triad of low energy levels, delayed or absent menstrual periods and osteoporosis is a hallmark of these conditions. Considering 90 percent of bone development in women occurs before the age of 19, lifelong vulnerability to bone fractures are a consequence.

“Eating disorders are common in adolescent athletes training at a high-level. Some may go down a dangerous path trying to attain a supposed 'ideal' body type to enhance performance,” states Dr. Kathryn Ackerman, an endocrinologist specializing in conditions affecting female athletes. “While initial improvements in performance are often seen, these are unfortunately followed by more injuries, poorer recovery, more illnesses, and a decline in performance. Often the athlete struggles mentally and physically and the eating disorder that has developed gets overlooked.”

Denial on the part of athletes can play a big role in delaying diagnosis. Coaches and parents must be aware of early signs of an eating disorder and intervene immediately.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu