The danger of sexual predators in sports

The recent conviction and sentencing of Larry Nassar should be a reminder to all that vigilance is necessary to protect children from predators.

More importantly, Nassar violated an established trust between a patient and physician. This and other recent episodes of abuse have also shattered the faith placed in organizations and universities entrusted to protect young athletes.

Sexual predators often methodically build relationships with victims over a period of years. The underlying premise in many abusive situations is the exertion of power over a victim. Early recognition of typical behaviors can avoid a potential crisis.

Grooming is one technique used by predators. It is a process by which an offender draws a victim into a sexual relationship and maintains that relationship in secrecy. Typical targets are young, unsuspecting athletes who have low self-esteem and little parental oversight. Athletes with intellectual impairments can be particularly vulnerable.

Establishing a bond with the athlete and parents allows a sexual predator a lot of opportunity.

Private coaching or physical treatments specific for that athlete can be warning signs.

Isolation is also a crucial element in an abusive relationship. Participation on travel teams and competitions that require overnight accommodations can present occasions for abuse.

Excessive physical contact that appears inappropriate can also be a sign of abuse. If physical contact is necessary in the course of a medical examination, a parent or other adult should be present. The practitioner should welcome inquiries regarding the nature of the examination. Unfortunately, many young athletes actually report incidents of abuse but are not taken seriously.

There are many dedicated coaches, medical personnel and parents involved in youth sports. Vigilance on the part of all adults involved in youth sports is crucial to stopping what has become a disheartening trend.

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.







Diet, exercise prove helpful in treating MS

Multiple sclerosis (MS) affects at least 400,000 Americans and two million people worldwide. It is a chronic inflammatory disorder that targets the brain and spinal cord. Specifically, the immune system attacks the insulation around nerves as if attacking a foreign object.

MS often presents with symptoms of visual loss in one eye, weakness, numbness, double vision or difficulty walking. The course of the illness is typically marked by periods of deterioration lasting days or weeks followed by remission.

Approximately 15 percent of patients have a progressive unremitting course of illness.

Although there is no cure for MS, there has been tremendous progress in the development and use of disease-modifying medications that increase the length of the symptom-free periods. The goal of treatment is to redirect the immune system.

In addition to medications, several other modalities in the form of diet and exercise have been proven to be helpful in treating MS.

MS is most commonly found in temperate climates where exposure to sunlight is reduced. Vitamin D supplements have been shown to be helpful in treatment.

Diets rich in whole grains, fruits and vegetables with reduced intake of processed sugars and red meat is optimal.

Interestingly, regular physical exercise has also demonstrated a beneficial effect in maintaining patients’ neurologic function. Moderate aerobic exercise combined with light resistance exercise has proven to be an effective regimen. Overheating the body from vigorous exercise or use of a hot tub can be detrimental.

“A structured exercise regimen that allows for gradually increased intensity under the guidance of a physical therapist and a physician can provide a benefit for patients with MS and other neurologic diseases,” reports Dr. Vernon Williams, Director of Sports Neurology at the Kerman-Jobe Clinic.

MS patients should consider multiple treatment modalities.

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

Go slow with new exercise routine

Among the most popular New Year resolutions is weight loss. Beginning or resuming an exercise program after a long lay-off can result in significant injury that will impact a weight-loss program.

Exercise is an intricate part in regulating how much a human eats, drinks and sleeps. It dates back to hunting and gathering activities. In addition to these essential functions, exercise is key to cardiovascular, neurologic and mental health. Recent studies have also indicated that exercise has a protective effect against certain forms of cancer and dementia.

One pressing question remains: “How much exercise is needed to acquire the potential health benefits?” The best current data indicates that even light exercise can provide a big advantage.

Recent studies indicate that consistent daily activities including dog walking, housework, opting for stairs instead of an elevator or even performing home chores can result in improved overall longevity. The greatest benefit comes from 30 minutes of moderate to vigorous activity. This level of activity can reduce the risk of death by 50 percent.

One of the first steps toward a healthy activity program is to incorporate more standing and less sitting. The human body was not designed to withstand the stresses of prolonged sitting. Modifying a workstation to allow for periods of standing can produce a positive result.

An enthusiastic return to the gym should be tempered by the potential for injury. Light aerobic exercise in the form of walking on a treadmill, riding a stationary bike at low resistance or using an elliptical machine at no incline can be a good introduction.

Measuring steps with the use of a variety of technologic devices can provide a big boost to a walking program. A goal of 10,000 steps per day is ideal but any steps are a move in the right direction.

The operative message to beginning a safe exercise regimen is to get the approval of a physician and start slow.

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






Golfer’s severe disability gives hope for others

Muscular dystrophy is a progressive disorder that results in severe disability and in some forms, death. The fact that it targets muscle and causes wasting and weakness makes the announcement this month that a competitive PGA Tour golfer has been suffering from a form of muscular dystrophy for more than a year amazing.

Morgan Hoffman is a 28-year-old professional golfer who in November, 2016, was diagnosed with Fascioscaphohumeral Muscular Dystrophy (FSHD). He recounts his odyssey in a first person account in The Players’ Tribune beginning with his earliest symptom of wasting of his right pectoral (chest) muscle in 2011.

Muscular dystrophy was first described in the mid-1800s as a progressive wasting of muscles seen in male members of the same family. This eventually became known as Duchenne Muscular Dystrophy, the most well-known and deadly of this category of diseases.

FSHD is a variation of muscular dystrophy that targets the face, arms and chest muscles. It does not affect respiratory or cardiac muscles, thus it does not limit a person’s longevity. It does result in profound weakness, making a continued successful career in professional sports remarkable.

Physical therapy should be aimed towards optimizing function of unaffected muscles. Overworking involved muscles will not improve strength but will lead to painful muscle cramps. Non-steroidal anti-inflammatory drugs can be used if pain is a factor.

“Isolation of the gene involved in some forms of FSHD on chromosome 4 has lead to exciting research and hopefully a genetic treatment for FSHD,” reports Catherine Alessi, MD, a neuromuscular fellow at the University of Connecticut.

Golf requires core strength and careful coordination of upper and lower extremity muscles making Hoffman’s success noteworthy and encouraging for others.

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





Steelers’ Shazier suffered a spinal concussion

Last week, Pittsburgh Steelers’ linebacker, Ryan Shazier, attempted to tackle an opposing player with his head down. This position transmitted sudden pressure from the brain to the spinal canal and resulted in paralysis. This type of non-penetrating spinal trauma is also known as a spinal concussion.

A concussion is a syndrome of immediate and transient neurologic impairment that results from a biomechanics force being applied to the nervous system.

Although the term has become synonymous with a brain injury, it can also be applied to the spinal cord.

The spinal cord contains an extensive network of nerve tracts that provide sensory and motor function to the extremities. It is divided into the cervical, thoracic, lumbar and sacral levels. The uppermost cervical level contains fibers extending to both the upper and lower extremities.

Like brain concussion, spinal concussion is the mildest form of trauma when considering a range that extends to penetrating trauma as the most severe form. Mild injuries typically do not produce any changes on CT scans or other imaging studies.

The pathology involved in this type of trauma is typically severe inflammation and swelling. There is a response to cellular injury where electrolytes that typically reside outside the cell rush inward through a breech in the nerve cell membrane causing swelling within the cell and eventual cell death. 

Typical symptoms are immediate sensory loss and paralysis of the affected limbs. Careful positioning and stabilization of the spine are critical on the field, followed by ambulance transport to a hospital. Hospital care includes imaging with CT or MRI and may include treatment with steroids to reduce swelling.

Fortunately, most spinal concussions, like brain concussions, can fully resolve with little to no permanent damage. Hopefully, this is also the case for Shazier.

Editor’s note: The Steelers placed Shazier on injured reserve on Tuesday. The 25-year-old Shazier underwent spinal stabilization surgery last week and remains in the hospital.

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

Wrist, hand injuries a concern in youth sports

Youth sports injuries have become a topic of concern for physicians, coaches and athletes. The biggest fear centers on how these injuries will affect a child’s growth and intellectual abilities. 

Among the injuries that have raised the most interest is concussion. But a recent study published this month in the medical journal for Pediatrics reports that the rates of injuries to the wrist and hand are unusually high.

Sports such as football, ice and field hockey, lacrosse, softball and wrestling were most represented in frequency of injury. Overall, any stick, puck, ball or contact sport can have a high rate of injury. The human wrist is a complex joint that consists of 15 bones that form connections enabling the wrist to move in multiple planes.

The carpal bones in the hand attach to the two bones of the forearm: the ulna and radius.

These bones are connected to each other as well as various muscles by an intricate network of tendons and ligaments. Blood vessels and nerves are intertwined in this grid to provide circulation and sensation.

The most common injuries cited in the study include fracture, contusion, and ligament sprain in descending order of frequency. While most of the injured athletes were able to return to their sports in seven days or less, 12.4 per cent were out for more than three weeks.

Initial treatment often includes rest, ice and immobilization but some fractures may require surgery. 

“Persistent pain and swelling after a wrist or hand injury in a child requires further evaluation by a physician,” reports Dr. Joel Ferreira, an Assistant Professor of Orthopaedics at the University of Connecticut, where he specializes in hand and wrist injuries. “Imaging studies may be necessary to rule out fractures affecting the growth plate that may result in a chronic condition.”

Prompt evaluation and treatment of hand and wrist injuries in young athletes can help speed 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

Improper use of smelling salts a growing concern

Athletes are always looking for an edge that will improve performance.

Often these efforts are ill-advised and at times harmful. One practice that has become popular among high-level athletes is the use of smelling salts to increase alertness.

Smelling salts consist of spirits of ammonia. The use of smelling salts dates back to the Roman Empire but they became popular during the Victorian era. They were used to help revive women who were fainting.

Syncope or fainting is a loss of consciousness as a result of a slowed heart rate triggered by a vagal reflex. This reflex is often initiated by dehydration, anxiety or pain. Ammonia salts directly irritate the nasal mucosa and elicit a noxious reflex. This causes the heart to beat faster and hopefully counteract the vagal response.

Approximately 50 years ago, they became popular in sports to supposedly counteract the effects of head trauma. Smelling salts became popular in boxing where their use eventually was banned.

Trauma patients often suffer neck injuries that may be undetected. The first response to the noxious smell is to suddenly jerk the head away from the stimulus. This can result in dislocating an injured spine and potential paralysis.

More recently, athletes have begun to use smelling salts with the belief that their use will keep them more alert.

The use of smelling salts is particularly popular among football and hockey players who believe this reflex will counteract the effects of concussion.

Recent estimates report 80 percent of NFL players using smelling salts, according to a recent article in ESPN The Magazine.

It is only natural that athletes at lower levels will follow this practice.

Smelling salts should only be used in limited situations under the guidance of a health professional.

Coaches, parents and athletic trainers are crucial to ending the inappropriate use of smelling salts in young athletes.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport.








As cheerleading evolves, injuries continue to rise

The controversy over whether cheerleading should be classified as a sport or an activity is ongoing. One thing that is not disputed is that cheerleaders are athletes with athletic injuries.

Cheerleading first became prominent in the late 19th century in Ivy League schools. In the 1920s, it became more common in other universities. Interestingly, it was a male-dominated activity until the 1940s when many men had enlisted in the military.

The two venues today for cheerleading are scholastic, where the emphasis is placed on energizing the crowd for a sporting event, and competitive, consisting of cheerleading squads that compete in front of judges for points.

The basic cheerleading skills include tumbling, jumping and stunting. Stunting involves complex formations of team members and airborne acrobatics. As cheerleading has evolved, it is stunting that has gained the most attention.

The participants in stunting are classified as “base” and “flyers.”

Several recent publications have looked at the most dangerous youth sports. Cheerleading is on all these lists and considered the most dangerous in a report published by the National Center for Catastrophic Sports Injury Research.

Lower extremity injuries are the most common and include sprains and strains. The most catastrophic injuries involve the brain and spinal cord in the form of traumatic brain injuries and spinal injuries that result in temporary or permanent paralysis.

These injuries have been on the rise due to the growing popularity of cheerleading and the increasing complexity of the stunts being performed.

The American Academy of Pediatrics has called for changes to make cheerleading safer. Among these is the need for coaches at all levels to be properly trained and certified to direct stunting maneuvers and be able to recognize head injuries.

Parents should not be shy about inquiring about any coach’s credentials when it comes to their child’s safety.

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

Learning about shin splints and leg pain

Long distance runners are in the midst of both cross-country and marathon running seasons. Running on trails or asphalt can lead to lower leg pain. Shin splints, also known as medial tibial stress syndrome, is a general term used to describe lower leg pain.

The lower portion of the leg consists of two large bones: the tibia and the fibula. A membrane between these bones, the interosseous membrane and the anterior intermuscular septum, form four compartments. These compartments consist of an intricate network of muscles, arteries, veins and nerves that allows the ankle to move in multiple directions.

Shin splints are often associated with changes in running patterns. They can be attributed to using different types of footwear including excessively worn running shoes, rapidly increasing running distances and association with other injuries in the same or opposite extremity.

Compartment syndrome is among the most serious conditions that may be mistaken for shin splints. This syndrome consists of increased pressure within one of the four compartments of the lower leg. The increased pressure is a direct result of an injury causing swelling within a closed space.

The increased compartment pressure results in an inability for venous blood to drain and arterial blood to enter. The consequence is a lack of nutrients and oxygenated blood to muscles and nerves causing these tissues to atrophy and cease to function.

“The first step in treating shin splints is to find the cause,” reports Ms. Janeen Beetle, head athletic trainer at Norwich Free Academy. “Ice cup massage combined with anti-inflammatory medications provides the best treatment. Strengthening lower extremity muscles can help prevent recurrences.” 

Careful evaluation of lower leg pain can avoid serious complications.

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

What does CTE really mean?

The recent information that former New England Patriots football player, Aaron Hernandez, was found to have evidence of Chronic Traumatic Encephalopathy (CTE) at autopsy has been followed by multiple opinions and at least one lawsuit.

Before drawing conclusions it is important to understand CTE and what the initial scientific studies really mean.

CTE is a diagnosis based on post-mortem findings of the brain. The diagnosis is actually a refinement of the previous findings of Dr. Harrison Martland, a medical examiner in Newark, N.J., who first described post-mortem changes in the brains of boxers in 1928.

A hallmark of CTE is the presence of tau protein, a substance that naturally occurs in nerve cells and appears to leak from the cells with repeated head trauma. The amount and distribution of the staining for tau coincide with the severity of CTE.

Although the predominant studies have been done on a group of deceased football players, many of whom have faced some life challenges, a direct causation between football and CTE has not been established.

One challenge with this condition is the fact that this can only be diagnosed after death. A study published last week in the journal PLOS ONE reports the identification of a potential biomarker to diagnose CTE in the living. The protein, known as CCL11, can be found in the spinal fluid of patients suspected of suffering from CTE.

It is important to note that no one has firmly linked the actions of someone with the CTE findings. The only thing we do know is that there are changes in the brain after repeated blows.

CTE research is ongoing and there is much to learn about chronic brain injury and its relation to sports. It is unfair and dangerous to make clinical assumptions that affect society and peoples’ lives at this early stage of investigation.

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