Violent collisions can cause cervical spine injuries

New York Giants linebacker Antonio Pierce suffered a neck injury during a game on Oct. 25. He was reported to have symptoms of neck pain and a burning sensation radiating to his arm. After his symptoms subsided over the next few days, he returned to his normal activity. When neck pain returned weeks later, an MRI revealed a bulging disc in the cervical spine, placing him on the disabled list.

Pierce’s situation is not that uncommon, especially for a linebacker. The cervical spine consists of a series of seven bony vertebrae designed to protect the fragile spinal cord and nerve roots. This area of the nervous system is responsible for sensation and movement of the upper extremities.

Sandwiched between each of the vertebrae is a cartilaginous disc. The center of the disc consists of soft, moist material to cushion any impact.

In a situation where there is repeated trauma to the head and neck causing compression, the discs become brittle and susceptible to fracture and eventual herniation (bulging). A disc that is out of place can irritate the nerve roots and/or the spinal cord.

Football players who use their heads when blocking and stretch their necks to one side tackling are particularly susceptible to these injuries. An MRI scan of a linebacker’s cervical spine typically shows bony arthritic changes and compressed discs consistent with that seen in an elderly person.

Treatment for these injuries can be conservative with physical therapy, anti-inflammatory medications and rest. Surgical intervention may include simply removing the herniated portion of disc alone or in combination with fusing the vertebrae for stability.

Cervical spine injuries can be avoided by strengthening supporting neck muscles, wearing a protective collar and most importantly, utilizing proper blocking and tackling techniques.

Athletes with sickle cell must be cautious

Two years ago, Ryan Clark of the Pittsburgh Steelers nearly died after playing in Denver. He required emergency surgery to remove his spleen and gall bladder. Ryan, along with one in 12 African-Americans, has sickle cell trait and must be cautious about competing at high altitudes.

Sickle cell disease affects the ability of red blood cells to carry oxygen. It is an evolutionary adaptation that provides resistance to malaria and is found in people who come from areas where malaria is endemic like Africa, the Middle East, South America as well as the Mediterranean, Caribbean and other areas. The decreased oxygen-carrying ability of hemoglobin results in damage to a variety of organs including the brain, lungs and spleen.

Sickle cell disease differs from sickle cell trait. The trait is found in those who have both a normal and a sickle component to hemoglobin. During intense exertion, dehydration or conditions that decrease oxygen, red blood cells change their shape and clog blood vessels throughout the body.

The condition can also result in a potentially lethal breakdown of muscle known as acute exertional rhabdomyolysis.

While it is generally safe for athletes with sickle cell trait to compete, certain precautions must be followed:

• Athletes from at-risk groups must be tested before participation.
• When competing at high altitudes, sufficient time must be spent adapting to the new environment.
• Adequate hydration is crucial.
• Symptoms of fatigue, shortness of breath and abdominal or leg pain are often a hallmark of impending crisis.
• Workouts in extreme heat must be modified.

There is some controversy that finding the gene may potentially adversely impact an athlete’s financial value in professional sports. While this is highly unlikely, it must be weighed against the potential loss of life.

Boxing needs safety measures

Last week, HBO viewers and those attending championship boxing at the XL Center in Hartford witnessed one of the most horrific knockouts in recent memory.

In the third round of the co-feature match between Harry Joe Yorgey and Alfredo Angulo, it became apparent that Angulo was the dominant fighter. Yorgey was rendered unconscious, and reminded all present of the brutality of this sport.

In an age when awareness of head injury in sports has been heightened, something must be done about the sport of boxing where the only way to score points is to neurologically impair the opponent.

Attempts to ban boxing have been misguided and have failed miserably. Boxing is a not just a sport, it is part of the American cultural fabric. Boxing can represent a vehicle for young men to gain respect in their communities while avoiding negative peer pressure.

Safety measures must be instituted nationally to reduce permanent neurological injury to boxers:

• Every professional fighter (both boxers and mixed martial artists) must have a complete annual neurological examination.
• Exposure to head blows must be limited during a fighter’s career. This can be done by regulating the number of rounds fought, the total number of fights and/or age of the fighter.
• A system of national regulation must be put in place similar to other sports. The current statewide commission system offers too much variability and federal regulation may be cumbersome.

This week, the Connecticut Boxing Hall of Fame will induct new members at the Mohegan Sun Casino. As at most similar affairs, there will be a lot of discussion about “the good old days.” Wouldn’t it be great if the legacy left behind by these brave men was to make their sport safer?

Athletes have make-up to overcome physical and mental challenges

The 2009 baseball season has officially closed. After a season filled with late-inning comebacks and walk-off home runs, a World Series champion has been crowned.

Two stories of baseball comebacks deserve some extra attention while we await the spring arrival of pitchers and catchers:

• In August, Jerry Remy returned to the Red Sox broadcast booth after an extended illness. He was diagnosed with lung cancer the previous fall and underwent surgery. An infection followed but after going through appropriate treatment, it was depression that crippled him. Remy then stepped forward to make people aware of the scope of the problem. He now openly encourages those suffering from depression to get help in the form of medication and psychotherapy. His bold admission helps remove any stigma associated with psychiatric diseases.

• Aaron Boone underwent open heart surgery in March at the age of 36. The surgery repaired a chronic problem with his aorta that included replacement of the aortic valve. He impressively returned to major league play in September with the Houston Astros. His recovery included standard cardiac rehabilitation in addition to extensive work aimed at regaining his baseball skills.

Both stories highlight some essential personality traits necessary for success in athletics. Athletes do not fear challenges, even in the face of insurmountable odds. Successful athletes have a dedication to training that distinguishes them from others. The burden of not trying to return far outweighs any embarrassment associated with being unsuccessful in that effort.
Aaron Boone may never play another major league game and Jerry Remy may still have to deal with depression, but both know that their stories have helped many others face physical and mental challenges.

UConn homicide shows how athletes cope with loss

Grief, bereavement and mourning are terms that define the intense feeling of sorrow over the loss of a beloved person. While these sentiments are apparent in many situations, the loss of a favorite athlete or performer seems to attract great attention.

Two weeks ago, tragedy struck the University of Connecticut football team when Jasper Howard was murdered. The response to this event by players, fans and opposing teams is what makes this situation remarkable.

In 1969, Dr. Elisabeth Kubler-Ross described the five stages of grief:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

Every individual works through these stages at a different pace and uses a variety of mechanisms to deal with each. Athletes tend to revert to what they know best by immersing themselves in athletic competition while dealing with their loss.
Two goals of grieving involve finding a way to cope with loss and living on in the face of that loss. Sports are a very physical and instrumental way of coping for many people. Some prefer other outward signs such as dedication to a cause, starting a charitable foundation or even wearing a tattoo.

“Grieving helps meet the challenge of resuming life in the face of loss; we must respect the different ways people cope with loss,” said Dr. Kenneth J. Doka, a professor at the College of New Rochelle and consultant to the Hospice Foundation of America. Death of a teammate is no different than any other death in the workplace. It must be recognized and all involved should be supportive in continuing on.

Jasper Howard’s death has brought so many people together to mourn and hopefully work together to stop the senseless violence that ended his life too soon.

Marathon Walking

Walking has been an essential function in human evolution. This form of mobility allowed early man to hunt, gather and defend.

As more sedentary lifestyles have emerged, walking is proving to be an effective means of increasing longevity. The American Heart Association recommends 10,000 steps per day (five miles) to reap the full health benefit. Although this may be a lofty goal, after consulting with a physician, any distance is movement in the right direction.

Benefits include:
• Lower blood pressure
• Weight reduction
• Better stamina

The increased popularity of fitness walking has given rise to many walking events including race walking, charity walks and more recently, marathon walks. As opposed to race walking, where speed and form are crucial, marathon walking is a distance event extending 26.2 miles.

Like any marathon, preparation and support are crucial. Training includes progressively increasing distances, nutrition and using proper equipment.

Hundreds of walkers recently participated in a marathon walk from Old Saybrook Point to Harkness Memorial Park in support of the Terry Brodeur Breast Cancer Research Foundation. Participants were required to complete the walk in an allotted period of time. Training and race day support was provided by the foundation.

Deb Hinchey of Norwich was one of the participants. She trained with a group of seven adult women over a period of months. “We all attained a great feeling of accomplishment when finishing and realized we could go well beyond anything we thought our bodies could do,” said Hinchey. Other than fatigue, the biggest obstacle was avoiding blisters. Many participants purchased shoes a full size larger than normal to accommodate swelling.

In addition to becoming more fit, charity marathon walk participants gain a great feeling of knowing they helped a worthwhile cause.

Experts explore connection between contact sports and dementia

Multiple recent reports have raised awareness of the dangers of repeated head trauma. The information contained in these studies is helping experts plan strategies to make contact sports safer.

In 1928, Dr. Harrison Martland first described “Dementia Pugilistica,” a disorder seen in boxers that results in impaired movement and thought. Today this condition is known as “Chronic Traumatic Encephalopathy” and is associated with any sport such as football, hockey and wrestling, where the participants are subjected to repeated head blows.

A telephone survey of former NFL players revealed a startling number of participants who suffer from memory disorders. While this study has been criticized as unscientific, experts agree that there is some validity to the information and a need for further study is indicated.

This week the American Association of Professional Ringside Physicians (AAPRP) held its annual meeting at the Mohegan Sun Casino. This convocation brought together physicians with first-hand experience treating athletes who have suffered multiple concussions.

A concussion is best defined as a complex process affecting the brain after trauma.

Typical symptoms include headache, dizziness, confusion and nausea. Surprisingly, many athletes accept headaches as part of their sport and never equate them with repeated head trauma.

“I was a Harvard graduate and never saw the connection between episodes of headache and personality change with the head blows I took as a wrestler and football player until I sought medical attention,” said Chris Nowinski.

Nowinski now serves as co-director of the Center for the Study of Traumatic Encephalopathy and was a speaker at the AAPRP meeting. He spends much of his time on the road educating athletes and urging them to seek help.

Chronic Traumatic Encephalopathy (CTE) consists of a triad of symptoms: cognitive
decline, personality changes and movement disorders.

Dr. Ann Mckee, a neuropathologist at Boston University, has published extensively on CTE and spoke at the AAPRP. Dr. Mckee has studied the brains of NFL players who have generously donated them for post-mortem study.

“These brains show deposition of tau protein in crucial areas of the brain that is disproportionate to brains that have not been traumatized,” said McKee. She has found this abnormal accumulation in football players as young as 18.

“This is more than just a sports problem, it is a public health issue,” according to Dr. Robert Cantu, a neurosurgeon who has dedicated much of his career to treating athletes and now serves as a director of the Boston University-based center. These same changes are also found in military personnel, victims of abuse and others who have been subjected to brain injury.

The question now is how can the problem be corrected? Is there a way of treating these tau protein deposits? Is there too much opportunity for brain injury in football and other sports? At what age should contact sports be started?

After reading the Healthy Sports column two weeks ago on the internet, a young woman contacted me regarding her father and his brother who played in the NFL. Along with another brother who played college football, all have been diagnosed with dementia.

While this seems like a situation where heredity is a probable factor, she reports that two other brothers who never played football have no evidence of dementia. She is now in contact with the Center for the Study of Traumatic Encephalopathy and her family is considering brain donation.

The recently published NFL study reported that retired NFL players are typically generous and support their communities. Whoever thought that this spirit of giving would continue after their deaths?

Brain donation is crucial to solving this problem. If you know of someone who has suffered repeated head trauma, please contact Megan Wullf at 617-638-6143.

As athletes age, aerobic exercise is important

A notable conclusion in the recent study of retired NFL players dealt with cardiovascular fitness. The study was based on telephone interviews with 1,063 former players.

Body Mass Index (BMI) is a measure of obesity based on a ratio of height and weight. Despite a much higher BMI, NFL players had fewer heart attacks, strokes and diabetes. The information gathered provides an important message for the general population, as well as retired athletes.

BMI is probably not a good measure of obesity when body weight consists of a high percentage of muscle.

“In this situation, a percentage body fat calculation based on the use of a skin-fold caliper is more accurate,” said Mary Beth Green, a clinical dietitian at Backus Hospital.

Many younger athletes lift large weights to gain muscle bulk. This results in a sudden increase in blood pressure and diminished cardiac efficiency.

As athletes become older, aerobic exercise should be emphasized. Aerobic fitness is best described as the human body’s ability to use oxygen efficiently. Resistance training, in the form of light weight with high repetitions or stretch bands, will improve muscle tone.

“I encourage patients to begin a regimen of walking 30 minutes a day for at least five days per week. They should gradually increase to other forms of aerobic activity like biking or rowing,” said Dr. James Healy, a Norwich cardiologist. Healy reports that larger-strength athletes who become inactive are at high risk for heart attack.

Dr. Healy, like many physicians, believes that a medically-designed exercise program is as important as any medicine in the prevention of cardiovascular events. The fact that this carries over to large, former athletes is especially encouraging.

Study: Football can damage the body and mind

This week the most comprehensive study of retired NFL players was released. The study was conducted by the University of Michigan on behalf of the NFL. A total of 1,063 retired players were interviewed regarding a variety of sociological and medical topics.

Two major issues discussed in the report concern cardiovascular and neuropsychiatric health.

Although NFL players are larger than average Americans, they are not necessarily fatter. Many continue to remain physically active and have a lower incidence of heart attack, diabetes and stroke than the general population.

But their large size and intense physical activity has lead to increased arthritis and the subsequent need for joint replacement at a young age.

The Michigan study also revealed a rate of “dementia, Alzheimer’s disease and other memory-related diseases” 19 times the expected rate for males ages 30 through 49 and 6 times the normal for ages 50 and above. Dementia is best defined as the inability to learn and utilize new information.

A proxy reporter had to be utilized for instances where a player was unable to answer for himself.

“The take-home message from this data is that we must now re-evaluate how football is played,” said Chris Nowinski, a former professional wrestler and football player whose career was cut short due to multiple concussions. Nowinski now serves as co-director of the Center for the Study of Traumatic Encephalopathy. He believes the rules, practice sessions and the age when players begin must all be reconsidered.

Based on this study, the general profile of an NFL retiree is a well-educated, religious man who supports his community. He is physically fit but plagued by arthritic pain.

Unfortunately, he is also much more likely to become cognitively impaired at a young age.

It is the final characteristic that must be addressed immediately.

Hand hygiene and shots can help athletes win against swine flu

This season, the star players on many football teams may not be on the offense, defense or specialty teams. Instead, it may be up to the medical team to execute a successful game plan.

The H1N1 influenza virus has proven to be a formidable opponent for even the toughest teams. Over recent weeks, legions of players throughout the southeast have been relegated to isolation, causing some games to be canceled. H1N1 is now heading north.

Viruses are not susceptible to antibiotics and the best way to limit spread is by immunization. Unfortunately, that requires forewarning and preparation. H1N1 is particularly virulent and a large scale immunization program has yet to be initiated.

Symptoms include high fever, chills, fatigue, nausea and coughing. College athletes are more vulnerable because dormitories and other close living quarters are breeding grounds for any virus. Universities have instituted strict isolation policies but the virus can be spread for approximately 24 hours before and after the onset of fever.

This attack has actually changed how sports-related injuries are treated.

“The H1N1 outbreak has caused us to refrain from using any medications that might even remotely suppress the immune system when treating injuries,” said Dr. Jeffrey Anderson, medical director for the University of Connecticut Department of Athletics.

He hopes the H1N1 vaccine will be available for winter sport athletes.

The best way to limit the spread of any virus is by practicing good hygiene:
• Wash hands with soap and water or alcohol-based antimicrobial hand cleaner, especially after sneezing or coughing.
• Avoid unnecessary human contact.
• Do not share utensils.

Instituting some basic precautions may prepare athletes to limit the spread of this virus and chalk up some extra victories.