Severity of spinal fractures can vary

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

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

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

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

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

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

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

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

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

Paddleboarding provides core workout

One of the newest water sports devices that is rapidly growing in popularity is the stand-up paddle board. This device can now be seen on many calm, protected bodies of water. 

Typical dimensions are 12 feet long and 31 inches wide with a weight of about 30 pounds. These boards are surprisingly stable and can support up to 275 pounds.

The fitness aspect includes using core muscles to generate power and maintain balance. Core muscles include lower abdominal muscles that run from the lower rib cage to the pelvis. Low back muscles and ligaments that support the spine are also crucial to providing stability.

Upper leg muscles deliver strength to the hips and are involved in stabilizing the torso during lateral movements.

Muscles throughout the upper extremities from the shoulders to the hands are important for paddling. Although paddleboarding is typically performed on calm bodies of water, any waves or swift currents can quickly increase the intensity of a paddling workout.

Among the greatest health risks the elderly face are falls. This problem is sometimes a result of poor balance and an inability to recover quickly. Paddleboarding and other activities that demand good balance can develop skills that may avoid these dangers in the future. Interestingly, some paddleboarders have incorporated yoga exercises while paddleboarding.

Stretching is always advised before any athletic activity and paddleboarding is no exception. Like kayaks and windsurfers, paddleboards are water vessels and a personal flotation device should always be worn.

In addition to the fitness aspects of paddleboarding, many have been drawn to this activity for its peaceful nature and opportunity to relax.

Paddleboarding presents an opportunity for people with average athletic skills to engage in a new activity.

Foot care integral to athletic success

Among the physical obstacles athletes can face are conditions that affect the feet. Many of these problems can be avoided with good preventive care.

Some common injuries such as sprains, strains and fractures result in painful movement and swelling. These conditions trigger an inflammatory response that will often prohibit further activity and may require a long layoff from a chosen activity.

Another group of conditions that specifically affect the skin, soft tissues and nails may not prohibit activity but can impede optimal performance. Surprisingly, many of these problems are avoidable.
Athlete’s foot is the result of a fungal infection that typically begins in the web area between the toes. A warm, dark, humid environment is a perfect setting for a fungal infection.

Blisters occur with friction from ill-fitting shoes. The inflamed area can easily breakdown and become infected with a variety of organisms. These are particularly dangerous in athletes with diabetes who may have impaired circulation.

When toenails grow into the fleshy borders of the nails they become ingrown and can be a painful site of infection. The toenails are also potential areas for fungal infection, creating a condition known as onchomycosis.

Many of these problems can be avoided through regular inspection of the feet and proper trimming of the nails. Professional foot care may be necessary.

Drs. Karla and Michael Scanlon, podiatrists from eastern Connecticut, offer advice for optimal foot health. After events, wash and dry feet thoroughly and allow sneakers to air-dry completely. Use moisture-wicking socks and change them when damp. Always wear shower shoes when using a public facility. Use Lysol liberally on them and other athletic footwear at least once weekly.

Practicing good foot hygiene can keep athletes performing at their best.

Keep active to ward off fibromyositis

Fibromyositis is a medical term used to describe chronic inflammation of muscles and connective tissue.  It often results in joint stiffness and intense muscle pain.  An unlikely, but effective treatment for this condition is exercise.

Currently, fibromyositis is used interchangeably with a common and equally debilitating condition known as fibromyalgia.  This latter problem is estimated to affect five million Americans.

Similar symptoms of widespread pain and fatigue are found in both conditions but additional symptoms of sleep disturbances and psychological distress are more profound in fibromyalgia.

Fatigue is a big factor in both conditions. The fatigue is most likely related to the increased exertion required to perform even simple tasks and a disturbance in sleep patterns. This can lead to profound depression.

Non-narcotic medications such as anti-inflammatory medications and anti-seizure drugs have been used successfully. Antidepressants have the advantage of providing pain relief and improving a patient's spirits. It must be emphasized that narcotic drugs should never be used for chronic pain.

Regular exercise provides an interesting adjunctive therapy to medications. Multiple studies have demonstrated that moderately intense aerobic exercise can improve pain thresholds.

A typical regimen should include adequate stretching and a program such as low-impact aerobic dance, tai chi or an aquatic exercise.  Light resistive exercises are also helpful.   Any program should be adjusted to the patient’s pain tolerance to assure adherence to the program.

"I believe exercise programs are beneficial because they help to develop better coping skills to deal with the condition,” states Norwich rheumatologist, Dr. Harjinder Chowdhary, who treats many patients with fibromyalgia. “This may be related to a release of naturally-present brain chemicals known as endorphins that can reduce pain.".

A regular exercise program will build stamina and improve any person's physical appearance despite the presence of a chronic painful condition. 

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN.  He can be reached at agalessi@alessimd.com.

Effects of head trauma can be felt beyond just football, boxing

Pat Grange was a healthy 27-year-old soccer player in 2010 when he was diagnosed with Amyotrophic Lateral Sclerosis (ALS) also known as Lou Gehrig’s disease.  He passed away two years later.

ALS is a neurodegenerative disease that affects motor nerves at their origin in the spinal cord.  It results in profound muscle wasting and loss of motor function.  Its victims lose their ability to speak and breathe.  ALS does not affect sensory function or the ability to think clearly.

Pat Grange’s situation was unique.  He was much younger than the average patient with ALS and he had suffered repeated head trauma in the form of heading the soccer ball.  A previous study of Italian soccer players showed that they were six times more likely to develop ALS than the normal population.  

Grange’s family generously donated his brain for study to investigate a potential link between repeated head trauma and degeneration of the nervous system that appears in the form of chronic traumatic encephalopathy (CTE).  Researchers reported that based on the study of Grange’s brain there was a link.

The hallmark of CTE is the deposition of a  protein in  specific areas of the brain along with brain atrophy.  It has been most widely reported in football players and other athletes who play violent collision sports. 

At this time, the diagnosis of CTE can only be made after a person’s death.  The finding of CTE in Pat Grange is the first time it has been described in a soccer player.

Although some members of the scientific community have speculated that there is a link between heading the ball and ALS, many believe it is a premature conclusion. 

Repeated blows to the head will result in chronic symptoms and should be discouraged, especially in young athletes, but any link between heading and CTE will require more study. 

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN.  He can be reached at agalessi@alessimd.com

NFL trust looks out for former players

Approximately 20,000 athletes have played in the NFL since its inception.  Despite this relatively small number, many of these men are among the most severely injured in sports.

Football is a high-velocity, collision sport.  Success is based on the ability to resist injury and tolerate pain.  Many of the injuries incurred while playing become chronic and lead to lifelong debility.  Although many injuries are orthopedic, an increasing number of traumatic brain injuries and psychiatric problems are emerging.

Sadly, little has been done to support these former football players and their families.  Some have moved into other professions that provide health benefits.  Others have been left to find entitlement programs where health care is limited and preventive care is non-existent.

Fortunately, in the most recent collective bargaining agreement, active NFL players negotiated for approximately $200 million to be set aside for the ongoing health care of former players.  The program through which this is administered, currently known as “The Trust,” has become much more than a health program.

“The Trust is a set of resources, programs and services designed to provide former players with the support, skills and tools to help ensure success off the field and in life after football,” states Bahati VanPelt, executive director of The Trust.

The Trust consists of six pillars that address brain and body, career, education, finances, personal interaction and lifestyle.  The brain and body pillar utilizes national health centers at the Cleveland Clinic, Tulane University and the University of North Carolina.

“I received the most comprehensive medical evaluation I have had since playing in the NFL,” reports former player, Bernard Whittington.

The Trust is a unique program.  Establishing a system of care for former players by active players sends an important message to skeptical sports fans that it’s not always about the money.

Genomics could hold the key to improved athletic performance

Genomics is a scientific discipline that may have significant impact on the future of athletics at all levels.

The human body consists of approximately 50 trillion cells.  Each cell contains a nucleus with 46 pairs of chromosomes.  Half of these are maternal, the other half paternal.  Chromosomes are made of DNA and a gene is a distinct section of DNA that determines particular characteristics such as hair color, height and eye color.  Some genes increase the likelihood of developing diseases like cancer, hemophilia and Alzheimer’s.

The human genome is the complete set of genetic information for humans.  Mapping the human genome remains the “holy grail” of genetics.  Caenorhabditis elegans (C. elegans) is a tiny worm.  It is also the first multicellular organism whose entire genome has been mapped. 

Considering it takes only three days to mature from birth to adulthood and the entire lifecycle is only two weeks, C. elegans provides an excellent opportunity for scientific study.  It can be studied under a variety of conditions and cellular damage assessed.  More importantly, these studies can provide a key to how an organism can adapt.

“When dealing with stress, human metabolism must adjust and this results in fatigue and diminished concentration.  Experiments have shown that C. elegans can be acclimated to heat and stress,” states Dr. Elaine Lee, assistant professor of kinesiology at the University of Connecticut and a leading genetics researcher.

Stress includes conditions such as heat, dehydration, illness, infection, inadequate sleep and poor diet.  These can all result in cell damage.  The cumulative effect not only results in poor athletic performance but also leaves athletes vulnerable to more severe injury.

Genomics can lead to information on how organisms adapt to stress.  The correct balance of aerobic and resistive exercise, along with proper diet, can lead to resistance to illness as well as improved athletic performance.

Interestingly, the key to these breakthroughs may depend on genetic studies performed on a worm that is just one millimeter in size.

Professional athletes not immune to strokes

 

A stroke is the result of a blockage or a tear in a blood vessel that brings blood to the brain.  Among the last people expected to suffer a stroke are professional athletes.

On Jan. 29, Kris Letang, a National Hockey League defenseman for the Pittsburgh Penguins, developed unremitting symptoms of dizziness and nausea.  A thorough medical work-up revealed his symptoms to be the result of a stroke.  Further evaluation discovered a patent foramen ovale (PFO).

PFO is a hole between the upper two chambers of the heart called the atria.  The hole is the result of incomplete closure of a wall that forms between these two structures in the developing fetus.  A PFO is estimated to be found in between 25 and 40 percent of adults.

Obviously, not everyone with a PFO suffers a stroke and in fact, there are no typical symptoms of a PFO.  Nevertheless, Kris Letang has joined a growing list of athletes who have suffered strokes associated with a PFO.  Among the most notable members of this group is Teddy Bruschi.

Letang is expected to make a full recovery and return to hockey in six weeks thanks to quick action and his good health. The controversy is whether the PFO should be repaired.

“Studies looked at closure of PFOs as a means of reducing recurrent stroke and it did not make a difference,” states Dr. Anita Kelsey, a cardiologist and director of the Women’s Heart Program at St. Francis Hospital.  These studies compared closure to medical treatment with blood thinners.

Athletes’ hearts undergo large shifts in pressure during competition and workouts.  It is also unwise for contact sports athletes to be on blood thinning medications. These factors favor surgical repair.

In summary, there is no definitive direction for treatment of PFOs in athletes. More detailed studies in this population are necessary.

Dr. Alessi is an on-air contributor for ESPN and can be reached at agalessi@alessimd.com.

Mental training critical for Olympians

Competing at the Olympic level requires superior physical training and skill. Today, mental training has become a huge component in preparing for competition at this level.

One obstacle to performing at the highest level is anxiety. Performance anxiety is the result of a malfunction in a complex neurologic system.

The human brain is organized into two basic structures. The diencephalon is the reflex portion. Some examples of these reflexes include breathing or removing an extremity from a painful surface. The telencephalon is the thinking portion that controls cognitive activity.

The “fight or flight” response is a reflex that includes a wave of adrenaline resulting in increased heart rate, rapid breathing and tremors. This response is typically brought on by fear. When this reflex redirects the thinking portion of the brain, havoc can ensue.

If the “fight or flight” response can be channeled by the cognitive regions, the energy produced can result in a phenomenal performance. It is the goal of sports psychologists to provide the necessary tools for athletes to harness this energy and direct it appropriately.

Similar to physical training, this is accomplished by practice. Mental and physical repetition of a skill or presentation makes the process more automatic and smooth.

A basic approach involves identifying a goal, visualizing the goal and then blocking out distractions.

“The mental side of sport is actually the mental side of preparation. Many athletes work hard but they don’t work with purpose. One principal aspect of sports psychology is learning how to integrate the mental side with physical preparation,” states Dr. Douglas Gardner, a sports psychologist who works with many amateur and professional athletes.

Application of this approach to training for any endeavor can result in new levels of success.

Russian boxer's plight shows dangers of combat sports

Magomed Abdusalamov is a professional heavyweight fighter who has reached the highest level of his sport. On Nov. 2, 2013, two hours after a brutal 10-round decision loss at Madison Square Garden, Abdusalamov became comatose and remains hospitalized.

Combat sports include boxing and a variety of mixed martial arts contests.  Points are usually scored by successfully neurologically impairing an opponent.

Little has been revealed about Abdusalamov’s injuries other than the fact that he suffered a brain hemorrhage.  Based on descriptions, he most likely suffered an epidural hemorrhage.

An epidural hemorrhage often results from tearing the middle meningeal arteries after a skull fracture.  Blunt trauma is the most common cause as opposed to a concussion that is usually caused by rapid acceleration and deceleration of the brain. Headgear is more effective in avoiding skull fractures and hemorrhages than it is in avoiding concussion.

Epidural hemorrhages are arterial in origin and therefore occur quickly and with large volumes of blood making them especially serious if not detected quickly. A typical presentation includes a brief loss of consciousness followed by a lucid period during which the hemorrhage expands.  This is followed by a deep coma.

During the lucid period, there are few findings to raise suspicion of this deadly condition.

Treatment includes removing the blood and part of the skull to allow the brain to swell without causing deadly levels of pressure within the closed cranium.  Patients are often placed in a medically-induced coma to slow brain metabolism and control swelling.

Abdusalamov has now emerged from coma and has hopefully begun the long process of rehabilitation that includes retraining the brain to perform basic functions like speaking and eating.

This tragedy serves as a grim reminder that combat sports are more than the difference between a win or loss but may be life or death.