Muscular dystrophy is a progressive disorder that results in severe disability and in some forms, death. The fact that it targets muscle and causes wasting and weakness makes the announcement this month that a competitive PGA Tour golfer has been suffering from a form of muscular dystrophy for more than a year amazing.
Morgan Hoffman is a 28-year-old professional golfer who in November, 2016, was diagnosed with Fascioscaphohumeral Muscular Dystrophy (FSHD). He recounts his odyssey in a first person account in The Players’ Tribune beginning with his earliest symptom of wasting of his right pectoral (chest) muscle in 2011.
Muscular dystrophy was first described in the mid-1800s as a progressive wasting of muscles seen in male members of the same family. This eventually became known as Duchenne Muscular Dystrophy, the most well-known and deadly of this category of diseases.
FSHD is a variation of muscular dystrophy that targets the face, arms and chest muscles. It does not affect respiratory or cardiac muscles, thus it does not limit a person’s longevity. It does result in profound weakness, making a continued successful career in professional sports remarkable.
Physical therapy should be aimed towards optimizing function of unaffected muscles. Overworking involved muscles will not improve strength but will lead to painful muscle cramps. Non-steroidal anti-inflammatory drugs can be used if pain is a factor.
“Isolation of the gene involved in some forms of FSHD on chromosome 4 has lead to exciting research and hopefully a genetic treatment for FSHD,” reports Catherine Alessi, MD, a neuromuscular fellow at the University of Connecticut.
Golf requires core strength and careful coordination of upper and lower extremity muscles making Hoffman’s success noteworthy and encouraging for others.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Steelers’ Shazier suffered a spinal concussion
Last week, Pittsburgh Steelers’ linebacker, Ryan Shazier, attempted to tackle an opposing player with his head down. This position transmitted sudden pressure from the brain to the spinal canal and resulted in paralysis. This type of non-penetrating spinal trauma is also known as a spinal concussion.
A concussion is a syndrome of immediate and transient neurologic impairment that results from a biomechanics force being applied to the nervous system.
Although the term has become synonymous with a brain injury, it can also be applied to the spinal cord.
The spinal cord contains an extensive network of nerve tracts that provide sensory and motor function to the extremities. It is divided into the cervical, thoracic, lumbar and sacral levels. The uppermost cervical level contains fibers extending to both the upper and lower extremities.
Like brain concussion, spinal concussion is the mildest form of trauma when considering a range that extends to penetrating trauma as the most severe form. Mild injuries typically do not produce any changes on CT scans or other imaging studies.
The pathology involved in this type of trauma is typically severe inflammation and swelling. There is a response to cellular injury where electrolytes that typically reside outside the cell rush inward through a breech in the nerve cell membrane causing swelling within the cell and eventual cell death.
Typical symptoms are immediate sensory loss and paralysis of the affected limbs. Careful positioning and stabilization of the spine are critical on the field, followed by ambulance transport to a hospital. Hospital care includes imaging with CT or MRI and may include treatment with steroids to reduce swelling.
Fortunately, most spinal concussions, like brain concussions, can fully resolve with little to no permanent damage. Hopefully, this is also the case for Shazier.
Editor’s note: The Steelers placed Shazier on injured reserve on Tuesday. The 25-year-old Shazier underwent spinal stabilization surgery last week and remains in the hospital.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
A concussion is a syndrome of immediate and transient neurologic impairment that results from a biomechanics force being applied to the nervous system.
Although the term has become synonymous with a brain injury, it can also be applied to the spinal cord.
The spinal cord contains an extensive network of nerve tracts that provide sensory and motor function to the extremities. It is divided into the cervical, thoracic, lumbar and sacral levels. The uppermost cervical level contains fibers extending to both the upper and lower extremities.
Like brain concussion, spinal concussion is the mildest form of trauma when considering a range that extends to penetrating trauma as the most severe form. Mild injuries typically do not produce any changes on CT scans or other imaging studies.
The pathology involved in this type of trauma is typically severe inflammation and swelling. There is a response to cellular injury where electrolytes that typically reside outside the cell rush inward through a breech in the nerve cell membrane causing swelling within the cell and eventual cell death.
Typical symptoms are immediate sensory loss and paralysis of the affected limbs. Careful positioning and stabilization of the spine are critical on the field, followed by ambulance transport to a hospital. Hospital care includes imaging with CT or MRI and may include treatment with steroids to reduce swelling.
Fortunately, most spinal concussions, like brain concussions, can fully resolve with little to no permanent damage. Hopefully, this is also the case for Shazier.
Editor’s note: The Steelers placed Shazier on injured reserve on Tuesday. The 25-year-old Shazier underwent spinal stabilization surgery last week and remains in the hospital.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Wrist, hand injuries a concern in youth sports
Youth sports injuries have become a topic of concern for physicians, coaches and athletes. The biggest fear centers on how these injuries will affect a child’s growth and intellectual abilities.
Among the injuries that have raised the most interest is concussion. But a recent study published this month in the medical journal for Pediatrics reports that the rates of injuries to the wrist and hand are unusually high.
Sports such as football, ice and field hockey, lacrosse, softball and wrestling were most represented in frequency of injury. Overall, any stick, puck, ball or contact sport can have a high rate of injury. The human wrist is a complex joint that consists of 15 bones that form connections enabling the wrist to move in multiple planes.
The carpal bones in the hand attach to the two bones of the forearm: the ulna and radius.
These bones are connected to each other as well as various muscles by an intricate network of tendons and ligaments. Blood vessels and nerves are intertwined in this grid to provide circulation and sensation.
The most common injuries cited in the study include fracture, contusion, and ligament sprain in descending order of frequency. While most of the injured athletes were able to return to their sports in seven days or less, 12.4 per cent were out for more than three weeks.
Initial treatment often includes rest, ice and immobilization but some fractures may require surgery.
“Persistent pain and swelling after a wrist or hand injury in a child requires further evaluation by a physician,” reports Dr. Joel Ferreira, an Assistant Professor of Orthopaedics at the University of Connecticut, where he specializes in hand and wrist injuries. “Imaging studies may be necessary to rule out fractures affecting the growth plate that may result in a chronic condition.”
Prompt evaluation and treatment of hand and wrist injuries in young athletes can help speed recovery.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Among the injuries that have raised the most interest is concussion. But a recent study published this month in the medical journal for Pediatrics reports that the rates of injuries to the wrist and hand are unusually high.
Sports such as football, ice and field hockey, lacrosse, softball and wrestling were most represented in frequency of injury. Overall, any stick, puck, ball or contact sport can have a high rate of injury. The human wrist is a complex joint that consists of 15 bones that form connections enabling the wrist to move in multiple planes.
The carpal bones in the hand attach to the two bones of the forearm: the ulna and radius.
These bones are connected to each other as well as various muscles by an intricate network of tendons and ligaments. Blood vessels and nerves are intertwined in this grid to provide circulation and sensation.
The most common injuries cited in the study include fracture, contusion, and ligament sprain in descending order of frequency. While most of the injured athletes were able to return to their sports in seven days or less, 12.4 per cent were out for more than three weeks.
Initial treatment often includes rest, ice and immobilization but some fractures may require surgery.
“Persistent pain and swelling after a wrist or hand injury in a child requires further evaluation by a physician,” reports Dr. Joel Ferreira, an Assistant Professor of Orthopaedics at the University of Connecticut, where he specializes in hand and wrist injuries. “Imaging studies may be necessary to rule out fractures affecting the growth plate that may result in a chronic condition.”
Prompt evaluation and treatment of hand and wrist injuries in young athletes can help speed recovery.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Improper use of smelling salts a growing concern
Athletes are always looking for an edge that will improve performance.
Often these efforts are ill-advised and at times harmful. One practice that has become popular among high-level athletes is the use of smelling salts to increase alertness.
Smelling salts consist of spirits of ammonia. The use of smelling salts dates back to the Roman Empire but they became popular during the Victorian era. They were used to help revive women who were fainting.
Syncope or fainting is a loss of consciousness as a result of a slowed heart rate triggered by a vagal reflex. This reflex is often initiated by dehydration, anxiety or pain. Ammonia salts directly irritate the nasal mucosa and elicit a noxious reflex. This causes the heart to beat faster and hopefully counteract the vagal response.
Approximately 50 years ago, they became popular in sports to supposedly counteract the effects of head trauma. Smelling salts became popular in boxing where their use eventually was banned.
Trauma patients often suffer neck injuries that may be undetected. The first response to the noxious smell is to suddenly jerk the head away from the stimulus. This can result in dislocating an injured spine and potential paralysis.
More recently, athletes have begun to use smelling salts with the belief that their use will keep them more alert.
The use of smelling salts is particularly popular among football and hockey players who believe this reflex will counteract the effects of concussion.
Recent estimates report 80 percent of NFL players using smelling salts, according to a recent article in ESPN The Magazine.
It is only natural that athletes at lower levels will follow this practice.
Smelling salts should only be used in limited situations under the guidance of a health professional.
Coaches, parents and athletic trainers are crucial to ending the inappropriate use of smelling salts in young athletes.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport.
Often these efforts are ill-advised and at times harmful. One practice that has become popular among high-level athletes is the use of smelling salts to increase alertness.
Smelling salts consist of spirits of ammonia. The use of smelling salts dates back to the Roman Empire but they became popular during the Victorian era. They were used to help revive women who were fainting.
Syncope or fainting is a loss of consciousness as a result of a slowed heart rate triggered by a vagal reflex. This reflex is often initiated by dehydration, anxiety or pain. Ammonia salts directly irritate the nasal mucosa and elicit a noxious reflex. This causes the heart to beat faster and hopefully counteract the vagal response.
Approximately 50 years ago, they became popular in sports to supposedly counteract the effects of head trauma. Smelling salts became popular in boxing where their use eventually was banned.
Trauma patients often suffer neck injuries that may be undetected. The first response to the noxious smell is to suddenly jerk the head away from the stimulus. This can result in dislocating an injured spine and potential paralysis.
More recently, athletes have begun to use smelling salts with the belief that their use will keep them more alert.
The use of smelling salts is particularly popular among football and hockey players who believe this reflex will counteract the effects of concussion.
Recent estimates report 80 percent of NFL players using smelling salts, according to a recent article in ESPN The Magazine.
It is only natural that athletes at lower levels will follow this practice.
Smelling salts should only be used in limited situations under the guidance of a health professional.
Coaches, parents and athletic trainers are crucial to ending the inappropriate use of smelling salts in young athletes.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport.
As cheerleading evolves, injuries continue to rise
The controversy over whether cheerleading should be classified as a sport or an activity is ongoing. One thing that is not disputed is that cheerleaders are athletes with athletic injuries.
Cheerleading first became prominent in the late 19th century in Ivy League schools. In the 1920s, it became more common in other universities. Interestingly, it was a male-dominated activity until the 1940s when many men had enlisted in the military.
The two venues today for cheerleading are scholastic, where the emphasis is placed on energizing the crowd for a sporting event, and competitive, consisting of cheerleading squads that compete in front of judges for points.
The basic cheerleading skills include tumbling, jumping and stunting. Stunting involves complex formations of team members and airborne acrobatics. As cheerleading has evolved, it is stunting that has gained the most attention.
The participants in stunting are classified as “base” and “flyers.”
Several recent publications have looked at the most dangerous youth sports. Cheerleading is on all these lists and considered the most dangerous in a report published by the National Center for Catastrophic Sports Injury Research.
Lower extremity injuries are the most common and include sprains and strains. The most catastrophic injuries involve the brain and spinal cord in the form of traumatic brain injuries and spinal injuries that result in temporary or permanent paralysis.
These injuries have been on the rise due to the growing popularity of cheerleading and the increasing complexity of the stunts being performed.
The American Academy of Pediatrics has called for changes to make cheerleading safer. Among these is the need for coaches at all levels to be properly trained and certified to direct stunting maneuvers and be able to recognize head injuries.
Parents should not be shy about inquiring about any coach’s credentials when it comes to their child’s safety.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Cheerleading first became prominent in the late 19th century in Ivy League schools. In the 1920s, it became more common in other universities. Interestingly, it was a male-dominated activity until the 1940s when many men had enlisted in the military.
The two venues today for cheerleading are scholastic, where the emphasis is placed on energizing the crowd for a sporting event, and competitive, consisting of cheerleading squads that compete in front of judges for points.
The basic cheerleading skills include tumbling, jumping and stunting. Stunting involves complex formations of team members and airborne acrobatics. As cheerleading has evolved, it is stunting that has gained the most attention.
The participants in stunting are classified as “base” and “flyers.”
Several recent publications have looked at the most dangerous youth sports. Cheerleading is on all these lists and considered the most dangerous in a report published by the National Center for Catastrophic Sports Injury Research.
Lower extremity injuries are the most common and include sprains and strains. The most catastrophic injuries involve the brain and spinal cord in the form of traumatic brain injuries and spinal injuries that result in temporary or permanent paralysis.
These injuries have been on the rise due to the growing popularity of cheerleading and the increasing complexity of the stunts being performed.
The American Academy of Pediatrics has called for changes to make cheerleading safer. Among these is the need for coaches at all levels to be properly trained and certified to direct stunting maneuvers and be able to recognize head injuries.
Parents should not be shy about inquiring about any coach’s credentials when it comes to their child’s safety.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Learning about shin splints and leg pain
Long distance runners are in the midst of both cross-country and marathon running seasons. Running on trails or asphalt can lead to lower leg pain. Shin splints, also known as medial tibial stress syndrome, is a general term used to describe lower leg pain.
The lower portion of the leg consists of two large bones: the tibia and the fibula. A membrane between these bones, the interosseous membrane and the anterior intermuscular septum, form four compartments. These compartments consist of an intricate network of muscles, arteries, veins and nerves that allows the ankle to move in multiple directions.
Shin splints are often associated with changes in running patterns. They can be attributed to using different types of footwear including excessively worn running shoes, rapidly increasing running distances and association with other injuries in the same or opposite extremity.
Compartment syndrome is among the most serious conditions that may be mistaken for shin splints. This syndrome consists of increased pressure within one of the four compartments of the lower leg. The increased pressure is a direct result of an injury causing swelling within a closed space.
The increased compartment pressure results in an inability for venous blood to drain and arterial blood to enter. The consequence is a lack of nutrients and oxygenated blood to muscles and nerves causing these tissues to atrophy and cease to function.
“The first step in treating shin splints is to find the cause,” reports Ms. Janeen Beetle, head athletic trainer at Norwich Free Academy. “Ice cup massage combined with anti-inflammatory medications provides the best treatment. Strengthening lower extremity muscles can help prevent recurrences.”
Careful evaluation of lower leg pain can avoid serious complications.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
The lower portion of the leg consists of two large bones: the tibia and the fibula. A membrane between these bones, the interosseous membrane and the anterior intermuscular septum, form four compartments. These compartments consist of an intricate network of muscles, arteries, veins and nerves that allows the ankle to move in multiple directions.
Shin splints are often associated with changes in running patterns. They can be attributed to using different types of footwear including excessively worn running shoes, rapidly increasing running distances and association with other injuries in the same or opposite extremity.
Compartment syndrome is among the most serious conditions that may be mistaken for shin splints. This syndrome consists of increased pressure within one of the four compartments of the lower leg. The increased pressure is a direct result of an injury causing swelling within a closed space.
The increased compartment pressure results in an inability for venous blood to drain and arterial blood to enter. The consequence is a lack of nutrients and oxygenated blood to muscles and nerves causing these tissues to atrophy and cease to function.
“The first step in treating shin splints is to find the cause,” reports Ms. Janeen Beetle, head athletic trainer at Norwich Free Academy. “Ice cup massage combined with anti-inflammatory medications provides the best treatment. Strengthening lower extremity muscles can help prevent recurrences.”
Careful evaluation of lower leg pain can avoid serious complications.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
What does CTE really mean?
The recent information that former New England Patriots football player, Aaron Hernandez, was found to have evidence of Chronic Traumatic Encephalopathy (CTE) at autopsy has been followed by multiple opinions and at least one lawsuit.
Before drawing conclusions it is important to understand CTE and what the initial scientific studies really mean.
CTE is a diagnosis based on post-mortem findings of the brain. The diagnosis is actually a refinement of the previous findings of Dr. Harrison Martland, a medical examiner in Newark, N.J., who first described post-mortem changes in the brains of boxers in 1928.
A hallmark of CTE is the presence of tau protein, a substance that naturally occurs in nerve cells and appears to leak from the cells with repeated head trauma. The amount and distribution of the staining for tau coincide with the severity of CTE.
Although the predominant studies have been done on a group of deceased football players, many of whom have faced some life challenges, a direct causation between football and CTE has not been established.
One challenge with this condition is the fact that this can only be diagnosed after death. A study published last week in the journal PLOS ONE reports the identification of a potential biomarker to diagnose CTE in the living. The protein, known as CCL11, can be found in the spinal fluid of patients suspected of suffering from CTE.
It is important to note that no one has firmly linked the actions of someone with the CTE findings. The only thing we do know is that there are changes in the brain after repeated blows.
CTE research is ongoing and there is much to learn about chronic brain injury and its relation to sports. It is unfair and dangerous to make clinical assumptions that affect society and peoples’ lives at this early stage of investigation.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Before drawing conclusions it is important to understand CTE and what the initial scientific studies really mean.
CTE is a diagnosis based on post-mortem findings of the brain. The diagnosis is actually a refinement of the previous findings of Dr. Harrison Martland, a medical examiner in Newark, N.J., who first described post-mortem changes in the brains of boxers in 1928.
A hallmark of CTE is the presence of tau protein, a substance that naturally occurs in nerve cells and appears to leak from the cells with repeated head trauma. The amount and distribution of the staining for tau coincide with the severity of CTE.
Although the predominant studies have been done on a group of deceased football players, many of whom have faced some life challenges, a direct causation between football and CTE has not been established.
One challenge with this condition is the fact that this can only be diagnosed after death. A study published last week in the journal PLOS ONE reports the identification of a potential biomarker to diagnose CTE in the living. The protein, known as CCL11, can be found in the spinal fluid of patients suspected of suffering from CTE.
It is important to note that no one has firmly linked the actions of someone with the CTE findings. The only thing we do know is that there are changes in the brain after repeated blows.
CTE research is ongoing and there is much to learn about chronic brain injury and its relation to sports. It is unfair and dangerous to make clinical assumptions that affect society and peoples’ lives at this early stage of investigation.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Ankle sprains becoming more common among athletes
As athletes are drawn to more extreme sports that involve increasingly challenging terrain, the frequency of ankle injuries increases. Depending on the severity, ankle injuries can require an extended period of rehabilitation.
The ankle joint is made up of three bones — the tibia and fibula that make up the lower part of the leg and the talus that is part of the foot. A complex network of ligaments that allow the foot to bend upward and downward holds the joint together.
The principal mechanism of injury involves a forceful overpowering of the ligaments in a variety of directions. This type of injury is known as a sprain. The most common ankle injuries are the inversion, eversion and high ankle sprains.
The inversion ankle sprain is the result of suddenly turning the foot inward and damaging the ligaments on the outside of the ankle joint. An eversion sprain is the consequence of the foot turning outward and stressing the ligaments on the inside of the ankle.
A high ankle sprain is the result of injury to the ligaments that attach the tibia and fibula. It is caused by the sudden rotation of the foot outward.
The best treatment approach to an ankle sprain is the RICE protocol (Rest, Ice, Compression, Elevation). Reducing blood circulation to ligaments diminishes the availability of factors that aid healing.
“Sprains can take a long time to recover,” states Dr. Lauren Geaney, Assistant Professor of Orthopedic Surgery at the University of Connecticut, who specializes in foot and ankle injuries. “Ice and elevation in the early stages and early mobilization and strengthening as soon as the swelling and pain allow. Surgery is rarely needed and almost never indicated during early recovery.”
Appropriate treatment of ankle sprains can avoid having them develop into a chronic problem.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu.
The ankle joint is made up of three bones — the tibia and fibula that make up the lower part of the leg and the talus that is part of the foot. A complex network of ligaments that allow the foot to bend upward and downward holds the joint together.
The principal mechanism of injury involves a forceful overpowering of the ligaments in a variety of directions. This type of injury is known as a sprain. The most common ankle injuries are the inversion, eversion and high ankle sprains.
The inversion ankle sprain is the result of suddenly turning the foot inward and damaging the ligaments on the outside of the ankle joint. An eversion sprain is the consequence of the foot turning outward and stressing the ligaments on the inside of the ankle.
A high ankle sprain is the result of injury to the ligaments that attach the tibia and fibula. It is caused by the sudden rotation of the foot outward.
The best treatment approach to an ankle sprain is the RICE protocol (Rest, Ice, Compression, Elevation). Reducing blood circulation to ligaments diminishes the availability of factors that aid healing.
“Sprains can take a long time to recover,” states Dr. Lauren Geaney, Assistant Professor of Orthopedic Surgery at the University of Connecticut, who specializes in foot and ankle injuries. “Ice and elevation in the early stages and early mobilization and strengthening as soon as the swelling and pain allow. Surgery is rarely needed and almost never indicated during early recovery.”
Appropriate treatment of ankle sprains can avoid having them develop into a chronic problem.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu.
Ex-UConn, sports medicine doctor will be missed
Last week, with the sudden passing of Dr. Jeffrey Anderson, the UConn athletics family and athletes everywhere lost a compassionate physician and strong advocate for health and safety in sports. Dr. Anderson was head team physician for UConn from 1993-2014. He left that position to take on the challenges of directing student health services at UConn while serving as the impartial administrator for Major League Baseball and the Major League Baseball Players Association Joint Drug Prevention and Treatment Program.
Dr. Anderson graduated from the University of Michigan Medical School, where he did his residency in Family Medicine. This provided him with a broad medical background that he decided to apply to sports medicine. He did a fellowship in Primary Care Sports Medicine (PCSM) before taking the position at UConn.
PCSM, a relatively new field thirty years ago, has continued to grow and attract many bright young physicians. Prior to the increased involvement of primary care physicians, orthopedic surgeons managed most of sports medicine.
The increasing complexities of sports performance have resulted in the expansion of the sports medicine team. Dr. Anderson saw the need before others and invited a variety of specialists to join him including this writer.
PCSM fellowships are open to physicians who have completed residencies in family medicine, emergency medicine, pediatrics or internal medicine. The principal focus of these specialists is non-operative orthopedic problems and general medical conditions.
Another crucial role of the PCSM physician is preventing injury. This often involves counseling athletes and creating an effective rehabilitation program.
Knowledge of performance enhancing drugs and how they are used has become another important facet to PCSM. In many of these situations athletes are trying to gain an edge by taking supplements that unknowingly contain banned substances. These circumstances can only be avoided by education.
Dr. Anderson was masterful at treating and protecting athletes while providing an example for other physicians.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu.
Dr. Anderson graduated from the University of Michigan Medical School, where he did his residency in Family Medicine. This provided him with a broad medical background that he decided to apply to sports medicine. He did a fellowship in Primary Care Sports Medicine (PCSM) before taking the position at UConn.
PCSM, a relatively new field thirty years ago, has continued to grow and attract many bright young physicians. Prior to the increased involvement of primary care physicians, orthopedic surgeons managed most of sports medicine.
The increasing complexities of sports performance have resulted in the expansion of the sports medicine team. Dr. Anderson saw the need before others and invited a variety of specialists to join him including this writer.
PCSM fellowships are open to physicians who have completed residencies in family medicine, emergency medicine, pediatrics or internal medicine. The principal focus of these specialists is non-operative orthopedic problems and general medical conditions.
Another crucial role of the PCSM physician is preventing injury. This often involves counseling athletes and creating an effective rehabilitation program.
Knowledge of performance enhancing drugs and how they are used has become another important facet to PCSM. In many of these situations athletes are trying to gain an edge by taking supplements that unknowingly contain banned substances. These circumstances can only be avoided by education.
Dr. Anderson was masterful at treating and protecting athletes while providing an example for other physicians.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu.
Health protocols vital for scholastic sports
Millions of students will be returning to scholastic sports in the coming weeks. Reducing the risk of catastrophic injury is a priority for everyone involved in sports.
The most common causes of sudden death in athletes are cardiac, neurologic and heat-related. Measures to minimize tragedies associated with these conditions include effective screening of athletes and the availability of established protocols with appropriate resuscitative equipment in the event of an emergency.
Cardiac conditions can be effectively screened based on careful evaluation of symptoms and testing performed on athletes who have a significant personal or family history of cardiac arrhythmias. The availability of an AED (automated external defibrillator) at all athletic events has proven to be lifesaving.
Traumatic brain injuries result from high-velocity impact causing hemorrhage and swelling in the brain. Recognizing the signs and symptoms of this injury and taking immediate steps can avoid a tragedy. Any athlete who sustains head trauma should be removed from play and evaluated.
Exertional heat stroke occurs when the body temperature reaches 105 degrees Fahrenheit. Symptoms include confusion, lightheadedness and headache. If untreated, persistent hyperthermia will result in coma and death.
One effective way to avoid these catastrophes is to have appropriate protocols and policies in place. Among these are emergency action plans (EAPs) that apply to each situation.
In a recent report published in the Orthopedic Journal of Sports Medicine, Connecticut ranked 38th in a survey of all states with respect to having the proper protocols in place.
“EAPs are a no-cost way to facilitate communication across all key stakeholders for athletics programs and reduce critical delays in care for athletes,” reports Samantha Scarneo, Director of Sport Safety at the Korey Stringer Institute at UConn and one of the study’s authors.
Every school should have a plan that can be easily put into action to deal with medical emergencies on the athletic field.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
The most common causes of sudden death in athletes are cardiac, neurologic and heat-related. Measures to minimize tragedies associated with these conditions include effective screening of athletes and the availability of established protocols with appropriate resuscitative equipment in the event of an emergency.
Cardiac conditions can be effectively screened based on careful evaluation of symptoms and testing performed on athletes who have a significant personal or family history of cardiac arrhythmias. The availability of an AED (automated external defibrillator) at all athletic events has proven to be lifesaving.
Traumatic brain injuries result from high-velocity impact causing hemorrhage and swelling in the brain. Recognizing the signs and symptoms of this injury and taking immediate steps can avoid a tragedy. Any athlete who sustains head trauma should be removed from play and evaluated.
Exertional heat stroke occurs when the body temperature reaches 105 degrees Fahrenheit. Symptoms include confusion, lightheadedness and headache. If untreated, persistent hyperthermia will result in coma and death.
One effective way to avoid these catastrophes is to have appropriate protocols and policies in place. Among these are emergency action plans (EAPs) that apply to each situation.
In a recent report published in the Orthopedic Journal of Sports Medicine, Connecticut ranked 38th in a survey of all states with respect to having the proper protocols in place.
“EAPs are a no-cost way to facilitate communication across all key stakeholders for athletics programs and reduce critical delays in care for athletes,” reports Samantha Scarneo, Director of Sport Safety at the Korey Stringer Institute at UConn and one of the study’s authors.
Every school should have a plan that can be easily put into action to deal with medical emergencies on the athletic field.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
New CTE study provides uncertain link to football
A recent study published in the Journal of the American Medical Association-Neurology looks at the first large-scale study of the brains of deceased American football players. This study has attracted the attention of the media and comes at a time when parents must decide whether to permit their children to play football this season.
The study reports the results of neuropathological and clinical studies performed on 202 football players. The athletes studied played at multiple levels of competition: 14 high school, 53 college, 14 semiprofessional, eight Canadian Football League and 110 National Football League.
The principal neurological condition studied was Chronic Traumatic Encephalopathy (CTE). This entity has been studied in a variety of forms since Dr. Harrison Martland published his original studies in JAMA in 1928 titled “Punch Drunk.”
In 2009, Dr. Ann McKee and her colleagues at Boston University published a seminal paper in the Journal of Neuropathology describing CTE in three professional athletes. That same group published this most recent study. The pathology in CTE is based on brain atrophy and the deposition of tau protein. Tau protein is a normal constituent of the brain that is believed to leak after trauma.
Clinical findings in CTE are primarily changes in behavior, motor abnormalities and dementia. These features can be present in isolation or in total. Several of the athletes studied committed suicide.
The recent study reports an escalating frequency of CTE based on the level of football played. The percentage of players affected increased from 21 per cent of high school players to 99 per cent of NFL players.
Although this study demonstrates an association between CTE and football it does not prove that football is the cause of this condition. Among the faults in this study is “selection bias.” This refers to the fact that the only athletes who volunteered were those who had clinical symptoms. Healthy football players who went on to successful careers and stable family lives were not part of this study.
Unfortunately, this study provides little direction for parents who are faced with a difficult decision. Several important factors to consider are whether a child has had previous concussions, if the child is of high school age and how important playing football is to the child’s overall well being.
Football is a great sport but parents must make responsible decisions regarding participation in any high-velocity collision sport.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
The study reports the results of neuropathological and clinical studies performed on 202 football players. The athletes studied played at multiple levels of competition: 14 high school, 53 college, 14 semiprofessional, eight Canadian Football League and 110 National Football League.
The principal neurological condition studied was Chronic Traumatic Encephalopathy (CTE). This entity has been studied in a variety of forms since Dr. Harrison Martland published his original studies in JAMA in 1928 titled “Punch Drunk.”
In 2009, Dr. Ann McKee and her colleagues at Boston University published a seminal paper in the Journal of Neuropathology describing CTE in three professional athletes. That same group published this most recent study. The pathology in CTE is based on brain atrophy and the deposition of tau protein. Tau protein is a normal constituent of the brain that is believed to leak after trauma.
Clinical findings in CTE are primarily changes in behavior, motor abnormalities and dementia. These features can be present in isolation or in total. Several of the athletes studied committed suicide.
The recent study reports an escalating frequency of CTE based on the level of football played. The percentage of players affected increased from 21 per cent of high school players to 99 per cent of NFL players.
Although this study demonstrates an association between CTE and football it does not prove that football is the cause of this condition. Among the faults in this study is “selection bias.” This refers to the fact that the only athletes who volunteered were those who had clinical symptoms. Healthy football players who went on to successful careers and stable family lives were not part of this study.
Unfortunately, this study provides little direction for parents who are faced with a difficult decision. Several important factors to consider are whether a child has had previous concussions, if the child is of high school age and how important playing football is to the child’s overall well being.
Football is a great sport but parents must make responsible decisions regarding participation in any high-velocity collision sport.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
MMA fighters risk lives during bouts
Recent deaths during combat sports events have attracted the attention of fans and officials. The circumstances surrounding these catastrophes require further review.
As opposed to boxing, Mixed Martial Arts allows the application of multiple fighting disciplines including: wrestling, judo, Brazilian Jiu-Jitsu, boxing and Muay Thai kickboxing. The variety of these skills has helped attract fans who follow and participate in these martial arts primarily for fitness and self-defense.
Unfortunately, the operative word in these contests is “combat” and it is meant to be taken literally. These amateur and professional fighters are placed in a situation where the body invokes the “fight or flight” response. This reflex causes the heart to race, muscles to tighten, blood pressure to rise and glucose to elevate. Essentially, these changes prepare the human body for battle. This level of stress demands that the athlete be in excellent condition.
Since 2007, at least 15 MMA fighters have died either preparing for or during a contest. Two of those deaths have occurred in the last six weeks.
Tim Hague, an MMA fighter, died in a boxing match in Edmonton, Alberta, after a punishing blow resulted in a brain hemorrhage. Donshay White died of what is believed to be a cardiac event after an amateur MMA event.
Pre-fight medical requirements vary among states and Native American tribal jurisdictions. Although not perfect, these studies are important to screen for potential tragedies.
“Deaths in combat sports are unfortunate occurrences. Uniform medical requirements across all state and tribal commissions must be established,” reports Mr. Michael Mazzulli who heads the Mohegan Tribe Department of Athletic Regulation and currently serves as president of the United States Association of Boxing Commissions. “In Connecticut, the medical regulations are identical for the State, Mashantucket-Pequot and Mohegan commissions.”
Despite its popularity, participants in MMA contests must realize that potential death is a very real risk.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
As opposed to boxing, Mixed Martial Arts allows the application of multiple fighting disciplines including: wrestling, judo, Brazilian Jiu-Jitsu, boxing and Muay Thai kickboxing. The variety of these skills has helped attract fans who follow and participate in these martial arts primarily for fitness and self-defense.
Unfortunately, the operative word in these contests is “combat” and it is meant to be taken literally. These amateur and professional fighters are placed in a situation where the body invokes the “fight or flight” response. This reflex causes the heart to race, muscles to tighten, blood pressure to rise and glucose to elevate. Essentially, these changes prepare the human body for battle. This level of stress demands that the athlete be in excellent condition.
Since 2007, at least 15 MMA fighters have died either preparing for or during a contest. Two of those deaths have occurred in the last six weeks.
Tim Hague, an MMA fighter, died in a boxing match in Edmonton, Alberta, after a punishing blow resulted in a brain hemorrhage. Donshay White died of what is believed to be a cardiac event after an amateur MMA event.
Pre-fight medical requirements vary among states and Native American tribal jurisdictions. Although not perfect, these studies are important to screen for potential tragedies.
“Deaths in combat sports are unfortunate occurrences. Uniform medical requirements across all state and tribal commissions must be established,” reports Mr. Michael Mazzulli who heads the Mohegan Tribe Department of Athletic Regulation and currently serves as president of the United States Association of Boxing Commissions. “In Connecticut, the medical regulations are identical for the State, Mashantucket-Pequot and Mohegan commissions.”
Despite its popularity, participants in MMA contests must realize that potential death is a very real risk.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Patellar tendon injuries are more common than you think
Dustin Fowler recently made his major league debut in the outfield for the New York Yankees. Unfortunately, his appearance was cut short when he ran into a wall trying to make a play. As a result, he suffered an open rupture of his patellar tendon requiring urgent surgery and months of rehabilitation.
Although rupture is uncommon, injuries to the patellar tendon are often seen in athletes. The patellar tendon is the principal connection between the patella (knee cap) and the tibia. The fact that it connects two bones actually makes it a ligament by definition.
The quadriceps tendon attaches the quadriceps muscle to the patella. Together with the patellar tendon, it plays a crucial role in the extensor mechanism of the knee. This provides stability when the leg is straightened. Weakness and swelling from sprain or rupture will result in a loss of power when extending the leg and potentially the leg collapsing.
Early symptoms include knee pain that worsens with any exertion. This increasing discomfort is often a warning to an impending rupture. An athlete should begin a regimen of rest, ice and possibly anti-inflammatory medications. If the inflammation becomes chronic the tendon will lose elasticity over time and lead to tearing and rupture.
“Common scenarios for injury include: a misstep when going downstairs, stepping into a hole unexpectedly, or slipping on wet grass in which one leg has to sustain body weight,” states Dr. Cory Edgar, Assistant Professor of Orthopedics at the University of Connecticut and Head Team Physician at the Coast Guard Academy.
“The good news is rupture of the patellar tendon is very easy to repair surgically but requires 3-6 months of recovery during which the first 2-3 weeks are very limiting.”
In the case of Dustin Fowler, the rupture was the result of direct trauma without warning signs. Careful attention to knee pain on exertion can avoid serious injury.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Although rupture is uncommon, injuries to the patellar tendon are often seen in athletes. The patellar tendon is the principal connection between the patella (knee cap) and the tibia. The fact that it connects two bones actually makes it a ligament by definition.
The quadriceps tendon attaches the quadriceps muscle to the patella. Together with the patellar tendon, it plays a crucial role in the extensor mechanism of the knee. This provides stability when the leg is straightened. Weakness and swelling from sprain or rupture will result in a loss of power when extending the leg and potentially the leg collapsing.
Early symptoms include knee pain that worsens with any exertion. This increasing discomfort is often a warning to an impending rupture. An athlete should begin a regimen of rest, ice and possibly anti-inflammatory medications. If the inflammation becomes chronic the tendon will lose elasticity over time and lead to tearing and rupture.
“Common scenarios for injury include: a misstep when going downstairs, stepping into a hole unexpectedly, or slipping on wet grass in which one leg has to sustain body weight,” states Dr. Cory Edgar, Assistant Professor of Orthopedics at the University of Connecticut and Head Team Physician at the Coast Guard Academy.
“The good news is rupture of the patellar tendon is very easy to repair surgically but requires 3-6 months of recovery during which the first 2-3 weeks are very limiting.”
In the case of Dustin Fowler, the rupture was the result of direct trauma without warning signs. Careful attention to knee pain on exertion can avoid serious injury.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Hip pain in athletes not easy to diagnose
Hip pain is a frequent injury in athletes who participate in sports requiring running and jumping. The variability of presenting symptoms and pathology make correct diagnosis and treatment a challenge.
The hip joint is a ball and socket joint between the femur (thigh) and the pelvis. The head of the femur articulates with the acetabulum of the pelvis.
The pelvis is made up of three bones: the ilium, ischium and pubis. These bones come together in the acetabulum. A cartilaginous rim around the acetabulum called the labrum holds the femur in place.
A complex network of ligaments, nerves and blood vessels holds this joint together. Injury to any of these structures can result in pain that is often difficult to localize.
Athletes typically suffer from a variety of overuse syndromes of the hip. The pain in these syndromes is the result of inflammation, arthritis and fractures. Hip pain in young athletes is often related to overuse and can lead to lifetime difficulties unless activities are restricted.
Direct trauma to the pelvis can result in hip and pelvic fractures. A “hip pointer injury” is often seen in high-velocity collision sports like football and hockey when a blow to the rim of the pelvis results in hemorrhage.
Hip pain can also be referred to the low back and be mistaken for a spine injury. Only after careful examination by a qualified physician can the differential be clarified.
“The treatment of hip injuries in elite and recreational athletes is finally beginning to catch up to the treatments we know are routinely successful for shoulder and knee injuries,” reports Dr. Michael Joyce, Co-Director Connecticut Sports Medicine Institute. “Minimally invasive arthroscopic procedures allow athletes the potential to come back from injuries that were once considered career-ending.”
Early diagnosis and treatment are critical to resolving hip pain in athletes.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
The hip joint is a ball and socket joint between the femur (thigh) and the pelvis. The head of the femur articulates with the acetabulum of the pelvis.
The pelvis is made up of three bones: the ilium, ischium and pubis. These bones come together in the acetabulum. A cartilaginous rim around the acetabulum called the labrum holds the femur in place.
A complex network of ligaments, nerves and blood vessels holds this joint together. Injury to any of these structures can result in pain that is often difficult to localize.
Athletes typically suffer from a variety of overuse syndromes of the hip. The pain in these syndromes is the result of inflammation, arthritis and fractures. Hip pain in young athletes is often related to overuse and can lead to lifetime difficulties unless activities are restricted.
Direct trauma to the pelvis can result in hip and pelvic fractures. A “hip pointer injury” is often seen in high-velocity collision sports like football and hockey when a blow to the rim of the pelvis results in hemorrhage.
Hip pain can also be referred to the low back and be mistaken for a spine injury. Only after careful examination by a qualified physician can the differential be clarified.
“The treatment of hip injuries in elite and recreational athletes is finally beginning to catch up to the treatments we know are routinely successful for shoulder and knee injuries,” reports Dr. Michael Joyce, Co-Director Connecticut Sports Medicine Institute. “Minimally invasive arthroscopic procedures allow athletes the potential to come back from injuries that were once considered career-ending.”
Early diagnosis and treatment are critical to resolving hip pain in athletes.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Be wary of skin conditions during summer sports
Summer sports present new challenges for protection from skin conditions that can potentially affect athletic performance. Specifically, sunburn and skin cancers have become increasingly troublesome.
The human skin constitutes the largest organ in the human body. It is designed to protect the body from harmful microbes. It also has a system of glands, nerves and blood vessels that allow the skin to regulate temperature.
The skin is divided into three levels: the epidermis, dermis and hypodermis. The epidermis is the outermost layer that provides a barrier against the elements. The dermis contains the sweat glands, hair follicles and connective tissue. The hypodermis consists of adipose tissue that insulates the human body. Blood vessels dilate and constrict to allow for cooling and warmth.
Chronic and acute exposure to harmful ultraviolet rays will result in skin damage. Acute damage typically appears in the form of a burn with reddening of the skin and blistering. This leads to pain and the blisters create the potential for infection.
Chronic exposure can result in skin cancer. Skin cancer is the most common form of cancer in the United States, affecting one in five Americans according to the American Academy of Dermatology.
Basal cell carcinoma and melanoma may be prevented through the use of lotions containing an SPF (skin protection factor) of 30 or greater. Athletic clothing should have a UPF (ultraviolet protection factor) of 50 or more.
“Most skin conditions that come as a result of summer sports can be prevented if precautions are taken ahead of time,” reports Dr. Jennifer Pennoyer, a board certified dermatologist practicing at Pennoyer Dermatology in Bloomfield. “Anticipating potential exposure as well as regular skin checks can avoid a lot of anguish.”
Athletes rely on skin and sweat glands to regulate large variations in climatic conditions during workouts. Skin care can keep an athlete competing longer.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
The human skin constitutes the largest organ in the human body. It is designed to protect the body from harmful microbes. It also has a system of glands, nerves and blood vessels that allow the skin to regulate temperature.
The skin is divided into three levels: the epidermis, dermis and hypodermis. The epidermis is the outermost layer that provides a barrier against the elements. The dermis contains the sweat glands, hair follicles and connective tissue. The hypodermis consists of adipose tissue that insulates the human body. Blood vessels dilate and constrict to allow for cooling and warmth.
Chronic and acute exposure to harmful ultraviolet rays will result in skin damage. Acute damage typically appears in the form of a burn with reddening of the skin and blistering. This leads to pain and the blisters create the potential for infection.
Chronic exposure can result in skin cancer. Skin cancer is the most common form of cancer in the United States, affecting one in five Americans according to the American Academy of Dermatology.
Basal cell carcinoma and melanoma may be prevented through the use of lotions containing an SPF (skin protection factor) of 30 or greater. Athletic clothing should have a UPF (ultraviolet protection factor) of 50 or more.
“Most skin conditions that come as a result of summer sports can be prevented if precautions are taken ahead of time,” reports Dr. Jennifer Pennoyer, a board certified dermatologist practicing at Pennoyer Dermatology in Bloomfield. “Anticipating potential exposure as well as regular skin checks can avoid a lot of anguish.”
Athletes rely on skin and sweat glands to regulate large variations in climatic conditions during workouts. Skin care can keep an athlete competing longer.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Wrist injuries common in sports, can lead to long-term disability
Boston Red Sox second baseman Dustin Pedroia was placed on the disabled list Tuesday after spraining his wrist during a game against the Chicago White Sox on Monday. Peoria’s case is not uncommon since hand and wrist injuries account for up to 25 percent of all sports-related injuries, according to a study published in the Journal of Orthopaedic Surgery and Research last year.
Another recent study revealed that 14.8 percent of youth athletes have suffered upper extremity injuries and 9 percent of those involved the wrist. These injuries account for a significant number of emergency room visits. The correct diagnosis and treatment of wrist injuries can be challenging and lead to extended periods of inactivity and rehabilitation.
The wrist joint is a complex joint that is formed by the connection of the forearm to the hand. The principal forearm bones are the ulna and radius. Although there are eight carpal bones in the hand, only the scaphoid and lunate directly articulate with the radius and ulna.
These bones are held together by a series of ligaments that permit free movement of the joint. The median, ulnar and radial nerves are the principal nerves that innervate the hand. These nerves are intimately associated with the bones and ligaments as they traverse the wrist.
The most common injuries to the wrist are fractures, ligamentous injuries (loose ligaments) and tendonitis. A typical mechanism for an acute injury is falling on an outstretched hand, which is how Pedroia was injured. Although this happen in any sport, it is especially common in snowboarding and contact sports.
Chronic injuries are commonly seen in overuse. These are the result of repetitive movements often seen in racquet sports, golf and gymnastics.
Particular attention should be paid to young athletes who are more prone to overuse injuries as the wrist joints develop.
“Wrist injuries can be worse than you think,” reports Dr. Joel Ferreira, Assistant Professor of Orthopaedics at UConn. “An injury that may feel like a sprain may actually be a fracture or a severe ligament tear. Persistent injuries should be evaluated by a physician with special training and access to advanced imaging techniques.”
Sports-related wrist injuries can lead to long-term disability if not treated properly.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Another recent study revealed that 14.8 percent of youth athletes have suffered upper extremity injuries and 9 percent of those involved the wrist. These injuries account for a significant number of emergency room visits. The correct diagnosis and treatment of wrist injuries can be challenging and lead to extended periods of inactivity and rehabilitation.
The wrist joint is a complex joint that is formed by the connection of the forearm to the hand. The principal forearm bones are the ulna and radius. Although there are eight carpal bones in the hand, only the scaphoid and lunate directly articulate with the radius and ulna.
These bones are held together by a series of ligaments that permit free movement of the joint. The median, ulnar and radial nerves are the principal nerves that innervate the hand. These nerves are intimately associated with the bones and ligaments as they traverse the wrist.
The most common injuries to the wrist are fractures, ligamentous injuries (loose ligaments) and tendonitis. A typical mechanism for an acute injury is falling on an outstretched hand, which is how Pedroia was injured. Although this happen in any sport, it is especially common in snowboarding and contact sports.
Chronic injuries are commonly seen in overuse. These are the result of repetitive movements often seen in racquet sports, golf and gymnastics.
Particular attention should be paid to young athletes who are more prone to overuse injuries as the wrist joints develop.
“Wrist injuries can be worse than you think,” reports Dr. Joel Ferreira, Assistant Professor of Orthopaedics at UConn. “An injury that may feel like a sprain may actually be a fracture or a severe ligament tear. Persistent injuries should be evaluated by a physician with special training and access to advanced imaging techniques.”
Sports-related wrist injuries can lead to long-term disability if not treated properly.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Even professional athletes not immune to the yips
Some athletes have faced the sad situation where, for no apparent reason, they suddenly lose the ability to perform a basic skill that was previously effortless. Although most commonly seen in golf and baseball, it also has been known to occur in place-kickers and musicians who have reached the highest levels in their fields.
Commonly known as the “yips,” the cause and treatment continue to elude physicians, psychologists and other sports medicine specialists. There is no consensus regarding a physical or psychological origin of this problem. In baseball, the yips have detoured the careers of Rick Ankiel, Steve Sax and Chuck Knoblauch to name a few.
Many specialists believe the yips are the result of a movement disorder best classified as a focal dystonia. The most common example of a focal dystonia is writer’s cramp.
Movement disorders are neurologic disorders that affect the brain’s ability to execute smooth, coordinated movements. The brain consists of a variety of regions that contribute to movement. These include the cortex, basal ganglia and brain stem. Communication among these areas is accomplished through neurochemicals. Any imbalance in these substances will result in an abnormality.
One part of this chain of activity that is believed to play a crucial role in the yips is proprioception. This is the ability for the brain to recognize the position of an extremity in space. A change in the usual position of the arm when throwing may be the initial disruption of the chain of events.
“Sensorimotor retraining exercises, oral medications and Botox injections can help with the dystonia,” reports Dr. Bernardo Rodrigues, a neurologist specializing in the treatment of movement disorders at UConn. “In some cases, Deep Brain Stimulation (DBS) surgery can also be offered to aggressively treat this condition.”
The yips may be more than a psychological condition and treatment with appropriate medications can possibly revive a failing career.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Commonly known as the “yips,” the cause and treatment continue to elude physicians, psychologists and other sports medicine specialists. There is no consensus regarding a physical or psychological origin of this problem. In baseball, the yips have detoured the careers of Rick Ankiel, Steve Sax and Chuck Knoblauch to name a few.
Many specialists believe the yips are the result of a movement disorder best classified as a focal dystonia. The most common example of a focal dystonia is writer’s cramp.
Movement disorders are neurologic disorders that affect the brain’s ability to execute smooth, coordinated movements. The brain consists of a variety of regions that contribute to movement. These include the cortex, basal ganglia and brain stem. Communication among these areas is accomplished through neurochemicals. Any imbalance in these substances will result in an abnormality.
One part of this chain of activity that is believed to play a crucial role in the yips is proprioception. This is the ability for the brain to recognize the position of an extremity in space. A change in the usual position of the arm when throwing may be the initial disruption of the chain of events.
“Sensorimotor retraining exercises, oral medications and Botox injections can help with the dystonia,” reports Dr. Bernardo Rodrigues, a neurologist specializing in the treatment of movement disorders at UConn. “In some cases, Deep Brain Stimulation (DBS) surgery can also be offered to aggressively treat this condition.”
The yips may be more than a psychological condition and treatment with appropriate medications can possibly revive a failing career.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Spinal fusion surgery helping athletes extend careers
Spinal fusion procedures have become increasingly common. Among the patients who have undergone this procedure are athletes with spinal injuries, including Peyton Manning and Tiger Woods. This has allowed them to extend careers that would have ended without modern surgical techniques.
The human spine consists of a system of nerves, bones, cartilage and ligaments divided into the cervical, thoracic and lumbar segments. The cervical segment is the uppermost segment and the lumbar is the lowest.
The vertebrae are bones that surround and protect the spinal cord and nerve roots. Cartilage provides cushioning between the vertebrae. Ligaments that allow the spinal segment to bend and twist hold the vertebrae and cartilage together.
Spinal injuries typically result in extreme amounts of pain given the intimate association with nerves. These injuries include fractures of bone and cartilage, as well as displacement of the cartilaginous discs that can impinge on the nerve roots. Repetitive trauma to the spinal elements can result in arthritis that will narrow the passages through which the nerve roots exit.
Often surgery is required to alleviate these conditions. Multiple surgeries will eventually alter the complex mechanics involved in coordinating spinal movement.
Spinal fusion involves joining bony vertebrae together with the use of metal plates and screws as well as bony fragments that eventually form a solid body of one or more levels. This will result in diminished flexibility and range of motion at those levels.
“With modern surgical techniques, many athletes of all levels can return to sports after one or two level lumbar (low back) and cervical (neck) fusions. Prior to return to sport it must be confirmed that the bone has successfully healed, which can take up to one year from the time of surgery” said Dr. Isaac Moss, assistant professor of orthopaedic and neurosurgery at UConn. “The most significant determinants of return to sport are usually the patient’s preoperative level of function and the extent of surgery required to fix the problem. I recommend that patients be upfront with their surgeon prior to surgery and discuss their functional goals once they have recovered to make sure that the optimal surgical procedure is selected and their post-op expectations are realistic.”
Spinal fusion does not have to be a game-ending condition.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
The human spine consists of a system of nerves, bones, cartilage and ligaments divided into the cervical, thoracic and lumbar segments. The cervical segment is the uppermost segment and the lumbar is the lowest.
The vertebrae are bones that surround and protect the spinal cord and nerve roots. Cartilage provides cushioning between the vertebrae. Ligaments that allow the spinal segment to bend and twist hold the vertebrae and cartilage together.
Spinal injuries typically result in extreme amounts of pain given the intimate association with nerves. These injuries include fractures of bone and cartilage, as well as displacement of the cartilaginous discs that can impinge on the nerve roots. Repetitive trauma to the spinal elements can result in arthritis that will narrow the passages through which the nerve roots exit.
Often surgery is required to alleviate these conditions. Multiple surgeries will eventually alter the complex mechanics involved in coordinating spinal movement.
Spinal fusion involves joining bony vertebrae together with the use of metal plates and screws as well as bony fragments that eventually form a solid body of one or more levels. This will result in diminished flexibility and range of motion at those levels.
“With modern surgical techniques, many athletes of all levels can return to sports after one or two level lumbar (low back) and cervical (neck) fusions. Prior to return to sport it must be confirmed that the bone has successfully healed, which can take up to one year from the time of surgery” said Dr. Isaac Moss, assistant professor of orthopaedic and neurosurgery at UConn. “The most significant determinants of return to sport are usually the patient’s preoperative level of function and the extent of surgery required to fix the problem. I recommend that patients be upfront with their surgeon prior to surgery and discuss their functional goals once they have recovered to make sure that the optimal surgical procedure is selected and their post-op expectations are realistic.”
Spinal fusion does not have to be a game-ending condition.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Professional athletes not immune to influenza — just ask the Red Sox
The influenza virus affects millions of people each year. It also accounts for tens of thousands of deaths primarily among elderly, infirm patients and children with chronic illnesses. It also has tremendous impact on productivity in the workplace. Recently, that impact became evident by the direct effect of the influenza virus on the Boston Red Sox lineup.
There are multiple types of the influenza virus that can change their genetic footprint. These changes make immunization a challenging guessing game each year to predict what strains will have the most impact.
Immunization consists of administering a weakened form of the virus allowing the immune system to build up antibodies against a potential infection. Infections can spread quickly among individuals living in close proximity, such as in dormitories.
Typical symptoms include: fever, cough, nasal congestion, nausea, vomiting, joint pain and headache. These symptoms can persist for days or weeks. Treatment is best described as symptomatic with fluid replacement to avoid dehydration and medications to bring down a fever. More recently, antiviral medications are helpful if they are taken soon enough.
Flu season in the United States extends from October to May with peak frequency in February. Unfortunately, baseball spring training begins at the height of flu season and precautions need to be taken to avoid spread if an individual athlete begins to show symptoms.
Like many workers, baseball players are afraid that they may be risking their positions and may force themselves to come to work when ill. This puts other team members at risk.
Clearly the initially-infected athlete was not identified and isolated on the Boston Red Sox team. This has led to numerous players missing time in the starting lineup. Sanitizing locker rooms and avoiding excessive personal contact will avoid prolongation and recurrence.
An outbreak of influenza can slow workplace productivity, even in professional sports.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
There are multiple types of the influenza virus that can change their genetic footprint. These changes make immunization a challenging guessing game each year to predict what strains will have the most impact.
Immunization consists of administering a weakened form of the virus allowing the immune system to build up antibodies against a potential infection. Infections can spread quickly among individuals living in close proximity, such as in dormitories.
Typical symptoms include: fever, cough, nasal congestion, nausea, vomiting, joint pain and headache. These symptoms can persist for days or weeks. Treatment is best described as symptomatic with fluid replacement to avoid dehydration and medications to bring down a fever. More recently, antiviral medications are helpful if they are taken soon enough.
Flu season in the United States extends from October to May with peak frequency in February. Unfortunately, baseball spring training begins at the height of flu season and precautions need to be taken to avoid spread if an individual athlete begins to show symptoms.
Like many workers, baseball players are afraid that they may be risking their positions and may force themselves to come to work when ill. This puts other team members at risk.
Clearly the initially-infected athlete was not identified and isolated on the Boston Red Sox team. This has led to numerous players missing time in the starting lineup. Sanitizing locker rooms and avoiding excessive personal contact will avoid prolongation and recurrence.
An outbreak of influenza can slow workplace productivity, even in professional sports.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Mental training an important part of recovery
Recovery from an injury or illness of any type can be challenging. It is especially difficult for an athlete who is accustomed to performing at a high level. Incorporating a regimen of mental training can speed recovery and possibly even improve pre-injury performance.
The concept of neuroplasticity involves the ability of the human brain to recover after injury. This is most commonly seen after a stroke or traumatic brain injury. Early rehabilitation will limit the extent of permanent damage by allowing new pathways to compensate for those that were injured.
One of the biggest challenges when going through rehabilitation is that suddenly a patient will have time available that they did not have before. That time element must be managed carefully in a positive sense or it can lead to depression, anxiety and slowed or incomplete recovery.
Mature athletes accept that injury is part of sports and rehabilitation is part of the experience. These athletes often return to successful careers. Unfortunately, some athletes are consumed by the injury and never return.
Among the most notable success stories are those of Peyton Manning and Adrian Peterson, who both returned from serious injuries to have great seasons.
The key elements to the mental aspect of injury recovery include: setting realistic goals, positive self-talk, relaxation and visualization. The visualization component is the most intriguing and difficult.
Visualizing a task in great detail can activate neural pathways from the visual cortex to the motor strip of the human brain. This has been confirmed in recent studies performed with functional MRI imaging. The regular practice of visualizing the throwing motion in detail after a shoulder injury has proven to shorten recovery when the physical ability returns.
The mental aspects of recovery from any injury should not be ignored.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
The concept of neuroplasticity involves the ability of the human brain to recover after injury. This is most commonly seen after a stroke or traumatic brain injury. Early rehabilitation will limit the extent of permanent damage by allowing new pathways to compensate for those that were injured.
One of the biggest challenges when going through rehabilitation is that suddenly a patient will have time available that they did not have before. That time element must be managed carefully in a positive sense or it can lead to depression, anxiety and slowed or incomplete recovery.
Mature athletes accept that injury is part of sports and rehabilitation is part of the experience. These athletes often return to successful careers. Unfortunately, some athletes are consumed by the injury and never return.
Among the most notable success stories are those of Peyton Manning and Adrian Peterson, who both returned from serious injuries to have great seasons.
The key elements to the mental aspect of injury recovery include: setting realistic goals, positive self-talk, relaxation and visualization. The visualization component is the most intriguing and difficult.
Visualizing a task in great detail can activate neural pathways from the visual cortex to the motor strip of the human brain. This has been confirmed in recent studies performed with functional MRI imaging. The regular practice of visualizing the throwing motion in detail after a shoulder injury has proven to shorten recovery when the physical ability returns.
The mental aspects of recovery from any injury should not be ignored.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Recovering from a concussion even more difficult in baseball
Concussions are typically associated with high-velocity collision sports. Although baseball is a limited-contact sport, athletes who suffer concussions have a difficult challenge when attempting to return to their pre-injury level of performance.
A concussion is a clinical syndrome of neurological impairment that results from a biomechanical force that is applied to the brain. It is a disruption of the complex circuitry that makes up the human nervous system.
Typical symptoms include headache, dizziness, visual changes, loss of consciousness and incoordination. Symptoms typically improve within 10 days of the injury if there are no other conditions that may prolong recovery.
In a recent study, functional MRI images were performed while an athlete was trying to identify what pitch was being thrown. This study demonstrated that multiple regions of the brain must be involved in a hitting decision. The number of areas involved increases as the number of potential pitches increases.
Since 2011, Major League Baseball has been tracking concussions in both the major and minor leagues. Two recent publications looking at this data have both confirmed previous beliefs and raised new questions.
In the 2011 and 2012 seasons, 41 concussions were reported in the major leagues and 266 in the minors. Fielding injuries accounted for 163 of the concussions with catchers being disproportionately at risk with 40.8% of concussions in the majors and 47.6% in the minors. The average time to return was between eight and 10 days.
In another study, concussed batters were compared to a control group. Interestingly, batting averages, on-base percentages and slugging percentages were significantly lower in the concussed group. These numbers did not recover to the pre-concussion performance level until four to six weeks after return.
Although recovery time for concussed baseball players is consistent with other sports, regaining the skill to effectively hit a baseball may require significantly more time.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
A concussion is a clinical syndrome of neurological impairment that results from a biomechanical force that is applied to the brain. It is a disruption of the complex circuitry that makes up the human nervous system.
Typical symptoms include headache, dizziness, visual changes, loss of consciousness and incoordination. Symptoms typically improve within 10 days of the injury if there are no other conditions that may prolong recovery.
In a recent study, functional MRI images were performed while an athlete was trying to identify what pitch was being thrown. This study demonstrated that multiple regions of the brain must be involved in a hitting decision. The number of areas involved increases as the number of potential pitches increases.
Since 2011, Major League Baseball has been tracking concussions in both the major and minor leagues. Two recent publications looking at this data have both confirmed previous beliefs and raised new questions.
In the 2011 and 2012 seasons, 41 concussions were reported in the major leagues and 266 in the minors. Fielding injuries accounted for 163 of the concussions with catchers being disproportionately at risk with 40.8% of concussions in the majors and 47.6% in the minors. The average time to return was between eight and 10 days.
In another study, concussed batters were compared to a control group. Interestingly, batting averages, on-base percentages and slugging percentages were significantly lower in the concussed group. These numbers did not recover to the pre-concussion performance level until four to six weeks after return.
Although recovery time for concussed baseball players is consistent with other sports, regaining the skill to effectively hit a baseball may require significantly more time.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Bioengineering could help orthopedic injuries
Bioengineering is the term best used to describe the utilization of multiple disciplines to solve a health-related problem. The incorporated disciplines involved often include medicine, life sciences, mathematics and engineering.
Most recently, bioengineering has emerged as a potential solution for many orthopedic injuries, including those related to sports. Some of the most promising research has been in the area of tendon and ligament regeneration.
Anterior cruciate ligament injuries are among the most common and disabling sports-related injuries. According to the American Orthopedic Society for Sports Medicine, there are approximately 150,000 ACL tears each year. These injuries account for approximately $500 million in health care costs annually in the United States.
The knee is a hinged joint where the femur and tibia articulate. The bony surfaces are cushioned by cartilage. Four main ligaments hold the entire joint together: the ACL, posterior cruciate ligament, medial collateral ligament and the lateral collateral ligament.
ACL injuries are most common in high-intensity sports, including soccer, football and basketball. Damage can result from sudden changes in direction, landing awkwardly after jumping or direct impact from a collision.
Bioengineering is being used to build new ligaments by applying stem cells to a scaffold and allowing the cells to generate a new ligament or through the application of stem cells to allow a ligament to be repaired.
"The use of stem cells, osteobiologics and biodegradable synthetic polymers is the frontier of sports medicine surgery and surgical augmentation," said Dr. Cory Edgar, assistant professor of orthopedic surgery and UConn team physician. "These approaches will significantly impact surgery success rates, recovery times and return-to-play timelines."
The routine use of bioengineered tendon repair may not be far off.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Most recently, bioengineering has emerged as a potential solution for many orthopedic injuries, including those related to sports. Some of the most promising research has been in the area of tendon and ligament regeneration.
Anterior cruciate ligament injuries are among the most common and disabling sports-related injuries. According to the American Orthopedic Society for Sports Medicine, there are approximately 150,000 ACL tears each year. These injuries account for approximately $500 million in health care costs annually in the United States.
The knee is a hinged joint where the femur and tibia articulate. The bony surfaces are cushioned by cartilage. Four main ligaments hold the entire joint together: the ACL, posterior cruciate ligament, medial collateral ligament and the lateral collateral ligament.
ACL injuries are most common in high-intensity sports, including soccer, football and basketball. Damage can result from sudden changes in direction, landing awkwardly after jumping or direct impact from a collision.
Bioengineering is being used to build new ligaments by applying stem cells to a scaffold and allowing the cells to generate a new ligament or through the application of stem cells to allow a ligament to be repaired.
"The use of stem cells, osteobiologics and biodegradable synthetic polymers is the frontier of sports medicine surgery and surgical augmentation," said Dr. Cory Edgar, assistant professor of orthopedic surgery and UConn team physician. "These approaches will significantly impact surgery success rates, recovery times and return-to-play timelines."
The routine use of bioengineered tendon repair may not be far off.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Rib fracture is most common serious injury to chest
Fractured ribs are commonly associated with collisions, falls or other forms of trauma. These injuries can lead to extended periods of disability in athletes.
The human rib cage consists of 24 ribs (12 on each side) connected to a bone in the center of the chest called the sternum and attached in the back to the thoracic vertebrae. There are muscles, nerves and connective tissue located between the ribs.
The rib cage is designed to protect vital organs including the heart, lungs and major blood vessels. It is also an important functional component as part of the respiratory system. The rib cage will expand and contract with each breath.
Fractured ribs in adults are most commonly the result of falls and motor vehicle accidents. In young people these injuries result from blunt trauma associated with athletic injuries. The middle and lower ribs are most often injured. The involved trauma is often a sudden, high impact to a small focal area such as that inflicted by an elbow or a baseball.
Rib fractures are the most common serious injury to the chest. Severe fractures can result in a punctured lung. Multiple fractures can cause a condition called flail chest that will diminish the ability to effectively exchange air. Intense pain is the most common initial symptom. The pain intensifies with breathing, coughing or any activity that requires movement of the chest wall.
Treatment involves the use of rest, ice and pain medication. Pain medication can range from non-steroidal anti-inflammatory medications to narcotics.
An ongoing study at St. Francis Hospital and Medical Center in Hartford involves the comparison of current medical treatment including narcotics versus marijuana administered in a fixed-dose pill form.
"Rib fractures are an excellent condition for this trial since it fairly predictably results in pain that improves in six weeks and resolves in eight weeks," reports Dr. James Feeney, associate director of trauma and principal investigator for the study.
Returning to sports after a rib fracture can be expedited with early recognition and effective treatment.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
The human rib cage consists of 24 ribs (12 on each side) connected to a bone in the center of the chest called the sternum and attached in the back to the thoracic vertebrae. There are muscles, nerves and connective tissue located between the ribs.
The rib cage is designed to protect vital organs including the heart, lungs and major blood vessels. It is also an important functional component as part of the respiratory system. The rib cage will expand and contract with each breath.
Fractured ribs in adults are most commonly the result of falls and motor vehicle accidents. In young people these injuries result from blunt trauma associated with athletic injuries. The middle and lower ribs are most often injured. The involved trauma is often a sudden, high impact to a small focal area such as that inflicted by an elbow or a baseball.
Rib fractures are the most common serious injury to the chest. Severe fractures can result in a punctured lung. Multiple fractures can cause a condition called flail chest that will diminish the ability to effectively exchange air. Intense pain is the most common initial symptom. The pain intensifies with breathing, coughing or any activity that requires movement of the chest wall.
Treatment involves the use of rest, ice and pain medication. Pain medication can range from non-steroidal anti-inflammatory medications to narcotics.
An ongoing study at St. Francis Hospital and Medical Center in Hartford involves the comparison of current medical treatment including narcotics versus marijuana administered in a fixed-dose pill form.
"Rib fractures are an excellent condition for this trial since it fairly predictably results in pain that improves in six weeks and resolves in eight weeks," reports Dr. James Feeney, associate director of trauma and principal investigator for the study.
Returning to sports after a rib fracture can be expedited with early recognition and effective treatment.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Avoid long-term use of narcotics for chronic nerve pain
Chronic pain has become an accepted complication of a career in high-velocity collision sports and combat sports. Unfortunately, the pain doesn't end with retirement and in fact can intensify with age. Novel approaches to treatment are needed to avoid chronic use of opiate medications.
The human nervous system is divided into the central nervous system and the peripheral nervous system. The central nervous system consists of the brain and spinal cord. The peripheral nervous system is made up of the nerves that extend from the spinal cord to the muscles, joints and skin.
Pain is transmitted via signals from peripheral receptors to the brain where they are interpreted. Peripheral nerve pain from contact sports is often the result of direct trauma or stretching of large nerve trunks.
Trauma to sensory nerves can result in sensory loss. Often, injured sensory nerves will typically transmit misinformation called paresthesias. These "perversions" of sensation are typically described as burning, crawling, tingling or pins and needles. They can escalate from being an annoyance to debilitating.
The key element in treating chronic pain is to avoid the use of narcotics or other habit-forming medications since they are not a long-term solution. Opiates and other narcotics are designed for short-term therapy only.
Non-pharmacologic treatments in the form of mindfulness meditation, regular aerobic exercise and yoga are accepted approaches. Acupuncture also has been reported to show significant benefit in reducing pain for some patients.
Non-narcotic medications are often successful in treating chronic pain. Antiepileptic drugs as well as antidepressants are designed to treat conditions that affect the brain by altering brain chemistry. These medications also are effective in treating chronic pain.
Non-narcotic treatment of chronic pain demands a multidimensional approach for the best chance of success.
Further research into innovative approaches for the long-term treatment of pain, including the role of cannabis, is necessary.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
The human nervous system is divided into the central nervous system and the peripheral nervous system. The central nervous system consists of the brain and spinal cord. The peripheral nervous system is made up of the nerves that extend from the spinal cord to the muscles, joints and skin.
Pain is transmitted via signals from peripheral receptors to the brain where they are interpreted. Peripheral nerve pain from contact sports is often the result of direct trauma or stretching of large nerve trunks.
Trauma to sensory nerves can result in sensory loss. Often, injured sensory nerves will typically transmit misinformation called paresthesias. These "perversions" of sensation are typically described as burning, crawling, tingling or pins and needles. They can escalate from being an annoyance to debilitating.
The key element in treating chronic pain is to avoid the use of narcotics or other habit-forming medications since they are not a long-term solution. Opiates and other narcotics are designed for short-term therapy only.
Non-pharmacologic treatments in the form of mindfulness meditation, regular aerobic exercise and yoga are accepted approaches. Acupuncture also has been reported to show significant benefit in reducing pain for some patients.
Non-narcotic medications are often successful in treating chronic pain. Antiepileptic drugs as well as antidepressants are designed to treat conditions that affect the brain by altering brain chemistry. These medications also are effective in treating chronic pain.
Non-narcotic treatment of chronic pain demands a multidimensional approach for the best chance of success.
Further research into innovative approaches for the long-term treatment of pain, including the role of cannabis, is necessary.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Oregon athletes show dangers of overtraining
Athletes can sometimes become so focused on accomplishing a particular goal that the warning signs of potential injury are ignored. This was the case last week at the University of Oregon where four football players were hospitalized after an offseason workout.
Organized training during the offseason has become common at many levels of sport. Gone are the days when athletes would shift their focus to work and school after a season ended only to resume activity several months prior to the upcoming regular competition.
Much of the responsibility for the physical training of athletes has fallen into the hands of a growing group of strength and conditioning coaches. Credentials for these specialists fall into a variety of realms, including highly trained exercise physiologists, athletic trainers and physical therapists.
Unfortunately, it is an area where certifications and appropriate credentials are not monitored and no state licenses or liability insurances are required for practitioners.
Prescribed workouts should not be one-size-fits-all recipes for making an individual or a team tougher and able to perform herculean tasks. Although many cite the military as the model for extreme workouts, they fail to note that there are severe consequences for commanding officers who ignore the human limits to training that result in permanent injury or death of a recruit.
In the case of the athletes in Oregon, it appears that the workouts crossed the fine line between training and torture. Those athletes' muscles began to break down due to increased energy demands and inability to supply necessary nutrients to large muscle groups. This resulted in a condition known as rhabdomyolysis where the muscle breaks down and the toxic products of that breakdown cause kidney failure. A key sign of this condition is darkened urine.
Many parents have bought into the belief that intense offseason workouts will increase their child's chances to play sports at a high level. Although this may be true, interviewing the person leading these workouts, checking their credentials, and making sure a child is enjoying these activities can avoid a potential disaster.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Organized training during the offseason has become common at many levels of sport. Gone are the days when athletes would shift their focus to work and school after a season ended only to resume activity several months prior to the upcoming regular competition.
Much of the responsibility for the physical training of athletes has fallen into the hands of a growing group of strength and conditioning coaches. Credentials for these specialists fall into a variety of realms, including highly trained exercise physiologists, athletic trainers and physical therapists.
Unfortunately, it is an area where certifications and appropriate credentials are not monitored and no state licenses or liability insurances are required for practitioners.
Prescribed workouts should not be one-size-fits-all recipes for making an individual or a team tougher and able to perform herculean tasks. Although many cite the military as the model for extreme workouts, they fail to note that there are severe consequences for commanding officers who ignore the human limits to training that result in permanent injury or death of a recruit.
In the case of the athletes in Oregon, it appears that the workouts crossed the fine line between training and torture. Those athletes' muscles began to break down due to increased energy demands and inability to supply necessary nutrients to large muscle groups. This resulted in a condition known as rhabdomyolysis where the muscle breaks down and the toxic products of that breakdown cause kidney failure. A key sign of this condition is darkened urine.
Many parents have bought into the belief that intense offseason workouts will increase their child's chances to play sports at a high level. Although this may be true, interviewing the person leading these workouts, checking their credentials, and making sure a child is enjoying these activities can avoid a potential disaster.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
Safety, preparation vital for combat sport participants
Combat sports are among the fastest growing sports worldwide. Previously, this category of sports was restricted to boxing but has now expanded to karate, jiu-jitsu, kickboxing, judo and wrestling. These additional disciplines have come to be known as mixed martial arts (MMA).
The popularity of MMA should not come as a surprise. It has broad appeal to practitioners of these various combat forms as well as fans. Interestingly, the origins of combat sports in general date back to 400 B.C. when the participants were primarily slaves who were trying to win their freedom. Those contests often ended with the death of one opponent.
The ancient practice was eventually banned, not due to safety issues but because the contests had become so popular that spectators were not getting any work done.
Despite today's concern over the safety of these sports, there is a wide variation regarding regulation in the United States and internationally. Connecticut has become one of the strictest states to obtain a license to fight professionally. These regulations have evolved over years of experience at the state level and, more recently, at the Mohegan and Mashantucket Pequot Tribal nations.
The health regulations include blood screening for HIV, Hepatitis B and Hepatitis C every six months. Annual physical exams in addition to those performed at the fight venue are required. An EKG must also be performed annually. This encourages combat sport athletes to establish care with a primary care physician.
Particular attention is paid to neurologic impairment. Participants are required to have either an MRI or CT of the brain at some time in their career. In addition, an annual examination by a board-certified neurologist is required to assess any previous brain damage.
"Establishing a core set of health requirements and sharing them with other jurisdictions has been a priority," reports Mr. Michael Mazzulli, Director of the Mohegan Tribe Department of Athletic Regulation. Mr. Mazzulli and his team now travel internationally to regulate MMA events.
Safety and careful preparation are imperative for combat sports participation at any level.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
The popularity of MMA should not come as a surprise. It has broad appeal to practitioners of these various combat forms as well as fans. Interestingly, the origins of combat sports in general date back to 400 B.C. when the participants were primarily slaves who were trying to win their freedom. Those contests often ended with the death of one opponent.
The ancient practice was eventually banned, not due to safety issues but because the contests had become so popular that spectators were not getting any work done.
Despite today's concern over the safety of these sports, there is a wide variation regarding regulation in the United States and internationally. Connecticut has become one of the strictest states to obtain a license to fight professionally. These regulations have evolved over years of experience at the state level and, more recently, at the Mohegan and Mashantucket Pequot Tribal nations.
The health regulations include blood screening for HIV, Hepatitis B and Hepatitis C every six months. Annual physical exams in addition to those performed at the fight venue are required. An EKG must also be performed annually. This encourages combat sport athletes to establish care with a primary care physician.
Particular attention is paid to neurologic impairment. Participants are required to have either an MRI or CT of the brain at some time in their career. In addition, an annual examination by a board-certified neurologist is required to assess any previous brain damage.
"Establishing a core set of health requirements and sharing them with other jurisdictions has been a priority," reports Mr. Michael Mazzulli, Director of the Mohegan Tribe Department of Athletic Regulation. Mr. Mazzulli and his team now travel internationally to regulate MMA events.
Safety and careful preparation are imperative for combat sports participation at any level.
Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu
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