Cheerleading a much more dangerous sport these days

Cheering during sporting events has changed radically over the past ten years. Young girls no longer wave pompoms while leading rhythmic cheers for their team.

Cheerleading has become a performance that captures the attention of the entire audience. Tumbling, jumping and spectacular human formations are now the norm.

Participants consist of powerful men and women who provide a base for the formations, as well as petite “flyers.”

Cheerleading is a collegiate scholarship sport and not just a sideshow.

As the sport has become more athletic and spectacular, the frequency and severity of injuries related to cheerleading have also climbed.

A recent study in the medical journal Pediatrics documented over 200,000 emergency room visits for cheerleading injuries. This study covered a period of 13 years with most injuries involving teenage girls. Since the study only looked at injuries requiring hospital care, it is believed the injury rate is much higher when considering visits to physician offices and urgent care centers. The principal injuries are musculoskeletal but neurologic injuries like concussion and spinal trauma are increasingly common.

In some states, cheerleading is not a sanctioned sport. This often leaves cheerleaders without medical support and safety requirements like in other competitive sports.

Martha Davis is a cheerleading parent whose 11-year-old daughter, Morgan, has been competing for the past four years with the Impact All-Stars. Practice requires about 12 hours per week in addition to competitions. Some cheerleaders begin as young as age four.

A major factor contributing to the high rate of injury in cheerleading is the increased level of risk associated with the stunts performed. Since becoming more competitive and drawing national TV coverage, the performances have become more breathtaking and dangerous.

Some basic guidelines for parents and athletes:

• Make sure your cheerleading coach is certified and properly trained. This training should include first aid certification.
• Practice stunts in a gym with proper supervision and equipment.
• Get a physical before participating.

This weekend the best regional cheerleading squads will be competing at the Mohegan Sun Arena. Participants range from the very young to highly competitive collegians. It promises to be an exciting and safe performance.

If you want further information on cheerleading, listen to the podcast at Norwich Bulletin or Backus Hospital. Post any comments you have on this blog.

Carotid Laceration

Richard Zednik is a professional hockey player for the Florida Panthers. On February 10th, while competing against the Buffalo Sabres, he collided with a teammate whose skate accidentally cut Zednik’s right carotid artery.

All who have seen the video of this incident have been both horrified by the event and impressed by the medical response to this life-threatening injury. The fact that Zednik was discharged from Buffalo General Hospital in less than a week with no apparent permanent injury is amazing.

The carotid arteries are the two main arteries responsible for blood flow to their respective halves of the brain. Any prolonged deprivation of blood flow will result in a stroke with symptoms of weakness, numbness, and possible loss of speech. Anatomically, muscles protect the carotid artery. An injury requires great force and a very sharp blade.

Since Zednik was in superior general health, crucial minutes were added to the time frame during which a safe repair could be performed. The proximity of the arena to a hospital where an experienced surgeon was available also helped Zednik’s situation.

Locally, the Backus Hospital Trauma Center provides this service to sports venues including Mohegan Sun Arena, Foxwoods Casino, and Dodd Stadium.

This incident raises the issue of NHL players using more protective equipment.

Facial lacerations and eye injuries have steadily increased in frequency and severity. Hockey players have become bigger, faster, and stronger as compared to the “good old days” when no one would be seen wearing a now-required helmet. Protective collars are mandated by all junior hockey organizations. Some are made of lightweight Kevlar for maximum neck protection. Visors are also considered essential at the junior level and provide necessary eye protection without impeding performance.

Many professional athletes have come to the realization that by training harder and avoiding injury, they can extend their longevity in professional sports and earn more money. Hopefully, they will all soon realize that taking a more mature, business-like approach to sports includes the use of protective gear.

If you wish to learn more about carotid artery injuries or protective equipment in hockey, listen to the podcast or go to the Healthy Sports Blog at Norwich Bulletin or Backus Hospital.

A balanced diet is a key for athletes

Shopping catalogs advertising the latest swimwear are among the earliest signs of spring.

This automatically triggers intense fear that a body that may have put on several pounds during the holiday season needs to soon look presentable in swim attire. Following that is a feeling of confident resolve that the task of getting in shape before exposing ourselves to public scrutiny can be accomplished.

Current and former athletes typically face the dilemma of increased body weight by beginning a program of vigorous exercise. This may include running, fitness classes, or weight training. Any successful weight loss plan includes diet changes.

When engaging in an intense physical regimen, a balanced diet is essential to avoid serious health problems.

A nutritional plan for an athlete should be customized based on body type and size. Consulting a registered dietician is advised. Relying on someone you met at a gym or who happens to work in a vitamin store is a mistake. Online advice through sites that sell supplements could lead to trouble.

The basic human diet consists of three essential components:

• Carbohydrates are the main source of energy for muscle. They are broken down into sugars for immediate energy and stored in muscle as glycogen for later use.

• Proteins are essential for building and repairing muscle that breaks down during exercise. Proteins also help store glycogen in muscle. Proteins themselves are not easily stored and must be consumed daily for a healthy diet.

• Fats provide the highest concentration of energy. They are the main fuel source for any long duration (greater than 60 minutes) of sports activity.

Many weight-loss diets emphasize either carbohydrates or proteins as a foundation. While this may be effective for weight loss alone, it could lead to disaster for anyone engaging in intense workouts. Aerobic athletes taking a high-protein, low-carbohydrate diet are at risk for kidney failure.

Vegetarian athletes face the challenge of meeting nutritional demands without meat, fish, or eggs as a source of protein. Milk, tofu, yogurt, cheese, and peanut butter are great dietary alternatives.

Whitney Bundy, a registered dietician and Director of the Food and Nutrition Department at The William W. Backus Hospital, said that distance athletes must be sufficiently hydrated before, during, and after a workout. Peanut butter is an excellent pre-workout meal.

Isn’t it ironic that with so many commercially available energy bars, a childhood favorite like PB&J can sufficiently fuel a great athletic performance?

If you wish to learn more about sports nutrition, listen to the podcast at Norwich Bulletin or Backus Hospital.

Anthony G. Alessi, MD, is a member of The William W. 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

Fans can't forget their own health

Sports medicine professionals are responsible for the safety of athletes. Sometimes that obligation extends to sports fans.

A study published in this week's New England Journal of Medicine reported an increase in cardiac emergencies during the 2006 World Cup Soccer Championship at more than twice the normal rate. The study took place in Munich when the German national team was competing in the semi-finals.

Another study performed at the University of Maryland in 2006 showed a 50% rise in emergency department visits after professional football games as opposed to during the game.

Dr. Robert Sidman, Chief of Emergency Services at Backus Hospital, confirmed in an online article at Backus Hospital, that these patterns of behavior apply locally. Fans tend to delay getting emergency care despite the urgent nature of cardiac and stroke interventions.

All of these reports set off an avalanche of cautionary alerts throughout the media in preparation for the Super Bowl. These recommendations include:

• Avoid tobacco
• Don’t overeat
• Limit alcohol
• Take prescribed medications
• Try to stay calm
• If you have cardiac symptoms, get to a hospital immediately

Sports fans around the world consider the days on which major sporting events are held as holidays. Unfortunately, this changes their behavior to “holiday mode” similar to Christmas, Thanksgiving, and Easter where none of the recommendations listed above apply.

The typical scenario for disaster at a party or sporting event occurs when participants don’t take prescribed medications, especially diuretics that cause increased urination. This is followed by eating every food item available, drinking immoderately and getting caught up in the intense excitement of a competitive game.

Ignoring the signs of an apparent heart attack or stroke may further worsen the situation.

Many people who are not involved in sports consider the excitement over a game as craziness. However, passion for a sport or a team is a healthy outlet for stress. The way to avoid a catastrophe lies in moderation. Fans need to pace themselves and avoid this “holiday mode” mentality. As in all sports, safety is key and remember: your team needs you.

If you wish to learn more about spectator safety, listen to the podcast at Norwich Bulletin or Backus Hospital.

Originally published February 5, 2008.

Stay active this winter, but avoid frostbite

Winter activities are now in full swing. In frigid climates, they include skiing, snowshoeing, and snowboarding. Many will try to keep up with outdoor walking, running, or cycling programs.

These sports now add the challenge of staying warm while being active. The goal is to avoid the serious damage of frostbite.

Frostbite results when skin becomes exposed to extreme cold. Prolonged exposure leads to freezing the skin and tissue below. Typically, frostbite affects the hands, feet, nose and ears. These body parts are furthest from the heart and most vulnerable to cold.

Physiologic conditions that lead to impaired circulation increase susceptibility to frostbite. Peripheral vascular disease and diabetes as well as caffeine and tobacco use can make people vulnerable to frostbite.

A condition known as Raynaud Phenomenon can be particularly dangerous with exposure to cold. This condition causes vasospasm in the small blood vessels of hands and feet in those affected. Cold will precipitate the spasm, resulting in diminished blood supply to tissues involved.

Frostbite can appear in two forms: superficial and deep. The superficial form causes burning, tingling and numbness. The affected areas appear white and frozen. The tissues retain some elasticity when pressure is applied. In deep frostbite, blood-filled blisters are found over hard frozen skin.

Frostbite can be avoided by dressing in layers and being certain to cover all exposed surfaces. New devices such as heated gloves and socks are very effective. Activated charcoal heat packets can be placed in gloves and shoes.

Treatment consists of warming the affected area and keeping it elevated to avoid swelling. Never warm a limb if there is a chance it will freeze again. Do not rub the skin since friction can cause further tissue damage. Bathing the injured area in warm water is the most effective method of rewarming.

Before heading out for a cold weather workout, be sure attire is appropriate. Don’t be fooled by football linemen who wear short sleeves while playing in arctic cold. Even they retreat to heated benches in between series of plays.

If you wish to learn more about frostbite, listen to the podcast at Norwich Bulletin or Backus Hospital.

Originally published January 29, 2008.

Medicine plays role in strength contests

Historically, the earliest competitions among humans were feats of strength. Biblical and mythical figures are often admired for their physical prowess. George Costanza, of Seinfeld fame, popularized the “feats of strength” as part of his Festivus celebration.

Over the past 30 years, strength athletics has grown under the banner of World’s Strongest Man.

World’s Strongest Man and World’s Strongest Woman competitions are international events. Each competition consists of lifting, pulling, pushing, and running with tremendous amounts of weight. The weight is in the form of vehicles (usually buses or cars), large stones, tires, or concrete blocks.

There are approximately 400 active participants in strength events like those that appear annually at the Mohegan Sun Arena. They range from 22-56 years old. The youngest strength athlete is Massachusetts resident Kevin Nee, who began his career at the age of 18.

Liane Blyn is a certified athletic trainer and strength coach who works with many strength athletes.

“Principal injuries include torn tendons which result from overuse and the increased pressure on joints. Average active longevity is only 4-6 years,” Blyn said. “Training for these competitions consists of performing each event to gain strength and better technique.”

Strength athletics is very interesting from the standpoint of cardiovascular and cerebrovascular physiology, thanks to an Italian anatomist named Antonio Valsalva.

In the 18th century, he described what has come to be known as the “Valsalva maneuver.” It occurs when a person forcefully contracts their muscles against a closed airway. This increases pressure in the chest and middle ears. Due to the increase in pressure, blood flow to the heart is diminished and the pulse slows. Subsequently, blood flow to the brain also decreases, followed by a loss of consciousness. When the muscles involved relax, pressure diminishes and the heart rate speeds up, thus restoring adequate blood flow.

This maneuver can be seen sometimes during prolonged coughing or defecation, and in the case of strength athletes, when lifting large amounts of weight. Participants will try to divert blood flow from their muscles to their hearts and brains by wearing very tight neoprene suits during the dead-lift competition.

Since 1977, World’s Strongest Man competitions have attracted the attention of millions of fans around the world, including the watchful eye of the sports medicine physician in attendance.

If you wish to learn more about World’s Strongest Man events, listen to the podcast at Norwich Bulletin or Backus Hospital.

Originally published January 22, 2008.

Use of performance enhancing drugs defies logic

Hot stove baseball season should be at its peak this month. “Hot stove baseball” is a time-honored tradition where baseball fans discuss and often argue about trades their favorite team should be making in the off-season.

In New England, the issues typically revolve around the Yankees’ and Red Sox’ preparations for the upcoming season. These discussions take place in bars, at work, and often on sports radio stations where fans call in at all hours of the night to advocate for a big trade.

This year, these colorful arguments have unfortunately been replaced by a media blitz involving players suspected of injecting their bodies with performance enhancing drugs.

The latest culprit in this scandal is Human Growth Hormone (HGH). Many questions have been raised regarding its use:

What is HGH?

HGH is a substance produced by the pituitary gland in the brain. It promotes growth in childhood and supports tissues and organs throughout life. It is an integral part of a complex series of hormonal interactions which make up the endocrine system.

Why is it used?

Synthetic HGH is approved for use in children with short stature or kidney failure. It is also used for adults with muscle wasting from AIDS.

Why would an athlete use HGH?

Athletes use HGH to increase muscle mass and reduce body fat. It will also increase exercise capacity. Interestingly, a recent study demonstrated increased muscle mass in healthy adults but no increase in strength.

What are the dangers of HGH?

There are many risks to using HGH including high blood pressure, diabetes, hardening of the arteries, and muscle pain.

Use of HGH is against the rules in many sports. Currently, it can only be found in a blood sample. HGH may not provide an athlete much of a physical advantage and will put users at risk for life threatening chronic illnesses. After assessing the risks and benefits, using HGH as a supplement defies logic.

The turmoil created by these latest accusations has left fans in search of the truth listening to interviews and testimony by their favorite players. Many never thought they’d see the day when they missed hearing “John from the Bronx” or “Mike from Springfield” calling in to tell Theo Epstein and Brian Cashman how to do their job.

If you wish to learn more about human growth hormone, listen to the podcast at Norwich Bulletin or Backus Hospital.

Originally published January 15, 2008.

Exercise can help diabetics and those at risk of developing the disease

Glucose is the fuel necessary for essential body functions. It allows the brain to maintain awareness and provides energy for muscle activity.

Diabetes results from an inability to regulate normal glucose metabolism. Regular exercise plays an important role in making this metabolic process more efficient in healthy individuals, diabetics and especially those at risk for developing diabetes.

A basic diet includes starches, sugars and other nutrients. Insulin, a hormone produced in the pancreas, converts these nutrients into energy. Type 1 diabetes results from the body’s failure to produce insulin. Type 2 diabetes results from the body’s failure to properly use insulin.

Regular exercise helps people with diabetes in several ways:

• Weight loss will decrease the demand for insulin
• The body will become more sensitive to insulin
• Improved circulation will reduce the chance of harmful complications from diabetes.

Patients with a condition known as “pre-diabetes” typically have borderline high blood sugar and a family history of diabetes. These people have not yet required medication to lower their blood sugar and can often avoid the need for medication with diet and exercise.

As with any exercise program, consultation with a physician should be the first step.

“An effective exercise program should consist of 150 minutes of aerobic exercise along with three 30 minute sessions of resistive exercises over the course of a week,” said Dr. Leslie Domalik, an endocrinologist specializing in diabetes at the Backus Department of Diabetes, Endocrinology and Metabolism.

She advises that the workouts should be at least moderate in intensity although many of her healthier patients perform high intensity workouts for 90 of the recommended 150 minutes.

Typical aerobic workouts include walking, running, and cycling. Resistive workouts consist of weight lifting and using machines requiring motion against force. Resistive exercises should include both upper and lower body muscles.

When exercising, diabetics must be mindful of hydration and drink more fluids. Blood sugars should be checked before, during, and after a workout to avoid low blood sugar (hypoglycemia).

Regular exercise is imperative to promoting good health. It is an important tool in treating and potentially avoiding diabetes.

If you wish to learn more about exercise and diabetes, listen to the podcast at Norwich Bulletin or Backus Hospital.

Originally published January 8, 2008.