Education is key to preventing concussions

Eleven high school students died in 2015 while playing football. Seven of those players lost their lives to brain injuries. The question now facing parents, physicians, athletes and coaches is whether more can be done to avoid severe brain injuries. Potential solutions may be centered on education, legislation and rule changes.

In 2009, the state of Washington approved the Lystedt Law. It is named for Zachery Lystedt, a 13-year-old junior high school football player who suffered permanent brain damage after being allowed to return to a game shortly after a concussion. Since then, all 50 states have passed some variation of this law requiring that a player suspected of having suffered a concussion must be removed from a contest and not allowed to return until cleared in writing from a medical professional.

These laws typically require all scholastic coaches to complete an education program that addresses the signs of concussion. Unfortunately, these laws only address coaches at the high school or higher level.

Ironically, despite best efforts at education, the most vulnerable brains are at the youth level where there are approximately 3 million football players, 3 million soccer players and another 500,000 hockey players. This also is the level where there are the least experienced coaches and often no athletic trainers.

Rule changes at every level have been met with resistance from traditionalists. Interestingly, many professional coaches and former players believe that contact is not necessary to teach the necessary skills to advance in these sports.

Recent studies looking at the effectiveness of these laws have demonstrated increased reporting of concussions but no firm direct correlation with the educational efforts associated with them.

“As a pediatric neurologist, I am acutely aware of the importance of physical activity and sports for the developing brain and body,” said Dr. Meeryo Choe, a pediatric sports neurologist and assistant professor at UCLA Mattel Children’s Hospital. “Playing a team sport can teach children about teamwork, responsibility and sportsmanship. As children progress through years of participation, they may also learn leadership skills in a unique way. Participation in sports should always begin with education on not only the rules of the game, but how to play the game safely, no matter the sport.”

The remedy for any public health problem is education and concussion is no exception.  

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

Popularity of combat workouts skyrocketing

Combat sports have provided a major entertainment diversion throughout history. Today, boxing and martial arts have become popular participation sports for many who are on the road to fitness.

Records dating back to 4000 B.C. recount “pankration,” a predecessor to what we now know as mixed martial arts (MMA). Historically, this sport developed in parallel to boxing. Participants were typically slaves or criminals who fought for their freedom.

Both sports were eventually banned by the Emperor Theodisius when he felt that they provided too much diversion. The earliest recorded boxing match was in 1681 when the Duke of Abermarle waged a match between his butcher and butler.

Modern era combat athletes are among the best-trained in the world. Fighting demands stamina, strength and agility. Those who are successful have mastered those skills and possess the ability to concentrate and plan strategy under severe conditions.

Combat athletes’ work outs consist of intense roadwork to build cardiovascular endurance. A normal average resting heart rate is between 60 and 100 beats-per-minute. The resting heart rates of combat athletes are often in the 40 beats-per-minute range. This is reflective of superior cardiac efficiency.

Strength is improved by resistive exercise with weight training and repetitively hitting a heavy bag. Superior coordination is attained by drills that require timing such as jumping rope and hitting a speed bag.

“Boxing provides a great workout due to the variability of the fitness skills,” reports Jody Sheely, boxing trainer at Strike Force gym in Norwich and former boxer.

 Interestingly, many of the activities utilized for combat sports training do not require striking or choking an opponent and may be an essential part of a new fitness regimen for many who will never get in a ring or cage.  

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

Don't neglect working out your brain along with your other muscles

Athletes spend many hours honing skills in their particular sports while building strength and stamina. More recently, they are devoting time toward establishing more efficient thought processes and better performance.

The human brain is made up of nerve cells that are organized in networks that interact to perform specific functions. These specialized networks influence all activities.

The simplest action is a reflex. A reflex consists of movement that doesn’t require any thought. The neurons necessary communicate directly through the spinal cord without any cognitive input.

One goal of training is to eliminate as many variables as possible while performing the specific task. This type of mental training can take several forms and coaches are now employing a variety of professionals to work with their teams.

Visualization is probably the best-known technique. Visualization involves repeatedly anticipating an outcome or situation before it occurs. Kickers see the ball going through the uprights, golfers visualize a perfect shot and football defenders see themselves making a crucial tackle.

Mindfulness is a technique used to relax the mind. It is essentially a skill used to eliminate all interfering thoughts and allowing concentration only on the task at hand.

Like most athletic skills, these techniques become most effective when they are practiced. Repeatedly applying visualization and mindfulness with a discipline such as yoga can dramatically improve performance.

“Yoga and mindfulness are a powerful combination of physical, mental and spiritual skill work that compliments and enhances sport-specific conditioning,” states Carol Pandiscia, a yoga and mindfulness instructor who works with high-level athletes.

Although these skills have been frequently applied in sports, they are effective instruments for success in any profession.

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

Airbag technology makes downhill skiiers safer

Downhill ski racers practice their craft by gliding down the side of a mountain at speeds in excess of 80 miles per hour. The slightest mistake at those speeds can end in tragedy. New technological innovations may avoid life-threatening injuries.

On Dec. 19, Olympic champion, Mathias Mayer, was the beneficiary of a technological breakthrough that has gradually become more accepted in the sport of ski racing. A protective vest that inflates in a similar way to an automobile airbag can now provide necessary protection in a potential crash.

The airbag system is one of two that are currently approved for competitive use. The protective vest will inflate when the struggling athlete reaches an angle and vector that can only result in a fall. These calculations are based on data input from the vest and appropriate algorithms.

The inflated vest softens the impact to the chest and supports the neck. Approximately 40 people die from ski and snowboard-related accidents each year. Many of these are brain injuries.

Helmet technology has evolved to the current level where a helmet is lightweight while providing maximum protection. Typically, these injuries occur at high velocity and involve skull fracture and hemorrhage within the brain.

Neck injuries that result from sudden extension of the cervical spine similar to whiplash in a high-speed automobile accident can cause fracture of the cervical spine and potential paralysis.

Another less common neck injury is the result of tearing of the vertebral arteries leading to the brain and causing a massive stroke. This is believed to be the injury that may have caused the death of freestyle skier Sarah Burke.

More common injuries to the lower extremities have been diminished thanks to improved ski boot design and quick release bindings.

As winter sports become more extreme, protective equipment design must also improve.

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

More details emerging on concussions

Over the past week, two events have highlighted the growing concern among athletes, fans and parents about concussions in the NFL.

Case Keenum, quarterback for the St. Louis Rams, suffered a head injury when his head struck the ground after being tackled. He could only get up with the assistance of another player. He staggered and was assisted to the sideline. After what appeared to be a cursory examination, to the astonishment of fans and viewers, he was allowed to return to the game.

Despite the efforts of the NFL and the NFLPA to impart safeguards, these protocols were circumvented. After the initial symptoms clear, athletes will often do anything to return to the game and in some cases, to their own detriment, they are able to deceive the medical professionals involved.

Frank Gifford was an icon in the NFL. Not only was he an outstanding player, but he later went on to become an accomplished and highly respected football commentator. He played in an era where head injuries were an accepted part of the game.

After passing away earlier this year at the age of 84, Gifford’s family generously donated his brain for scientific study. This week it was revealed that his brain had changes consistent with Chronic Traumatic Encephalopathy (CTE).

CTE is a condition diagnosed on post-mortem examination where an abnormal deposition of tau protein is found in certain areas of the brain. It is typically found in athletes who participate in sports where head trauma is common. Clinical symptoms of slowed movements, dementia and behavioral abnormalities can be found in some of these patients.

 Unfortunately, some athletes who believe they may have CTE become desperate and resign themselves to their despair and in some cases commit suicide. Gifford obviously made a different choice and did not let his condition define him.

Both of these events emphasize how much work still needs to be done in the field of sports concussions.

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

Diabetes should not derail an athlete's goals

November is Diabetes Awareness Month. Many patient programs are centered on food and medication restrictions. New treatments and a better understanding of this condition have led to increased sports participation.

Approximately 29.1 million people in the United States (~9 per cent of the population) have been diagnosed with diabetes. This represents a rising health problem with significant impact on health care costs.

Diabetes is divided into three types:

• Type 1 or insulin-dependent diabetes is the result of an inability of the pancreas to produce a sufficient amount of insulin. Insulin is a hormone responsible for taking sugar from the bloodsteam and allowing it to enter a cell where it is used for energy.
• Type 2 or non-insulin dependent diabetes is typically due to a resistance of cells to respond to the insulin available.
• Prediabetes or Impaired Glucose Tolerance is a reversible condition where blood sugars are elevated but not to a sufficient level to define the person as diabetic.

The goal of diabetic treatment is to keep the blood sugar at a constant, acceptable level. Establishing this state of euglycemia is much more difficult in a diabetic.

Diet, exercise and medication are the basic approaches to treatment. Increased activity will burn more sugar and therefore lower the insulin demand.

The use of programmable insulin pumps has allowed many athletes to participate at the highest levels of competition. The pump can sense the blood sugar level and release an appropriate amount of insulin.

“I advise patients to just move,” states Dr. Nathan Lassman, Chief of Endocrinology at St. Francis Hospital and Medical Center. “Any activity that a patient enjoys and can perform regularly is a big plus in treating diabetes.” Diabetes should not be a disabling condition for aspiring 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

Special Olympics has grown from humble beginnings

At the time of its inception in 1968, Special Olympics was a program designed to provide an athletic outlet for people in the United States who had intellectual disabilities.  It has grown to become one of the largest athletic organizations in the world with over 4.4 million athletes, 1 million coaches and 226 programs in 170 countries.

Special Olympics was started by Eunice Shriver Kennedy and her husband, Sargent Shriver, to address the lack of access to organized sports for people with intellectual disabilities.  Many of the original 1,000 participants suffered from Down’s Syndrome.

In the past, many of these people were isolated from society and often placed in institutions.  This restricted any meaningful physical activity and socialization with peers.

Participants must qualify by being certified by an agency or health professional as having intellectual disabilities, cognitive delays or significant learning or vocational problems.

Special Olympics has grown from summer sports to winter sports with a variety of team competitions.  World games are held every two years and vary between summer and winter venues. 

Unified sports teams consist of participants who have intellectual disabilities with those who do not.  This provides another step toward more inclusive sports participation. There are now half a million participants in unified sports worldwide.

It is clear that periodic training culminating in a single event is not sufficient for athletic fitness.  This has lead to establishing Unified Sports Fitness Clubs where fitness activities are measured and studied.

“The success of Special Olympics over the past 46 years is based on its ability to evolve with the changing needs of intellectually impaired athletes,” states Mr. Beau Doherty, president of Special Olympics Connecticut.

Special Olympics has become part of the fabric of worldwide sports by including athletes who were previously excluded.

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

Athletic activity avoids fractures

Physical activity in children has many benefits including cardiovascular conditioning, muscular development and socialization skills.  A recent study demonstrates fewer fractures in active children.

Bone development begins during the third month of fetal development but is not complete until adolescence.  Cartilage serves as the scaffolding necessary for the deposition of layers of minerals that will eventually form bones. This process is known as ossification.

The principal cells involved in the ossification process are osteoblasts.  These cells are responsible for laying the groundwork and creating ossification centers that will eventually expand and replace cartilage.  Long bones such as the femur and humerus require more time to fully mature.

The process of bone formation and remodeling doesn’t end in adolescence.  As patients get older, bones will remodel based on responses to pressure.  This same hydrostatic pressure stimulates new bone growth and repair of fractured bones.

Osteoporosis is a weakening of the bone structure as a result of demineralization of bone that often occurs with poor nutrition and age.

The study cited above looked at two groups of children.  The first group had 40 minutes of moderate physical activity daily as part of their school curriculum while the second group had only 60 minutes per week of activity.  After eight years of study, the first group showed less risk of fracture.

Additional studies on these children measured bone mass.  These reports showed greater bone mineral density in the active group and subsequently less chance of developing osteoporosis.

Approximately one-third of all children will experience a bone fracture before bone growth is complete.  Many school districts have cut back on time dedicated to physical activity during the school day for economic and academic reasons.

Increasing active playtime in elementary schools may have a huge impact on future health care costs.

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

Chocolate milk: The next great recovery drink

Sports nutrition is an industry that has experienced steady growth since Gatorade first came into use in the 1960s. Some teams have now rediscovered the benefits of chocolate milk as part of an athlete’s dietary regimen.

Most successful athletes and teams have specific nutritional plans formulated by dietitians, strength and conditioning coaches and a variety of other consultants. Typically there are pre-performance, performance and post-performance elements. The post-performance nourishment has become known as the recovery phase.

Each segment has a specific goal regarding replacement of fluids, electrolytes, fats, proteins and carbohydrates. Recovery supplements are specifically focused on rebuilding muscle. “The best options for a recovery snack are those that provide carbohydrates to replenish glycogen lost in muscles as well as protein and amino acids,” states Carrie Taylor, a registered dietitian from Big Y Foods.

“The recommended carbohydrate-to-protein ratio falls between 3:1 and 4:1. A glass of chocolate milk is ideal by providing a ratio of 3.5:1.”

More recently, several college and professional sports teams have begun to follow this trend by providing easy access to chillers that dispense chocolate milk. Locally, the Coast Guard Academy has also advocated for its athletes to use chocolate milk for recovery.

This trend has not been lost on dairy farmers. The Farmer’s Cow is a group of six family-owned dairy farms that have supported this movement by becoming involved in many athletic events throughout the region.

“The Farmer’s Cow Chocolate Milk combines 1 percent chocolate milk that is free of artificial hormones with calcium, vitamin D and protein,” according to Robin Chesmer its managing partner.

Chocolate milk can provide a less expensive and equally beneficial alternative to specialty bars and shakes.  

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

Severity of spinal fractures can vary

Spinal fractures are among the most variable injuries in sports. Based on the location and type, they can result in death or a minor setback. Fortunately, Baylor quarterback Bryce Petty will only face a short layoff after fracturing his spine last week.

The spinal cord is the network of nerves that runs from the brain to the peripheral nerves that communicate impulses to the muscles in the limbs and vital organs. This crucial network is protected by the bony spinal column.

The spinal column is made up of a series of 33 vertebrae separated by cartilaginous discs. The cervical, thoracic and lumbar levels serve different regions of the body. The discs provide cushioning between the bones that allow the body to twist and bend.

A vertebra consists of three principal parts. The body is the weight-bearing surface of the bone. The vertebral arch is a circular structure that surrounds the spinal cord. The processes are protrusions that extend off of the arch and provide a surface for ligamentous attachments.

Trauma is the principal cause of spinal fractures. Sudden downward pressure results in crushing the vertebral body producing a compression fracture or a more serious burst fracture.

Fractures of the spinal processes, similar to the injury suffered by Petty, are often produced by lateral pressure similar to that seen in a violent tackle.

The biggest factor that determines the extent of injury is whether the vertebra becomes dislocated as a result of the fracture. The sudden movements can severely injury the spinal cord or nerve roots.

Barring dislocation, pain is produced from muscular and ligamentous injury that will improve by immobilizing the levels affected. This can be done through an external brace or surgical fusion.

 Spinal fractures can often be treated with prompt care from multiple medical specialists.