Healthy Sports

Giants' Mark Herzlich overcomes bone cancer

2012-01-19T12:34:00.000-08:00

Inspirational comeback stories abound in the world of sports. This year’s NFL season is no exception, such as the come-from-behind, underdog victories by the Denver Broncos, led by Tim Tebow.

One story that bears noting is the return of Mark Herzlich to the sport many thought was part of his past and not his future.

Herzlich, a 24-year-old linebacker for the New York Giants, was diagnosed with Ewing’s sarcoma, a form of bone cancer, while playing for Boston College. His treatment included chemotherapy, radiation therapy and excision of the tumor that involved the largest bone in the human body, the femur. A titanium rod reinforced the bone shaft.

A two-year course of physical therapy and intense training followed. After being invited to try out for the New York Giants, he accomplished something many thought was impossible: He made the team.

Ewing’s sarcoma is a malignant tumor that typically is seen in children and young adults. It generally appears in the long bones of the body.

The most common presenting symptom is intense bone pain. Unfortunately, in approximately one-third of patients, the tumor already has spread to the lungs and other bones at the time of diagnosis.

Treatment of Ewing’s sarcoma includes aggressive chemotherapy and radiation therapy that is focused on the tumor site. Surgical excision of the tumor follows.

Dr. Dinesh Kapur, an oncologist and director of cancer services at The William W. Backus Hospital, isn’t surprised by Herzlich’s recovery.

“Early detection, combined with the multimodality approach of chemotherapy, radiation and surgery, has dramatically improved survival from Ewing’s sarcoma,” Kapur said.

Herzlich’s return to the highest level of professional sports not only required a combination of modern medical therapies, but an unwavering spirit and commitment to succeed.

Celtics player saved from aortic aneurysm

2012-01-03T07:01:00.000-08:00

Amidst the confusion of ending the NBA lockout and hurriedly beginning a shortened season, a young life was saved.

Jeff Green, a 25-year-old forward, had signed a one-year, $9 million contract to play for the Boston Celtics. During a routine preseason physical examination, he was diagnosed with an aortic aneurysm. Instead of heading over to the practice court, Green was headed to the operating room.

The aorta is the largest artery in the human body. It provides the main passageway for richly oxygenated blood to vital organs. The aorta is divided into two main sections:

• The thoracic aorta leads blood from the heart and downward through the chest cavity.
• The abdominal aorta continues into the abdomen feeding branches to the kidneys, liver, spleen and intestines.

An aneurysm is an abnormal enlargement of a blood vessel. It results from a weakening of the supporting tissue that provides a firm lining in an artery. Under constant pressure, the weakened area will enlarge and cause the artery to dilate and eventually rupture. This results in profuse life-threatening hemorrhage.

Aortic aneurysms can be repaired by cutting out the affected section of aorta and replacing it with a synthetic segment. Another approach is an endovascular repair. In this procedure, a new lining is inserted in the weakened area via a catheter through an artery in the groin.

Aneurysms are typically associated with high blood pressure, elevated cholesterol levels, obesity and smoking. All of these potential causes are not typically associated with professional athletes.

Green’s aneurysm will be repaired and he is expected to return to the NBA next season.

Jeff Green’s circumstance should serve as a reminder of the importance to have annual physicals performed by a physician even if you are young and in excellent health.

Fitness gifts for the holiday season

2011-12-20T12:08:00.000-08:00

Finding an appropriate gift for someone interested in fitness can be a complex and daunting task. The vast array of offerings may be confusing and an error will result in another dust collector. This week is a good time to make some recommendations and provide some caution.

Michael Sena’s Traveling Trainer. This product provides a perfect combination of fitness equipment, instruction and dietary tips in a convenient travel case. Sena, a nationally known personal trainer, provides instruction on the use of elastic stretch tubes of varying resistances. Although the premise is for this product to be used while traveling to places where a gym isn’t available, it is a great way to begin a home workout that requires minimal cost and space.

Fitness Monitors. These devices include pedometers, heart rate monitors and computerized bands that monitor all physical activity and diets. The range is vast and the usefulness varies. In general, the more comprehensive the apparatus the more technical ability is required. The objective here is to provide feedback regarding the intensity of an individual’s activity. That feedback will hopefully encourage more effort. Much of this can be accomplished by using a simple pedometer and bathroom scale.

P90X2. This is the latest iteration in a wildly successful video workout series. Each consists of intense exercises that last approximately 60 minutes and utilize a variety of muscle groups. They provide an excellent daily fitness experience and, based on many testimonials, accomplish the goal of getting subscribers in shape in 90 days. Although the series is expensive, it requires minimal equipment and space.

The current trend in fitness programs emphasizes equal parts aerobic and resistance exercises utilizing body weight for resistance. Stretching, balance and constant movement are essential elements.

A fitness program combined with dietary moderation will lead to a healthy new year.

Nonsteroidal Anti-Inflammatory Drugs

2011-12-06T10:20:00.000-08:00

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most prescribed medications worldwide. In sports medicine, they are often referred to as performance “enabling” drugs.

Common NSAIDs like Motrin, Naproxyn, Toradol, Voltaren and Celebrex can be administered orally, by injection or applied to the skin. As opposed to steroids, the NSAIDs have fewer side effects and do not build muscle like androgenic steroid drugs.

Inflammation is a normal response of the human body to injury. NSAIDs are effective in treating headache, injured nerves, arthritis and painful chronic conditions. In sports, NSAIDs are primarily used to treat acute muscle tears (strains), ligamentous injuries (sprains) and joint trauma (bursitis).

The classic inflammatory response causes signs of swelling, elevated temperature, redness and pain that are readily apparent to an observer. At a microscopic level, there is an intense cellular response where blood flow increases to the affected region allowing chemicals and white blood cells to leave the bloodstream and attack the injury.

While the inflammatory response is essential to good health, it can cause damage if it becomes chronic. NSAIDs are designed to reduce inflammation by blocking the cyclooxygenase enzymes (COX-1 and COX-2) and subsequently halting the production of prostaglandins, essential components of the inflammatory response.

Although NSAIDs have an analgesic effect, they reduce pain by altering the actual process causing the pain, as opposed to opiate drugs that merely block pain receptors.

It is not uncommon in sports to have more than one ongoing injury. NSAIDs do not target a specific injury and work at multiple areas simultaneously.

Although generally safe, potential side effects of NSAIDs include stomach ulcers, kidney damage and elevation of blood pressure.

In sports, where chronic musculoskeletal injuries are common NSAIDs have extended the careers of many athletes. After consultation with a physician, NSAIDs may be able to keep you in the game.

Sports injuries can't hide from imaging techniques

2011-11-22T20:44:00.000-08:00

Sports injuries often require the use of x-rays and more sophisticated diagnostic imaging studies to determine the nature and severity of the injury. These studies and techniques have evolved significantly over recent years.

Among the most commonly used imaging studies are x-ray, computerized tomography (CT) and magnetic resonance imaging (MRI). X-rays were first used in the late 19th century, primarily to determine fractures and other boney injuries. CT scans came into use in the early 1970s and are designed to measure differences in density, especially in bones. MRIs create images based on changes in tissues such as tearing and swelling.

Dr. Nathaniel Dueker is a board certified musculoskeletal radiologist at The William W. Backus Hospital. He took time to review some of the most common sports injuries that require imaging:

• Head injuries. Concussions are among the most common injuries seen in sports. While there is no image that can diagnose a concussion, a CT scan should reveal any evidence of acute hemorrhage or skull fracture. Persistent symptoms may warrant the eventual use of an MRI to look for chronic damage.

• Shoulder injuries. These injuries typically involve tendons and ligaments. After a plain x-ray to rule out a fracture, an MRI is the best diagnostic tool. This study can demonstrate structural changes in the complex system that makes up the shoulder joint. An MRI of the shoulder can be performed with dye injected into the joint. This exam, called an MRI arthrogram, can be performed in different positions and may reveal subtle tears.

• Knee injuries. Traumatic sports injuries to the knee typically result in ligament and cartilage tears. While x-rays will rule out bone injuries, MRI is an outstanding technique for viewing damage to these structures.

Appropriate diagnostic imaging studies can limit the need for surgery and get athletes back in the game sooner.

The heart is a muscle that needs training too

2011-11-08T19:25:00.000-08:00

When athletes are described as “having a lot of heart” it often refers to their desire to compete even in the face of overwhelming adversity. In sports medicine, an “athlete’s heart” has an entirely different meaning.

The human heart is composed of four chambers: the right atrium, right ventricle, left atrium and left ventricle. The heart functions as a pump moving blood from the right side of the heart to the lungs where it becomes infused with oxygen. The left-sided chambers then jettison oxygenated blood throughout the circulatory system to other organs.

The left ventricle has the greatest demand and tends to become enlarged, creating a condition known as “left ventricular hypertrophy.”

If blood vessels become narrowed due to atherosclerosis, it requires more work for the heart to pump against resistance. The pumping mechanism must work harder and faster. That strain can lead to heart failure and death.

Like all muscles, the heart can be trained to increase in size and work more efficiently. A fitness regimen that will improve cardiac efficiency should consist of several forms of exercise:

• Aerobic activities such as running, rowing or cycling will maintain a high heart rate over an extended period of time.

• Resistance activities include weight lifting and other strength-oriented sports.

• Cross-training programs include a combination of aerobic and resistance activities. Boxers and other athletes who participate in sports where high levels of strength must be maintained over long periods of time rely heavily on these programs.

“The enlarged, more efficient athlete’s heart is a normal response to exercise training,” said Dr. Craig Denegar, a professor of kinesiology at the University of Connecticut. Screening athletes before athletic participation can be challenging since an enlarged left ventricle can also indicate significant cardiac disease.

A regular exercise program can produce a heart that pumps more blood with less effort.

The simple act of jumping rope

2011-10-27T13:44:00.000-07:00

The decision to get into better physical condition can become a very expensive enterprise. When the effort involves children, the interest can be short-lived and lead to unused gym memberships.

Some activities involve little cash outlay and can be enjoyed by the entire family. Among these is jumping rope.

The history of jumping rope is believed to date back to Egypt in 1600 AD. Rope jumping not only served as child’s play but as training for warriors.

Dutch children in early America jumped with two ropes simultaneously and subsequently the term “Double Dutch” became common.

Jumping rope continues to provide an outstanding exercise for burning calories, building strength and improving coordination. Jumping rope for one hour can burn 1300 calories.

Modern rope jumping has become a group exercise activity performed as part of exercise classes. Although it is typically associated with children, it continues to be a preferred method of training for boxers and other combat athletes.

Athletes recovering from lower extremity injuries are often prescribed jumping rope as part of their recovery to rebuild strength and joint proprioception. Proprioception is the brain’s ability to detect the position of an extremity in space.

Childhood obesity is a major problem in the United States today. Physical education programs with shrinking budgets have found rope jumping to be an effective, inexpensive exercise.

Locally, a group of students from the Integrated Day Charter School who love to jump rope have put together a service-learning project titled, “Ambassadors for Heart.” Their goal is to perform at public events and raise awareness of the dangers of physical inactivity and obesity in children and adults.

The efforts of these young ambassadors are entirely supported by private donations. They deserve our support.

Jumping rope can be a first step toward better health.

Peyton Manning and cervical radiculopathy

2011-10-11T20:07:00.000-07:00

Among recent recurring stories in sports is speculation regarding the successful return of Indianapolis Colts quarterback Peyton Manning. On Sept. 8, Manning underwent a third surgery to alleviate pressure on a nerve root in his neck.

The cervical spine consists of seven bones called vertebrae located below the skull. Discs made of cartilage separate each of the vertebrae to avoid the friction and wear of bone rubbing on bone. This entire system is held together by a series of ligaments.

The cervical spine is designed to protect the spinal cord and the nerve roots that emerge from the spinal cord to conduct motor and sensory impulses to and from the limbs and vital organs. Damage to these fragile nerves can result in paralysis or death.

Typical injuries to the cervical spine include:

• Fracture of the vertebral bones
• Tearing of the ligaments that attach the bony vertebrae
• Rupture of the intervertebral discs from their central location

In football and other violent collision sports, it is not uncommon to see worn and ruptured discs on imaging studies like MRI and CT scans. Unfortunately, these findings are sometimes seen in young healthy athletes.

The cervical nerve roots responsible for triggering the muscles of the arm are also the ones most commonly injured. Without adequate neural control, throwing is a difficult task, especially for an NFL quarterback.

Surgical intervention includes removing pieces of the offending discs. If the surgery or surgeries require removing a large volume of disc, bone chips are inserted between the vertebrae to prevent dislocation.

While fusing the spine creates a firm repair, it also limits the range of motion of the neck. It is this loss of motion, along with arm weakness, that will make Manning’s return a formidable challenge.

Peyton Manning’s recovery will require all the discipline and effort he has acquired over the years.

Amateur boxing has its place when done correctly

2011-09-27T07:08:00.000-07:00

Amateur boxing has been described as being a part of the fabric of society. Boxing, for many young athletes, is their first exposure to organized sports.

Recently, the American Academy of Pediatrics and the Canadian Paediatric Society issued a policy statement on boxing participation by children and adolescents. The position states that they “…oppose boxing and, in particular, discourage participation by children and adolescents.”

The position statement goes on to encourage alternative sports such as “swimming, tennis, basketball and volleyball.” This position is based on limited data and doesn’t account for many intangible advantages or disadvantages.

Amateur boxing is highly regulated under the watchful eyes of experienced coaches. Physicians are present for events and pre-fight and post-fight physicals are required.

Head protection and heavily padded gloves protect against serious injury. Bouts are brief and sportsmanship is stressed. Style and finesse are the principal ways to score points and officials are quick to end a one-sided match.

The health advantages for amateur boxers are numerous. Each participant must train regularly to build strength and stamina. The structure of a boxing gym often substitutes for a stable home life.

Boxing provides a reason to avoid tobacco, alcohol and criminal mischief.

Jody Sheeley owned the Second Chance Gym in Norwich and has been involved in amateur boxing for many years. “Amateur boxing helps build self-confidence, especially for children who don’t do well in team sports,” said Sheeley. In his experience, he has never seen a youngster require emergency medical care as a result of an amateur boxing match.

Amateur boxing has provided a healthy outlet for many young people who do not have access to other competitive sports that require significant financial investment. It is a sport that deserves public support and not restriction.

Pat Summitt will battle Alzheimer's from the bench

2011-09-13T12:36:00.000-07:00

Pat Summitt is the “winningest” coach in women’s basketball. At age 59, she has reached the pinnacle of her career, including induction into the Basketball Hall of Fame. Unfortunately, she now joins over 5 million other Americans in their battles with Alzheimer’s Disease (AD).

AD is a degenerative disease of the nervous system that prohibits its victims from learning new information and recalling recent events. The cause of AD is unknown but it can occur in families, as is the case with Coach Summitt.

Forgetfulness is a common part of normal aging. Difficulty finding the right word or recalling someone’s name is acceptable. When these difficulties progress to becoming lost in familiar surroundings and not recognizing close family members, AD must be considered.

Symptoms of AD also include difficulties with executive planning, loss of judgment and social withdrawal. The pressure and cognitive demands of successful coaching can be overwhelming. Pat Summitt’s attempt to continue coaching at the University of Tennessee at a high level is amazing.

There are several medications available for patients with mild to moderate symptoms of AD. Unfortunately, none of these medications alter the actual progression of AD.

Coach Summitt has not chosen to “ride off into the sunset.” Instead she is approaching this disease like any athletic challenge. She is preparing her assistant coaches to take on more responsibilities. She is also beginning a regimen of medication, cognitive exercises and mental preparation.

This approach is not surprising to those of us who work with athletes. When presented with an obstacle that is seemingly insurmountable, athletes dig in and prepare for battle.

Pat Summitt is a great coach and a leader for the rights of women in sports. Now she will put a famous face to a crippling terminal illness and hopefully stimulate interest toward a cure.

Preparation is key for triathletes

2011-08-31T09:08:00.000-07:00

In the most recent New York City triathlon, two competitors died because of injuries incurred during the swimming event. While this should not discourage triathlon participation, it is a reason for caution.

Triathlon competitions are a combination of swimming, cycling and running in a single event. The most well-known event is held each year in Hawaii and consists of a 2.4-mile swim, 112-mile bike ride and a 26.2-mile run.

These events are more popular when distances are shortened. The New York event is made up of a 0.9-mile swim, 24.8-mile bike and 6.2-mile run. These shorter distances allow for broader participation, in regard to age and ability.

Recent studies show the death rate for triathletes is twice that of marathon participants. In a 2010 study published in the medical journal, JAMA, where 14 deaths from triathlons were analyzed, 13 of these occurred during the swim portion of the event while the other resulted from a bike accident.

Autopsies revealed the majority of those who died had cardiac abnormalities. Autopsy reports are unavailable for the two most recent triathlon deaths, although the cause of death is presumed cardiac in origin.

While the number of deaths in triathlon is relatively small (15 deaths per million participants), efforts should be taken to make these events safer. Physical examination of each athlete before an event is not practical, but all participants should be examined annually by their personal physician to determine if it is safe to participate in extreme events like triathlons.

The mass start of the swim event makes collisions inevitable and impedes the ability to reach an injured athlete. Staggered starts should be considered.

Triathlons are a great way to crosstrain and remain physically fit. Adequate preparation must include a thorough medical evaluation at any age.

Heat stroke is an avoidable tragedy

2011-08-16T08:25:00.000-07:00

Seven young athletes have already died in the United States this month; most of these deaths were the result of exertional heat stroke (EHS). High school football camps will begin this week in the northeast and it is imperative that athletes, coaches and parents are aware of the early symptoms and treatment of EHS.

EHS, along with heat exhaustion and heat cramps, are part of a group of conditions known as heat-related illnesses. EHS is the most severe in what is a succession of events that can result in death without prompt intervention.

Most athletic activities in warm climates will easily get an athlete’s body temperature to 102 degrees Fahrenheit from the norm of 98.6. As the body approaches 105, sweating stops and the athlete will begin to experience headache, nausea, lightheadedness and confusion.

Treatment consists of rapidly lowering the body temperature. Certified athletic trainers are familiar with a protocol that requires the athlete to be immersed in an ice bath before transport to a hospital. The results are dramatic and lifesaving.

“We are now seeing more EHS since athletes spend most of the off season training in air-conditioned environments,” said Dr. Douglas Casa, a professor at the University of Connecticut and a recognized expert in heat-related illnesses. “This doesn’t allow their bodies to acclimatize to the warmer temperatures.” He also believes the increased size of athletes plays a significant role in EHS.

EHS can be prevented by following these simple steps:

• Gradually acclimatize to warmer temperatures before full workouts begin. The most vulnerable period is the first five days of practice
• Athletes should report early symptoms to a knowledgeable coach or an athletic trainer.
• An ice bath should be easily accessible for emergency use.

Early tips to ward off childhood obesity

2011-08-01T17:33:00.000-07:00

Childhood obesity continues to be a growing worldwide problem. It results in the early onset of many chronic conditions not typically seen in children like type 2 diabetes, high blood pressure, elevated lipids and heart disease. It may also lead to significant depression and poor self-image.

Recent calls for obese children to be removed from their homes emphasize the parental responsibility of overseeing that children are physically fit. A program should begin at infancy and proceed through scholastic sports.

Infant programs typically involve both parents and children. Swim classes introduce infants to aquatic activities while making them safer around bodies of water. Parent-child groups that include a combination of walking and stretching have become popular from both fitness and social perspectives.

Youth sports are often a child's first introduction to team sports and the advantages and disadvantages that go along with these activities. In the past, youth sports were a playground and sandlot activity. Now they are subject to parental coaches, uniforms and draft systems to choose the most talented players.

Team competitive sports may not be the best choice for some children. Individual activities such as swimming, running, martial arts and cycling can be a better alternative. Multiple activities help develop a broader interest and utilize different muscle groups. Specializing in one sport at an early age may lead to disappointment. Many successful athletes played multiple sports and some were drafted professionally in more than one sport.

As academic and social pressures increase in high school and college, sports become an outlet for expression and relaxation. Unfortunately, it is at this stage when a sense of perspective should be reinforced. Injuries must be monitored and treated properly, but are often the end of promising careers.

Choosing and supporting a child's participation in sports is important for proper physical and mental development.

ACSM reveals exercise guidelines

2011-07-19T18:55:00.000-07:00

Guidelines for what constitutes the most effective exercise regimen have been elusive. Recently, the American College of Sports Medicine (ACSM) created a committee of medical and fitness experts to review the scientific literature and make recommendations.

The ACSM committee sought to provide guidance regarding the quantity and quality of exercise needed to remain fit and reduce the risks of developing disorders associated with inactivity. These conditions include heart disease, obesity, high blood pressure, stroke and diabetes.

Regarding the quantity of exercise, the group concluded that adults should perform a minimum of 150 minutes of moderate-intensity exercise each week. This should be in addition to limiting the amount of sedentary activities such as watching TV, reading and playing computer games.

The quality of exercise was divided into four categories:

• Cardiorespiratory Exercise: Also known as aerobic exercise, this category includes running, cycling, rowing, elliptical training and many other activities. The recommended 150 minutes can be divided over five days or three days. The frequency and intensity should be gradually increased.

• Resistance Exercise: The goal should be to train each major muscle group two to three days per week. Between two and four sets of 8-12 repetitions work best. Free weights, bands or machines are all acceptable modalities but the amount of resistance should be low at first.

• Flexibility Exercise: Stretching exercises are imperative before engaging in any fitness regimen. For many adults stretching should be performed upon awakening to avoid injured muscles through the course of a normal day. Each stretch should be held for 10-30 seconds and repeated two to four times.

• Neuromotor Exercise: This group of exercise is aimed at improving coordination and balance. It is particularly important as athletes grow older and has been proven to avoid falls. Activities including yoga, tai chi and dance are part of this group.

While these guidelines set an ideal goal, any activity is a “step” in the right direction.

Baseball players are most susceptible to lower back injuries

2011-07-07T06:11:00.000-07:00

A review of the current Major League Baseball disabled list reveals five players out of action due to injuries affecting the low back.

Low back injuries involve the elements that make up the lower spine in addition to the muscles that provide support and strength. Due to the amount of sports-related repetitious movement involving the low back, injuries are common and very disabling.

The lumbo-sacral spine consists of five bony, lumbar vertebrae and the sacrum. Each vertebra is separated by a cartilaginous disc to provide a cushion. The entire structure is held together by a series of ligaments.

This elaborate design protects the spinal nerves contained within the bony spinal canal. These nerves exit the canal via small holes called foramina and proceed to provide sensory and motor function to the lower extremities.

The low back musculature connects the lower ribs, spine, pelvis and sacrum. It is the muscular system that provides the strength and stamina necessary for repeated movement.

The most common sports-related injuries are caused by sudden impact that compresses the spine and twisting injuries due to torque placed on the muscles and ligaments.

Low back strain results from torn muscle fibers. These injuries are best managed conservatively with rest, anti-inflammatory medications and physical therapy. Baseball players and especially pitchers are prone to these injuries given the need to generate throwing power by twisting.

Injuries that involve the intervertebral discs can result in breakage of the disc and protrusion of the broken piece. If the herniated disc compresses the spinal nerve, the athlete may experience symptoms of weakness, sensory loss and severe pain.

Treatment may involve decompressive surgery and a long rehabilitation. A rigorous regimen of stretching and back strengthening exercises often referred to as a “back program,” is the best way to avoid time on the disabled list.

Warmer weather brings need for acclimatization

2011-06-22T06:23:00.000-07:00

Acclimatization is the process by which an organism adjusts to a change in the environment. Now that warmer weather has arrived and many athletes have decided to get back into action, acclimatization is a crucial element to any regimen.

In sports, acclimatization is best applied to structural and metabolic functions. Structural aspects include muscles, tendons and bones and how they work together. Metabolic systems provide energy to support movement and activity.

In order to avoid potential structural injuries, athletes should stretch adequately before beginning a workout. Starting slowly with a shorter exercise interval and a moderate pace helps. A non-jarring workout such as swimming or cycling before hitting the road for a long run is advisable.

The most reliable indication of a structural problem is pain. Discomfort for 24 hours after a workout is not uncommon but after that, pain should subside. If muscle and joint pain persist or worsen, a medical evaluation is advised.

Metabolic injury can result from extreme physical stress, dehydration, oxygen deprivation or a combination of these factors.

Muscle breakdown from overexertion results in the release of enzymes from damaged muscles. This condition, known as rhabdomyolysis, can lead to renal failure.

Dehydration in the face of working out in hot weather can lead to heat stroke and cardiac failure.

Workouts at high altitude can lead to dizziness and headaches from changes in oxygen concentration.

“Injuries due to metabolic overload typically occur when an athlete is being pushed to work harder by a coach or personal trainer,” said Dr. Jeffrey Anderson, Director of Sports Medicine at the University of Connecticut. Coaches at all levels must be aware of human limitations, especially at the youth sports level, according to Anderson.

The human body has built-in warning signs of impending disaster, including lightheadedness, fatigue and pain. It’s only when these signs are ignored that tragedy occurs.

Regenerative medicine makes older athletes new again

2011-06-07T09:27:00.000-07:00

Some athletes have successfully returned to their sports after reconstructive surgery and superseded their preoperative performances. The latest example is the return of pitcher Bartolo Colon who, after elbow surgery in 2010, has returned to his previous award-winning form.

Much of the credit for his return is being given to “regenerative medicine.” The field of regenerative medicine involves the use of stem cells to repair or replace damaged tissues. Regenerative medicine is based on recent breakthroughs in cell biology and presents seemingly endless possibilities toward the treatment of injuries and disease.

Stem cells are key elements in this exciting new field. Stem cells are found in organisms and have the ability to differentiate into various tissues. The most vivid example occurs in embryonic development but adult stem cells can be found in a variety of tissues.

Bone marrow is an abundant source of stem cells. Transplanting compatible stem cells between individuals has become fundamental in treating cancers that involve blood cells.

Orthopedic applications of regenerative medicine involve the repair and regeneration of tendons and ligaments. These procedures require a scaffold to build on, growth factors and stem cells. Finding the right combination of these essential items continues to be a formidable challenge.

“The science behind regenerative procedures is very solid but no one has been able to successfully apply these elements to the satisfaction of the FDA and insurance companies,” said Dr. Michael Joyce, an orthopedic surgeon specializing in sports-related injuries. Until then, he warns that athletes must be wary of ineffective, expensive substitutes.

Regenerative medicine will likely play a role in the treatment of athletic injuries in the future but at this time the only thing these procedures seem to regenerate is an athlete’s confidence.

Athletes can suffer strokes too

2011-05-26T06:54:00.000-07:00

A stroke results from a lack of blood supply to an area of the brain and causes damage to cells. Common factors for stroke include diabetes, high blood pressure, obesity, high cholesterol and inactivity. Due to the scarcity of these risk factors in athletes, stroke is rarely seen in this group.

Although uncommon, an entirely different group of factors plays a role when an athlete suffers a stroke.

Head and neck trauma are often factors in stroke during athletic competitions. Direct head trauma can result in leakage from blood vessels, depriving large regions of the brain of necessary nutrients.

Violent forward and backward movement of the head can result in tearing the inner lining of vital arteries responsible for directing blood to the brain. This condition, known as arterial dissection, can form a clot within the affected blood vessel or become a source of small clots. These smaller clots often move toward the brain as emboli and block other arteries.

Treatment for arterial dissection involves the use of blood thinning medications and avoiding violent collision sports.

Another common risk factor for stroke in athletes is the existence of a patent foramen ovale (PFO). A PFO is a hole between the upper chambers of the heart, the right and left atria. The foramen ovale forms in the fourth week of embryonic development and should close in the first three months after birth. When it does not close, it is considered patent or open.

This abnormal channel allows direct passage of blood clots to the brain. These clots often originate in the legs and may result from immobilized lower extremities.

PFOs can be treated with equal success by surgical closure or blood thinning medications. Athletes appear to do better with surgical closure and usually make a full recovery to return to sports.

While considered rare, strokes do occur in athletes and treatment requires a different approach.

Athletes and energy drinks don't mix

2011-05-12T06:00:00.000-07:00

Every athlete is looking for a competitive advantage. That advantage may be a better training technique, more advanced equipment or a different strategic approach.

Medicinal supplements have recently become a focus of attention and among the more popular are energy drinks. Most energy drinks are a combination of caffeine and sugar with assorted other herbal additions to boost the potency. The marketing and sale of energy drinks has become a multi-billion dollar enterprise that attempts to appeal to all segments of society regardless of gender, age or socioeconomic status.

Despite the marketing success of these products, no objective evidence has been produced regarding the ability of energy drinks to improve athletic performance. In fact, stories of physical detriment from the use of these supplements have begun to emerge.

One such incident impacted the life of Drake Williams, a high school senior basketball player, and was reported by Tanya Arja for Fox News Tampa. It was the first day of practice and the team was performing drills when he collapsed, a victim of sudden cardiac arrest. Fortunately, a defibrillator was immediately available and his heart was shocked back into normal rhythm.

While no direct correlation could be established, his doctors believe that the fact that he drank two energy drinks in the 24 hours prior to the incident played a role.

Energy drinks, like other nutritional supplements, are not regulated by the Food and Drug Administration. Soft drinks are considered food and limited to no more than 71 mg of caffeine per 12 ounces, while energy drinks can contain between 75 mg and 400 mg per serving.

Studies show that energy drinks are regularly consumed by 30 percent to 50 percent of children, adolescents and young adults. Some common effects of high doses of caffeine include irritability, restlessness, increased blood pressure and heart rate, headaches and tremors. Ironically, many of these effects may be detrimental to athletic performance rather than enhancing.

During any athletic endeavor, heart rate and blood pressure typically soar. The addition of highly caffeinated supplements such as energy drinks can create a deadly combination.

Baseball in Haiti

2011-04-26T06:16:00.000-07:00

The smell of freshly cut grass, the sound of a ball hitting a bat and the feel of a freshly oiled mitt all signify the beginning of baseball season. It is a ritual that evokes pleasant memories for many Americans. During the past week, I have come to realize that Haiti is no exception.

Baseball has developed an international following beginning with exportation during World War II by American soldiers stationed abroad. Haiti has never been known as a center for the development of future baseball stars. In fact, there are no current professional baseball players from Haiti, yet a short trip over to the Dominican Republic reveals the largest number of foreign-born baseball players currently playing in the major leagues.

That may soon change. During my most recent trip to Haiti, I had a chance to work out with the “Tabarre Tigers,” a team of 20 boys from the streets of Port-au-Prince. They were first brought together by several Americans working as part of the Haitian relief effort through “Artists for Peace and Justice.”

The Tabarre Tigers play baseball in an actual cow pasture complete with cows and manure. Bases are sandbags previously used as flood barriers. Equipment includes well-used mitts, balls and metal bats. Athletic shoes consist of shower shoes, sandals and poorly fitting sneakers. A Haitian coach is present for safety and to provide basic instruction.

I soon came to find out that what these young athletes lacked in skill and equipment they made up for in spirit. The joy of playing the game was readily apparent. When it came time to play a practice game, sides were chosen playground style with the last chosen showing his frustration.

As the game went on, there was cheering, shouting and congratulations. Solid contact and successful throws were appreciated.

My afternoon with the Tabarre Tigers was strangely reminiscent of a time in sports many of us remember. No shouts of encouragement or disappointment from parents who are often too involved. No overly coached players. There is no “every player wins” philosophy in Haitian baseball or in Haitian life. It is highly motivating to learn that there are times when someone does lose.

This experience reminded me of the importance of youth sports in its simplest and purest form.

If you have new or slightly used baseball equipment and would like to donate it to this cause, you can drop off the equipment at the WXLM 980-AM studios, 7 Gov. Winthrop Blvd. in New London.

Baseball is back — and so are oblique muscle injuries

2011-04-12T13:17:00.000-07:00

Baseball season has officially begun and, unfortunately, so has the ever-present disabled list (DL).

The DL is used to signify that a player is unable to compete and it allows the team to promote a substitute player from a lower level to the major league team. It also serves as a barometer for the success of strength and conditioning specialists as well as athletic trainers.

Among the injuries seen early in the season are those that affect the abdominal muscles. These are typically strains or tears in the muscle fibers. They can be very painful and debilitating for an athlete who competes in a throwing sport.

The oblique muscles consist of four paired muscles, the internal and external obliques. They are large, flat muscles that extend from the rib cage to the pelvis in a perpendicular orientation to each other. The principal role of these muscles is to provide stability to the trunk while protecting the abdominal contents.

Injury results from sudden tension on muscle fibers that are not supple. Oblique muscle injuries are most common in tennis, baseball and other sports where throwing and twisting are principal movements. Pitchers are especially impaired by these injuries.

Treatment of oblique muscle injuries consists of rest, alternating hot and cold applications and anti-inflammatory medications. The challenge is resting any muscle that provides support to the trunk. Whenever an athlete stands or turns, these muscles fire. Taping these muscles in an effort to restrict motion can result in diminished breathing.

The best way to prevent oblique muscle strain is through adequate stretching before any activity along with a core strengthening regimen.

Taking time to warm up before tossing a ball or swinging a racquet can keep all athletes off the disabled list.

Caution necessary with head injuries

2011-03-30T04:36:00.000-07:00

The gravity of traumatic brain injury (TBI) in sports cannot be overemphasized. It is among the few ways an athlete can die during a contest.

The responsibility for determining when and if brain-injured athletes can return to full participation in their sports is often the most difficult decision a sports medicine specialist must make. A concussion is the mildest and most frequently encountered form of TBI.

Medical technology offers a vast array of imaging, as well as psychological and electrodiagnostic examinations, as part of the neurological evaluation. Despite the magnitude of the decision to return to play, there is no single test or formula to rely on for guidance.

Before 2008, a rating scale based on the presence or absence of loss of consciousness was used. Unfortunately, the scale was an unreliable indicator of when it was safe to return.

The most dependable approach to this dilemma involves two stages:

• The first is careful analysis of the clinical data, history of the incident and previous TBIs, physical examination and observation. An athlete must be symptom-free, including headaches, dizziness, confusion and visual changes.

Based on this information, it is determined whether an athlete can safely begin a rehabilitation program aimed toward full activity. This decision is best made by a physician experienced in treating athletes.

• The second stage in the recovery process includes returning to activity without symptoms. This procedure begins with a low-impact aerobic exercise for 20-30 minutes, then light resistance training and finally concludes with sport-specific activities performed under observation by a certified athletic trainer.

The rehabilitation process after TBI can take months and, sadly, many outstanding athletes never return to their sports.

Interestingly, it is often the great athletes who take the lessons learned from years of hard work and channel them into immense success in another field of endeavor.

Hip injuries can be avoided by stretching properly

2011-03-15T08:56:00.000-07:00

Hip pain is often a difficult problem to diagnose and treat due to the challenge of finding the origin of the pain. In many instances, the source of hip pain involves injury to the iliopsoas muscle.

The iliopsoas muscle is formed by a combination of the psoas major, psoas minor and iliacus muscles. These muscles originate from the lumbar spine and pelvis and attach to the upper portion of the femur. Any injury in this area will result in poorly localized pain in the low back, hip and groin.

Typical injuries include iliopsoas strain, where there is tearing of muscle fibers, and iliopsoas tendonitis that is marked by inflammation of the iliopsoas tendon. These injuries are the result of sudden stretching of the muscle by flexing the hip or externally rotating the thigh. Repetitive hip flexion can also cause harm.

Symptoms of iliopsoas injury include pain and stiffness in the hip that can often radiate into the thigh. The pain can be very intense and often results in an athlete withdrawing from competition.

Iliopsoas injuries are most common in gymnasts, dancers, track and field athletes and soccer players. Venus Williams was recently forced to withdraw from the Australian Open due to what was reported as an injury to the iliopsoas. Any activity that requires repeated hip flexion can result in damage.

These injuries can be avoided through a stretching program performed regularly. Strengthening of core muscles including the hip and pelvis will not only improve overall athletic performance but avoid injury to the hip, pelvic and upper leg muscles.

Treatment includes rest, ice and anti-inflammatory medications. A stretching program should be instituted when pain subsides. Unfortunately, an iliopsoas injury often requires up to three weeks of rest.

Many musculoskeletal hip injuries can be avoided and successfully treated with a carefully executed stretching regimen.

NFL collective bargaining centers on safety

2011-03-01T13:03:00.000-08:00

A collective bargaining agreement is the result of a negotiation between a group representing the interests of employees and an employer. Collective bargaining has now become an important term in professional sports. Unfortunately, when there is a breakdown in negotiations and a work stoppage results, it is the fans who suffer.

The current collective bargaining drama involves the NFL and the NFL Players Association. While financial issues are central to most employment agreements, this negotiation appears to have a focus on safety.

Dave Duerson was a 50-year-old, successful businessman and former Chicago Bears safety. In recent years, his life began to unravel with marital problems, business failures, uncharacteristic temper outbursts and an inability to remember simple information.

Duerson was diagnosed with Chronic Traumatic Encephalopathy (CTE) as a result of the multiple concussions he had suffered during his years of playing football. He was also an active NFL alumnus fighting for better health benefits for retired players and making the game safer for younger players.

Unable to face a future of dementia, on Feb. 17, Duerson committed suicide by shooting himself in the chest. He chose this manner to preserve his brain for future study. His desperate action has placed a new light on the current negotiations.

Neuropathologists around the world have recently begun to delve into the study of cumulative brain trauma and subsequent Alzheimer’s-like dementia. Some studies have shown changes in the brains of teenage athletes involved in violent collision sports like football and hockey.

“There is no reason, no medical justification, for any child younger than 18 to play football, period,” said Dr. Bennet Omalu, a neuropathologist in California. His opinion is based on studies emphasizing the importance of brain development in the first 18 years of life and the fact that when brain cells are destroyed there is no cellular recovery.

Young people everywhere often believe they are indestructible and are willing to take unacceptable risks for financial reward. The NFL is no exception. It will be interesting to see if the wisdom of elder veterans will direct these negotiations.

Sleep can improve athletic performance

2011-02-15T12:26:00.000-08:00

The most potent way to heal injured tissues and rejuvenate multiple organ systems is not a new wonder drug or expensive supplement, it’s sleep. Sufficient amounts of sleep are crucial for outstanding human performance, especially in athletes.

Sleep actually consists of a series of stages that have different physiologic roles. The ability to cycle repeatedly through each stage with an adequate amount of time spent at each level is called “sleep efficiency” and serves as the goal when looking at the architecture of this process.

The two primary divisions of sleep are REM (rapid eye movement) and NREM (non-rapid eye movement). NREM is further divided into three other stages. Only 25% of total sleep time is spent in the REM stage.

During sleep, natural hormones are released in the body and enhance the physical recovery process. Among these are serotonin and growth hormone, the latter being a much publicized “performance enhancing drug” and subsequently a banned substance. Serotonin improves psychomotor performance. These factors alone can give an athlete a tremendous advantage in competition.

Adequate amounts of sleep are crucial to take full advantage of this hormonal production. Unfortunately, an athlete’s schedule that may include long trips, inconsistent sleeping conditions and erratic performance times are obstacles to sleep efficiency.

Dr. Setu Vora, a physician on the Backus Hospital Medical Staff specializing in the diagnosis and treatment of sleep disorders, advocates a simple approach when dealing with insufficient sleep in athletes.

“The best medication is no medication. The same discipline that athletes apply to their sports must also be applied to sleep. The bedroom should be used solely for sleep and an average of eight hours each night is the goal,” said Vora.

International athletes who must endure transatlantic travel should try to sleep on the flight. Earplugs and sleep masks can be helpful.

Adequate sleep, proper diet and a regular workout schedule is vital for athletes at any level.

Too much exercise can cause muscle breakdown

2011-02-01T06:54:00.000-08:00

Last week, 13 University of Iowa football players were hospitalized for a condition known as rhabdomyolysis. This condition results from an extreme breakdown of muscle fibers and complications caused by the circulation of the breakdown products.

Rhabdomyolysis generally results from muscle injury. Trauma is typically the most common cause of rhabdomyolysis. Other causes include genetic conditions, dehydration, medications, supplements, seizures, heatstroke, vascular insufficiency, severe exertion or any combination of these.

There are two types of muscle, smooth or involuntary muscles and striated or voluntary muscles. Muscles consist of a complex system of filaments that contract and relax in response to impulses from the nervous system.

Striated muscles are the engines that drive the movement of joints. Like all engines they rely on a fuel source to continue working. If the demand placed on muscles exceeds the availability of nutrients, the fibers “lock up” and cramp. If the imbalance continues, muscle fibers begin to break down.

When muscles break down, proteins and enzymes are released into the bloodstream. Among these enzymes is creatine kinase (CK). The concentration of CK can be measured in a blood sample and indicates the degree of muscle breakdown. CK also appears in various forms that indicate what types of muscles have been injured.

In rhabdomyolysis, myoglobin is among the breakdown products. When high concentrations of this protein are emitted, urine develops a reddish discoloration. If high levels persist, kidney failure will result.

Treatment consists of intravenous infusion of fluids and renal dialysis if necessary.

In the case of the Iowa athletes, it is believed that extreme exertion as part of an offseason workout was the cause. One player reported having to perform 100 squat repetitions with 240 pound weights.

Physical exercise is a big step toward good health, but as 13 Iowa football players have discovered, moderation is essential.

Cold-weather sports can pose health risks

2011-01-19T08:36:00.000-08:00

A recent trend in sports has been a return to outdoor winter events. Outdoor hockey games held in stadiums have drawn large crowds. The roof collapse of the Minnesota Vikings home field and relocation to a much colder venue added an additional element to the game.

This shift to more athletic events being held in inclement weather, especially sub-freezing temperatures, poses a danger for both athletes and patrons. During vigorous exercise, energy is expended both by the activity and the need to keep muscles warm.

The two most common forms of injury from exposure to cold include frostbite and hypothermia. Shivering is the first sign of impending cold injury. It consists of involuntary muscle contractions as a means for the body to generate heat. When shivering begins, an effort to get to a warmer environment should be the next step. Alcoholic beverages should be avoided.

Frostbite is the freezing of superficial tissues. It typically appears on fingers, toes and facial structures. Symptoms include pain, tingling, and pale skin that will often blister. The most effective treatment is gradual warming, being careful to avoid friction that can result in permanent tearing of damaged tissues.

Hypothermia is the most severe form of cold injury. It is the result of the core body temperature falling below 95 degrees Fahrenheit. The most severe impact involves neurologic and cardiac function. Patients become confused and sleepy with slurred speech. The clinical presentation resembles alcohol intoxication. Changes in cardiac rhythm can lead to sudden death.

The best treatment for cold injury is avoiding continued exposure. Appropriate attire should include thermal garments that retain heat. Dressing in layers is important. Special attention should be given to the extremities.

Exercising in cold weather does burn more calories and an outdoor workout should be modified accordingly.

Fencing exercises the body and mind

2011-01-04T07:40:00.000-08:00

For many people, the start of a new year is an invitation to take on new challenges. This may include dieting, quitting smoking or beginning a fitness regimen. Those who have been involved in a workout program are often looking for some new element. Fencing is a worthwhile consideration.

The origins of fencing can be traced back to ancient Egypt and Rome, yet it remains both a physical and mental challenge even today. Participation is not dependent on age, size or gender.

Fencing builds stamina, strength and balance. Each match involves a series of advances and retreats combined with the skillful use of a weapon called a foil.

The sport appears to emphasize upper body strength but it is the lower body and core muscles that are crucial for success. Most athletic activities are based on forward rather than lateral movement. Fencing is among the activities that requires sideways movements that help train the neuromuscular system to avoid potential lateral falling injuries.

Common fencing injuries include wrist and ankle sprains, bruising and strained muscles. Physical preparation includes both strength and aerobic training. Meticulous stretching of upper and lower extremity muscles as well as core muscles is imperative to avoid injury.

Fencing is a sport in which lessons are necessary for full enjoyment and safety. Aaron Hughes, Head Fencing Coach at St. Bernard High School and Eastern Connecticut State University, offers weekly lessons and training sessions at Fitness World in Norwich.

“Participants are surprised at the amount of stamina and concentration required for fencing,” said Hughes.

One recent Sunday, local radio talk show host Lee Elci and I joined a class hosted by Hughes. We both enjoyed the class and competitive dueling afterward.

Fencing is a sport that exercises both the body and mind at any age.

The best of 2010 makes for good advice for 2011

2010-12-29T22:22:00.000-08:00

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

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

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

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

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

Sports can taken on new meaning during season of giving

2010-12-22T11:49:00.000-08:00

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

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

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

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

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

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

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

Give the gift of fitness this holiday season

2010-12-15T15:00:00.000-08:00

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

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

Some items worth considering:

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

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

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

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

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

Longer seasons means longer disabled lists

2010-12-08T05:28:00.000-08:00

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

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

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

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

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

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

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

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

Hockey coaches must know signs of concussions

2010-11-30T20:41:00.001-08:00

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

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

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

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

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

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

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

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

Elliptical trainers can help keep the pounds off during holiday season

2010-11-23T20:30:00.000-08:00

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

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

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

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

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

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

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

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

Physical activity helps those with Parkinson’s disease

2010-11-16T07:05:00.000-08:00

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

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

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

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

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

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

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

Football safety debate could benefit from local examples

2010-11-09T19:41:00.000-08:00

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

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

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

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

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

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

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

Maybe there is something to be learned.

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

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

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

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

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

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

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

Swimmer’s death a reminder that we all have limits

2010-11-02T06:31:00.000-07:00

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

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

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

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

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

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

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

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

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

Take precautions when exercising on trails

2010-10-26T09:29:00.000-07:00

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

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

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

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

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

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

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

When the leaves change, so can workouts

2010-10-19T04:47:00.000-07:00

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

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

Trail Biking Safety

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

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

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

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

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

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

Barefoot running takes adjusting to get in stride

2010-10-12T08:36:00.000-07:00

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

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

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

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

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

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

Yoga benefits a wide range of people

2010-10-07T08:16:00.000-07:00

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

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

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

Among the benefits of yoga are improved:

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

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

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

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

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

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

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

‘Stroller strides’ help new moms lose weight

2010-09-28T11:15:00.000-07:00

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

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

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

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

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

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

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

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

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

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

Family histories are tools to avoid sports injuries

2010-09-21T16:04:00.000-07:00

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

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

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

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

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

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

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

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

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

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

Exercise helps those with Multiple Sclerosis

2010-09-14T13:16:00.000-07:00

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

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

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

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

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

• An adequate period of warm-up and stretching

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

• Resistance exercise on alternating days

• Activities that improve balance

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

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

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

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

Tai chi and fibromyalgia

2010-09-07T20:29:00.000-07:00

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

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

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

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

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

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

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

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

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

Exertional heat symptoms cannot be ignored

2010-08-31T19:26:00.000-07:00

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

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

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

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

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

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

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

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

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

Lou Gehrig’s disease and head trauma

2010-08-24T08:08:00.001-07:00

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

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

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

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

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

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

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

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

Hula Hoop your way to better health

2010-08-17T20:02:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

Yoga provides early opportunity for parents to exercise with children

2010-08-10T07:51:00.000-07:00

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

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

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

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

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

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

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

Magnets attract loyal following among athletes

2010-08-03T14:43:00.000-07:00

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

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

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

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

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

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

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

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

Q&A: Frequently asked questions about youth sports concussions

2010-07-27T04:24:00.000-07:00

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

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

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

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

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

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

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

Weightlifting can be part of youth exercise programs

2010-07-19T15:20:00.000-07:00

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

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

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

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

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

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

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

We can prevent concussions in youth sports

2010-07-13T06:17:00.000-07:00

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

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

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

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

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

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

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

Field conditions can cause injuries

2010-07-06T08:12:00.000-07:00

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

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

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

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

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

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

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

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

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

Eating disorders can impact athletes

2010-06-29T07:04:00.000-07:00

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

There are three forms of eating disorders:

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

Bulimia — a cycle of binging and purging.

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

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

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

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

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

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

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

KJ Life tourney celebrates athlete

2010-06-22T04:46:00.000-07:00

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

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

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

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

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

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

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

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

Don’t overlook the importance of bike seats

2010-06-15T06:13:00.000-07:00

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

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

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

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

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

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

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

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

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

Sports medicine technology showcased

2010-06-08T05:40:00.000-07:00

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

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

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

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

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

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

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

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

Athletes can overcome migraine headaches

2010-06-01T07:19:00.000-07:00

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

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

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

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

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

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

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

Warming up reduces chances of groin strains

2010-05-24T15:35:00.000-07:00

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

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

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

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

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

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

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

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

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

Spine injuries can be pain in the neck

2010-05-17T13:56:00.000-07:00

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

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

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

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

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

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

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

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

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

Ban tobacco use in baseball

2010-05-11T14:05:00.000-07:00

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

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

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

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

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

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

Female athletes at risk for concussion

2010-05-04T13:40:00.000-07:00

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

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

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

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

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

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

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

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

Lacrosse’s popularity has led to rise in injuries

2010-04-27T06:03:00.000-07:00

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

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

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

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

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

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

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

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

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

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

Concussion bill would protect young athletes

2010-04-19T09:22:00.000-07:00

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

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

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

There are two important steps necessary to treat concussion:

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

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

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

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

Warm up before you ‘Play ball!’

2010-04-13T08:00:00.000-07:00

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

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

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

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

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

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

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

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

Health history crucial to treat young athletes

2010-04-06T10:44:00.000-07:00

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

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

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

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

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

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

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

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

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

You can’t coast through an indoor cycling workout

2010-03-30T11:48:00.000-07:00

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

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

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

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

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

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

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

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

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

Red Sox prospect faces long road to recovery

2010-03-23T09:31:00.000-07:00

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

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

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

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

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

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

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

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

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

Echocardiograms can save athletes’ lives

2010-03-16T08:56:00.000-07:00

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

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

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

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

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

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

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

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

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

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

Cardiac screening is crucial for athletes

2010-03-09T08:22:00.000-08:00

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

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

Designing an effective cardiac screening program presents a challenge.

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

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

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

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

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

Olympian breaks down barriers for diabetics

2010-03-02T06:50:00.000-08:00

Twelve kilometers into the Olympic 30-kilometer cross-country ski event, Kris Freeman literally ran out of gas and collapsed. Freeman, an American hoping to medal in the event, shocked everyone when he was found lying in the snow asking for sugar. He is the first Olympic distance athlete who has type 1 diabetes.

Insulin is a hormone produced by the pancreas. People with type 1 diabetes produce little or no insulin. Insulin allows glucose to move into cells and produce energy.

Distance athletes must be meticulous about balancing energy requirements and extreme physical demands. This challenge is infinitely more difficult for athletes with diabetes.

Technology has made a huge difference in preparing diabetic distance athletes for their quest. The insulin pump is a computerized apparatus that provides a constant infusion of insulin. It is programmed according the expected level of activity.

Dr. Leslie Domalik, Medical Director of The William W. Backus Hospital Diabetes, Endocrinology and Metabolism Center, recalls her experiences at Duke University. She enjoyed the challenge of managing athletes with diabetes.

“In the past, patients would have to regulate their activities based on a fixed insulin dose. We can now alter the insulin based on the patient’s activity level,” she said.

In the case of Freeman, he anticipated a slower pace in the cross-country event and programmed the insulin pump to release more insulin. Unfortunately, the pace was faster and there wasn’t sufficient time to re-program the pump, resulting in a drop in blood sugar and loss of consciousness. A nearby German coach was able to give him some sugar and he eventually completed the race.

Although he didn’t do as well as he would have liked, Kris Freeman’s efforts in long distance sports have successfully broken a previous barrier, and isn’t that what the Olympics are really about?

Biathlon strategy can be useful in daily life

2010-02-23T11:19:00.000-08:00

Multi-sport Olympic events have always been considered the most difficult. In fact, the reigning decathlon champion is typically considered “the world’s best athlete.”

Sports consisting of both extreme athletic effort and a technical skill require very different approaches to training. Among these, biathlon is considered to be the most challenging.

Biathlon first became an Olympic sport in 1960, but its origins date back to 2000BC. It is a combination of cross country skiing and marksmanship. The object is to complete a skiing course (20km or 12.4 miles for men and 15km or 9.3 miles) in the shortest amount of time while stopping to shoot at targets in the prone and standing positions. Missed targets add minutes to the final time.

Cross country skiing is an intense aerobic activity requiring both upper and lower body strength as well as cardiovascular stamina. Training sessions often last 21⁄2 hours and it is not uncommon to average 13 such sessions per week.

During the season, workouts typically consist of a combination of skiing and shooting. Off-season activities include roller skiing, rowing and elliptical work outs.

Physiologically, the challenge in biathlon is going from a state of high adrenergic stimulation with rapid breathing, elevated heart rate and sweating to a condition of calm and precise movements. All humans have a slight, often imperceptible tremor. When agitated, this tremor becomes coarser. Biathletes must condition themselves to make this transition quickly.

The key to making this dramatic transition is the ability to control breathing. In doing so, the heart rate slows and a rhythm is established to perform a necessary skill.

Cadenced breathing is an effective tool for athletes to create calm in the midst of agitation. It is also a skill that will serve non-athletes when dealing with stress.

Winter Olympic Training

2010-02-18T07:56:00.000-08:00

Over the course of the next two weeks, new records will be posted in a variety of winter sports. These exciting feats of athletic prowess are often made possible by innovations in physical training.

Since the first recorded Olympics in 773 B.C., dedication to a physical regimen of diet, exercise and good health habits has been paramount. Like their ancestors, modern Olympic athletes train year-round for their events and begin at an early age. Even in ancient Greece, many had access to the services of a personal trainer who was generally a retired athlete. What have changed dramatically are the training techniques used today.

When reviewing the training regimens of winter Olympic athletes, three recurring patterns, in addition to their sport-specific workouts, are universal: cross training, resistance training and core training.

Cross training simply refers to training in different ways to improve overall performance. Skating, sledding and skiing participants cross train by cycling. They will do this on the road during the off-season and by using a stationary bike during winter months. A stationary bike is also a good way to warm up cold muscles immediately before an event.

Resistance training is primarily performed by lifting weights. Various workouts are based on a specific sport to determine which muscles need to be developed and whether they are being utilized for a distance or sprint event.

Core training involves building strength in muscles that stabilize the abdomen, pelvis and spine. Exercises can include the use of a medicine ball, a physio ball, dumbbells or something as simple as push-ups.

The winter Olympics will provide a lot of entertaining moments, but they should also serve as a lesson in good health practices and personal fitness.

Rapid weight loss is dangerous for athletes

2010-02-09T15:34:00.000-08:00

Historically, wrestling is one of the first competitive sports. It dates back to the first Olympic Games in Greece. Millions of amateur athletes are drawn to wrestling because it matches competitors of similar weight and size. It requires strength, coordination and endurance.

There is a very dangerous side to wrestling and other weight-based sports like boxing. The danger is the tendency for competitors to “cut weight.” Cutting weight is the practice of losing large amounts of weight in a short period of time so that the athlete qualifies to compete in a lower weight class. Athletes generally weigh-in 24 hours before a match, then try to replenish fluids prior to their match. This results in large fluid shifts.

Common techniques for cutting weight include exercising in a sauna while wearing an impermeable plastic suit and sweats. This causes hyperthermia and, in three well-publicized cases, has lead to the death of athletes. Some will use laxatives and diuretics in addition to sweating off fluid.

Vigorous exercise at high temperatures will result in muscle breakdown called rhabdomyolysis. As muscle breaks down, the athlete becomes weaker.

In boxing, the pre-fight weigh-in includes a physical exam. It is often during the exam that the ringside physician can detect signs of cutting weight like a rapid heart rate and low blood pressure. This can lead to disqualification.

USA Boxing and the NCAA now require athletes to weigh-in shortly before the event so that there is no time to replenish fluid and anyone who has cut an extreme amount of weight will be physically unable to compete at peak performance.

This unfortunately has not discouraged these dangerous practices and there are internet websites advising young athletes how to rapidly lose weight.

Athletes often feel invincible and it becomes the job of coaches, athletic trainers and parents to monitor their weight.

Keeping youth sports safe

2010-01-26T06:38:00.000-08:00

Aside from the physical benefits, youth sports are an effective means of shaping a child’s work habits and character. Approximately 30 million children under the age of 14 participate in organized youth sports throughout the United States. The problem is that many of these activities are unsafe.

The statistics are staggering:

• Approximately 8,000 children are treated in emergency rooms each day for sports-related injuries
• 62% of injuries occur during practices
• There are five times as many catastrophic football injuries in high school athletes as opposed to college athletes
• Cardiac and neurological injuries account for the predominance of sports related deaths.

The National Athletic Trainers Association (NATA) and the Connecticut Athletic Trainers Association (CATA) are diligently trying to make youth sports safer. The NATA has assembled an alliance of medical organizations to address the issues surrounding youth sports safety at a summit meeting.

Locally, the CATA has been politically active in promoting legislation requiring automatic external defibrillators (AEDs) to be available at all high school sporting events. They are currently spearheading legislation regarding sports concussion management in Connecticut high school athletes.

“Pre-high school youth sports programs often do not provide adequate medical coverage,” said Vicky Graham, a certified athletic trainer and president-elect of the CATA. Personnel trained in first aid and CPR should be available at every youth sports league game and practice.

Commotio cordis, a fatal heart arrhythmia from direct trauma, is most commonly seen in lacrosse, hockey and baseball. AEDs should be required at all of these youth programs.

As youth sports programs schedule rules and coaching clinics in preparation for their season, a clinic on sports safety is imperative. These can be arranged by contacting the CATA at www.ctathletictrainers.org

Weightlifting Safety

2010-01-19T11:37:00.000-08:00

The most dangerous phrase heard in the weight room of any gym is, “Don’t worry, I have it.” That usually means the person lifting the weight is self confident enough that they don’t need or wish to bother anyone to serve as a spotter.

Now that new year’s resolutions are in full swing, for many that includes cardio (treadmill, elliptical, rower) and resistive (Nautilus, Bowflex, free weights) workouts. Resistive exercise can be dangerous if certain precautions are not followed.

The basis of resistive exercise is to maximally exert a muscle so that it will gradually hypertrophy (enlarge) to handle increasing amounts of weight. This can be done in sudden short spurts with large amounts of weight or by increased repetitive movements with lighter weights.

Body builders typically prefer the first option, especially when bench pressing. In a bench press position, any loss of control of the weight can lead to disaster.

Stafon Johnson, a USC running back, was bench pressing in September when the weight fell on his throat, collapsing his trachea and obstructing his air flow. He missed most of the season and his voice hasn’t fully recovered.

Helpful tips before engaging in any resistive exercise include:

• Adequate warm up before lifting
• Know the amount of weight you can lift safely
• Stop if you feel pain or become lightheaded
• When performing any routine where you may be in danger if control of the weight is lost, always use one or two spotters.

Marc Nee, a personal trainer with “Training with Heart,” advises to always be prepared for the worst when lifting free weights. “If you really want to attempt to lift the maximum amount of weight, use a machine and leave the free weights alone,” he said.

Complete recovery possible from knee injury

2010-01-12T05:35:00.000-08:00

On Sunday, Jan. 3, Patriots wide receiver Wes Welker made a routine catch and proceeded to elude potential tacklers. Unfortunately, his effort resulted in tearing two of the four main ligaments in his left knee.

A season-ending knee injury to a player of Welker’s magnitude prompts several questions from fans. Why did it happen? How will the injury be repaired? Will he be able to return to his previous level of performance?

The knee is the largest joint in the human body and joins the lower portion of the femur and upper portion of the tibia. Ligaments provide stability for the joint. When an athlete makes a sudden lateral move, the force placed on the joint is several times the athlete’s weight. Even slight instability can cause disruption of the ligaments.

Another factor is turf consistency. There are two important factors in adequate turf: resistance and friction. A slippery field or one with an inconsistent base can lead to disaster.

Torn ligaments often require surgical repair after swelling subsides. Any surgery of this nature requires an intense postoperative rehabilitation program.

The remaining question of possible return to previous performance levels is the most difficult to answer.

“Restoring the knee to its original integrity and an athlete returning to their pre-injury activity level are different issues,” said Dr. John Giacchetto, an orthopedic surgeon in Norwich who treats many athletes. “It is difficult to reconstruct the knee to the point where it has the same specifications regarding flexibility and range of motion but many athletes have returned to their previous levels of athletic performance.”

High-level athletes understand that injuries and rehabilitation are part of their profession. Considering Wes Welker’s injury and his work ethic, Patriots’ fans should expect a complete recovery.

Cheerleading is a sport and should be treated like one

2010-01-05T08:14:00.000-08:00

On January 9-10, a sport considered by some to be among the most dangerous in America will be coming to the Mohegan Sun Arena. While initially sports fans would think of boxing, cage fighting or bull riding, the sport is actually cheerleading.

The Spirit Festival National Cheer and Dance Championships consist of 150 teams and 3,000 participants. The last cheerleading event hosted at Mohegan Sun resulted in 68 injuries with 10 of those requiring a visit to Backus Hospital.

As cheerleading continues to grow in popularity, so has the controversy surrounding issues of safety, regulation and sport status.

A sport is best defined as having at least 50% competitive activity. Without that designation, standard medical and safety requirements are waived.

While there is no central regulatory body for cheerleading, the American Association of Cheerleading Coaches and Administrators (AACCA) represents over 20,000 coaches.

“The principal role of the AACCA is to serve as a risk management resource by providing educational and rules seminars, and advocating for safety at all venues,” said Jim Lord, the AACCA executive director.

Unfortunately, the AACCA has no power of enforcement.

In 2008, the Catastrophic Sports Injury Research Center cited statistics demonstrating a disproportionate number of catastrophic injuries in cheerleading when compared to other women’s sports. This led some to unfairly dub cheerleading as the “most dangerous sport in America.” The data did not consider the number of injuries in relation to the millions of participants.

Fortunately, the Mohegan Tribe has not become engaged in this legal controversy. Instead, it regards cheerleading as a sport and provides what is among the safest venues for cheerleading in the United States.

Parents must always be mindful of what systems are in place at any sports venue in the event of catastrophe. Cheerleading is no exception.

Healthy Sports: 2009 year in review

2009-12-29T07:51:00.000-08:00

Looking back over 2009, there have been several “Healthy Sports” stories that have sparked comments and controversies worth mentioning:

• In April an article dealt with the topic of safety in baseball. One point addressed “avoiding injury from a hard-hit ball coming off a metal bat.” This comment sparked a swift response from the “Don’t Take My Bat Away Coalition” (DTMBA), a special interest group funded by metal bat manufacturers. Armed with engineering data, their executive director made the argument that a ball comes off the bat no faster with a metal versus a wooden bat. When confronted on the “Healthy Rounds” radio show with the option of using a metal or wooden bat to hit a life-saving home run, he would choose the metal bat.

• The Healthy Sports column that discussed sports options for autistic children received outstanding comments by many groups of dedicated parents and educators. I was pleasantly surprised to find there are more options for these children than I had mentioned, including a soccer program in Hawaii just for children with autism.

• A column about sports anxiety quoted many local professional and amateur sports personalities regarding how they deal with this problem. Comments showed that this is a very common obstacle not only for athletes but also for other performers including public speakers.

• The column that has garnered the most interest this year reviewed information surrounding “Chronic Traumatic Encephalopathy” (CTE). Previously referred to as “Dementia Pugilistica,” it was believed to only pertain to repeated blows to the head from boxing. New data shows that this entity has resulted in premature dementia in football players. This has prompted congressional hearings and anticipated rule changes in football. There is much more to come on this subject.

Let’s all hope for a safe and healthy 2010.

Weight loss surgery should not be taken lightly

2009-12-22T06:03:00.000-08:00

Bariatric surgery, also known as weight loss surgery, is increasing in popularity among Americans. Before going to the operating room, there are certain necessary steps to be taken — including a trip to a local gym.

The two most common forms of bariatric surgery are gastric bypass and laparoscopic banding.
The gastric bypass involves altering the digestive tract so that fewer calories are absorbed and the patient feels full more quickly.

Gastric banding is a less permanent approach where a band is placed around the stomach. The band can be tightened by injecting saline at different times.

Surgical candidates must have a body mass index (BMI) of 40 or more. This is the equivalent of a 5-foot, 10-inch person weighing 285 pounds. If the person has an obesity-related illness (diabetes, hypertension, high cholesterol), a BMI of 35 is acceptable.

“All potential patients must undergo extensive pre-surgical evaluations including psychological, dietary and exercise counseling,” said Dr. Carlos Barba, a bariatric surgeon and director of the bariatric surgery program at the Hospital of Central Connecticut. Dr. Barba believes that surgery is only part of the program and the most common cause of failure is a lack of commitment.

Exercise is crucial to any weight loss program. The type of exercise is variable. Consultation with a personal trainer is advisable. Morbidly obese patients may begin with an aquatic program where they are buoyant and progress to walking and weight lifting. Many arthritic patients use a low impact routine that may include recumbent cycling.

Bariatric surgery has helped many people eliminate risk factors for heart attack, stroke and cancer but weight loss surgery is not a “quick fix,” it is an invitation to a life-long commitment to fitness.

Body sends signals of serious injuries

2009-12-15T12:10:00.000-08:00

The physical demands placed on professional football players are astounding. The amount of physical contact and the impact of this contact continue to intensify.

The length of disabled lists at Week 14 has also grown. The highest profile disabled players appear to be quarterbacks and running backs: Tom Brady, Kurt Warner, Brian Westbrook and Ben Roethlisberger.

Unfortunately, there are also a growing number of unqualified critics casting doubt on the validity of these injuries. Sadly, among these critics are outspoken teammates.

The human body has a remarkable ability to let a person know when it’s injured. Symptoms such as pain, diminished performance and cognitive changes are a clear indication that rest is needed. Although this sounds simplistic, the amazing part is how often athletes ignore these symptoms and go on to more severe or chronic injuries.

Many young, inexperienced athletes may disregard these indications. That is why coaches, parents and athletic trainers must monitor their activities. Adult athletes have no excuse for not being “in touch with their bodies.”

The NFL has recently assigned impartial neurologic consultants to every team. Their job is to specifically determine when an athlete should not play after a concussion. The difficulty is that there are no clear physical signs of concussion like a sprain or wound and the MRI is usually normal. The physician must rely on the information provided by the athlete.

One role of a sports medicine physician is to “run interference” for injured athletes. At times, athletes will come forward and explain symptoms that indicate a need for rest. It is the responsibility of that physician to place that player on the disabled list and deflect any criticism aimed at the athlete.

Successful athletes at any level know how to read their injury signals.

Ankle sprains can be serious injuries

2009-12-08T17:29:00.000-08:00

Ankle sprains are among the most common injuries that will sideline an athlete at any level of competition.

A new term appearing on injury reports is the “high ankle sprain.” The high ankle sprain refers to severe trauma to the ankle joint often requiring aggressive therapy.

The ankle joint consists of three bones: the tibia, the fibula and the talus, along with a series of ligaments connecting these bones. The most common ankle sprain occurs when the foot and ankle rotate inward. This results in stretching and tearing of ligaments followed by swelling.

Treatment with Rest, Ice, Compression, Elevation (RICE) is usually sufficient for a full recovery.

The high ankle sprain, also called a syndesmotic ankle sprain, involves the ligaments that stabilize the tibia and fibula. The mechanism of injury consists of outward twisting of the foot and ankle. It is most commonly seen in football, basketball and soccer. It may result from rapid changes in direction or direct impact. Initial treatment is similar to any ankle sprain but this may not be sufficient.

“If a high ankle sprain does not become stable, it will develop into a chronic problem,” said Dr. Michael Joyce, an orthopedic sports medicine specialist and UConn team physician. A plain X-ray of the ankle is not sufficient and accurate diagnosis requires a weight-bearing X-ray or MRI to see if the bones spread apart, according to Dr. Joyce.

Surgical intervention includes a variety of procedures with the goal of permanently stabilizing the joint while allowing for full return to sports.

High ankle sprains are serious athletic injuries and require careful evaluation and treatment. Coaches have enough familiarity with high ankle sprains to know that they mean an extended recovery.

Violent collisions can cause cervical spine injuries

2009-12-01T08:38:00.000-08:00

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

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

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

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

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

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

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

Athletes with sickle cell must be cautious

2009-11-24T07:56:00.000-08:00

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

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

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

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

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

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

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

Boxing needs safety measures

2009-11-17T10:50:00.000-08:00

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

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

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

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

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

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

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

Athletes have make-up to overcome physical and mental challenges

2009-11-10T07:39:00.000-08:00

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

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

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

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

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

UConn homicide shows how athletes cope with loss

2009-11-03T12:26:00.000-08:00

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

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

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

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

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

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

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

Marathon Walking

2009-10-27T13:37:00.000-07:00

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

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

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

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

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

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

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

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

Experts explore connection between contact sports and dementia

2009-10-19T12:21:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

As athletes age, aerobic exercise is important

2009-10-13T10:32:00.000-07:00

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

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

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

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

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

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

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

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

Study: Football can damage the body and mind

2009-10-08T13:47:00.001-07:00

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

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

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

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

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

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

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

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

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

It is the final characteristic that must be addressed immediately.

Hand hygiene and shots can help athletes win against swine flu

2009-09-28T12:42:00.000-07:00

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

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

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

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

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

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

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

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

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

Young athletes need good role models

2009-09-22T06:49:00.000-07:00

Athletes making poor decisions both personally and professionally are now a common occurrence. Sports fans read about these indiscretions so often that they are almost expected behavior.

Although many of these choices have legal implications including time in prison, they also can have serious health consequences. Young athletes are now using unprescribed supplements purchased on the internet in astonishing numbers. Peer pressure to drink alcohol and use illicit drugs continues to rise.

No one will argue that things have changed for the worse over the past several decades. Recently publicized events raise many questions:
• What has changed in sports and in society that has resulted in a “leadership void?”
• How can parents, coaches and teachers help correct this and hopefully protect athletes?
• What is the role of the media?

Football has traditionally been the team sport serving as a model for leadership in the United States. No other sport is so similar to battle and requires careful coordination of many skills for success. The quarterback position is analogous to that of a field general leading troops. Bad behavior is more dramatic in football because of the team implications.

“Thirty years ago, the technology to broadcast every college football game wasn’t available,” said Tim Prendergast, director of football operations at the University of Connecticut. “The internet, 24-hour sports television and U-Tube now dramatically increase the exposure of athletes.”

This exposure also influences the behavior of young athletes who imitate their heroes’ poor sportsmanship in the end zone and at times bad health decisions. Prendergast believes that good leaders are able to identify a goal, remove any obstacles to achieving that goal and thank others for their help.

Coaches and administrators agree that leadership is best taught by example. Youth organizations and church activities provide good opportunities other than athletic events to influence young adults.

“The community now also serves as the extended family for many athletes. Many people serve a role in raising a leader,” said Jamal Davis, head coach of the Norwich Free Academy football team. This year Coach Davis is emphasizing the importance of commitment, character and courage both on and off the field with his players. He repeatedly drives home the point that after football, it is these characteristics that will be their legacy.

Dr. Michael Joyce, an orthopedist and highly-regarded team physician, along with his wife, Pam, are embarking on a large-scale effort to provide the necessary skills for athletes to become leaders. The KJ Life Foundation (www.KJLife.org) was established in 2009 in memory of their son, Kenneth, who died tragically in a ski accident.

The foundation has begun a series of seminars for athletes to serve as peer role models by setting good examples and developing character.

“There are moment-to-moment examples of good character. We need to capture those moments and use them as teaching tools,” said Dr. Joyce.

The recurring theme is that personal responsibility is crucial to getting the most out of any athletic experience and making the right decisions to stay healthy.

Athletes require a team of physicians

2009-09-15T13:04:00.000-07:00

At one time, sports medicine solely consisted of orthopedic surgeons and athletic trainers. There is now a myriad of physicians associated with professional sports teams and scholastic athletic programs. While each contributes something different, it is important for an athlete to understand how various physicians approach sports-related injuries.

Primary Care Physicians: These are medical doctors (MDs) or doctors of osteopathic medicine (DOs) who have completed a residency program in either family medicine, pediatrics or internal medicine. They then enter a one-year fellowship program in sports medicine and complete an examination to attain added qualifications in sports medicine (AQSM). Most major sports programs now have one or more primary care physicians who treat non-operative sports injuries.

Orthopedic Surgeons: Many orthopedic surgeons who specialize in sports medicine complete an additional year of fellowship training after residency. This year is exclusively devoted to sports-related orthopedic injuries and working with a variety of sports teams.

Sports Neurologists: While there is currently no formal fellowship in sports neurology, these are MDs or DOs who complete a neurology residency and treat athletes with neurologic injuries. Concussions, spinal injuries and injuries to peripheral nerves are typical.

Sports Psychologists: Sports psychologists have PhD degrees in clinical psychology. They help athletes deal with the mental aspects of their sport to improve performance.

Other physicians who are commonly utilized as part of the sports medicine team include chiropractors, podiatrists and dentists.

In the case of a sports-related injury, the approach and goals of treatment center around how to get an athlete back to sports participation safely. When seeking care it is wise to investigate what experience that physician has in sports.

Sports medicine involves a wide range of specialists

2009-09-08T08:04:00.000-07:00

“The advice you receive is only as good as the source.” This adage is especially true when seeking medical advice for a sports-related injury.

As sports medicine has become more inclusive of various disciplines, it is sometimes hard for athletes to determine where they should be going for consultation and treatment. Here is a rundown:

Certified Athletic Trainers (ATCs): These professionals are the quarterbacks when it comes to evaluating and treating sports injuries. They are often employed by a school or team to oversee medical care. Their role includes obtaining consultation with appropriate medical specialists. Athletic trainers serve as the intermediaries between physicians and administrative staff.

Physical Therapists (PTs): Physical therapists specialize in rehabilitating medical conditions. These can be musculoskeletal, cardiac or neurologic in nature. A variety of modalities can be used including ultrasound, traction and stretching exercises. Many physical therapists specialize in rehabilitating sports-related injuries.

Certified Strength and Conditioning Specialists (CSCSs): This group typically works with teams or individuals to put together a workout regimen that will avoid injury and improve athletic performance. They accomplish this through exercise and nutrition.

Personal Trainers: Personal trainers are usually employed at gyms and by individuals to provide advice and instruction on proper ways to exercise. They emphasize putting together an effective workout routine and avoiding injury.

The most important difference between these groups is that athletic trainers and physical therapists are medically-based disciplines. They are trained to diagnose and treat sports injuries while working closely with a physician. Strength and conditioning specialists and personal trainers are performance-based and emphasize reaching athletic goals.

Many sports medicine professionals are certified in multiple disciplines. Deborah Gardiner of Procare Physical Therapy in Willimantic has both a Master’s degree in physical therapy and certification as an athletic trainer.

Scott Di Francesco is a certified athletic trainer and certified strength and conditioning specialist. Along with his brother, Tim, a physical therapist, they own TD Athletes Edge in Salem, Mass. They work with many professional athletes to rehabilitate injuries and help them exceed previous accomplishments.

Sport-specific programs for rehabilitation and training are now growing in popularity. These consist of various medical and performance professionals who specialize in a specific athletic activity. They often work with athletes beginning in their teens during the off season to develop strength in muscles needed for their sport and a diet that will help them succeed during the season. Surprisingly, these programs are very different and can be designed for any sport.

Sports medicine physicians have also become a diverse group. Next week, Healthy Sports will clarify some of the confusion surrounding how different physicians approach sports injuries.

Don't be sidelined by stress fractures

2009-08-31T08:00:00.000-07:00

An overzealous approach to exercise can bring even the best fitness program to a grinding halt. Stress fractures are often the result of an aggressive running program.

Stress fractures are best described as very small cracks in a bone, usually seen in the lower leg and foot. As opposed to a typical fracture that results from a single traumatic event, stress fractures result from repeated trauma. They are commonly seen in athletes such as runners, basketball players, and dancers who run and jump on hard surfaces.

Bone is a dynamic organ that is constantly weakening and growing. The rate at which more bone is produced is determined by weight-bearing activities and general health. Osteoporosis is a condition seen in individuals unable to bear weight on a bone and older people whose bone metabolism has slowed. It results in fragile bones that are more susceptible to fracture.

Stress fractures are rarely seen on routine X-rays and diagnosis often requires an MRI scan or bone scan.

“There is a delicate balance between bone metabolism and bone stress. Any factor that rapidly upsets this balance can result in stress fractures,” said Dr. John Giacchetto, an orthopedic surgeon in Norwich. As older people begin to participate in impact sports like running, the incidence of stress fractures has also risen.
Preventive measures include using proper footwear and trying to run on a softer surface. Dr. Giacchetto recommends an incremental approach beginning with walking before running.

Treatment of stress fractures often includes restricting activity and acetaminophen for pain. Vitamin D and calcium supplements should be considered.

Now that summer is drawing to an end, many people will be resuming or starting an exercise program. Consultation with a physician is advisable and gradually increasing intensity can avoid being sidelined.

Preparation can help ease sports anxiety

2009-08-25T11:41:00.000-07:00

Intense fear of failure is something everyone can relate to at some point in life. This sensation typically arises before any performance, whether it is in the realm of academics, entertainment or sports. Surprisingly, performance anxiety is becoming more common in the area of high-level sports competition.

Stories of athletes who have reached the highest level of their sport and can suddenly no longer perform simple tasks are well-known. An infielder who can no longer throw a baseball to first base, a pitcher who can’t find home plate, a basketball player who puts up an air ball from the foul line and competitive swimmers who fear drowning when on the starting block are examples.

The human brain can be divided into two parts. The diencephalon, or primitive brain, controls emotions and consists of the hypothalamus, thalamus and limbic lobe. The telencephalon makes up the thinking portion of the brain and includes the more highly developed cortical structures.

The “fight-or-flight response” is based on the perception of danger. It triggers an outpouring of adrenaline and the body responds with increased heart rate, rapid breathing, profuse sweating and increased muscle strength.

“When an athlete becomes anxious, the primitive areas of the brain hijack the regions that control coordinated movement, making simple learned skills impossible to perform,” reports Dr. John Sullivan, a sports psychologist in Rhode Island who works with amateur and professional athletes. Emotions always impact physical activity and the ability to balance this interaction will improve performance.

Dr. Jeffrey Anderson, a sports medicine specialist, believes that anxiety among young athletes is rising.

“We have created a youth sports system where there are no losers and everyone receives a trophy. As these athletes get to higher levels, they encounter the harsh reality that losses do occur. For many, the thought of losing is overwhelming,” said Anderson. He half-jokingly states that as a matter of principle, he allows his children an opportunity to fail on a regular basis.

Many athletes develop their own ways of dealing with anxiety.

John Paesani, a professional golfer in Norwich, competes regularly in regional and national tournaments. He deals with the inevitable anxiety all golfers experience on the first tee by following a routine that begins the morning of an event. He allows enough time to eat, stretch and practice to increase confidence in his performance.

Amber Holt, a star forward for the Connecticut Sun, also has devised a coping strategy.

“When I get to the foul line, I slow my breathing and just think about making the shot to avoid anxiety,” she said.

Lee Elci has had to deal with performance anxiety as both a professional baseball player and as an entertainer.

“In baseball, I was always confident that I could be successful against any pitcher. Entertainment was a different arena for me and dealing with anxiety was difficult and demanded a lot of time and practice.” Elci is now a top-rated radio talk show host and believes good preparation avoids a fear of failure.

Treating performance anxiety requires training athletes to connect their emotions with their physical strengths. This often requires professional help and sometimes medication.

Dr. Sullivan advises that an inordinate amount of anxiety in a young athlete is often the result of factors other than sports and early intervention can avoid serious psychiatric problems.

A successful performance depends on both emotional preparation and physical practice in any arena.

Bean balls have no place in baseball

2009-08-19T04:32:00.000-07:00

On the same day recently, three major league baseball players were struck on the head by baseballs. Two of the incidents required hospitalization; all three raise the issue of safety improvement.

David Wright and Ian Kinsler were struck by baseballs thrown at high velocity. Hiroki Kuroda, a pitcher, was hit by a line drive back to the mound.

Although helmets provide some measure of safety, the impact of any projectile can cause skull fractures, bleeding into the brain and subsequent death. Even mild forms of traumatic brain injury like concussion carry repercussions of persistent headache, dizziness or cognitive impairment. In baseball, this is enough to end a promising career.

Athletes have become stronger and more proficient at their sports, necessitating better protective equipment. The need for improved batting helmets and designing helmets for pitchers is under discussion and supported by many sports medicine specialists.

The real problem in baseball lies beneath the surface. An unwritten rule in baseball is that a pitcher is expected to hit a batter in certain circumstances or be shunned by his teammates.

Organized baseball has tried to control “plunking” by giving umpires greater leeway in ejecting players. The legal question here is whether a baseball pitcher who uses his skill to intentionally harm another player should be charged with assault? In 2006, the Supreme Court of California ruled that baseball players assume the risk of being hit by baseballs even if thrown to intentionally cause injury.

Professional athletes must realize that their actions are imitated by youngsters. Intentionally throwing at an opponent is not the behavior of a sportsman. Hopefully it will not result in death.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org, or listen to his podcasts, comment on his blog or buy his book at www.backushospital.org.

Bicycle police combine helping others with staying fit

2009-08-10T09:52:00.000-07:00

Many occupations require workers to remain physically fit in order to complete their assignments. Sometimes it is possible to combine a love of sports with a means of earning a living. Police bicycle patrols permit many avid cyclists to accomplish this.

Bicycle police patrols became common in the 1890s. Police departments found bicycles effective for rapid response and the ability to traverse difficult terrain. Although motor vehicles have dominated law enforcement transportation, bicycles have undergone a resurgence with the use of mountain bikes.

Modern police bicycles have wide, deeply treaded tires and multiple gears. They allow officers to maneuver through confined spaces as well as off-road trails.

Police officers assigned to bicycle patrols are enthusiastic about riding. A typical patrol can require between five and fifteen miles of riding. A slow- paced ride will burn 400 calories per hour.

The International Police Mountain Bike Association (IPMBA) provides training that includes stretching and fitness along with riding skills. Courses last one week and are held nationwide.

Other than police, EMS personnel and security officers utilize bicycles.

“Bicycle patrols add to visibility and communication with pedestrians and business owners,” said Mark Gendron, a Connecticut State Trooper assigned to Hebron who is trained by the IPMBA. The stealth approach of bicycles have aided in drug arrests and crowd control. Trooper Gendron keeps a bike rack on his patrol car so that his bike is always available.

Backus Hospital and the Mohegan Sun Casino use bicycle patrols for security purposes in parking lots and to assist visitors. Lowell Yeager, a retired fireman, bikes approximately 1,500 miles per year in addition to the time he spends on bike patrol at Backus Hospital.

These patrollers are dedicated to helping others and are passionate about staying fit.