The best of 2010 makes for good advice for 2011

This is the time of year when looking back helps give direction for the future. After reviewing the “Healthy Sports” columns for 2010, it is clear that several themes developed:

• Many people faced with chronic illnesses like Multiple Sclerosis, Fibromyalgia and Parkinson’s Disease fare better when they are involved in a fitness program. Yoga, dance and a combination of aerobic and resistance exercises can slow disease progression and improve symptoms. Remaining active is crucial when putting together an effective treatment plan.

• The long-standing effects of repeated brain trauma continue to be a focus of concern and research. This year, a connection between repeated head trauma and Amyotrophic Lateral Sclerosis (ALS) was proposed. While this theory garnered a great deal of notoriety, much more research is needed before any conclusions can be made. It is encouraging to see many athletes who have been involved in violent collision sports now donating their brains for postmortem analysis.

• An area of national concern is safety in youth sports. This pertains to all sports where the participants are younger than 14. The lack of medically trained personnel in attendance, the violent nature of the individual sport and the fact that children are more susceptible to catastrophic injury are all factors that have heightened awareness. Thanks to this increased level of interest, USA Hockey is considering raising the age where checking is allowed to 14. A symposium sponsored by the National Football League and the American College of Sports Medicine will convene next month to address urgent safety modifications in youth sports.

The most rewarding trend is knowing that “Healthy Sports” readers continue to be active and safe in whatever sport they choose.

Sports can taken on new meaning during season of giving

Recently, You Tube and various news services brought us one of the most heartwarming stories in sports. It is especially appropriate during this season of giving.

Cross country runners compete on courses consisting of different types of terrain including steep inclines and dramatic descents. In this year’s California state high school championships, a young competitor named Holland Reynolds was in third place after two miles of a three-mile race when she hit what runners call “the wall.”

The wall is best described as the point in physical competition when large skeletal muscles become depleted of essential nutrients. This is manifested by extreme exhaustion and muscle cramping.

Although Holland is a well-trained athlete, she had been recovering from a flu-like illness the day of the race but felt well enough to compete in the crucial event. Unfortunately, with only several yards remaining in the race, exhaustion led to paralysis and left her crawling to the finish line.

Her effort resulted in victory for her team, but her motivation for continuing was much deeper than winning a trophy. Her coach, Jim Tracy, has been fighting his own battle with exhaustion since being diagnosed with Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease).

ALS is a degenerative neurological disorder that affects motor nerves that are responsible for triggering muscle movement. It results in progressive paralysis and eventual death. Coach Tracy’s persistence in continuing to work with his team despite adversity is what served as inspiration for Reynolds.

Many sports stories emphasize winning at all costs. Athletics is truly an adventure that lets everyone involved find out more about themselves. This series of events exemplifies what is best about sports and competition.

Give the gift of fitness this holiday season

The Christmas marketing assault continues as many consumers prepare to purchase gifts for family members and friends. The wide variety of offerings for athletes deserves some scrutiny.

Recently, there has been a surge in high-tech computerized items as well as expensive pieces of equipment. Novel fitness presents can add interest to a workout and many of the best items are not costly.

Some items worth considering:

• Suspension Trainers. Body weight suspension trainers provide a simple approach to resistance training. Athletes use their body weight to provide resistance in a variety of positions. The apparatus is a series of straps that are braced on a beam or pole. The exercises allow multiple muscle groups to be exercised during the movement. Many of the maneuvers are variations on push ups, sit ups and pull ups with an aerial component.

• Kettlebells. A kettlebell is best described as a cannonball with a handle. Its use provides an excellent workout that includes cardiovascular, resistance and flexibility elements. They come in different weights and are excellent for exercising both limb and core muscles. The dynamic component allows imitation of actual movements in a particular sport. Starting with low weight is crucial to avoiding injury.

• Safety Items. Many runners continue their workouts in “rain, sleet, snow and gloom of night.” If a member of this hardcore group is on your list, consider lights or clothing that add visibility, devices that bring warmth to cold extremities and anything that provides gripping power to sneakers on slippery surfaces.

• Lessons. A gift certificate for a class or lesson in an area of interest for the recipient can provide a special experience. Sometimes this can serve to begin a new challenge.

Fitness-related gifts can be an inexpensive investment in good health.

Longer seasons means longer disabled lists

As athletic seasons lengthen, so does the list of injured and disabled players. This trend is most prominent in collision sports like football, hockey and lacrosse.

Many teams are now competing for championships, bowl positions and other awards. Athletes are being seriously recruited for scholarships or professional contracts. It is not by coincidence that the most intense competition happens when individuals and teams are most challenged by fatigue and injury.

During this part of the season, a good working relationship between the medical staff and coaching staff is essential. Athletic trainers and team physicians must weigh the risks to athletes when granting permission to play after an injury.

In the past, these decisions were straightforward and based on the type of injury and what were very limited resources for rehabilitation. In sports medicine today, many new surgical and medical modalities allow for athletes to return sooner without significant risk.

The most noteworthy advancements have been in the area of orthopedic surgery. Athletes now return as soon as the week after injury when previously, similar fractured bones eliminated them for the season.

Their recovery is due to the insertion of hardware in the form of plates and screws that align the fracture. This stabilizes the site and allows a speedy recovery.

The resourcefulness of athletic trainers is an important component. One example is a quarterback who is able to return thanks to the creative design of an immobilizing boot fashioned around a football shoe. Another example is a defensive player who is able to start at his position only days after having hardware applied for a hand fracture using a specially designed glove/cast.

As football season comes to a close, good coaches know that some of their most valuable assets work in the training room and have the initials “ATC” after their names.

Hockey coaches must know signs of concussions

The topic of sports concussion has recently become very popular in the media. While most attention has been directed toward football, some of the most severe concussions are associated with ice hockey.

Concussion is one element in the spectrum of neurological injuries classified as traumatic brain injury. It consists of an alteration of neurological function as a result of the brain being impacted by an outside force. Young developing brains are more susceptible to permanent damage.

As athletes have grown in size, strength and speed, “violent collision sports” have become more aggressive.

Concussions in ice hockey are particularly severe because they often involve high-velocity impact. A typical scenario occurs when a player is skating on the open ice and is unexpectedly struck by another player moving at full speed. Recent studies also show that the element of surprise plays a role in the degree of injury.

In recognizing the gravity of the current situation, the NHL has passed Rule 48 forbidding “lateral or blindside hits to the head.” Connecticut has passed a new law requiring all scholastic sports coaches to complete a course on the recognition and treatment of concussion.

Unfortunately, none of the current regulations extend to youth sports where the youngest and most vulnerable athletes play. USA Hockey, the principal governing body for youth hockey, has no requirement for coaches to obtain any instruction about concussion.

Once again, the responsibility for safety in youth sports falls on the shoulders of parents. Both parents and athletes should become well-versed in the signs and symptoms of concussion. Although not required, parents should insist that their child’s coaches attend a course on concussion.

Participation in youth hockey is an expensive investment of time, effort and money. Before investing further, parents must be sure their children are safe.

Elliptical trainers can help keep the pounds off during holiday season

Over the course of the past 20 years, the elliptical trainer has become one of the most popular pieces of exercise equipment. Now that the holidays and the potential for overeating are rapidly approaching, investigating future fitness options should begin early.

The elliptical trainer was designed to simulate the movements of walking, running and climbing without the lower extremities impacting the ground. In doing so, repetitive trauma to the lower extremities is vastly reduced.

Among the most limiting factors in the careers of runners is a lower extremity injury. Chronic inflammation of the knees, hips and ankles eventually leads to arthritis.

Sometimes referred to as a cross trainer, the elliptical trainer incorporates the use of multiple large muscle groups in the lower extremities. The cardiovascular or aerobic portion of the workout allows for sustained elevation of the athlete’s heart rate.

Most elliptical trainers now have the option of adding a component where the arms can push and pull levers that alternate with the lower extremities. This adds an upper extremity component to a workout. The ability to increase the resistance of the mechanism adds the ability to build muscle.

Many experienced athletes find the workouts to be best at burning calories.

“If there was one piece of equipment to buy for a combined cardiac and strength workout, the elliptical is the best choice,” said Jeff Ehlers, manager of the Total Fitness store in Newington. Elliptical trainers have become the most popular fitness items sold.

The newest iteration of the elliptical — the suspension trainer — has no wheels or tracks. Although not inexpensive, elliptical trainers, like many other types of athletic equipment, are a worthwhile investment as long as they are regularly used.

Physical activity helps those with Parkinson’s disease

Parkinson's disease is a progressive neurodegenerative disorder affecting motor function. Recent information indicates that physical activity may slow the progression and improve the quality of life for those affected.

Movement disorders are a broad category of illnesses that include Parkinson's disease and related disorders. They are generally the result of a neurochemical imbalance. In the case of Parkinson's, it is due to a lack of dopamine in the area of the brain controlling the fluidity of movements.

Typical symptoms include a tremor along with very slow, stiff movements. Treatment involves supplementing the dopamine in the brain while increasing the sensitivity of dopamine receptors.

Standard physical therapy regimens consist of range of motion exercises to avoid tightening of joints. More recent programs emphasize balance and stretching by utilizing yoga and tai chi.

Dance has now become an accepted complementary modality in the treatment of Parkinson's disease. Dance programs are generally held in group sessions for patients and caregivers. A study performed at Washington University compared patients enrolled in Argentine tango classes to those receiving non-dance therapies. The tango group fared better regarding slowed progression and improved function. The Argentine tango was especially appropriate for this study since it requires dynamic balance, frequent turns, variable speeds and walking backward.

Locally, a weekly dance class for patients with Parkinson's disease and their caregivers has been ongoing at Connecticut College. These classes, led by instructor Rachel Balaban, are designed to improve the strength, stamina and balance of participants. "The dance program addresses the physical and emotional needs of patients by providing an outlet for both patients and caregivers," said Balaban.

While dance therapy may be an unconventional treatment for Parkinson's, it has certainly proven to be effective.

Football safety debate could benefit from local examples

The topic of safety in football has recently risen to become a priority at all levels. There is a high level of concern that changing the rules, equipment or strategy will detract from the entertainment value of one of America's most popular sports.

Specifically, this initiative is the result of the rising number of concussions and spinal injuries, as well as the potential long-term effects of cumulative trauma.

Football is among what are best described as violent collision sports. Others include hockey and rugby. Concussion is a group of symptoms that results from a blow to the brain. It may be from a direct blow or a sudden jerking of the head causing the brain to strike the inner skull.

Proposed changes in football include changing the rules to penalize players for what is felt to be excessive violence as well as using their helmets as weapons. Another proposed change is modifying the execution of plays to minimize vulnerability to injury. Some absurd proposals include eliminating the use of helmets entirely.

One change that would make a difference is creating a "culture of safety" in football.

Arguably, from the standpoint of neurological injury, the most violent sports are combat sports like boxing, mixed martial arts and kick boxing. In boxing, the only way points are scored is by inflicting neurological injury on the opponent.

In Connecticut, the Mohegan Tribe Department of Athletic Regulation, the Mashantucket Pequot Athletic Commission and the Connecticut State Boxing Commission have developed this approach over recent years. Interestingly, the changes put in place have not taken away from the "entertainment factor" in any of these events.

Maybe there is something to be learned.

A culture of safety means that the safety of athletes is the highest priority. Safety takes precedence over money and winning. It is also not limited by time and is an ongoing process.

Boxing has shortened the number of rounds involved in a bout. A typical championship match used to be 15 rounds and is now 12.

Locally, many bouts are four or six rounds and there are more bouts on a card for the night. MMA uses three, five-minute rounds. This provides an opportunity for more athletes and removes them from exposure to injury.

The NFL is currently considering lengthening the season to 18 games from the current 16- game schedule. This will increase the exposure of professional football players to neurological injury.

Combat sports utilize independent physicians to evaluate participants. These physicians are not employed by the venue, promoter or fighter. Professional football relies on a system where physicians are direct employees of the team.

Rules have evolved in combat sports to allow for safety. Football is trying to implement similar rules. These are in place to make the contest safe and officials will gradually become more comfortable with enforcement, while athletes will become more comfortable with following the rules. In boxing, the loss of points or disqualification have been effective penalties. Hefty fines as proposed by the NFL have little impact.

Creating a culture of safety is not an overnight process but a gradual evolution. Football does not need to "reinvent the wheel" to promote safety at all levels.

Swimmer’s death a reminder that we all have limits

Among the goals of all athletes is to establish higher standards of performance. This applies to any level whether on a treadmill in a basement or breaking an Olympic record. There are also physical limits that must be respected or a workout can potentially end in disaster.

The recent death of Fran Crippen, a champion swimmer who died at the age of 26 in a 10-kilometer open-water race, serves as a sobering reminder of the inherent danger of sports.

Intense competition puts tremendous energy demands on the human body. The cardiovascular system must provide adequate blood supply to vital organs including the brain, heart, lungs and kidneys while meeting the increasing vascular needs of large muscles.

There is also a thermoregulatory component to be considered. Exercising in extreme environments of heat or cold puts added stress on human organ systems. The physiological mechanisms involved in human function work best at a stable temperature. Any variance requires added energy to provide adequate cooling or warming.

Safety considerations often include making certain the venue is safe for competition. Medical support, adequate nutrition, hydration and properly functioning equipment must be available and supervised by officials.

Athletes typically envision themselves as indestructible. While that belief may serve as a driving force, it may also lead to trouble.

In the case of Crippen, there is evidence that he recognized this event and others may be unsafe. Inadequate medical support and dangerous conditions were reported but not changed.

Crippen suffered extreme physical exhaustion and eventual cardiopulmonary failure. The most likely cause was exertional heat stroke given that the water temperature was in the high 80s.

This incident provides a reminder that all athletes, spectators and officials have an obligation to safety.

Take precautions when exercising on trails

An off-road experience can be both exhilarating and a welcome change of venue for a good workout. This especially applies to athletes who exercise in areas where fall color changes are beautiful and the climate is moderate.

Safety measures such as wearing bright, visible colors, trail knowledge and adequate nourishment can be applied to almost all trail sports, but some precautions are specific to trail running and hiking:

• Stretching and warm-up: Even if this is done as part of a normal pre-run routine, special attention should be made before moving to rough terrain. Specifically, the feet and ankles become more vulnerable to injury on an irregular surface. Suddenly inverting the ankle can result in torn ligaments. Small muscles of the feet will be more prone to strain. The best way to loosen these muscles is by rocking forward and backward from heel to toe.

• Footwear: As opposed to typical running shoes, trail shoes have higher ridges for more traction. This helps when climbing and descending steep inclines.

• Adjust speed-running: Off-road requires a slower, more careful pace than road running. Hidden, wet surfaces, along with varying terrain, demand more attention.

• Avoid distractions: Many runners like to listen to music while on the road. While this may be safe in a controlled environment like a running track, it can be a dangerous distraction on a trail. Sound provides important information when running off-road and typically these natural sounds provide part of the enjoyment.

The fall season in New England provides an outstanding opportunity for workout variation. It is also a perfect setting to begin a new outdoor activity along with friends. Planning an outdoor adventure with safety in mind goes a long way.

When the leaves change, so can workouts

When fall arrives, athletes may be tempted to change the setting of outdoor workouts to more colorful and challenging terrain. Although this will add a new and more exciting element to any fitness regimen, it deserves caution.

Typically, biking, running and hiking are most suitable for an off-road experience.

Trail Biking Safety

• Equipment: Road bikes are not well-suited for trail cycling. Mountain bikes are equipped with wide, densely treaded tires that are able to grip rugged terrain. The gearing of a mountain bike is also unique and allows for steep climbs and descents. The braking systems and handlebar grips are also safely positioned.

• Protective clothing: Helmets are always imperative when cycling to avoid catastrophic injury — even the most experienced mountain bikers wear helmets. Other protective clothing includes gloves, elbow and knee pads. The rule in off-road cycling is that falling should be expected as part of the experience. Brightly colored clothing is also advisable when riding in areas that may be shared by hunters.

• Knowledge: Try to use trails that you are familiar with or study the area on a posted map before entering a wooded area. A compass or GPS device is a wise investment. A cell phone or other communication device is helpful.

• Group ride: It is best to travel with others when going off-road, and stay together as a group. This is important from the standpoint of safety as well as adding an aspect of socialization.

• Nourishment: Water and energy bars are worth bringing along. Fatigue can be very dangerous and a rider shouldn’t hesitate to take a break for rest and nourishment.

Safety should always be the highest priority in any sport, even when they border on the extreme. Next week we’ll discuss trail running and hiking.

Barefoot running takes adjusting to get in stride

Consumers are constantly updated on the latest innovations in running shoes. Arch supports, gel insoles and weather-resistant fabrics are now standard components. Recently, a growing group of runners have gone against the “more is better” trend by beginning to run barefoot.

In his recent best-selling book, “Born to Run,” Christopher McDougall investigates the running habits of the Tarahumara Indians of Mexico. Members of this tribe are able to run hundreds of miles without rest. These tribal runners accomplish these amazing feats by running barefoot or by wearing a leather sandal to protect their soles in rugged terrain.

The human foot is made up of 26 bones held together by small ligaments. These joints are activated by a network of muscles and nerves. There are three anatomic regions to the foot: the forefoot in front, the midfoot and the hindfoot.

Barefoot runners use a different stride that keeps the hip and knee flexed while landing on the forefoot instead of the heel. Running experts believe that this style of running can diminish injuries to hips, knees and low back. Flexing a joint on impact will absorb more shock and avoid trauma to the cartilage, tendons and ligaments.

“The key to beginning a barefoot running program is to start slow on a level, natural surface,” said Dr. Jeffrey Kierstein, a podiatrist in Norwich. “Many runners don’t realize that when using the barefoot technique, they are beginning to use different muscles. Starting out too hard and too fast will injure those muscles and cause stress fractures to the small bones of the foot.”

Barefoot running is not for everyone, but runners who have been able to adapt are enthusiastic about their new sense of freedom.

Yoga benefits a wide range of people

The mind-body connection has intrigued scientists for centuries. The ability to meditate and visualize various physical activities is believed to be instrumental in healing as well as athletic performance.

This mental and physical collaboration is essential to yoga. Yoga has been practiced for more than 5,000 years. The meditative aspects were the principal emphasis, with the physical component added later.

Poses vary based on each person’s abilities and the yoga style. Many older participants with health limitations are able to benefit from the mental relaxation and stretching along with the camaraderie of class participation.

Among the benefits of yoga are improved:

• Flexibility: Stretching ligaments and tendons protects against sprains and muscle strains.

• Strength: The resistive component of some poses will improve strength especially in core muscles.

• Concentration: Yoga encourages focusing on a specific task without distraction.

Medical studies have demonstrated that patients suffering from cardiac disease, respiratory conditions and neurologic illnesses have all been helped by adding yoga to their therapeutic regimen.

The image of a yoga participant as a thinly built individual able to contort themselves into a variety of “double-jointed” poses immediately comes to mind when thinking about a yoga class. Recently, Lee Elci, a local talk show host, and I challenged that image by attending a yoga class at the Centerspace Wellness Studio in Bozrah. We were both impressed by the intensity of the workout and the benefits.

“The popularity of yoga has steadily grown in Eastern Connecticut,” said Lyndsay Meiklem, a certified yoga teacher and owner of Centerspace. “Many young athletes participate to enhance performance in their primary sport and patients recovering from orthopedic injuries use yoga for rehabilitation.”

Utilizing yoga to treat and prevent illness may provide an effective tool in controlling future healthcare expenses. If interested, contact Centerspace Wellness at 860-886-8562.

‘Stroller strides’ help new moms lose weight

Pregnancy and childbirth are among the greatest events in life. The physiologic changes potentially impact every aspect of a woman’s body.

The most disheartening change for most women is weight gain. Ideally a woman should gain 25 to 30 pounds during pregnancy. This number can increase drastically with inactivity and overeating.

One of the most difficult challenges is returning to pre-pregnancy weight and physical activity. Among the obstacles to achieving this goal include erratic sleep schedules, demands of returning to work and caring for a new baby.

An outstanding solution to this problem is a program called “Stroller Strides.” Stroller Strides is a national, total fitness program for new mothers. It consists of a combination of aerobic and resistive exercise performed along with a child six weeks after giving birth.

The configuration of a stroller has changed over time. The large, inflated tires along with lightweight construction are perfect for running and power walking. The resistance component is introduced with the use of resistive bands and body-weight exercises.

April Holtmeyer is a certified instructor and local franchise owner who lost 145 pounds after giving birth to her first child.

“I always struggled with weight gain and found myself obese and a new mother. My obstetrician confronted me with the likelihood that I would die young and have to leave this beautiful child behind,” said Holtmeyer.

After moving to Eastern Connecticut, she purchased a local franchise and leads classes consisting of 15 to 20 mothers and children.

One hour sessions are offered six days-per-week; most participants attend four sessions per week. An added benefit is the social interaction among the mothers and children. The playgroup aspect helps combat post-partum depression.

Stroller Strides is a program worth considering for young mothers. If interested, visit www.strollerstrides.com

Family histories are tools to avoid sports injuries

Alarming numbers of children are the victims of sports-related injuries each year. Unfortunately, some of those are fatal.

Sports medicine specialists throughout the world persistently look for ways to avoid these tragedies. Perhaps one way is already within grasp.

One of the most important parts of a medical examination is recording a family history. Information regarding illnesses that have affected a patient’s ancestors is noted.

Diagnostic tests are growing in cost and the expense related to screening every athlete for potentially deadly conditions is prohibitive for many athletic programs.

Often the family medical history will indicate what tests will have the most value, based on specific conditions.

• Neurologic. Athletes in whom there is a family history of brain aneurysms should have radiologic studies to screen for any vascular abnormality. Epileptic seizures in close relatives or in the athlete’s childhood can be further investigated with an EEG. A family history of dementia at an early age suggests caution when participating in contact sports where concussions are common.

• Cardiac. Screening tests to avoid sudden cardiac death are increasingly common. These examinations are imperative for athletes with a family history of abnormal cardiac rhythms, coronary artery disease at a young age or sudden cardiac death. An EKG or echocardiogram is a useful screening test.

• Hematologic. Sickle cell trait and a variety of inherited forms of anemia can lead to abnormal clotting and decreased oxygenation of vital organs.

The success of this strategy is based on full disclosure by parents regarding the family medical history. Some families have refused to submit their children for testing despite the potential danger.

Careful attention to physical risk based on family medical history can make sports participation safer.

Exercise helps those with Multiple Sclerosis

Multiple Sclerosis (MS) is a neurologic illness that results in abnormal function of the central nervous system. Despite the seriousness of the diagnosis, exercise can be therapeutic and should be encouraged.

MS typically affects men and women between the ages of 20 and 40. There are two types of MS. The relapsing and remitting form consists of episodes of visual loss, numbness or weakness that improve. A more serious, chronic, progressive form follows a slowly deteriorating pattern.

Magnetic Resonance Imaging (MRI) scans are particularly sensitive to changes in nerve cells resulting in the formation of MS plaques. This has permitted earlier diagnosis and initiation of treatment.

Immunosuppressive medications have successfully reduced the number of MS relapses and slowed progression. Recent studies have shown that patients who suffer from MS and exercise regularly perform better on objective tests.

Any exercise regimen should only be performed after physician approval. The goals should be as follows:

• An adequate period of warm-up and stretching

• A minimum of 30 minutes of aerobic exercise three days per week

• Resistance exercise on alternating days

• Activities that improve balance

One area of concern for patients is the potential for making symptoms worse when exposed to extreme heat. MS patients must be especially careful not to exercise on hot days and to remain hydrated. Cooling vests are sometimes recommended to provide a more tolerable environment.

Among the best fitness activities for patients with MS are swimming, cycling, running and martial arts. Participation in group activities also provides a social outlet.

Inactivity can lead to joint spasticity and muscle atrophy. It can also lead to diminished coordination and potentially deadly falls.

Any treatment plan for MS should include a combination of medication and an appropriate fitness regimen.

Tai chi and fibromyalgia

A recent study published in the New England Journal of Medicine looked at the effectiveness of tai chi in the treatment of fibromyalgia.

Tai chi is a form of self-defense developed in China more than 2,000 years ago. It consists of flowing, circular movements that emphasize balance and meditation.

Fibromyalgia is a common, painful clinical syndrome. Typical symptoms include muscle pain, stiffness, fatigue, sleep disturbances and mood changes. It affects about 200 million people throughout the world. Symptoms vary with levels of stress, climactic conditions and other triggering events.

Tai chi has been described as an effective way of relieving painful musculoskeletal conditions, including low back pain. It has also provided a complementary treatment for cardiovascular conditions. This is the first time it has been studied in conjunction with fibromyalgia.

The study reported on 66 patients randomly assigned to a group participating in either tai chi classes or a wellness education and stretching session. At least 79 percent of the tai chi participants reported improvement of symptoms, while only 39 percent of the wellness group felt they had improved.

“I'm not surprised by the results of the study,” said David Chandler, a tai chi master from Quaker Hill. “I've worked with many patients with fibromyalgia over the years and in fact some have become tai chi instructors.”

Chandler’s classes include many people with medical conditions who have been encouraged by their physicians to participate in a fitness endeavor. He has found that brief, daily tai chi sessions can be very effective while patients are gradually increasing their stamina.

Medications used to treat fibromyalgia include antidepressants, anticonvulsants and anti-inflammatory agents. The response to long-term medical treatment alone has been disappointing.

Despite the need for further research, the potential benefits of a combined treatment approach that includes tai chi are encouraging.

Exertional heat symptoms cannot be ignored

Korey Stringer, an offensive lineman for the Minnesota Vikings, died suddenly in August 2001 while in football camp. The cause of death was determined to be exertional heat stroke, also known as EHS.

EHS consists of neurologic abnormalities and failure of multiple organs when the core body temperature reaches 104 degrees. As opposed to other causes of sports-related deaths, there are symptoms leading up to an EHS crisis that are fatal if ignored.

EHS, along with heat exhaustion, heat syncope and heat cramps, are exertional heat illnesses. EHS is the most serious and all are associated with dehydration and vigorous activity in hot environments. Symptoms include lightheadedness, hyperventilation, confusion, headache, fatigue, loss of balance, vomiting and diarrhea. More severe symptoms of seizures and coma are the result of an uncontrolled rise in temperature.

The Korey Stringer Institute was established at the University of Connecticut. Dr. Douglas Casa is a professor of kinesiology and among the world’s foremost experts on EHS.

“Athletes must listen to their bodies for signs of illness,” Casa said. Once symptoms begin, athletes should take a break, get to a shaded area and rehydrate.

“When EHS is suspected, immediately remove the athlete’s equipment and begin cooling,” said Bob Howard, Head Athletic Trainer for UConn.

The best way to initiate cooling is by immersion in a tub of cold water within 10 minutes of symptom onset. The player should remain submerged to the neck until the temperature drops to 101 degrees and improvement begins. This treatment alone has a perfect survival rate when properly followed.

Although most common in football, parents and coaches must be alert to these symptoms in all activities, including marching band.

Easy access to hydration and the availability of an ice tub or other rapid cooling mechanism can save lives.

Lou Gehrig’s disease and head trauma

Potential causes of amyotrophic lateral sclerosis (ALS) have eluded neuroscientists for many years. A proposed relationship between this deadly condition and contact sports has recently surprised the scientific community.

ALS is commonly known as Lou Gehrig’s disease. It is a uniformly fatal disease that results in degeneration of the motor nerves where they originate in the spinal cord. Like its namesake, its victims gradually lose control of all motor function — including their ability to speak and breathe.

The cause of ALS is unknown, with the exception of 10% of patients in whom there is a hereditary link. Recently, a paper connecting chronic brain injuries and ALS has been published in a major scientific journal.

Chronic traumatic encephalopathy is a condition consisting of cognitive decline, personality changes and movement disorders in people who have suffered multiple brain injuries. Post-mortem examination of the brains of athletes who participate in violent contact sports including football and boxing contain a protein not normally seen in patients who suffer dementia.

Three athletes who generously donated their brains and spinal cords died of a motor neuron disease resembling ALS. Careful study of their spinal cords revealed the presence of a protein not present in patients dying of similar illnesses who did not have a history of head trauma.

Chris Nowinski is a former professional wrestler and college football player who serves as co-director of the Center for the Study of Traumatic Encephalopathy.

“This study provides insight into why contact sports athletes have been diagnosed with ALS at far higher rates than the normal population,” said Nowinski, who assisted with the research.

While there are no clear conclusions to be drawn from a study of such a limited sample size, it raises many questions about the effects of repeated head trauma. Further research will hopefully provide some answers.

Hula Hoop your way to better health

Core fitness is essential to any exercise regimen. Hula hooping is becoming a popular way to improve core strength and increase stamina.

The abdominal, low back, pelvic and upper leg muscles make up the “core” muscles. They provide strength necessary for the agility and speed required for most sports.

"Hooping" as a fitness activity dates back to ancient cultures. The hula hoop first became popular in the 1950s. It is now part of a resurgent movement that includes informal groups and organized classes of adults and children.

The current iteration of the hula hoop consists of approximately 11 feet of ¾-inch PVC tubing sometimes filled with sand or water for added weight.

Participants gradually increase the amount of time while adding additional elements like light weights and running.

Stephanie Bennett is a certified hoop teacher at Centered Movement Hoops in Rhode Island. Participants in her classes are primarily women between the ages 7-75 years old, with the average being 34.

“Hula hooping is an alternative exercise that is not intimidating. The hoop merely provides a prop for an energetic workout,” said Bennett.

Bennett believes that a mind-body connection develops while hula hooping and this results in a meditative component to the workout.

Tami Renfro of Colchester is a registered nurse who gets together with a group of men and women after work to hoop. The group consists of nurses and other health workers who find it to be a good way to relieve stress. One member of their group lost 68 pounds since combining hula hooping with a diet.

“I have personally had fewer issues with low back pain and the laughter at our sessions is energizing,” said Renfro.

Rarely are terms like “refreshing,” “energizing” and “relaxing” used in association with a vigorous workout. Hula hooping is definitely something to explore.

Yoga provides early opportunity for parents to exercise with children

Creating a healthy lifestyle of diet, exercise and discipline presents a personal challenge. It is also among the greatest gifts parents can pass on to their children.

Many parents now realize that the earlier these habits are established, the easier they are to maintain. Over the past 30 years, parent-infant fitness programs have become a popular means of introducing fitness while providing a bonding experience. The first courses involved teaching infants to swim. This setting is perfect for fitness and the added feature of promoting water safety.

Yoga is a combination of mental and physical abilities. Its origins are part of ancient Indian culture with roots extending back to 3000 BC. The skills also provide an excellent foundation for infants as young as six weeks to begin a journey toward good health.

Itsy Bitsy Yoga is a program for parents and infants. It combines a child’s natural developmental movements with traditional yoga poses. Helen Garabedian founded Itsy Bitsy Yoga in 1999 to bring together parents who are interested in a holistic approach to health and their children.

“Yoga establishes early lines of communication between parents and children while exercising multiple muscle groups,” said Tara Armstrong, a certified Itsy Bitsy facilitator. She began teaching this innovative yoga program in the Norwich area three-and-a-half years ago when she was searching for a post-natal fitness endeavor to do with her child. She found yoga to be helpful during childbirth and felt it would be a natural transition. She now facilitates weekly classes at the Centerspace Wellness Studio in Bozrah.

Armstrong has classes for infants and toddlers from newborn to four years.

Instituting a regular schedule of fitness should start young to get a head start on good health habits. It will also diminish the likelihood of chronic illness and improve professional productivity. If interested, contact 860-886-8592.

Magnets attract loyal following among athletes

The power generated by magnetic fields has fascinated people for centuries. Many attempts have been made to utilize magnetic energy as a cure for medical ailments. These efforts have also ignited a $300-million-a-year industry in the United States, much of which involves athletes.

Magnetic therapy is the application of magnetic devices to the body as a means of achieving health benefits. Practitioners of this alternative medical practice claim success in wound healing and fatigue by improving circulation. The greatest notoriety has come from suggested anti-inflammatory effects and subsequent pain relief.

The first athletes to utilize magnetic therapy on a large-scale basis were golfers. It started with the use of copper bracelets. Although not magnetic, the color change produced on the skin was believed to indicate benefit. Magnets soon followed, with the use of more elaborate metals including stainless steel, titanium and tungsten carbide.

The use of magnetic bracelets, necklaces and inner soles has spread to all sports including football, basketball, tennis and even bull riding. This has led to success in the commercial market outside of sports.

“The use of titanium magnetic bracelets and necklaces is so widespread in baseball that it has become more of a fashion statement than a therapeutic device,” said TJ Saunders, head athletic trainer of the Connecticut Tigers.

Numerous controlled studies have been performed comparing the application of actual magnets and placebo magnets to similar populations of patients. Results indicate no beneficial effect of magnets. Scientists believe the magnetic fields generated are too weak to provide benefit.

The other part of this equation is that many patients have experienced subjective improvement of their symptoms and no harm has been demonstrated by using magnetic therapy.

Considering the options available to athletes for improved performance, magnets are a safe approach.

Q&A: Frequently asked questions about youth sports concussions

I recently had the opportunity to address a group of coaches, parents and athletes regarding concussions in youth sports. The seminar, sponsored by Backus Hospital, was designed to help the audience recognize the early signs of concussion and take appropriate action.

Many good questions arose from the discussion and the information may be helpful to others:

• After suffering a concussion, when is it safe for an athlete to return to competition? Recovery time varies depending on the severity of the incident. In general, the athlete should be symptom-free before beginning a program where activities gradually escalate from stationary cycling to a full return. If at any time symptoms return, the progression stops and the previous level resumes.

• If an athlete suffers a concussion, who determines when to resume an activity? After suffering a concussion, no athlete should return until they have been evaluated by a medical professional with experience in the treatment of concussion. Proof of medical clearance should be provided in writing.

• In a situation where there are complaints of a headache and nausea but head trauma is uncertain, should the athlete be removed from the contest? Absolutely. It is sometimes difficult to determine if and when head trauma occurred and the patient may have amnesia. When in doubt, it is best to eliminate the possibility of further harm.

• At what age should an athlete begin neck strengthening exercises to prevent indirect concussion? Any strengthening program in a child should be initiated in conjunction with a strength and conditioning specialist.

For those who could not attend this seminar, more information, including a video, can be obtained at www.backushospital.org/concussion. It was encouraging to see so many adults who are involved in youth sports become trained in the recognition of this potentially deadly injury.

Weightlifting can be part of youth exercise programs

Health club membership for participants between the ages of 6 and 17 is increasing. Along with this rise comes questions of what activities these athletes should be performing, especially with respect to weight lifting.

Exercise can be classified as primarily cardiovascular or aerobic and resistance or anaerobic. Sports like running, cycling or swimming are principally aerobic and designed to increase heart and lung capacity. Weight lifting and other strength-related challenges are designed to repeatedly stretch muscles against force to increase muscle fiber size and power.

The issue of safety regarding resistive exercise involves applying excessive force to developing muscles and joints resulting in tearing and deformation.

According to the American Academy of Pediatrics and other organizations, resistance activities are an essential part of a balanced exercise program, but must be performed properly. Benefits such as improving bone strength, maintaining a healthy weight, establishing a healthy lifestyle and better self esteem are some of the advantages.

Chris McNally, and his wife Sheri, of Norwich, are family fitness specialists with 20 years of experience working with children. They believe all children should start with “body weight exercises” like pushups, pull-ups and squats. In younger children, these should be performed as part of a game or other entertaining activity.

“If children start with a well-supervised program, the risk of harm is minimal. The bigger risk is not challenging their bodies when they are young and missing out on the benefits of being fit,” said McNally. He believes weight lifting can begin safely in a physiologically mature child at age 11.

As in most activities, children tend to imitate their parents or other adults they admire. A balanced fitness program is definitely a family investment that will pay huge dividends.

We can prevent concussions in youth sports

On July 1 , Connecticut proudly joined the growing ranks of states that have come forward and placed the safety of young athletes as a high priority on the legislative agenda.

A new law is now in effect that requires all scholastic coaches to attend a seminar on recognizing the early signs of concussion. The law also prohibits athletes from returning to a contact sport until cleared in writing by a medical professional with experience in the treatment of concussions.

As in other states, this law has had the added benefit of prompting serious discussion about how to make sports safer at all levels. In Connecticut, thanks to concerned parents, similar concussion restrictions are being implemented voluntarily at the youth sports (pre-high school) level.

As a neurologist involved in the field of sports neurology, I witness the devastating effects of concussion on a regular basis. A typical scenario is one where an athlete suffers a head injury but does not report it to a coach or parent. The first injury is then followed by a second impact before allowing the brain enough time to rest and heal. This second injury can result in more long-lasting and sometimes permanent symptoms of headache, dizziness and cognitive impairment.

Head injuries in younger children take longer to heal and are generally more severe. Ironically, it is the youth level of play where there are the fewest medical resources available, like a certified athletic trainer at every game.

On July 22, Backus Hospital is hosting a free lecture and discussion on the subject of head injuries in sports. It is designed for coaches, parents and athletes and will allow them to recognize early symptoms and take appropriate steps.

I highly recommend attending this seminar since the most effective treatment for a concussion is early recognition and rest.

Field conditions can cause injuries

Among the most prominent and often overlooked factors impacting athletic injuries at any level of play is the condition of the playing field. Many of these injuries are avoidable.

Athletic fields vary greatly depending on the sport, climate and funds available for upkeep. Most community sports teams cannot afford full time grounds-keeping staff. Parents shouldn’t hesitate to get involved by following some helpful hints:

• Get to the game early and walk on the field. Often coaches and officials are preoccupied with game preparation and don’t have time to inspect the grounds. Remove any debris, check for holes and be sure goal posts are securely padded.

• Baseball diamonds should be evenly mowed with no impediments that can cause a “bad hop” on the infield. Outfield fences should be inspected for sharp protrusions sticking out in the event a player runs into it.

• Indoor courts should be examined for moist areas that will affect traction.

• Seating must be a safe distance back from the players to avoid collisions between players and fans when chasing a loose ball.

“The amount of moisture on a field is crucial to avoid slipping. If a field is too moist or too dry, athletes will not be able to maintain firm footing and may potentially be injured,” said Ryan Lefler, Assistant Director of Stadium Operations and Turf Management at Dodd Stadium. Uniform moisture and smooth transitions from turf to dirt are essential in preparing a baseball field.

Despite 40 years of experience, the jury is still undecided regarding the safety of artificial turf when compared to grass. Technologic improvements in artificial turf make them more comparable each year.

When it comes to field safety, a vigilant coach, parent or fan may be the key to avoiding serious injury.

Eating disorders can impact athletes

Eight million Americans are estimated to be suffering from eating disorders. It is not surprising that many of them are athletes.

There are three forms of eating disorders:

Anorexia nervosa — a distorted body image creating a belief of being overweight despite profound weight loss.

Bulimia — a cycle of binging and purging.

Compulsive exercise — excessive and addictive exercise in an attempt to control or lose weight.

Athletes are typically dedicated and highly motivated. These personality traits, when combined with the positive reinforcement of improved athletic performance, make athletes particularly susceptible to eating disorders. It also makes diagnosis more difficult.

Eating disorders are most often seen in sports that rely on individual performance and light weight. Some examples are: rowing, horse racing, ice skating, dance and wrestling. While the vast majority of athletes who suffer from eating disorders are women, it is not uncommon to diagnose it in men.

The female triad consists of three principal symptoms that suggest the presence of an eating disorder including: fatigue, menstrual irregularity and weak bones.

“Eating disorders are complex and often not simply the reaction to a comment made by a coach or judge about weight,” said Dr. Jeff Anderson, Director of Sports Medicine at the University of Connecticut. Anderson believes that athletes prone to an eating disorder are drawn to a particular sport.

Compulsive exercise can be seen in adults who discover the physical benefits of exercise, including weight loss. Symptoms of compulsive exercise include exercising despite injury, ignoring family and business obligations to exercise and a fear that missing a day of exercise will result in weight gain.

Parents, coaches and friends must be alert to the possibility of an eating disorder in an athlete and direct them to get appropriate attention.

KJ Life tourney celebrates athlete

Among the greatest rewards in the world of sports is being able to compete purely for the joy of the contest. That simple joy is often lost as athletes move forward in their sports. The stakes get higher and the pressure increases.

This past weekend, more than 500 young people in Glastonbury re-discovered the pleasure of playing a sport for fun. They participated in the second annual KJ Life Flag Football Tournament.

This tournament is held each year in memory of Kenneth Joyce, who passed away in a skiing accident two years ago. The tournament raises money for youth leadership programs.

Like ultimate Frisbee, floor hockey and disc golf, flag football is a “cult” sport. It is played on open fields by students from elementary to graduate school levels. Teams vary in number and gender of players.

As in the traditional game, the goal is to run or pass the football until a touchdown is scored. Forward progress is stopped when a flag is removed from the waist of an opposing player. Plays are generally designed as the game develops.

While coaching and instruction are usually helpful, they can also be overdone. There are no coaches in the KJ Life Tournament, but officials are provided for each of the games.

“Players of any skill level can enjoy the game of flag football. All you need to do is know how to throw and catch,” said Pat Curry, a volunteer official. According to Curry, tournaments like this are a step back in time to the days of sandlot sports.

Flag football is an outstanding way to encourage fitness and fair play. A tournament like KJ Life is also a great way to memorialize the spirit of a young athlete who has inspired so many others.

Don’t overlook the importance of bike seats

Along with fair weather and extended daylight hours comes an opportunity for increased fitness activities. Many have already begun to tune up their bicycles in preparation for an evening ride or a daily commute.

An often overlooked but essential component to any tune-up or purchase is the bicycle seat.
The perineum is the anatomic region located at the base of the pelvis. It absorbs the pressure of the torso on a standard bicycle seat. Irritation from a poorly-fitted bicycle seat and inappropriate attire can be painful. In addition, impaired blood flow to reproductive organs can lead to dysfunction.

Lance Armstrong’s battle with testicular cancer has raised suspicion of a correlation between cycling and this potentially deadly disease. No clear relationship has ever been established in the scientific literature.

Pressure on the pudendal nerves and arteries reduces sensation and circulation to male genitalia. Longer rides can result in persistent symptoms and urinary tract difficulties in both men and women.

Bicycles seats have evolved from rudimentary cushions with springs to high-tech leather saddles that can cost up to $500.

“Many people make the crucial mistake of buying a wide seat thinking it is more comfortable. Unfortunately, the extra width places painful traction on the pelvis after an extended ride,” said Tom Girard, sales manager at Zane’s Cycles in Branford.

One of the newer design innovations includes an indentation that runs the length of the seat to accommodate nerves and blood vessels.

Girard recommends purchasing a seat that fits the individual, based on some simple measurements. Many companies sell padded shorts designed to fit the style of the seat.

When choosing the components for a new bicycle or tuning up an old favorite, careful attention to the seat can make a cycling workout much more comfortable.

Sports medicine technology showcased

The American College of Sports Medicine (ACSM) met last week in Baltimore – a gathering of thousands of physicians, athletic trainers, exercise physiologists and other professionals involved in sports medicine.

Meetings like this also provide an opportunity for exhibitors to display the latest innovations in sports medicine.

New technology in the area of athletic footwear was prominent. Specifically, shoe inserts and shoe design have undergone radical changes. The newest design has been popularized by brands like MBT, Sketchers, Reebok, New Balance, Nike and Clarks. Allowing for slight variations, these shoes have a rounded, bowed sole and are reported to add an extra element to any workout, allowing more calories to be burned.

Many of the new designs are attempting to emulate a sensation of walking on sand. This allows for the small bones, muscles and tendons of the feet to continue moving. It also creates a soft surface when the foot impacts the ground.

These changes in structure are a sharp diversion from rigid inserts that are designed for more support and restricted movement. Many foot and ankle specialists are skeptical of the claim that these new shoes will help burn calories but agree that they are probably a good investment from the standpoint of comfort.

Nutritional supplements continue to receive a lot of attention. Gatorade has a system of beverages to be used before, during and after competition. Power Bar now has a variety of calorie replacement products and improved flavors.

The field of computerized cognitive testing was an area of interest as health professionals search for better ways of tracking athletes who have suffered concussions. Cog State, the makers of Cog Sport, demonstrated several changes to its program.

As new health care products come to market, it is always wise to get advice before making a large investment.

Athletes can overcome migraine headaches

Migraine headaches affect 28 million Americans. While it is not surprising that many migraine sufferers are also athletes, participation in sports presents a therapeutic challenge.

Migraine headaches are best defined as recurrent headaches that can last anywhere from four to 72 hours. Symptoms include pulsating head pain sometimes accompanied by sensitivity to light and sound, along with nausea and vomiting.

The intense pain of a migraine episode can be precipitated and aggravated by head trauma and physical exertion. Understandably, those factors present tremendous obstacles to effective treatment in athletes. Other causes of migraines include changes in diet, erratic sleep habits and changes in altitude.

Migraine appears to be a disorder involving both the nerves and blood vessels of the brain. After a triggering event, a chemical cascade begins, resulting in dilation of blood vessels in the brain and stretching of nerve endings. The goal of treatment is interrupting or avoiding the chemical cascade before the onset of pain.

Assuring the optimal health and performance of athletes is the responsibility of all sports medicine professionals. Rapid, effective intervention can make the difference in winning or losing a decisive contest.

Terrell Davis, a known migraine sufferer, serves as a good example. In Super Bowl XXXII he was kicked in the head during the second quarter. This triggered a visual aura followed by a headache. The aura left him visually impaired and he was unable to play. At halftime, he was treated with intranasal DHE, a vasoconstrictive medication, and returned in the fourth quarter to become MVP. He later became a spokesman for that medication.

Many effective medications are available for the treatment of migraine but the best approach is often a combination of medications and a regular daily routine.

Warming up reduces chances of groin strains

Among the most common and disabling musculoskeletal injuries in sports is the infamous “groin injury.”

Groin injuries consist of trauma to the groin muscles and tendons. These muscles are located on the inner thigh and consist of the adductor longus, adductor magnus, adductor brevis, gracilis and pectinus muscles.

Groin muscles work together to pull the lower extremity toward the center of the body. A strain occurs when sudden excess force is applied to these muscles or there is chronic repetitive injury resulting in tearing of fibers and swelling.

These injuries are most frequently seen in sports that require powerful leg movements to gain momentum. It has been reported that 10% of all injuries to professional ice hockey and soccer players involve the groin muscles. Athletes who compete in rugby, fencing, hurdling, cross country skiing and football are also prone to groin strain.

Symptoms of a groin strain include pain along the inner thigh on exertion and to touch. In severe cases, bruising may occur.

Groin strains should not be confused with the less common sports hernia. A sports hernia results from thinning abdominal muscles allowing the intestines to rub against the abdominal wall. The pain radiates along the lower abdomen.

Treatment of any muscle strain incorporates rest, ice, compression and elevation (RICE). Anti-inflammatory medications are helpful in managing pain. Recovery involves gentle stretching followed by a gradual return to activity. If an athlete returns to play prematurely, groin strain can become a chronic problem.

A regimen of stretching and strengthening that emphasizes leg and core muscles is crucial to avoid these injuries. “Warming up” should consist of a moderate sport-specific activity both before and after an event.

It is becoming apparent that preparation is imperative to avoid being sidelined by a groin strain.

Spine injuries can be pain in the neck

Golf fans were amazed when Tiger Woods recently withdrew from a golf tournament due to neck pain.

The cervical spine consists of seven bony vertebrae that protect the fragile spinal cord. Emerging from the vertebrae are eight extensions from the spinal cord known as nerve roots. The cervical nerve roots are responsible for sensory and motor functions in the upper extremities.

Discs made of cartilage are positioned between vertebrae to serve as cushions. The discs are held in place by ligaments. Over time, discs become fragile and can move out of place, causing them to herniate.

Whenever there is injury to a nerve root, the term “radiculopathy” is used. The injury is often compressive or inflammatory in origin.

Although neck injuries are commonly seen in collision sports like football and ice hockey, it is not surprising to see it in golf. A powerful golf swing will create a significant amount of torque on the spine, stressing the supporting ligaments.

The evaluation of neck pain consists of a careful physical examination that includes an assessment of strength, sensation and deep tendon reflexes. An imaging study such as a plain X-ray or even an MRI may be necessary.

Conservative treatment often includes rest, anti-inflammatory medication and physical therapy. If this fails, a range of surgical procedures can be explored.

In the case of Tiger Woods, inflammation of a bony piece of vertebra known as a facet is the reason for his pain. This condition makes any neck movement difficult, but he should have a good response to conservative, non-surgical management.

Recognizing the significance of pain and stopping the precipitating activity is crucial, even if it means forfeiting a lucrative golf tournament.

Ban tobacco use in baseball

Young athletes often spend time imitating their sports role models. Mannerisms, attire and style of play are all elements of their admiration. Unfortunately, dangerous behaviors are also often imitated.

Tobacco use in the sport of baseball dates back to its origins in the 19th century. Baseball players originally chewed tobacco to keep their mouths moist in the dusty ball parks. Over time, cigarettes dominated and this was followed by snuff.

Head and neck cancers are often the result of risk factors that initiate changes in the DNA of cells. These changes are known as mutations and cause cells to grow uncontrollably. Eighty-five percent of cancers of the head and neck are associated with some form of tobacco use.
Treatment typically involves a combination of disfiguring surgery, chemotherapy and radiation. These cancers affect the ability to speak and eat.

In the 1990s, major league baseball initiated programs that resulted in banning tobacco products by minor league players while at the ballpark. These programs have resulted in a decline in the use of tobacco products among current players. Unfortunately, tobacco use continues to be permitted in the major leagues.

Congressional hearings recently raised the issue of prohibiting the use of all tobacco products by major league players while at the ballpark. This cannot be enacted without the approval of the player’s union. Regrettably, the player’s union currently defends the rights of its members to use these products while in the public eye.

Successful athletes recognize the importance of being in peak physical condition and there is no role for tobacco products in reaching this goal. Hopefully, the players’ association will soon come to realize the importance of protecting its members’ health as well as their rights.

Female athletes at risk for concussion

Over the past 30 years, the number of women participating in team sports has steadily increased. Many now begin as young girls and continue through college and into the professional ranks. While this expanded involvement has been a positive step, the number of catastrophic injuries in women has also risen.

The National Center for Catastrophic Sports Injury Research defines these injuries as:

• Fatal
• Non-Fatal — permanent, severe, functional disability
• Serious — no permanent, functional disability, but severe injury.

During the 1982-83 academic year, the first time period data was collected, only one female catastrophic injury was recorded. Over the past 28 years there has been an average of 8.5 catastrophic injuries per year reported in females.

Among the catastrophic injuries most commonly seen is mild traumatic brain injury in the form of concussion. Concussive injuries can span all three classifications of catastrophic injury. Typical symptoms include headache, dizziness and inability to concentrate.

A recent study reviewed 1,425 patients who had suffered concussion and looked at the severity of post-concussive symptoms three months after injury. The severity of symptoms was significantly greater in females. Specifically, the symptoms were most severe in women of childbearing age. This suggests a possible association between concussion and hormonal balance.

Female soccer players have an especially high rate of concussion due to head-to-head contact, head contact with other body parts and head-to-ground contact. Women are believed to under-report concussions and render themselves susceptible to repeat injury. Multiple head injuries can lead to prolonged cognitive impairment.

Due to the information now available, coaches, athletic trainers and physicians must recognize gender differences when diagnosing and rehabilitating women with concussion.

Lacrosse’s popularity has led to rise in injuries

Lacrosse is the oldest team sport in North America and the fastest growing team sport in the United States. There is also a rise in the number of injuries associated with this collision sport.

Male lacrosse players wear protective equipment that includes a helmet with a full facemask similar to those worn in hockey. They also wear shoulder pads, a mouth guard and arm pads with gloves.

Injuries in men’s lacrosse can be divided into two categories:

• Injuries above the waist: These injuries are generally the result of direct contact. Rules allow for body and stick checking when players possess or are within 5 yards of the ball. Head injuries in the form of concussion are the most common above-the-waist injury. This is followed by shoulder and other upper extremity injuries.

• Injuries below the waist: These account for approximately 40% of lacrosse injuries and are non-contact in nature. Lower extremity injuries result from pivoting and twisting and most often involve the ankle, upper leg and knee. Damage to ligaments in the form of sprains and tears are common along with muscle strains.

Women’s lacrosse is a non-collision sport. Despite the lack of contact, lower extremity injuries are similar to those seen in men.

The use of protective equipment in the women’s game is controversial. Eye protection only became mandatory three years ago.

“The use of protective goggles in women’s lacrosse has resulted in a dramatic decline in eye injuries,” said Janeen Beetle, head athletic trainer at Norwich Free Academy.

Impact injuries to the head and face from flailing sticks and balls moving at high velocity continue to cause contusions and lacerations. Requiring head protection has been proposed.

As the sport of lacrosse continues to increase in popularity, appropriate safety equipment must also be reconsidered.

Concussion bill would protect young athletes

Much has been written about the tragedies resulting from repetitive concussions in sports. Connecticut may soon be the third state to attack this growing problem.

Concussion is a physiologic disruption of brain function caused by biomechanical forces. There are about 3.8 million sports-related concussions in the United States each year. As youth sports participation rises, so have the number of concussions.

Typical symptoms include headache, confusion and unsteadiness. Resolution of symptoms varies between minutes to months. In more severe situations, these symptoms are permanent and may be accompanied by depression or learning disabilities.

There are two important steps necessary to treat concussion:

• Recognition – Athletes, coaches and parents must be aware of the symptoms of concussion and responsibly report them to the athletic trainer or physician involved in the activity.
  
  
• Return – Determining when it is safe for an athlete to safely return after a concussion is a complex decision that takes into account many factors. This decision should only be made by a qualified physician with experience treating brain injuries.

“We can easily teach the public about the signs and symptoms of concussion, but the decision of safe return is infinitely more complex,” said Dr. Jeffrey Kutcher, a sports neurologist who addressed the American Academy of Neurology at their recent annual meeting.

Connecticut Bill No. 456, introduced by state Senators Thomas Gaffey and Martin Looney, with local sponsorship from Senator Andrea Stillman, addresses these issues. If passed, the bill would require attendance at a certified course dealing with the recognition of concussion as part of obtaining a coaching permit. It would also require written clearance by a licensed health care professional trained in the evaluation and management of concussions.

Passage of this bill and its proper implementation represent a major step toward protecting young athletes.

Warm up before you ‘Play ball!’

Every spring like clockwork, athletes run to their closets and retrieve their baseball gloves to begin the summer ritual of tossing a baseball. Older participants in this time-honored ritual should proceed with caution or be faced with a possible career-ending injury.

Throwing a baseball or softball involves the coordinated movement of multiple joints.
Contracting and relaxing muscles control the bones that make up individual joints. The principal joints involved are:

• Shoulder — a ball and socket joint consisting of the humerus and scapula
• Elbow — a complex joint that contains three separate joints: the humerus-ulna, humerus-radial and radial-ulna
• Wrist — among the most intricate joints because of the interface of many bones.

Stressing these areas before stretching the appropriate muscles and tendons can result in tearing. Professional baseball players all have a program for stretching and strengthening the upper extremities that is followed religiously.

“A proper stretching routine should be performed with gentle movement and without pain. Bouncing or jerking movements must be avoided,” said Debbie Gardiner, a physical therapist and certified athletic trainer at Procare Physical Therapy in Willimantic. A short toss at half speed should follow stretching. Gradually increasing distance and power is advisable before throwing hard.

Baseball and softball coaches who throw long sessions of batting practice and warm up the pitchers can be particularly vulnerable to injury as they age. Coaches should stretch along with players.

Pain is the best indication that a problem exists and is most likely due to inflammation. Rest and ice are recommended. “Playing through” arm pain can have disastrous consequences.

Consultation with a certified athletic trainer to establish an arm program for any throwing athlete is a worthwhile investment. The program should be a year-round effort for optimal performance.

Health history crucial to treat young athletes

The Health Information Portability and Accountability Act (HIPAA) was enacted in 1996 to protect the privacy and confidentiality of patients’ health information. Unfortunately, it has also created a potentially deadly situation in sports medicine.

It is imperative that coaches, athletic trainers and team physicians have complete medical information on every athlete. HIPAA has unintentionally created an obstacle to the free exchange of health records.

Professional athletes agree to release all medical information as part of their contractual obligation. In boxing, a fighter must allow free access to medical data before being allowed to fight in any jurisdiction. The health records shared among various state boxing commissions have avoided many disasters.

College athletes are protected by the Family Educational Rights and Privacy Act (FERPA) that allows for the free flow of records within their educational institution.

Ironically, it is high school and youth sports athletes who are most impacted by this obstruction. In an effort to protect the rights of young athletes, many have been left vulnerable due to incomplete medical information regarding medical conditions, allergies and prescribed drugs.

Typically, the breakdown occurs between school health officials and athletic trainers. Athletic trainers are the conduit between coaches and health providers. Often, athletic trainers are employed by entities contracted to provide services to a school. This business relationship has mistakenly been interpreted as an obstacle.

“As we improve communication and protect patients’ privacy, HIPAA was never intended to compromise the communication among care givers,” said Glenn Stadnick, Corporate Compliance and Privacy Officer at Backus Hospital.

Penalties for violating HIPAA have only been levied when the information is used for malicious intent or financial gain.

Parents can protect their children by making sure they directly provide the athletic trainer or youth coach with accurate, complete medical information.

You can’t coast through an indoor cycling workout

Indoor cycling programs were originally designed to prepare participants for the outdoor season. Over the past 25 years, group indoor cycling classes have risen in popularity and in many cases are the only exposure to the sport of cycling.

Indoor cycling has become synonymous with the trademarked term “spinning.” The stationary bicycles used are fully adjustable and have a weighted flywheel that provides increasing momentum with each rotation. A key element to each workout is the ability to rapidly change the resistance necessary to drive the flywheel.

Different muscles are exercised based on whether the rider is sitting or standing and the position of the hands. Varying the pedaling cadence will also alter the work out.

Classes generally last one hour and the person leading the group will design a workout that is accompanied by high-energy music. A grimacing facial expression is typical of participants, based on the grueling nature of these workouts.

“Indoor cycling workouts are more difficult because the rider must use different muscles to control the momentum of the flywheel. As opposed to traditional cycling, there is no way to coast,” said Marc Nee, a personal trainer and owner of “Training with Heart.”

Lisa Weir, a spinning instructor at World Gym in Norwich, has been teaching spinning for two years. She previously taught aerobics and step classes. “The biggest advantage to spinning is the outstanding cardiovascular workout along with strengthening core muscles,” said Weir.

After researching this column, the temptation of personally experiencing one of these sessions was too great. I invited my friend, former professional baseball player and talk show host, Lee Elci, to join me in this challenge. We decided to attend a class at the Fitness Club in Old Saybrook.

At the end of the one-hour session both Lee and I, who work out regularly, clearly understood why these classes are so challenging. “I was most impressed by the rapid pace, allowing my heart rate to remain elevated throughout the class,” said Elci.

Overall, indoor cycling classes are a great way to get in shape for summer cycling or simply to improve aerobic fitness. The camaraderie of a class lead by a good instructor makes the experience worthwhile and enjoyable.

Red Sox prospect faces long road to recovery

When a patient presents with neurologic complaints of headaches and numbness, it is always cause for concern. If the patient is a healthy young professional athlete, it is alarming.

Last week, a cavernous angioma was discovered to be the reason for similar symptoms in Red Sox prospect Ryan Westmoreland.

A cavernous angioma is an abnormal mass of blood vessels. Although often inherited, the condition can be seen sporadically. The shape is similar to a raspberry with dilated areas where blood pools. Small hemorrhage is often the first symptom as opposed to an aneurysm where bleeding is explosive.

Location of this mass of blood vessels dictates the surgical difficulty. In the case of Westmoreland, it was located in the brain stem, making the situation more challenging.

The brain stem is the lower part of the brain where vital reflex functions like breathing and heart rate are regulated. Coordinated eye movements are also controlled in this delicate network of nerves and blood vessels.

Dr. Gregory Criscuolo, a neurosurgeon on the Backus Hospital Medical Staff who practices at Eastern Connecticut Neurosurgery, has operated on a similar lesion in another patient. “Surgery is potentially curable but there is a high likelihood of some permanent deficit,” said Criscuolo.

Hitting a baseball demands extremely precise eye-hand coordination to visualize the spin and direction of a high velocity pitch and to react appropriately. Any neurologic deficits like disequilibrium or double vision are career-ending in baseball.

Even in the best clinical situation, where there is no neurologic deficit, it is unlikely that Westmoreland will return to full activity this season.

The potentially life-threatening nature of this condition will make Westmoreland’s recovery and hopeful return to professional baseball exciting to watch.

Echocardiograms can save athletes’ lives

Chicago Bears’ defensive end Gaines Adams died in January of this year. Despite being in excellent physical condition, he was the victim of a potentially deadly heart condition known as Hypertrophic Cardiomyopathy (HCM).

HCM refers to abnormal enlargement of the heart muscle. It is an inherited disorder affecting one in every 500 people. Typical symptoms are brought on during exercise and include:

• Shortness of breath
• Chest pain
• Loss of consciousness
• Dizziness
• Fatigue
• Heart palpitations

Unfortunately, the first sign of HCM may be sudden death, as in the case of Adams. HCM accounts for 26 percent of all cases of sudden death in athletes.

The dilemma is that an enlarged heart is not uncommon in athletes. One of the benefits of intense training is that the heart muscle increases in size, allowing it to pump more blood with less effort. That is why most athletes have lower heart rates than the average person.

The definitive way of resolving this dilemma is by performing an echocardiogram. This test uses ultrasound technology to image the heart’s chambers and valves while measuring the volume of blood being pumped.

While cost is not an issue at the professional and collegiate levels, it is a tremendous obstacle for the millions of high school and youth sports athletes.

Norwich cardiologist Dr. John Foley, a member of the Backus Hospital Medical Staff, recommends a thorough pre-participation physical evaluation for every child partaking in a sports activity.

“Physicians performing these examinations should have a low threshold for ordering an ECG or echocardiogram when they suspect a problem,” said Foley.

Cost should not be an issue when dealing with a life-threatening problem like HCM.

Cardiac screening is crucial for athletes

Sudden cardiac death is always tragic. When it strikes highly trained athletes at the peak of their careers, further investigation must be carried out.

Locally, the 2007 death of Norwich Free Academy athlete Larry Pontbriant has resulted in legislation requiring the availability of automated external defibrillators (AEDs) at all high school athletic events in Connecticut. AEDs provide an electrical shock to the heart in order to correct a potentially fatal condition called arrhythmia.

Designing an effective cardiac screening program presents a challenge.

Ways to perform non-invasive assessments of the heart range from simply listening with a stethescope to highly technical imaging procedures. Some of those are:

• Auscultation — listening to heart sounds with a stethoscope. This is performed routinely as part of a pre-participation physical that should be required for all athletic activities at every level. Detection of a murmur or abnormal sound indicates the need for further evaluation.
• Electrocardiogram (ECG) — this examination provides an electrical map of cardiac function. It can detect a potentially fatal arrhythmia but provides only a snapshot while the athlete is relaxed.
• Cardiac Stress Test — evaluates the heart while the athlete is active, typically running on a treadmill.
• Echocardiography — allows visual examination of the heart’s chambers and valves through ultrasound.

The principle issue regarding the use of these examinations centers on cost.

At a recent American Heart Association meeting, one presentation addressed the ECG as a cost-effective way to screen student-athletes. The recent decline in the cost of laptop ECG machines allowed the authors to study every competitive sports athlete in a suburban high school for less than $3 each after an initial investment of $500 per school.

As technology progresses, sports medicine professionals must constantly re-evaluate the most efficient ways of screening athletes properly.