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.