Snowboarding offers an athletic adventure

Over the past thirty years, snowboarding has evolved from a small group of young participants trying to be different, to an Olympic sport. Most recently, snowboarding has increasingly attracted older, winter athletes defecting from the ranks of traditional skiing.

Although there are many comparisons between skiing and snowboarding, the technical approach, as well as the injuries, differs. As opposed to skiing, both feet are braced to a single snowboard and face in the same direction, making lower extremity injuries rare.

The most common snowboarding injuries involve:

Upper extremities. There is a natural inclination to extend the arm to break a fall. This produces a FOOSH (Fall On Out Stretched Hand) injury that can result in a wrist fracture. Other upper extremity injuries include wrist sprains, elbow and shoulder dislocations, rotator cuff injuries and broken collar bones. Upper extremity injuries are by far the most common snowboarding injuries.
Head and neck. Concussions are very common due to the tendency of the board to drift out from under the rider on icy surfaces. This causes trauma to the back of the head and violently flexes the neck. Strained neck muscles and herniated discs may occur.
Low back and hips. Repeatedly falling back will result in contusions to the low back and hips.

Learning to fall by crouching down and gently rolling to the side rather than extending the arm will avoid many upper extremity injuries. Never get on a snowboard without a helmet. Concussions can result in long-term brain damage and even death.

While learning to snowboard, invest in “crash pants” also worn by figure skaters who practice jumps. These fit tightly and are worn under ski pants. They contain padding that protects the low back and hips.

An exercise program with both aerobic and resistive components greatly helps in preparation. Stretching right before going out will keep ligaments limber and less prone to tearing.

After years of skiing, snowboarding may be a great mid-life adventure.

Adversity can lead to physical renewal

This year, Christmas presents the challenge of a weakened economy. New heights of unemployment often come with a loss of health benefits. This situation makes maintaining good health imperative.

A transition period can be a time for physical renewal. Taking time to begin a regular exercise regimen while searching for a new job can have many benefits:

• Improved cardiovascular fitness
• Breaking old habits of smoking, drinking alcohol and overeating
• Professional physical appearance
• Reduced need for prescription medications

These factors improve the odds of finding suitable employment. An employer who provides health benefits is taking a financial risk on the health of each employee. Good health habits count.

Getting started begins with a visit to a family physician for a complete physical. Refill any prescription medications before benefits end.

Once physical limits are defined, combine a healthy diet and a regimen that begins with stretching and walking. Aerobic and resistive workouts are most effective.
Recommended equipment includes comfortable footwear, clothing and inexpensive weights.

If weights aren’t available, exercises such as push-ups and sit-ups will improve muscle tone. Jumping rope and jumping jacks are outstanding.

As a walking regimen progresses, steep hills and stairs should be included. Thirty minutes each day is best and sticking to a regular schedule helps create a sense of discipline necessary for the competitive job market.

Volunteering at a hospital like Backus Hospital or a soup kitchen like St. Vincent de Paul will help keep an active schedule. It can provide valuable networking opportunities with fellow volunteers. Sharing time in the service of others has proven to reduce stress while creating a feeling of accomplishment.

Adversity frequently presents opportunity. Tough economic times may serve as a wake-up call. Take action by recognizing a chance to help yourself and others.

Stay safe while enjoying the slopes

The practice of strapping a board to each foot to make snow travel more manageable dates back to ancient times. Originally utilized to aid hunters, this olden practice has now developed into a major sports industry.

Although there are multiple variations of skiing, alpine and downhill skiing are the most popular and exciting. Amazingly, competitive downhill skiers can now reach speeds in excess of 70 miles per hour. Unfortunately, the nature and degree of injuries are no less dramatic.

Most ski injuries involve the lower extremities and include:

Knee sprain. Excessive twisting of the knee joint will often result in sprained or torn ligaments with subsequent damage to the cartilage.
Broken bones. Collisions and high speed falls will cause bones in the thigh and lower leg to fracture.
Lower spine injuries. Twisting and bending the lumbar spine can cause muscle strains and disc herniation.

Any injury that occurs on a mountain has the potential complexity of being in a remote area. Avoiding hypothermia is another challenge. Fortunately, most resorts provide adequate ski patrol personnel trained in first aid and wilderness medicine.

While many skiers are preparing their equipment and attire for the approaching holiday, skiing fitness should not be overlooked. Geoff Fabry is an experienced skier and supervisor of outpatient physical therapy in Rehabilitation Services at the Backus Outpatient Care Center.

“Any physical preparation for skiing must include a combination of aerobic and resistive training,” Fabry said. He recommends workouts that emphasize the lower extremities and core muscles.

Lunges and squats can be done as part of a strength regimen as well as being included in a stretching program just before going out on the trail. Aerobic exercises such as hill and stair climbing build stamina and fortify core muscles.
Proper physical preparation and utilizing modern, safe ski equipment is crucial to enjoying a day on the slopes.

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, or listen to his podcasts, comment on his blog or buy his book at

Sports medicine doctors sometimes need to separate ‘sports’ and ‘medicine’

When medicine collides with the big business of running a sports franchise, ethical problems may develop. Among these are a lack of credibility for the medical opinions of physicians employed by teams and false medical information generated by teams.

The relationships of sports medicine physicians generally fall into two broad categories:

1. Consulting Physician. In this situation, a physician’s primary responsibility is to provide advice to a client. That advice may include formulating appropriate procedures to be followed regarding prevention and treatment of injuries. It often involves recommending appropriate referral and treatment for athletes.
2. Treating Physician. This role involves a traditional doctor-patient relationship where the only obligation is to do what is best for the athlete, regardless of the interests of a team or other organization.

Sometimes these responsibilities become confused and ethical dilemmas arise.

In boxing, ringside physicians serve as consultants to the boxing commission. The physicians are responsible for making sure that only fighters in excellent health are allowed to participate by carefully screening medical reports and examining each participant before a match.

Ringside physicians also have the authority to end a fight if they believe one fighter is being severely injured. After a fight, the physician must re-examine each fighter and arrange for medical attention if needed.

Ringside physicians must be impartial and are never treating physicians for fighters. They should not be employed by a promoter who stands to financially gain by allowing a questionable fight to proceed.

Confidentiality is imperative in either relationship. Physicians are obligated to share information only with their client or the athlete. Often an athlete or organization may choose to share information with the press. This information may also be a strategic move. Medical information is sometimes concealed because of gambling.

Although sports medicine has created increasingly complex relationships, wise physicians will take a step back and make sure medical ethics are always of paramount importance.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. He also serves as a ringside physician for the Connecticut State Boxing Commission. E-mail him at, or listen to his podcasts, comment on his blog or buy his book at

Think twice before indulging in that Thanksgiving football game

Thanksgiving traditions include parades, family gatherings, turkey and often a friendly game of touch football. It is this last custom that may require medical consultation.

The athletes involved in any holiday competition fall into two groups: those who regularly participate in some competitive sport and those for whom competitive sports are a pleasant memory. It is this latter group that has the highest probability of visiting an emergency facility.

This Thanksgiving scenario provides a perfect background for a discussion of how to prevent and treat musculoskeletal injuries such as sprains and strains.

The best way to avoid any injury involving muscles, bones and their connections is with adequate warm up. This can be accomplished by an easy jog or jumping jacks.

Using any prescribed braces or wraps should not be ignored.

A sprain is best defined as the stretching or tearing of a ligament. Ligaments are the tissues that connect bones to other bones. Wrist and ankle sprains are commonly associated with recreational sports. A wrist sprain commonly involves a fall on an outstretched hand. Ankle sprains result from sudden inward motion of the ankle.

A strain involves injury to muscles or the tendons that connect muscles to bones.

The spine, especially the neck and low back, is particularly susceptible to strain injuries. Tendonitis such as that seen in tennis elbow is also considered a strain.
The best immediate treatment for these injuries consists of Rest-Ice-Compression-Elevation (RICE therapy). Ice should be applied for no more than 20 minutes, four to eight times per day. Longer applications of ice may result in frostbite and rebound swelling. RICE therapy should be continued for 24-72 hours or when swelling subsides.

Excessive swelling, bone pain or loss of motion in the joint involved makes a doctor’s visit necessary.

Many will see any avoidance of a family athletic contest as a sign of weakness, but discretion is always the better part of valor and no one wants to be in an ER when pumpkin pie is being served.

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, listen to his podcasts, comment on his blog or buy his book at

Diuretics for weight loss can have unintended consequences

What do actresses Joan Collins, Melanie Griffith and Beverly Johnson have in common with at least six NFL players? They all take the same weight-loss supplement.

Strange as that may seem, in recent weeks players from multiple teams have been suspended for using Star Caps, a popular 20-year-old weight-loss supplement primarily used by women. Advertised as being a natural way to lose weight, ingredients are listed as papaya, valerian, garlic and corn spices.

Unfortunately, off-shore labs are unregulated and all these athletes have tested positive for Bumetanide, a diuretic banned by the NFL.

Bumetanide is a potent diuretic commonly known as “water pills.” They act at the level of the kidney where they promote the excretion of electrolytes and water. Patients with heart failure are especially prone to dangerous fluid retention in the lungs and other organs. This retained fluid causes dangerously high blood pressure. Bumetanide and other prescription diuretics can be life-saving in these instances.

The fluid loss from diuretics also results in temporary weight loss. Athletes, models and others who are required to perform at a certain weight are particularly attracted to diuretics. Wrestlers and boxers have used diuretics to drop weight, allowing a powerful athlete to compete at a lower weight class. Bodybuilders use diuretics for appearance.

Some diuretics, including Bumetanide, are used to mask the presence of steroids in urine.

Diuretic use also has many dangers. By lowering blood pressure and depleting the body of electrolytes, they can cause dizziness, fatigue, irregular heart rhythms, muscle cramps and eventually permanent kidney damage.

Diuretic use has resulted in the deaths of several young high school and collegiate wrestlers.

The makers of Star Caps deny that their product contains Bumetanide.

The lesson here is that athletes thinking of taking any supplement should check with the team’s athletic trainer who can arrange for it to be tested. By not taking advantage of this option, several NFL teams will be without key players.

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, listen to his podcasts, comment on his Healthy Sports blog or purchase his book at

MRSA invades athletic arena

Much has been written about serious, and sometimes deadly, infections caused by so-called “super bugs.” Recently, this discussion has moved to the sports pages.

Tom Brady’s post-surgical knee infection will undoubtedly prolong his rehabilitation and emphasizes how infections can impact sports. Several NFL players have come forward to report how their careers have been shortened by persistent infections.

Staphylococcus aureus is a common bacterial organism found on skin. It is responsible for pimples and boils. Unfortunately, several factors have caused these bacteria to become a serious health problem.

Over time, “staph” has become resistant to many antibiotics. This is a result of antibiotics being overused when not required and the common use of antibiotics in animal feeds.

This common use has triggered the adaptive properties of bacteria to become resistant. MRSA (methicillin-resistant Staphylococcus aureus) is the most prevalent of these bacteria that have become resistant to many antibiotics.

Another factor in this problem is the nature of sports. Athletes are susceptible to open wounds that easily become infected and close contact during play allows for the direct spread of offending organisms. Towels and razors are often shared, providing additional vehicles for spread. Locker rooms are typically humid and damp, creating a perfect environment for bacterial growth.

“MRSA is not a problem in countries that have restricted the use of antibiotics,” said Richard Quintiliani, MD, a world-renowned infectious disease specialist who recently spoke at Backus Hospital on the topic of MRSA. He believes that people should not require antibiotics more than four times in their lifetimes.

Some tips for stopping the spread of infection in athletes:
• Wash hands frequently and thoroughly.
• Do not share personal items such as towels, razors and unwashed clothing.
• Cover all wounds with a clean bandage.
• Clean any shared sporting equipment with antiseptic solution.
• Avoid common whirlpools.

Paying attention to some basic rules of good hygiene should keep athletes in the
game and not on the sideline.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC in Norwich. To contact Dr. Alessi, email him To comment on his blog, listen to his podcasts or purchase his recently published “Healthy Sports: A Doctor’s Lessons for a Winning Lifestyle” book, log on to

Neurology Sports

In the past year, several sports and medical organizations have taken independent but cohesive actions toward making sports safer from a neurologic standpoint.

The American Academy of Neurology (AAN) represents more than 21,000 neurologists in the United States. In 2008, the AAN issued a position statement calling for greater neurologic participation in the regulation of sports that involve intentional trauma to the brain. Jasper Daube, M.D., chaired the AAN’s boxing task force. “It is the intention of the AAN to work closely with sports organizations to protect participants from serious neurologic injury,” Daube said.

Michael Mazzulli is vice-president of the Association of Boxing Commissions (ABC). “The ABC is working with physicians around the country to make boxing safer by imposing tougher medical regulations,” Mazzulli said. He also believes that only by educating fighters about the dangers of repeated concussions can we avoid chronic brain injuries and early dementia.

In Boston, the Sports Legacy Institute has begun the post-mortem analysis of donated brains from deceased NFL players to study the effect of repeated head trauma and the development of chronic traumatic encephalopathy. So far, five players who died in their 30s and 40s have donated their brains. All show pathologic changes consistent with those seen in dementia. Each player suffered multiple concussions in their careers.

Next week the PBR (Professional Bull Riding) will begin an extensive study including neurologic and neuropsychometric evaluations of its participants in an effort to make their sport safer. This study will include the use of accelerometers to measure the forces involved in injury and will compare results of riders using helmets versus those who do not.

These efforts indicate willingness for both medical and sports organizations to work together to reduce the risk of brain injury in athletes. Substantial changes can’t be far off with everyone moving in the same direction.

Gehrig's celebrity pushed ALS to forefront

No disease has become as synonymous with one of its victims as Amyotrophic Lateral Sclerosis (ALS). The victim was Lou Gehrig.

ALS is a neurodegenerative disease affecting motor nerves. It results in muscle wasting, weakness and eventual paralysis of all voluntary muscles. It is a fatal disease with the inability to breathe being the typical cause of death. Although it can strike at any age, most victims are between the ages of 40 and 70 years old.

Lou Gehrig was a Hall of Fame, major league baseball player with the New York Yankees from 1923 to 1939. Nicknamed the “Iron Horse” after playing in 2,130 consecutive games, his career is chronicled in the 1942 movie, “Pride of the Yankees.”

Dr. Eric Sorensen is a neurologist at the Mayo Clinic who specializes in ALS. He recently presented data that tracked Gehrig’s batting average over the 1936, 1937 and 1938 baseball seasons. Based on this graphic representation, it is apparent that his athletic performance was significantly worse in the spring of 1938 and dropped off dramatically ten weeks into the season. He retired on April 30, 1939.

In 1940, Lou Gehrig volunteered to participate in an experimental study using vitamin E to treat ALS. While initial results were believed to be promising, subsequent analysis did not show any benefit. Gehrig died June 2, 1941, at the age of 37.

There is speculation that Lou Gehrig never had ALS and instead suffered from cervical spinal stenosis, a narrowing of the spinal canal that eventually crushes the spinal cord. The Mayo Clinic maintains a policy of strict confidentiality and despite frequent inquiries, Gehrig’s medical records are secured in a vault where not even Mayo Clinic physicians have access.

While this controversy may never be resolved, it is evident that no other celebrity labeling of a disease has ever made more impact on the awareness and research efforts than we have seen with Lou Gehrig’s Disease.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. To contact Dr. Alessi, e-mail him at To purchase his recently published book, “Healthy Sports: A Doctor’s Lessons for a Winning Lifestyle,” visit

Chest Injuries in sports are rare but serious

Among the most serious injuries in sports are those involving trauma to the chest. Although rare, these injuries are most often seen with high-velocity impact as in motor sports. Other sports where chest injuries are seen involve animals weighing over 1,000 pounds like professional bull riding, which will be coming to the Mohegan Sun Arena this weekend.

Chest injuries are those that result from damage to the vital organs within the chest cavity, including the protective muscles and bones around the chest.

Trauma is the typical cause of any damage and can be the result of a penetrating wound or a closed compression mechanism.

Over the years, much has been done to protect athletes from these life- threatening injuries. The earliest form of chest protection was for baseball catchers, protecting them from a direct blow to the heart. Football and hockey players often wear rib protectors. Racing vehicles are equipped with devices to avoid penetrating trauma from the steering wheel.

Professional bull riders began wearing protective vests after the death of Lane Frost in 1989. They became mandatory in 1993. The vest is made of a closed-cell foam material that is protective while maintaining flexibility.

Tandy Freeman, MD, is an orthopedic surgeon specializing in bull riding and rodeo injuries. “When we compared the frequency and severity of chest injuries from before mandatory chest protection use to those after using chest protection, we saw a ten-fold decline,” Freeman said.

“The typical chest injury we see is when a fractured rib will penetrate the lung,” according to Juan Escalon, MD, a cardio-thoracic surgeon on the Backus Hospital Medical staff who treats these injuries. “Chest trauma that involves the heart or major blood vessels (like the one suffered by Frost) requires emergency surgery.”

We have made great strides in sports medicine when dealing with chest injuries, but it is apparent that the seriousness of these injuries requires immediate treatment by trained personnel, beginning at the arena.

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, listen to his podcasts, comment on his blog or buy his book at

Benefits of energy drinks outweighed by possible side effects

The latest craze among the party crowd, as well as those who must work through the night, is the use of so-called “energy drinks” (also marketed as gels or shots.) These caffeine and sugar concoctions are designed to keep people awake. Unfortunately, athletes have begun to use them as supplements to improve athletic performance.

These products should not be confused with drinks like Gatorade or Powerade that are designed to replace electrolytes and carbs after a strenuous workout.

Drugs such as caffeine, thyroid hormone and testosterone have long been used to increase muscle irritability in conditions causing chronic weakness like myasthenia gravis and muscular dystrophy. While they achieved some success, these drugs were replaced by more effective treatments.

Although they may have had some modest benefit to impaired muscles, there has never been any evidence suggesting a beneficial effect of stimulants upon healthy muscle. In fact, the result is often uncontrolled muscle twitching known as “fasciculations.”

Jeffrey Anderson, MD, is the medical director for UCONN athletics and the UCONN Human Performance Laboratory. “These drinks are nothing more than stimulants in a can; fortunately, their use has not been a problem with our athletes,” Anderson said.

Herbal stimulants like ephedrine have been popular for their ability to increase metabolism to produce weight loss.

Any stimulant has the potential for many serious side effects including tachycardia (rapid heart rate) and seizures. Athletes typically experience physiologic stimulation due to the release of adrenaline while participating in a sport. The addition of synthetic stimulants further amplifies this state to dangerous and potentially life-threatening levels.

There is continued debate whether energy supplements can cause disabling muscle cramps in healthy muscle. Even the possibility of this in a competitive athlete is troublesome since it can result in an athlete being unable to complete the event.

Based on both scientific and anecdotal information, athletes are better off sticking with a balanced diet and adequate hydration.

Paintball is good exercise but precautions must be taken

The analogy between sports and war is apparent in many athletic endeavors. Nowhere is it more pronounced than in the game of paintball.

Paintball is played by teams on an outdoor field with designated safety zones. The object is to shoot opponents with a small, gelatin capsule filled with paint. The weapon is an air-powered gun that shoots these capsules at high velocities. If a player is struck during a volley, it leaves a small welt.

Unfortunately, shooting paintballs has resulted in an increasing number of serious eye injuries. Organized paintball requires the use of a hard plastic mask with eye protection. No eye injuries have been reported when this apparatus is worn properly.
As in many activities, there is an organized version with rules, regulations and officials, as well as a backyard version without any of the above. The backyard approach has developed into a no-holds-barred free-for-all with weapons.

Nathan Lazourack is the owner of Final Shot Paintball in Voluntown, Connecticut. His facility supplies protective equipment including referees for all participants.
“Many corporations rent the field for a day and use paintball as a team-building exercise,” Lazourack said.

He reports that the problems come when parents buy these guns for their children.
The American Academy of Pediatrics cites an increasing number of serious eye injuries due to unsupervised paintball play.

Peter McKay, MD, a local ophthalmologist on the Backus Hospital Medical Staff, has treated several patients with eye injuries from playing paintball. Half of these patients have had at least partial permanent visual loss and some have had complete loss of vision in severely traumatized eyes.

A friendly game of paintball can be a great way to enjoy time with mature friends in the outdoors. Physicians support any patient increasing their level of physical activity. In the case of paintball, careful attention is necessary regarding the potential risks and benefits.

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, listen to his podcasts, go to the Healthy Sports blog at or buy his book at the Backus Hospital Gift Shop.

Cognitive testing important for athletes with head injuries

Whenever athletes are involved in sports that include physical contact, there is a dramatic increase in the rate of injury. The more contact that occurs, the greater the frequency and severity of injury.

Coaches, athletic trainers and parents have recently become more aware of traumatic brain injury. Among the symptoms of even mild brain trauma are amnesia and difficulty processing new information. The athlete begins to do poorly in class, has personality changes and slower motor responses.

These symptoms relate to an athlete’s cognitive ability and indicate a serious concussion. Unfortunately, these deficits can become permanent.

One challenge facing physicians has been finding a diagnostic tool to assess these deficits. Imaging studies like a CT scan or MRI are often normal. Typical neuropsychometric testing involves the administration of a series of IQ tests over several hours.

Today there are two diagnostic series that can be administered quickly and with accurate results:

• IMPACT, designed by neuropsychologists at the University of Pittsburgh, has been used for several years in the United States and has a large database.
• CogSport, developed by a group of Australian behavioral neurologists, can be administered from any Internet-accessible computer and takes only eight minutes.

CogSport is based on the use of playing cards, thus it is not language-dependent. This is a big advantage when working with non-English-speaking athletes.

Dr. Jeffrey Kutcher, Director of Michigan NeuroSport, is responsible for the evaluation and treatment of neurologic injuries involving athletes at the University of Michigan.

“Obtaining a pre-season baseline test on every athlete is crucial to the validity of any cognitive testing,” Kutcher said. The University of Michigan recently converted from IMPACT to CogSport because of its ease of use.

Parents should inquire whether these tests are being utilized as part of their children’s athletic programs.

These new methods of cognitive testing add a significant piece to the puzzle of when an athlete should return to contact sports, if ever.

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 If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at

Women's soccer serves as beacon of hope in Haiti

In the past few weeks, we have seen photos and video footage of the poverty and hunger that has besieged Haiti for decades. While on a recent medical mission to hurricane-ravaged Haiti, I came across one of the most inspiring and unexpected sports stories I’ve ever witnessed.

Haiti, located only ninety miles off the coast of Florida, is the poorest nation in the western hemisphere. Although slightly smaller than the state of Maryland, Haiti has a population of seven million.

The Haitian Health Foundation (HHF), of Norwich, Conn., has been caring for the poor of Haiti since 1982. Dedicated workers have built schools, medical clinics, and housing for the people of Jeremie, Haiti, and 105 surrounding villages.

HHF’s founder, local orthodontist Dr. Jeremiah Lowney, leads physicians, dentists, and willing volunteers from all walks of life to work with the people of Haiti four times a year for one week. “Over 90 percent of volunteers return to spend additional weeks among the poor,” Lowney said.

These pilgrimages are designed to benefit the poor but it is often the volunteers who find themselves invigorated both physically and spiritually.

While evaluating a young girl in an HHF clinic, I was surprised to discover that she was accompanied by her soccer coach. I couldn’t believe that in this remote area of a third world country, with people struggling simply to exist, women’s soccer had been organized and was thriving.

Ordinarily, women do not play soccer in Haiti; it is considered a “male” sport. Haitian girls, especially those in outlying villages, grow up believing that playing games like soccer will deform their reproductive organs and prohibit them from bearing children.

In 2006, HHF started a soccer league for girls between the ages of 13 to 19. Before being allowed to compete, they must complete a one-week course on responsible sexuality. At that time, they receive a uniform and shoes. The course is designed to empower women through knowledge. Classes consist of topics like reproductive anatomy, sexually transmitted diseases, and a woman’s rights under Haitian law. These young girls also learn that obtaining a firm educational base will lead to increased opportunities.

This year, almost 1,300 girls were educated in the program and 830 played in the league. Callie Kaplan, a young woman from Chicago, has served as the soccer program’s director for the past year. Kaplan played varsity soccer at Colgate University in New York. “Participation in the HHF soccer program has become a source of pride for the girls and their parents,” Kaplan said. Many of the girls’ teams train with the local boys’ teams.

On September 3rd, I attended the HHF soccer championship between the villages of Gobin and Fondrouge Dayere. The “field” was nothing like the plush, grassy surfaces we are accustomed to seeing here in the United States. Instead, it was an accumulation of rocks and shells. Scrapes, bruises, and bloodshed are commonly seen after a fall. Soccer balls wear out quickly and typical equipment like soccer shoes and protective shin guards are nowhere to be found.

Approximately 1,500 fans attended; many walked for hours from their villages to the city of Jeremie. There were no bleachers or chairs and many of the younger spectators climbed trees to get a better view. The team from Fondrouge Dayere won a hard-fought and exciting contest by a score of 2-1. From the standpoint of sheer entertainment, the cheering fans knew there were no losers.

When it comes to sports, much is taken for granted in the United States. It is comforting to know that women’s sports prevail despite extreme poverty. HHF has given young women an opportunity to learn about their bodies and the importance of fitness.

“The only way to curtail incidences of sexually transmitted disease and early pregnancy is through education,” Lowney said. “Often, this is best accomplished by linkage to athletics.” In Haiti, these sporting events have become a forum for athletes and spectators to communicate messages regarding responsible sexual practices through the use of banners and announcements.

I was amazed to find such a superb combination of health and sports in a third world country. This women’s soccer league serves as a beacon of hope for many young women living in despair.

Unfortunately, the HHF soccer program is losing its major grant support, potentially ending this worthwhile program. It costs only $1,000 to fund a team, including the most basic equipment and the educational component. While any donation will be gratefully accepted, I encourage any individual or business to join me in adopting a team. All donations should be sent to Haitian Health Foundation at 97 Sherman Street, Norwich, CT, 06360, or through its website at

Preventing football concussions starts with helmet design

Among the injuries of greatest concern for coaches, players, and parents are those involving the brain.

Football season is now underway and many young athletes will be participating at all levels from Peewee to the NFL. Interest in these injuries has heightened to the point where many collegiate and high school football programs have followed the lead of the NFL by including neurologists as part of the medical staff.

While much has been written about the diagnosis and treatment of concussions, little has been publicized about the prevention of concussion.

Any discussion of preventing concussion centers on improved football helmet design.

Until recently, football helmets have undergone few design changes since the conversion from leather to plastic and the addition of the facemask in the 1950s. Current research and development of safer helmets focuses on better fit and a shock-absorbing liner. Various combinations of air, water, and foam have resulted in more effective and comfortable helmets.

In 2002, the Revolution helmet was introduced. The Revolution as well as the ION 4D now dominate the market. Both emphasize improved cushioning, especially in regard to side impact. The Revolution uses an air suspension plus dual-density foam.

“Seventy-five percent of our helmet inventory consists of the Revolution, with the remainder being ION-4Ds,” said Bob Howard, head athletic trainer for the University of Connecticut football program.

This year UConn will also be using a specialized facemask designed for rapid safe release that allows easy removal of the helmet in case of neck injury.

New studies are being performed that involve the insertion of accelerometers in helmets to record the force and direction of impact during a football collision. This information can be immediately downloaded to a computer and analyzed.

Despite difficult economic times, the benefit of new technology in football helmets far outweighs the complications of a traumatic brain injury.

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 If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at

Virtual realty workouts are gaining popularity

Virtual sports are nothing new for those of us old enough to remember the game “Pong.” The Nintendo Wii sports system, and its newest addition Wii Fit, reflects how far computer science has come in 30 years.

Virtual reality is a way humans can interact with a computer-generated environment. This technology has existed for many years in the form of flight simulators used to test the capabilities of pilots or astronauts in critical situations.

This interaction is accomplished by stimulating various regions of the brain. Recent studies show that the more sophisticated a virtual environment is, the greater the activity in the prefrontal region of the brain. A sense of presence leads to a more realistic interaction.

Recently, a friend showed me a picture of her 92-year-old grandmother who, along with several octogenarians, won a Wii bowling competition at the assisted living facility where they live.

Nancy Michaud, recreation director at the Harrington Court Rehabilitation Center in Colchester, uses the Wii sports system regularly with patients undergoing rehabilitation. The system provides a variety of sports simulations including golf, bowling, and boxing. The object is to swing the upper extremities appropriately while pressing and releasing a button on the hand control. Interestingly, boxing is among the more popular programs.

The Wii Fit system has become a favorite with people who wish to forgo a gym membership and get a quick workout at home. Nikki Fennikoh is a 24-year-old who balances a busy home and work schedule. She regularly does push-ups, sit-ups, and yoga with this system.

“The feedback from the fit system regarding progress and correct form is encouraging,” Fennikoh said.

Variety is crucial to a good workout program. Virtual sports have clearly evolved to the point where they provide an adequate option. Most importantly, this technology has just begun to scratch the surface.

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 If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at

Olympic Finale

Olympic spectators are now either counting medals or complaining about biased judging. We have just witnessed an international sports festival where countries display their best athletes. The Olympics are often about the stories surrounding the sport.

Water polo is an unheralded sport consisting of seven athletes on each team competing in a 30- by 20-meter pool. Players must toss a ball past the opposing team’s goalie. The pool is 10 feet deep and players must be either swimming or treading water the entire time. Defending players can do almost anything to avoid a goal. It is a mixture of basketball and roller derby.

These athletes are among the most fit because of the need for both upper and lower body strength, with tremendous aerobic capacity. The injuries vary between those seen in overuse (hip, knee, and shoulder) and in a physical assault (scratches and facial trauma). Water polo matches are interesting to watch, yet demand excellent conditioning before participating.

Dara Torres, Jason Kidd and Jeff Hartwig are among the many American Olympians over 35 years old. Advances in sports medicine, including more efficient training techniques as well as improved surgical and non-surgical treatments for injuries, have played a huge role in making this possible at all levels of sports.

Siblings participating in the same Olympic sport always capture attention. This year the Lopez family led the way, with Jean Lopez coaching his three younger siblings, Steven, Mark, and Diana, in the sport of taekwondo. Several pairs teams consist of identical twins.

Parenting elite athletes should be an Olympic sport in itself. Parents must deal with domestic peace and the delicate balance of sibling rivalry at an Olympic level. They are truly deserving of their own gold medals.

The 2008 Olympics have provided an opportunity for the world to put differences aside and enjoy outstanding athletic performances. True sports fans know it’s not about the medals.

Anthony G. Alessi, MD, is a member of the Backus Hospital Medical Staff and a neurologist in private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Dr. Alessi at

Phelps story offers hope for children with ADHD

As the 2008 Olympic Games draw to a close, one story has attracted the attention of the world. It is about a young boy born with oversized hands and feet, the wingspan of a condor, and misshapen ears.

At age nine he was diagnosed with Attention Deficit Hyperactive Disorder (ADHD). Yet he has become arguably the greatest athlete in the world. The story of Michael Phelps epitomizes the ability to turn a potential tragedy into victory.

Athletes must make critical decisions regarding their careers, training, and nutrition. The parents of young athletes make many of these decisions. Deborah Phelps made a parental decision to have her son channel his energy into the sport of swimming and the rest is history.

Dr. Alnoor Ramji is a psychiatrist in Norwich who treats many children and adults with ADHD. He believes that establishing a structured environment is the most important element for successful treatment.

“The problem with setting up an orderly regimen for a child is that often the parent who must oversee the process also has ADHD and things fall apart,” Ramji said.

Structure is crucial since ADHD patients are easily distracted and frustrated. Many adults realize they too suffer from ADHD only after their child is diagnosed. There is a strong genetic linkage.

Stimulant medications like Ritalin are also an important part of treatment. The need for medication is optional in milder cases. Typically, the hyperactive component of ADHD improves at approximately 22 years of age.

Sports are strongly encouraged since they require discipline and provide an essential outlet. Sports involving a singular focus like swimming, martial arts, and running are ideal. Sports that require divided attention like football, basketball, and soccer are more challenging and often result in frustration.

This story is a reminder that when both parents and children are committed to a specific task, many obstacles can be overcome and success in sports and life attained.

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, listen to his podcasts or go to the Healthy Sports blog at

Martial arts have mental and physical health benefits

Although there are many forms of martial arts, only two -- taekwondo and judo -- have been chosen for Olympic competition. They were natural choices since they represent completely different skills and have the most internationally standardized regulations.

Taekwondo originated in Korea and is a “striking” form of combat. The moves consist of rapid, crisp strikes of the feet and fists against an opponent. Taekwondo emphasizes the use of the lower extremities. The mental and physical aspects of this sport blend together when an athlete attempts to break several boards.

Participants are attracted to the ability to develop speed, strength, balance, and stamina. Many professional athletes use taekwondo as a training tool for their primary sport.

Judo is a Japanese martial art and focuses on “grappling” as opposed to striking maneuvers. The object is to overcome an opponent by locking a major joint or applying a chokehold.

Judo was first introduced in Brazil in 1914. Carlos Gracie utilized these skills and developed Brazilian jiu-jitsu, which is commonly used in mixed martial arts or the now popular ultimate fighting.

While martial arts get international attention during the summer Olympics, it’s popular locally as well. Peter Rogers of Baltic, a martial arts instructor for 42 years, teaches many local mixed martial arts fighters in a form called KOBA, a combination of Korean, Okinawan, Burmese, and American martial arts. Incorporating these different skills adds to the versatility of each combatant and makes the workouts more intense.

Typical injuries in all martial arts involve muscle sprains, contusions, dislocations, and fractures. Chronic nerve damage can be seen in the hand used repeatedly to break boards or cinder blocks. Grappling sports render participants more prone to joint injuries. The most serious injuries are neurologic in origin and involve the spine and brain.

Many find the combination of meditative exercise with a physical workout the most attractive feature of martial arts. The health benefits as well as the ability to defend oneself if attacked certainly will add to a participant’s longevity.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and a neurologist in private practice at NeuroDiagnostics, LLC in Norwich. You can listen to his podcasts or comment on his blog at, or email him at

Kayaking attracting attention internationally and here at home

With the Summer Olympics beginning this week, I continue my focus on the training and fitness of athletes participating in the international competition.

As the algae begins to clear in Bejing, boating events are attracting a lot of attention.

Boating sports include kayaking, canoeing and rowing. All require tremendous stamina and strength. Both aerobic and resistive training are imperative to compete in these events at a high level.

Rowing includes races with one, two, four, or eight rowers. Coordination is crucial among the rowers to achieve maximum speed. A coxswain is responsible for steering and managing an eight-person boat. The Olympic level races are short, sprint events.

Rowers are positioned with their backs to the front of the boat. They sit on seats that slide and their feet are secured to the boat. The motion involved requires utilizing many muscles including those in the upper and lower extremities and the torso. Since it requires the use of many large muscles, an efficient aerobic workout can be attained in a short period of time.

Typical injuries involve the spine due to repetitive flexion and extension against resistance. Stress fractures and muscular injuries involving the ribs are also common.

Olympic canoeing and kayaking consists of 16 different events on both flat water and whitewater. Racing is both sprint and slalom. Canoeists typically kneel and use a single-bladed paddle while kayakers sit and use a double- bladed paddle.

These sports primarily utilize the upper extremities. Shoulder injuries and repetitive use injuries to the hands are most common.

Many communities have started local rowing and kayaking programs. Norwich is no exception.

Louis Depina is director of Parks and Recreation for the city of Norwich where a program has been established with the Chelsea Boat Club.

“All participants must review a safety video, pass a swim test and a dry test of their boating skills before being allowed on the water,” Depina said.

Rowing and kayaking lessons are available. A steady group of 25 will go out 2-3 times per week. They range in age from teens to over 70 years old.

Information regarding this program can be obtained by calling the Norwich Parks and Recreation Department at 860-823-3791 or logging on to

Programs like this will hopefully foster future Olympians, but a consistent enjoyable workout is a good alternative.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and a neurologist in private practice at NeuroDiagnostics, LLC in Norwich. You can email Alessi at, listen to his podcast or comment on his blog at

Off-Road biking is getting international attention

In preparation for the Summer Olympics, I will be spending the next several weeks looking at some lesser-known Olympic sports. Specifically, how these athletes train and the injuries they face.

Off-road biking, often called mountain biking, has steadily grown in popularity over the past 25 years. Cycling in general is on a dramatic upswing since the price of gas has risen.

There are over 60,000 competitive male and female riders in the United States ranging in age from 5-80. The inclusive nature of this sport makes it attractive to families and social for those looking to meet other health-minded people.

Zane’s Cycles of Branford, Connecticut is the world’s largest dealer of Trek bicycles and offers entry-level equipment, including a fully equipped bike and helmet, for approximately $450.

The international flavor of off-road biking is exemplified by the fact that it has become a sanctioned Olympic sport.

The USA Cycling/Mountain Bike National Championships were held this month at Mount Snow, Vermont. Over 2,000 riders from throughout the United States qualified for what has been described as the “Super Bowl of off-road cycling.”

Nicholas Girard of Glens Falls, New York is 19 and has been competing for four years. He became involved after visiting a local bike shop and seeing a video about the sport. He is now at the expert level and hoping to move up to the pro level. During his off-season, which extends from November to May, he spends time working out in the gym. He primarily lifts weights to improve leg, shoulder, and core muscle strength.

Heather Irmiger, a 29-year-old professional rider from Boulder, Colorado, has been competing for 11years. Irminger would like to see more women involved in competitive cycling.

“There are women-only programs to introduce people to the sport but none of these address women’s competition,” Irminger said.

The principal injuries in this sport involve the shoulder. They include shoulder dislocation, fractures, and torn rotator cuff. Concussions are rare thanks to newly designed, lightweight helmets.

The Olympic competition will be a cross-country event involving steep inclines, dramatic descents, and many jumps extending over a 20-25 mile course. The length of the course depends on the difficulty of the terrain.

Cycling has come a long way since the Schwinn cruiser, but participation in any form will lead to improved health and longevity. Fun is just an added benefit.

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 If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at

Testicular cancer among athletes raises awareness of the disease

Earlier this month, Olympic swimmer Eric Shanteau decided to defer treatment for testicular cancer until after his Olympic competition. Although no one can put themselves in another’s position, the ramifications of this decision could not be greater.

Shanteau’s delay could be life-threatening.

Several other well known athletes have fought testicular cancer, among them Mike Lowell, John Kruk, and Lance Armstrong. Fortunately, these three received treatment and were able to return to their sport, often reaching higher goals than in their pre-cancer careers.

Cancer of the testicles is rarely mentioned in public. In fact, Chicago Bears player Brian Piccolo, whose death became the subject of a popular book as well as the movie “Brian’s Song,” died after testicular cancer spread to his lungs. The movie never mentions the word “testicular.”

It is past time to put embarrassment aside and have a frank discussion about this serious topic.

Thankfully, open dialogue has aided in the tremendous strides made in fighting breast cancer in women of all ages. Breast self-examination has had a dramatic impact on early treatment and cure. The many displays of breast cancer awareness in the form of pink ribbons, charity walks, and other fundraisers have positively impacted this effort.

The statistics are astounding. Testicular cancer is the most common cancer in men between the ages of 15 and 34. Eight thousand new cases are reported each year. It is one of the most highly curable cancers, but can rapidly spread to the lymph nodes, lungs, bones, liver, and brain. This invasion of cancer cells dramatically increases the difficulty of achieving a cure.

There are two types of testicular cancer:

• Seminoma-this can occur in all age groups. It is the less aggressive of the two types and is more sensitive to radiation.
• Non-Seminoma-this is also called a “germ cell tumor.” It grows and spreads rapidly. This tumor is less sensitive to radiation and often requires chemotherapy.

Parents must be vigilant because the group with the highest risk of testicular cancer is children born with cryptorchid or undescended testes. These infants are at a significantly greater risk of developing testicular cancer later in life.

The only way to know the cell type of the tumor is by removal of the testicle (orchiectomy). This procedure is not only diagnostic but also therapeutic since the cancer source is removed. It allows oncologists (cancer specialists) to establish a treatment plan to attack the cancer.

Dr. George Bosl, Chairman of the Department of Medicine at Sloan-Kettering Memorial Cancer Center, is a medical oncologist and considered among the world’s experts in the treatment of testicular cancers. Although the overall cure rate for testicular cancer is 90%, Dr. Bosl references an article he published in a medical journal noting that after two months, the cure rate drops to 80% in non-seminomas.

“Men who note pain, swelling, or a nodule in a testis should get to a physician immediately,” Dr. Bosl urged. Self-examination is the best simple and direct way men can notice early testicular abnormalities.

Monthly testicular self-examination should include the following steps:

1. Perform the exam after a warm bath or shower, allowing the scrotum to relax and permitting a more thorough exam.
2. Stand in front of a mirror to look for swelling of the scrotum.
3. Roll each testicle with the index and middle digits on one side and the thumb on the other.
4. Make note of any palpable masses and report these to your doctor.

A physician will repeat the exam in the office and most likely order an ultrasound of the testicles. This test is not invasive and not painful. It gives a clear image of the testicle and determines if surgery is indicated.

Headline articles often prompt readers to personalize decisions made by those involved in the story. While many observers and medical experts doubt the wisdom of Shanteau’s decision to delay performance of a crucial diagnostic procedure, all support his quest for Olympic gold and, more importantly, the health battle ahead.

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 If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at

Proceed with caution when working out in the summer heat

During mid-summer, athletes throughout most of the United States face the challenge of keeping up with their outdoor workout routines despite high temperatures and humidity.

Normally the skin, blood vessels, and sweat glands work together as a cooling system. The heart serves as a circulatory pump. In extreme heat, blood vessels direct more blood flow to the skin where cooling takes place. This diverts circulation from muscles and leads to muscle cramps – an early sign of heat illness. Anytime ambient conditions reach 70% humidity and 70 degrees simultaneously, this system is at risk to fail.

The dangers of heat-related illness, such as heat exhaustion and heat stroke, include permanent neurologic impairment, heart attack, and death.

Symptoms of heat exhaustion include:
• Heavy sweating; cold, clammy skin
• Dizziness or fainting
• Muscle cramps
• Fast, shallow breathing

Symptoms of heat stroke include:
• Warm, dry skin; no sweating
• Confusion or loss of consciousness
• High fever
• Throbbing headaches

Nausea and vomiting are early symptoms of both conditions.

Potential catastrophe can be avoided by not working out during the hottest part of the day; wearing lightweight clothing that keeps moisture away from the skin and drinking plenty of fluids before, during and after working out.

Some innovative methods of keeping cool during competition include the use of a cooling vest. This was originally developed for Olympic athletes participating in the 2004 games in Greece where average temperatures exceeded 90 degrees. Athletes put on a vest that contains a gel material that is pre-cooled. It is worn until the time of competition. Consider it the opposite of “warm-up.”

Some athletes immerse their hands in buckets of cold water to cool the circulating blood. Wristbands containing a cooling substance are also effective.

Hot, humid weather should not halt your exercise regimen, but it is wise to proceed with caution.

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 If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at

Tennis injuries can be avoided with proper training

Tennis is regarded as a year-round sport for those fortunate enough to live in a region with a moderate climate or to have access to an indoor facility.

Another group of tennis players has a short season extending from Wimbledon to the U.S. Open. Interestingly, both groups are susceptible to different types of afflictions.

Injuries associated with tennis are divided into chronic and acute types. Chronic injuries are those resulting from longstanding overuse while acute injuries are sudden and short-lived. Many of these injuries can be avoided with proper training, stretching, and technique.

Cardiovascular fitness is essential before participating in any vigorous activity. Warm-up exercises and starting off with a slow, deliberate stroke will increase circulation to muscles.

A classification of common medical problems associated with tennis would include:

• Upper extremities: The shoulder, elbow, and wrist are most susceptible to chronic overuse given the nature of the sport. Since the rotator cuff is responsible for stabilizing the shoulder, a tennis serve can lead to a tear or impingement when executed poorly. Shoulder problems typically develop when the shoulder is lifted to a 90-degree angle. Increasing the angle between the shoulder and torso will minimize the chance of injury.

Tennis elbow, acute inflammation of the outer surface of the elbow, is caused by strain during the backhand stroke. A two-handed backhand stroke is helpful.

Wrist injuries occur when a player snaps the wrist to put spin on the ball.

• Lower extremities: Tennis involves a lot of stop-and-go activity that can stress the ligaments that hold the knee in place. This varies with the playing surface. Reports show fewer knee injuries when playing on clay as opposed to a hard surface. Ankle sprains are a common acute injury due to sudden changes in direction.

• Lower back: Constant bending and twisting is part of the sport of tennis. This activity leads to severe strain of muscles and ligaments which support the lower spine. Repeated injury can lead to tiny stress fractures of the vertebrae.

Tennis is a superb sport requiring much skill, strategy, and fitness. As time goes by, many players often transition from competitive singles to social doubles.

Sometimes the next step is golf.

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 If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at

Create your own ‘triathlon’

Since ancient times, multi-sport athletes have always been considered superior in terms of overall fitness. This sentiment has continued to the modern Olympics, where the decathlon champion is considered the world’s greatest athlete. The decathlon consists of 10 track and field events completed over a period of two days.

Cross training brings together a workout where athletes use multiple sports to achieve a higher level of fitness. Many participate in triathlons. Recently made popular by the Hawaiian Ironman event, triathlons consist of various combinations of swimming, cycling and running. The ironman distances include a 2.4-mile swim, 112-mile bike, and 26.2-mile run. In an effort to gain more participation, many shorter variations of triathlons have been established.

Swimming is always the first competition since exhaustion during the swim can lead to catastrophe. This event is held in open water where water temperature, waves and limited visibility are obstacles. Wet suits are often used for warmth.

The bike portion can be grueling and is the only event which depends not only on fitness, but the quality of equipment. A mechanical breakdown will really leave a participant behind. The running segment is last and is always the true test of endurance.

Triathlons are a great way to incorporate three cross training sports into anyone’s workout. There are no rules regarding which three sports must be used to create a friendly competition, or to just challenge yourself.

Try choosing three events you most enjoy. These sports may change with the season, using all indoor sports during winter (stationary bike, treadmill, and rower) or a combination of indoor and outdoor events in summer (running or walking, swimming, and rollerblading). The events should use different muscle groups. Work on at least one different segment each day and if possible try two. Allocate enough time to go through all three events during one long workout each week and keep track of time and distance.

Creating your own triathlon will add variation to your exercise routine and help limit overuse of certain muscles, while eliminating potential boredom.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. He can be emailed at You can listen to a podcast of this column at

Amputee sports

Disabled athletes face many challenges in their efforts to participate in competitive sports. Playing with or against a physically challenged athlete adds a new dimension to sports.

Several years ago, I had the opportunity to golf with a gentleman who had lost his leg to cancer. The level of his amputation was in the pelvis so he could not wear a functional prosthesis. He played every shot while balanced on one leg, including getting out of sand traps. He shot an 84 on a course he’d never played before and never slowed the pace of the game.

The human body has a tremendous ability to adapt to conditions as they are presented. This function is much more efficient in people who are in good general health. In the case of a lower extremity amputation, the nervous system adapts by refining the neurologic network of the cerebellum, inner ear, and peripheral nerves to improve balance. Often the biggest obstacle is fear and a lack of confidence.

Dr. James Leonard, a physical medicine and rehabilitation specialist at the University of Michigan, works extensively with amputees. “Young amputees adapt quickly and those who were athletes before their amputation seem to have a better understanding of their body than non-athletes and thus fair better,” Leonard said.

Oscar Pistorius is a double amputee born without supporting leg bones between his knees and ankles. This year he will be allowed to compete in track events at the Beijing Olympics. Several protests have been registered, complaining that his prosthetic legs give him an unfair advantage over able-bodied runners. After completing tests at the MIT laboratories, no advantage was found.

Amputees are unfortunately growing in numbers as a result of the wars in Iraq and Afghanistan. Many were accomplished athletes before their injuries and have a tremendous desire to return to sports. The Wounded Warrior/Disabled Sports Project establishes programs for wounded veterans to get back to competition.

While we tend to focus our interests in sports on famous, well-paid athletes, it is comforting to know that the athletic spirit is alive and well at other levels of sports.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. He can be emailed at You can listen to a podcast of this column at

Exercise is important for pregnant women

Throughout life, the human body undergoes various changes. These may be related to normal growth, aging, or illness. Among the most dramatic changes are those associated with pregnancy. Just as the body changes, the basic requirement of regular exercise also changes. Often the need for activity increases rather than decreases.

Many women do not feel like working out during pregnancy and may use that time as an excuse not to exercise. Studies have shown that regular exercise while pregnant is beneficial to both mother and child.

Dr. Stephen Briggs, an Ob/Gyn on The William W. Backus Hospital Medical Staff, has found that patients involved in a regular exercise program have “more efficient labor.” He defines this as requiring fewer pain medications, having shorter labor, with an overall better delivery.

After checking with your physician, an exercise plan can be implemented with the help of a personal trainer or local gym that sponsors fitness classes for pregnant women. Any program should be specific for the different stages of pregnancy. Contact sports, scuba diving, and vigorous weight training should be avoided. Any sports requiring balance such as skiing, skating, or cycling can lead to falls due to a shifting center of gravity and are also discouraged.

Exercise goals should not be set toward improving overall endurance and the “no pain, no gain” philosophy is the wrong approach. Heart rate, fluid intake, and body temperature should be monitored.

The best fitness program incorporates yoga and pilates-style exercises to improve flexibility. Walking is excellent and can easily be added to a swimming component. The buoyancy of a swimming pool alleviates the strain from additional weight in the last trimester. Regular use of a stationary bicycle is another outstanding way to stay fit.

Following an exercise program, along with proper nutritional requirements, is a great way to work through the life-changing experience of pregnancy. It may also be a good idea to get the coach involved in the program to make it a family affair.

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 If you wish to learn more about healthy sports topics listen to the podcast or go to the Healthy Sports blog at

Exercise can help your memory

Among the most frequent human fears is the loss of memory. Whether it is the result of Alzheimer’s disease or its recently identified predecessor, Mild Cognitive Impairment (MCI), the inability to recognize loved ones and remember recent events vastly diminishes quality of life.

MCI represents a transition state between cognitive impairment from normal aging and Alzheimer’s disease. People with MCI are more likely to develop Alzheimer’s than the normal aging population.

There is now an expanding body of data indicating that moderate, regular exercise will help avoid this tragic situation.

At this year’s meeting of the American Academy of Neurology, several research presentations addressed Alzheimer’s and MCI.

One of the most intriguing reports was presented by researchers from the Mayo Clinic. They studied 868 individuals between the ages of 70 and 89. They looked at the exercise habits of these people during the ages of 50 through 65. The study found that those participants who exercised moderately (30 minutes or more) two to five times per week were less likely to develop MCI in later years.

Another proposed strategy for diminishing the likelihood of developing MCI emphasized the incorporation of an intellectually stimulating activity while exercising. This can be done by performing various mathematical problems while monitoring activity such as heart rate, miles, or steps per minute.

Other presentations dealt with the early onset of Alzheimer’s disease in heavy drinkers (more than two alcoholic beverages per day) and smokers. High cholesterol levels in 40 to 50 year olds were also cited as precursors to Alzheimer’s disease. It is unknown if exercise stimulates the emission of a protecting substance that reduces the incidence of Alzheimer’s, or if it is one element in an overall healthier lifestyle necessary for better cognitive outcomes.

Based on these studies we can conclude that the combination of moderate exercise, no tobacco, a healthy diet limiting fats and alcohol, and intellectually stimulating activities will diminish the risk of severe cognitive impairment and improve our quality of life in later years.

ACL tear highlights a problem but also true sportsmanship

In April, sports fans witnessed an event that warmed everyone’s hearts and highlighted the true meaning of sportsmanship. It also emphasized a common sports injury.

Western Oregon and Central Washington Universities are Division II NCAA schools. Sara Tucholsky, a Western Oregon senior, hit the first home run of her softball career. She over ran first base and had to reverse direction to step on the bag. That sudden movement caused her right leg to collapse and left her writhing in agony. The umpire ruled that if she could not complete her home run trot, her effort would be recorded as a single.

Two players then lifted Tucholsky and carried her to each base so the home run would be recorded. The inspiring part of this story is that they were members of the opposing team and performed this unselfish act without a second thought. Tucholsky’s injury was a torn anterior cruciate ligament (ACL), the most common serious injury in women’s athletics.

The ACL is one of four major ligaments in the knee joint. It limits movement of the lower leg and stabilizes the knee’s front-to-back movement. It is often injured when an athlete suddenly stops running or pivots on a planted foot, twisting or overextending the knee.

Dr. Thomas Trojian, team physician for UConn women’s basketball, recently published a medical review of injuries in women’s basketball and cites the reason for increased ACL tears in women as multifactorial. Proper landing techniques, imbalance between quadriceps and hamstring muscle development, and hormonal influences have all been cited as contributing causes.

Treatment is surgical for those who wish to return to activities which involve pivoting. Rehabilitation is demanding and involves strengthening hamstring muscles to avoid further injury.

New physical training and conditioning regimens will hopefully reduce the incidence of ACL tears in women’s sports. No physical program can prepare an athlete to demonstrate sportsmanship the way it was in April. That training comes from great role models and coaches who truly understand what sports are all about.

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 If you wish to learn more about this column or other sports health topics – listen to the podcast or go to the Healthy Sports blog at

Chilly spring air can lead to injuries

In the early weeks of baseball season, cold weather can cause a sudden rise in muscle injuries. This year we have seen several well-known players spend time on the disabled list due to hamstring and quadriceps injuries. Most surprising is that it is late May and players in New England are still facing this problem.

In general, large muscles such as those in the lower extremities require increased circulation to maintain function. Cold exposure results in constriction of blood vessels and diminished blood supply. Sudden activity in this state may result in muscle tears. These injuries are not the result of poor conditioning. The goal is to maintain a high volume of blood supply despite cold exposure.

The challenge is particularly difficult in sports where there are long periods of rest alternating with the need for sudden bursts of speed. Baseball athletic trainers, especially those working for teams in colder climates, must directly face this obstacle.

Dustin Luepker is the certified athletic trainer assigned to the Connecticut Defenders. Despite the pungent smell, he recommends the use of oil of wintergreen on affected limbs, along with warm clothing and a heat pack placed in the back pocket of the throwing hand. Tim Lentych, the Trenton Thunder athletic trainer, suggests generous application of baby oil covered by tight, cold gear clothing.

This problem of keeping players warmed up is especially difficult in the American League where designated hitters wait several innings before getting a turn at bat. Athletic trainers will often send these players to the clubhouse to use a stationary bicycle.

Many people prefer workouts in the early morning when there is still a chill in the air. These regimens may include running, biking, or an early golf tee-time. It is important to take the time to stretch despite the temptation to begin immediately.
The consequences of a torn muscle include extended rehabilitation and time away from a much-enjoyed activity.

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 If you wish to learn more about this column or other sports health topics – listen to the podcast or go to the Healthy Sports blog at

Athletes are not immune to psychiatric issues

Psychiatric illness in sports is rarely discussed openly. The 1956 movie, “Fear Strikes Out” describes the struggle of Boston Red Sox player Jimmy Pearsall, who suffered from depression and anxiety. He eventually required hospitalization for his condition. That film may represent the first public testimonial of mental illness in an athlete.

Recently, former football great Herschel Walker wrote a book about his battle with a condition known as Dissociative Identity Disorder (DID). This is more commonly known as Multiple Personality Disorder. Although this condition has been dramatized in books and movies, it is now often diagnosed in conjunction with other psychiatric disorders. DID is defined as a state where two or more distinct personalities exist in an individual. As in all medical illnesses, there is a range of severity varying from mild to one requiring hospitalization.

DID is typically associated with stress, depression, and anxiety. Symptoms of physical abuse during childhood are a common finding. There are no specific medications to treat DID, but long-term psychotherapy has been successful in many instances.

The fact that athletes experience psychiatric conditions is not surprising. The demands placed on athletes, especially at the professional level, are astounding. They are expected to perform competitively, represent themselves and their team well. Many must also maintain a family life. They must do this while on the road for much of the year, away from family and support systems. It is impressive that psychiatric disorders are not more widespread in sports.

Dr. James O’Dea, Administrative Director of Psychiatric Services at Backus Hospital, agrees that the existence of psychiatric disorders shouldn’t be surprising. “It is crucial for athletes to overcome the stigma of mental illness and seek treatment,” O’Dea said.

Psychiatric disease is probably more common in sports than is at first apparent. This can be dangerous in athletes who are placed under extreme pressure and in hazardous situations. They may have access to narcotic medications due to sports injuries and this is always a troubling combination. Coaches, athletic trainers, and team physicians must carefully monitor athletes’ behaviors and be vigilant for signs of psychiatric illness.

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 If you wish to learn more about this column or other sports health topics – listen to the podcast, view the video or go to the Healthy Sports blog at

Stroke can hit athletes

Stroke is defined as a condition resulting from a lack of blood supply to an area of the brain. It is typically associated with elderly patients who have weakened or hardened blood vessels. That’s why so many people were shocked when in February 2005, 31-year-old NFL linebacker Tedy Bruschi was suddenly stricken with a stroke.

At this year’s American Academy of Neurology meeting, Bruschi received the Public Leadership Award for his work in the field of stroke awareness. The story of how his stroke evolved and his recovery is an important lesson.

He awakened on the morning of February 15, two days after playing in the Pro Bowl, with numbness and weakness of his left arm and leg. He described a severe headache with an inability to see objects on his left side. While he was inclined to ignore his symptoms, his wife called her father, a physician’s assistant, who advised them to get to a hospital. An MRI showed that he’d suffered a stroke in the back of the right side of his brain.

An ultrasound of Bruschi’s heart showed that he had a hole between the upper chambers of his heart known as a patent foramen ovale. This condition allowed free passage of a small clot from the right side of his heart to his brain, resulting in stroke. Placing a patch over the hole through a catheter sealed the hole. Unfortunately, he was left with left-sided weakness and visual loss.

Three months of intense physical therapy followed. He worked with therapists specially trained in rehabilitation of neurological disorders. During that time, Bruschi had to summon all of the toughness and drive he had acquired from his years of competitive sports.

By late spring, the cause of his stroke was treated and he had regained sufficient physical function to transition from rehabilitation to actual football workouts. Bruschi’s comeback culminated with a return to the NFL on October 15, 2005.

Tedy Bruschi’s story shows us that the combination of modern medical care, a strong will, and hard work can overcome the obstacle of a stroke. Even to the point of returning to the highest level of sports.

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 If you wish to learn more about this column or other sports health topics – listen to the podcast or go to the Healthy Sports blog at Backus Hospital.

Preparing for the ride

Training with a specific goal is an important element for a successful workout program. The goal may be weight loss for a reunion, improved lab values, or completion of an athletic endeavor like a marathon or triathlon. Charity fundraising events often require walking or cycling long distances for pledged support of a worthy cause.

Before taking on physical challenges, careful preparation is crucial for success. Stretching and adequate warm-up is necessary to avoid injury. Marc Nee, personal trainer and owner of “Training With Heart,” recommends jumping jacks or squats to increase circulation to large muscle groups before stressing the muscle during activity. Inadequate stretching can result in strained or torn muscles.

During a cycling event it is wise to set the gears on low resistance and high revolutions when first starting out. After a long-distance run or bike, a warm bath increases circulation and relieves tightness and cramping.

Diet plays a big role in getting in shape. It is also important for completing any physical goal. Chris Warren, a registered dietician at Backus Hospital, suggests increasing the amount of dietary carbohydrates to 80% for one to three days before a challenge. The last meal should be more than four hours prior. A cup of coffee and a light snack before beginning a morning race is appropriate. Warren recommends refraining from any high fiber or high fat foods before or during an event. Fruits such as oranges or bananas contain simple sugars and potassium which are helpful during competition. Jelly beans are often eaten during and after long distance training.

Adequate hydration in the form of water and electrolyte drinks is crucial to success. This will avoid muscle cramps.

A tandem was my chosen vehicle for the “The Five Boro Bike Tour” in New York City this spring. Tandem cycling is a unique approach to a cycling event. It requires a captain (front rider) and a stoker (rear rider). The most important duty of a captain is to be sympathetic to the stoker who has no control of the bicycle, yet works diligently with blind faith. The New York City event has become so popular, registration is capped at thirty thousand participants. Cycling through New York with riders of all ages on a beautiful day was very encouraging.

Each year it seems more people appreciate the joys of exercise and good health.

Exercising and saving gas is as easy as riding a bike

Riding a bicycle in spring brings back fond childhood memories. Learning to bike ride is a satisfying accomplishment. Many people can recall receiving their first adult bike. Today, this simple activity has taken on new meaning. It now carries significant fitness, environmental, and economic implications.

Cycling is an outstanding physical activity. It requires the use of large lower extremity muscle groups as well as core muscle training for the low back and hips. Cycling can be both an aerobic and anaerobic activity, depending on the terrain. When riding in a group, it is also a great way to socialize with others.

Over the course of the past 20 years, cycling equipment has changed dramatically. There are now many varieties of bicycles including road bikes, mountain bikes, hybrids, tandems, and folding bikes. A hybrid bicycle is a combination of a road bike and a mountain bike. It is currently the most popular due to light weight, versatility, and comfort.

Tom Girard is the retail manager of Zane’s Cycles in Branford, Conn. Worldwide, they are the largest dealer of Trek Bicycles. Girard notes that the latest trend in sales has been toward commuter bikes similar to those sold for many years in Europe. These are hybrids with fenders and safety lights. Girard believes this is a reaction to increasing gas prices and concerns about air pollution.

In an effort to encourage more bicycle commuting, municipalities are incorporating bike lanes into urban plans.

Once a rarity, helmets are now commonly used and have cut back on the number of head injuries among cyclists. The latest bicycle seats are gel-padded and designed to protect the prostate in men, making long rides more comfortable.

Many fundraising efforts now involve participants who cycle long distances for the promise of pledges. Some examples are the “MS Ride” and “Bike New York.” In next week’s column, I will report on how to adequately prepare for these long distance cycling journeys to make them most enjoyable.

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 If you wish to learn more about this column or other sports health topics – listen to the podcast or go to the Healthy Sports blog at

Physical Education helps kids learn

Physical education classes have not traditionally been considered necessary for a successful academic career. Standardized tests now used in elementary schools emphasize reading and math to determine educational success.

A study just published in the Journal of American Public Health demonstrates that it is time to rethink this approach to education. The study showed that reading and math scores for female students between kindergarten and fifth grade were higher in those who spent 70 to 300 minutes per week in physical education classes. Scores were much lower for students who received less than 35 minutes per week.

Interestingly, the benefit was not seen in the student’s male counterparts. It is believed that boys are more active than girls in sports and may require even more time in physical education classes to realize a benefit.

The goal of the Healthy People 2010 federal health initiative is 30 minutes of physical education daily for all students. The hope is this will become part of each student’s lifestyle and carry over into adulthood. Currently less than 13% of students meet this target.

Many school districts have been under pressure to increase class time for math and reading in order to comply with the federal No Child Left Behind law. Most often this is done at the expense of art, music, and physical education classes.

Previous studies have shown that test scores can improve by changing class schedules to allow for sufficient sleep. Proper nutrition also enhances academic performance.
Educating children involves exposing them to a broad range of experiences, not just how to pass a test.

Physical education is an important part of the educational experience and cutting back shortchanges our children. We now have proof that reducing time in physical education class sets them up for failure in other areas.

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 If you wish to learn more about the benefit of physical education for kids – or other sports health topics – listen to the podcast or go to the Healthy Sports blog at

Disc Golf a fun way to get exercise

While traditional golfers throughout the northeast begin to dust off their clubs and clean their spikes in preparation for another season, there is another group of golfers readying themselves for competition.

These people play a game called disc golf.

Disc golf first began in the 1970s. It was the brainchild of Ed Headrick who invented the Frisbee. The discs used in disc golf are a variation of the Frisbee. The shape is more aerodynamic with pointed edges to allow for longer flight. These edges make playing catch uncomfortable.

Much like traditional golf, there are different discs for the drive, mid-range and putting tosses. The discs are carried in a lightweight pouch that is typically worn around a player’s waist.

The object of the game is to throw a golf disc into a target. This is typically a “pole hole” or a basket with a pole in the middle and chains hanging from it. A typical disc golf course consists of nine to 24 holes varying from 150 to 500 feet each. The holes are designed to utilize the natural beauty of the parks where they are laid out. Hazards are thick brush, trees, and water.

Disc golf is a walking sport. There are no carts and average players can easily rack up a sufficient number of steps to meet the daily American Heart Association requirement of 10,000 steps. Novice players will get in a lot more steps. Players can set their own pace.

It is a very social game and allows time for laughter.

As in all other sports, there are those who are serious about the game. The Professional Disc Golf Association has about 14,000 members who compete in professional tournaments. There are an estimated 2,100 courses in the United States, most in public parks that do not charge for play. In Connecticut there are four courses that can be found by logging onto

Disc golf is a lighthearted way to get out of the house and exercise. It also allows for a peaceful way to enjoy the natural beauty that surrounds us.

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 If you wish to learn more about disc golf – or other sports health topics – listen to the podcast or go to the Healthy Sports blog at

Ultimate Fighting is not for children

In the field of sports medicine, rarely does a topic arise that requires immediate comment and action.

The participation of children in the sport of ultimate fighting is one such topic. Placing children in a cage to grapple with and strike each other until a winner is declared is wrong on many levels.

An ultimate fighting event involves adult, unarmed combatants entering a ring or cage where they pummel each other. Typically the participants are boxers, wrestlers, or mixed martial artists.

Its popularity has steadily increased over the past 10 years, appealing primarily to a young male demographic. Today’s version is much less brutal than its original form which was subsequently outlawed in many states.

Unbelievably, there are now clubs in Missouri where children as young as six are “taught” ultimate fighting. The protective gear worn by the participants is ineffective since it is not designed for the type of punishment inflicted.

There are many dangers in subjecting children to ultimate fighting:
• Striking (repetitive blows to the head) will cause permanent damage to a developing brain. It results in persistent headaches, dizziness, and learning difficulties.
• Grappling (bending an opponent’s limb to cause submission) can result in crippling a participant’s extremity, most commonly the shoulder, elbow or knee.
• Psychologically, it is never healthy to encourage aggressive behavior in children.

The parents of these children maintain that ultimate fighting is a vehicle for improved self-discipline. There are many healthier ways to achieve discipline and athleticism. Traditional martial arts including karate, judo, and kung fu all improve balance and coordination, which are crucial for the developing nervous system. The spiritual aspect of these sports provides a structure for discipline and self-respect.

Missouri is currently the only state that allows children to participate in ultimate fighting. In many states, an activity such as this is a criminal offense.

Children rely on parents and other adults for guidance. Clearly, some children have been mislead.

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 If you wish to learn more about children and ultimate fighting – or other sports health topics – listen to the podcast or go to the Healthy Sports blog at

Take a lesson from the pros: establish a daily routine

The Healthy Sports “Spring Training Tour” is now in the Florida swing.

Tampa is a leading center for competitive sports. It is not only the spring training home of the New York Yankees, but will also serve as host to the NCAA Women’s Basketball Final Four, the first round of the Men’s NCAA Basketball Tournament and the 2009 Super Bowl.

Access to players, coaches and staff is an added attraction to a spring training vacation. This year I had an opportunity to spend time with Billy Connors and Frank Howard.

Connors is a former major league pitcher and current Yankees vice president of player development. Howard was a major league slugger and now serves as a Yankees spring training instructor.

One conversation centered on the topic of ritualistic behavior by players.

Often these actions are misconstrued as superstitious. Eating the same meal before a game or fielding the same number of ground balls to each side during warm-ups are typical examples. Pre-shot routines are common in basketball when shooting foul shots or in golf before making putts.

In actuality, these actions are not superstition but part of careful preparation and result in added confidence. Following a set routine before each effort leaves fewer opportunities for error. Any successful performer spends many hours practicing so that the final performance seems natural and unrehearsed.

Similarly, a steady routine of daily activities can be beneficial for anyone. Many illnesses can be kept in check by maintaining a regular routine of eating, sleeping, and exercising. This is especially effective when treating migraine headaches, diabetes, and sleep disorders.

A well-established program can often improve cognitive disorders.

Many middle-aged patients present with a fear of Alzheimer’s disease due to simple forgetfulness. This is most often due to multi-tasking. These patients typically do not make lists of necessary tasks and are easily distracted.

A carefully designed routine, including rehearsal and review of daily activities, can significantly improve efficiency and reduce errors. It is worth the investment in time despite possibly being mistaken as superstitious.

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 If you wish to learn more about the Healthy Sports Tour or other sports health topics, listen to the podcast or go to the Healthy Sports blog at Backus Hospital.