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

Allergic rhinitis can impede spring sports performance


Most competitive and participatory sports get underway in the spring. Many of these outdoor activities are played around a variety of grasses and trees that can trigger an allergic condition and interfere with athletic performance. 

The most common condition is allergic rhinitis or hay fever. Symptoms include sneezing, runny nose, coughing, postnasal drip, sore throat, eye irritation and a feeling of generalized fatigue. It is no surprise that these symptoms can be an obstacle to athletic success.

The allergic response is based on a series of events that are triggered by exposure to an allergen. In the case of allergic rhinitis the allergen is typically pollen, ragweed or a mold. After exposure, a cascade of actions follows. This cascade consists of a cellular response that includes inflammatory cells. 

Similar to other forms of inflammation, swelling of tissues and pressure-like pain are common. Treatment is directed toward desensitizing the body against reactions to a particular allergen or interrupting the inflammatory response at several levels.

Antihistamines are the most commonly used medications to reduce irritation of the eyes and nasal membranes. Often these are combined with a decongestant that may be sedating and should be avoided by athletes. Nasal and oral steroids can reduce the overall response to allergens but may be among banned substances for competitive athletes and would require a therapeutic exemption.

Newer drugs originally designed to treat asthma, like Singulaire, block inflammatory chemicals and are a very effective treatment for allergic rhinitis in athletes.

“Untreated allergies can lead to worsening of nasal congestion and reactive airway disease or asthma which can impair breathing and oxygen absorption,” reports Dr. Gregory Lesnik, a Norwich ear, nose and throat specialist. “Additionally, untreated allergies can result in an overall decline in energy levels causing suboptimal athletic performance.”

Effective treatment of seasonal allergic rhinitis can provide a needed boost toward achieving athletic goals before taking the field.

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

Exercise may help with Parkinson’s symptoms


Parkinson’s Disease is among the most common movement disorders. It affects approximately 10 million people worldwide. Although there are many new pharmacologic therapies available, it appears that regular exercise may be among the most effective.

Movement disorders are a general category of illnesses that consist of involuntary movements that range from a mild tremor to violent spasms.

Parkinson’s disease is a constellation of symptoms and physical findings. The hallmark on examination is a combination of a tremor at rest, slowed movements, rigidity and postural instability.

The pathology is based on decreased production of dopamine, a neurochemical produced in the brain that regulates movement.

Patients will often present with complaints of falling and noticeable changes in handwriting. Sudden falls often lead to broken bones and lengthy hospitalizations.

Medical treatment has been available for approximately 50 years in the form of medication that can increase the declining levels of dopamine. There are now medications that can slow the metabolism of dopamine that has been produced.

“Regular physical activity has been associated with neuroprotection and has shown to improve gait and balance in Parkinson's disease,” reports Dr. Bernardo Rodrigues, a neurologist specializing in movement disorders at the University of Connecticut.

Programs that promote active motion such as “Big and Loud” physical therapy and aerobic exercise for 30 minutes three or more days per week are the key to the effectiveness of the neuroprotective factors produced in the brain.

Recent research has shown that patients with Parkinson’s disease who participate in Latin dancing programs have better outcomes regarding mobility when compared to those who did not participate. This may be related to the physical as well as mental demands of this activity.

Exercise can be a crucial element of a rehabilitation program for Parkinson’s 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

Safety of artificial turf needs further study


The feel and smell of natural turf has been a big part of the pleasure derived from outdoor sports. Increasingly over the past 50 years, that aspect of sports participation has been replaced with various artificial materials. Today, the safety of those materials has come into question.

The original Astroturf field consisted of nylon strands woven into a carpet and was designed for an indoor stadium like the Houston Astrodome. A subsequent version was made up of a tighter weave and more compact surface. These forms resulted in injuries from impact with a firm surface and friction burns.

This led to the current generation of artificial turf fields consisting of longer, softer synthetic strands filled with granulated recycled rubber. These fields now provide a softer surface with improved traction for cleated footwear.

Despite these innovations, an increase in the frequency of lower extremity injuries can be related to the change from natural to artificial surface. Among these injuries are turf toe, a painful condition that results from injury to the ligaments supporting the great toe. An increase in anterior cruciate ligament knee injuries is also believed to be related to the change in playing surface.

“The evidence suggests that synthetic turf increases the chance for injury, and at best the more natural the surface the less increase in injury — especially for the football player,” reports Dr. Stephanie Mazerolle, Assistant Professor of Kinesiology at the University of Connecticut. “I think when considering playing surface, natural surfaces (i.e. grass) may offer a more favorable environment when it comes to the safety of the student-athlete.”

More recently, ESPN’s “Outside the Lines” and others have called for further investigation into anecdotal reports of increased cases of cancer in athletes who have high exposure to the so-called “crumb rubber” fields. Soccer goalies are particularly vulnerable given their exposure to the rubber particles especially when playing indoors. The principal forms of reported cancers are blood related such as leukemia and lymphoma.

Despite the economic advantages of artificial turf, more investigation regarding safety must be carried out.  

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