Healthy Sports: 2009 year in review

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

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

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

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

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

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

Weight loss surgery should not be taken lightly

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

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

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

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

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

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

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

Body sends signals of serious injuries

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

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

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

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

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

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

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

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

Ankle sprains can be serious injuries

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

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

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

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

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

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

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

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

Violent collisions can cause cervical spine injuries

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

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

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

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

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

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

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

Athletes with sickle cell must be cautious

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

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

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

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

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

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

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

Boxing needs safety measures

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

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

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

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

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

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

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

Athletes have make-up to overcome physical and mental challenges

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

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

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

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

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

UConn homicide shows how athletes cope with loss

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

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

In 1969, Dr. Elisabeth Kubler-Ross described the five stages of grief:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

Every individual works through these stages at a different pace and uses a variety of mechanisms to deal with each. Athletes tend to revert to what they know best by immersing themselves in athletic competition while dealing with their loss.
Two goals of grieving involve finding a way to cope with loss and living on in the face of that loss. Sports are a very physical and instrumental way of coping for many people. Some prefer other outward signs such as dedication to a cause, starting a charitable foundation or even wearing a tattoo.

“Grieving helps meet the challenge of resuming life in the face of loss; we must respect the different ways people cope with loss,” said Dr. Kenneth J. Doka, a professor at the College of New Rochelle and consultant to the Hospice Foundation of America. Death of a teammate is no different than any other death in the workplace. It must be recognized and all involved should be supportive in continuing on.

Jasper Howard’s death has brought so many people together to mourn and hopefully work together to stop the senseless violence that ended his life too soon.

Marathon Walking

Walking has been an essential function in human evolution. This form of mobility allowed early man to hunt, gather and defend.

As more sedentary lifestyles have emerged, walking is proving to be an effective means of increasing longevity. The American Heart Association recommends 10,000 steps per day (five miles) to reap the full health benefit. Although this may be a lofty goal, after consulting with a physician, any distance is movement in the right direction.

Benefits include:
• Lower blood pressure
• Weight reduction
• Better stamina

The increased popularity of fitness walking has given rise to many walking events including race walking, charity walks and more recently, marathon walks. As opposed to race walking, where speed and form are crucial, marathon walking is a distance event extending 26.2 miles.

Like any marathon, preparation and support are crucial. Training includes progressively increasing distances, nutrition and using proper equipment.

Hundreds of walkers recently participated in a marathon walk from Old Saybrook Point to Harkness Memorial Park in support of the Terry Brodeur Breast Cancer Research Foundation. Participants were required to complete the walk in an allotted period of time. Training and race day support was provided by the foundation.

Deb Hinchey of Norwich was one of the participants. She trained with a group of seven adult women over a period of months. “We all attained a great feeling of accomplishment when finishing and realized we could go well beyond anything we thought our bodies could do,” said Hinchey. Other than fatigue, the biggest obstacle was avoiding blisters. Many participants purchased shoes a full size larger than normal to accommodate swelling.

In addition to becoming more fit, charity marathon walk participants gain a great feeling of knowing they helped a worthwhile cause.

Experts explore connection between contact sports and dementia

Multiple recent reports have raised awareness of the dangers of repeated head trauma. The information contained in these studies is helping experts plan strategies to make contact sports safer.

In 1928, Dr. Harrison Martland first described “Dementia Pugilistica,” a disorder seen in boxers that results in impaired movement and thought. Today this condition is known as “Chronic Traumatic Encephalopathy” and is associated with any sport such as football, hockey and wrestling, where the participants are subjected to repeated head blows.

A telephone survey of former NFL players revealed a startling number of participants who suffer from memory disorders. While this study has been criticized as unscientific, experts agree that there is some validity to the information and a need for further study is indicated.

This week the American Association of Professional Ringside Physicians (AAPRP) held its annual meeting at the Mohegan Sun Casino. This convocation brought together physicians with first-hand experience treating athletes who have suffered multiple concussions.

A concussion is best defined as a complex process affecting the brain after trauma.

Typical symptoms include headache, dizziness, confusion and nausea. Surprisingly, many athletes accept headaches as part of their sport and never equate them with repeated head trauma.

“I was a Harvard graduate and never saw the connection between episodes of headache and personality change with the head blows I took as a wrestler and football player until I sought medical attention,” said Chris Nowinski.

Nowinski now serves as co-director of the Center for the Study of Traumatic Encephalopathy and was a speaker at the AAPRP meeting. He spends much of his time on the road educating athletes and urging them to seek help.

Chronic Traumatic Encephalopathy (CTE) consists of a triad of symptoms: cognitive
decline, personality changes and movement disorders.

Dr. Ann Mckee, a neuropathologist at Boston University, has published extensively on CTE and spoke at the AAPRP. Dr. Mckee has studied the brains of NFL players who have generously donated them for post-mortem study.

“These brains show deposition of tau protein in crucial areas of the brain that is disproportionate to brains that have not been traumatized,” said McKee. She has found this abnormal accumulation in football players as young as 18.

“This is more than just a sports problem, it is a public health issue,” according to Dr. Robert Cantu, a neurosurgeon who has dedicated much of his career to treating athletes and now serves as a director of the Boston University-based center. These same changes are also found in military personnel, victims of abuse and others who have been subjected to brain injury.

The question now is how can the problem be corrected? Is there a way of treating these tau protein deposits? Is there too much opportunity for brain injury in football and other sports? At what age should contact sports be started?

After reading the Healthy Sports column two weeks ago on the internet, a young woman contacted me regarding her father and his brother who played in the NFL. Along with another brother who played college football, all have been diagnosed with dementia.

While this seems like a situation where heredity is a probable factor, she reports that two other brothers who never played football have no evidence of dementia. She is now in contact with the Center for the Study of Traumatic Encephalopathy and her family is considering brain donation.

The recently published NFL study reported that retired NFL players are typically generous and support their communities. Whoever thought that this spirit of giving would continue after their deaths?

Brain donation is crucial to solving this problem. If you know of someone who has suffered repeated head trauma, please contact Megan Wullf at 617-638-6143.

As athletes age, aerobic exercise is important

A notable conclusion in the recent study of retired NFL players dealt with cardiovascular fitness. The study was based on telephone interviews with 1,063 former players.

Body Mass Index (BMI) is a measure of obesity based on a ratio of height and weight. Despite a much higher BMI, NFL players had fewer heart attacks, strokes and diabetes. The information gathered provides an important message for the general population, as well as retired athletes.

BMI is probably not a good measure of obesity when body weight consists of a high percentage of muscle.

“In this situation, a percentage body fat calculation based on the use of a skin-fold caliper is more accurate,” said Mary Beth Green, a clinical dietitian at Backus Hospital.

Many younger athletes lift large weights to gain muscle bulk. This results in a sudden increase in blood pressure and diminished cardiac efficiency.

As athletes become older, aerobic exercise should be emphasized. Aerobic fitness is best described as the human body’s ability to use oxygen efficiently. Resistance training, in the form of light weight with high repetitions or stretch bands, will improve muscle tone.

“I encourage patients to begin a regimen of walking 30 minutes a day for at least five days per week. They should gradually increase to other forms of aerobic activity like biking or rowing,” said Dr. James Healy, a Norwich cardiologist. Healy reports that larger-strength athletes who become inactive are at high risk for heart attack.

Dr. Healy, like many physicians, believes that a medically-designed exercise program is as important as any medicine in the prevention of cardiovascular events. The fact that this carries over to large, former athletes is especially encouraging.

Study: Football can damage the body and mind

This week the most comprehensive study of retired NFL players was released. The study was conducted by the University of Michigan on behalf of the NFL. A total of 1,063 retired players were interviewed regarding a variety of sociological and medical topics.

Two major issues discussed in the report concern cardiovascular and neuropsychiatric health.

Although NFL players are larger than average Americans, they are not necessarily fatter. Many continue to remain physically active and have a lower incidence of heart attack, diabetes and stroke than the general population.

But their large size and intense physical activity has lead to increased arthritis and the subsequent need for joint replacement at a young age.

The Michigan study also revealed a rate of “dementia, Alzheimer’s disease and other memory-related diseases” 19 times the expected rate for males ages 30 through 49 and 6 times the normal for ages 50 and above. Dementia is best defined as the inability to learn and utilize new information.

A proxy reporter had to be utilized for instances where a player was unable to answer for himself.

“The take-home message from this data is that we must now re-evaluate how football is played,” said Chris Nowinski, a former professional wrestler and football player whose career was cut short due to multiple concussions. Nowinski now serves as co-director of the Center for the Study of Traumatic Encephalopathy. He believes the rules, practice sessions and the age when players begin must all be reconsidered.

Based on this study, the general profile of an NFL retiree is a well-educated, religious man who supports his community. He is physically fit but plagued by arthritic pain.

Unfortunately, he is also much more likely to become cognitively impaired at a young age.

It is the final characteristic that must be addressed immediately.

Hand hygiene and shots can help athletes win against swine flu

This season, the star players on many football teams may not be on the offense, defense or specialty teams. Instead, it may be up to the medical team to execute a successful game plan.

The H1N1 influenza virus has proven to be a formidable opponent for even the toughest teams. Over recent weeks, legions of players throughout the southeast have been relegated to isolation, causing some games to be canceled. H1N1 is now heading north.

Viruses are not susceptible to antibiotics and the best way to limit spread is by immunization. Unfortunately, that requires forewarning and preparation. H1N1 is particularly virulent and a large scale immunization program has yet to be initiated.

Symptoms include high fever, chills, fatigue, nausea and coughing. College athletes are more vulnerable because dormitories and other close living quarters are breeding grounds for any virus. Universities have instituted strict isolation policies but the virus can be spread for approximately 24 hours before and after the onset of fever.

This attack has actually changed how sports-related injuries are treated.

“The H1N1 outbreak has caused us to refrain from using any medications that might even remotely suppress the immune system when treating injuries,” said Dr. Jeffrey Anderson, medical director for the University of Connecticut Department of Athletics.

He hopes the H1N1 vaccine will be available for winter sport athletes.

The best way to limit the spread of any virus is by practicing good hygiene:
• Wash hands with soap and water or alcohol-based antimicrobial hand cleaner, especially after sneezing or coughing.
• Avoid unnecessary human contact.
• Do not share utensils.

Instituting some basic precautions may prepare athletes to limit the spread of this virus and chalk up some extra victories.

Young athletes need good role models

Athletes making poor decisions both personally and professionally are now a common occurrence. Sports fans read about these indiscretions so often that they are almost expected behavior.

Although many of these choices have legal implications including time in prison, they also can have serious health consequences. Young athletes are now using unprescribed supplements purchased on the internet in astonishing numbers. Peer pressure to drink alcohol and use illicit drugs continues to rise.

No one will argue that things have changed for the worse over the past several decades. Recently publicized events raise many questions:
• What has changed in sports and in society that has resulted in a “leadership void?”
• How can parents, coaches and teachers help correct this and hopefully protect athletes?
• What is the role of the media?

Football has traditionally been the team sport serving as a model for leadership in the United States. No other sport is so similar to battle and requires careful coordination of many skills for success. The quarterback position is analogous to that of a field general leading troops. Bad behavior is more dramatic in football because of the team implications.

“Thirty years ago, the technology to broadcast every college football game wasn’t available,” said Tim Prendergast, director of football operations at the University of Connecticut. “The internet, 24-hour sports television and U-Tube now dramatically increase the exposure of athletes.”

This exposure also influences the behavior of young athletes who imitate their heroes’ poor sportsmanship in the end zone and at times bad health decisions. Prendergast believes that good leaders are able to identify a goal, remove any obstacles to achieving that goal and thank others for their help.

Coaches and administrators agree that leadership is best taught by example. Youth organizations and church activities provide good opportunities other than athletic events to influence young adults.

“The community now also serves as the extended family for many athletes. Many people serve a role in raising a leader,” said Jamal Davis, head coach of the Norwich Free Academy football team. This year Coach Davis is emphasizing the importance of commitment, character and courage both on and off the field with his players. He repeatedly drives home the point that after football, it is these characteristics that will be their legacy.

Dr. Michael Joyce, an orthopedist and highly-regarded team physician, along with his wife, Pam, are embarking on a large-scale effort to provide the necessary skills for athletes to become leaders. The KJ Life Foundation ( was established in 2009 in memory of their son, Kenneth, who died tragically in a ski accident.

The foundation has begun a series of seminars for athletes to serve as peer role models by setting good examples and developing character.

“There are moment-to-moment examples of good character. We need to capture those moments and use them as teaching tools,” said Dr. Joyce.

The recurring theme is that personal responsibility is crucial to getting the most out of any athletic experience and making the right decisions to stay healthy.

Athletes require a team of physicians

At one time, sports medicine solely consisted of orthopedic surgeons and athletic trainers. There is now a myriad of physicians associated with professional sports teams and scholastic athletic programs. While each contributes something different, it is important for an athlete to understand how various physicians approach sports-related injuries.

Primary Care Physicians: These are medical doctors (MDs) or doctors of osteopathic medicine (DOs) who have completed a residency program in either family medicine, pediatrics or internal medicine. They then enter a one-year fellowship program in sports medicine and complete an examination to attain added qualifications in sports medicine (AQSM). Most major sports programs now have one or more primary care physicians who treat non-operative sports injuries.

Orthopedic Surgeons: Many orthopedic surgeons who specialize in sports medicine complete an additional year of fellowship training after residency. This year is exclusively devoted to sports-related orthopedic injuries and working with a variety of sports teams.

Sports Neurologists: While there is currently no formal fellowship in sports neurology, these are MDs or DOs who complete a neurology residency and treat athletes with neurologic injuries. Concussions, spinal injuries and injuries to peripheral nerves are typical.

Sports Psychologists: Sports psychologists have PhD degrees in clinical psychology. They help athletes deal with the mental aspects of their sport to improve performance.

Other physicians who are commonly utilized as part of the sports medicine team include chiropractors, podiatrists and dentists.

In the case of a sports-related injury, the approach and goals of treatment center around how to get an athlete back to sports participation safely. When seeking care it is wise to investigate what experience that physician has in sports.

Sports medicine involves a wide range of specialists

“The advice you receive is only as good as the source.” This adage is especially true when seeking medical advice for a sports-related injury.

As sports medicine has become more inclusive of various disciplines, it is sometimes hard for athletes to determine where they should be going for consultation and treatment. Here is a rundown:

Certified Athletic Trainers (ATCs): These professionals are the quarterbacks when it comes to evaluating and treating sports injuries. They are often employed by a school or team to oversee medical care. Their role includes obtaining consultation with appropriate medical specialists. Athletic trainers serve as the intermediaries between physicians and administrative staff.

Physical Therapists (PTs): Physical therapists specialize in rehabilitating medical conditions. These can be musculoskeletal, cardiac or neurologic in nature. A variety of modalities can be used including ultrasound, traction and stretching exercises. Many physical therapists specialize in rehabilitating sports-related injuries.

Certified Strength and Conditioning Specialists (CSCSs): This group typically works with teams or individuals to put together a workout regimen that will avoid injury and improve athletic performance. They accomplish this through exercise and nutrition.

Personal Trainers: Personal trainers are usually employed at gyms and by individuals to provide advice and instruction on proper ways to exercise. They emphasize putting together an effective workout routine and avoiding injury.

The most important difference between these groups is that athletic trainers and physical therapists are medically-based disciplines. They are trained to diagnose and treat sports injuries while working closely with a physician. Strength and conditioning specialists and personal trainers are performance-based and emphasize reaching athletic goals.

Many sports medicine professionals are certified in multiple disciplines. Deborah Gardiner of Procare Physical Therapy in Willimantic has both a Master’s degree in physical therapy and certification as an athletic trainer.

Scott Di Francesco is a certified athletic trainer and certified strength and conditioning specialist. Along with his brother, Tim, a physical therapist, they own TD Athletes Edge in Salem, Mass. They work with many professional athletes to rehabilitate injuries and help them exceed previous accomplishments.

Sport-specific programs for rehabilitation and training are now growing in popularity. These consist of various medical and performance professionals who specialize in a specific athletic activity. They often work with athletes beginning in their teens during the off season to develop strength in muscles needed for their sport and a diet that will help them succeed during the season. Surprisingly, these programs are very different and can be designed for any sport.

Sports medicine physicians have also become a diverse group. Next week, Healthy Sports will clarify some of the confusion surrounding how different physicians approach sports injuries.

Don't be sidelined by stress fractures

An overzealous approach to exercise can bring even the best fitness program to a grinding halt. Stress fractures are often the result of an aggressive running program.

Stress fractures are best described as very small cracks in a bone, usually seen in the lower leg and foot. As opposed to a typical fracture that results from a single traumatic event, stress fractures result from repeated trauma. They are commonly seen in athletes such as runners, basketball players, and dancers who run and jump on hard surfaces.

Bone is a dynamic organ that is constantly weakening and growing. The rate at which more bone is produced is determined by weight-bearing activities and general health. Osteoporosis is a condition seen in individuals unable to bear weight on a bone and older people whose bone metabolism has slowed. It results in fragile bones that are more susceptible to fracture.

Stress fractures are rarely seen on routine X-rays and diagnosis often requires an MRI scan or bone scan.

“There is a delicate balance between bone metabolism and bone stress. Any factor that rapidly upsets this balance can result in stress fractures,” said Dr. John Giacchetto, an orthopedic surgeon in Norwich. As older people begin to participate in impact sports like running, the incidence of stress fractures has also risen.
Preventive measures include using proper footwear and trying to run on a softer surface. Dr. Giacchetto recommends an incremental approach beginning with walking before running.

Treatment of stress fractures often includes restricting activity and acetaminophen for pain. Vitamin D and calcium supplements should be considered.

Now that summer is drawing to an end, many people will be resuming or starting an exercise program. Consultation with a physician is advisable and gradually increasing intensity can avoid being sidelined.

Preparation can help ease sports anxiety

Intense fear of failure is something everyone can relate to at some point in life. This sensation typically arises before any performance, whether it is in the realm of academics, entertainment or sports. Surprisingly, performance anxiety is becoming more common in the area of high-level sports competition.

Stories of athletes who have reached the highest level of their sport and can suddenly no longer perform simple tasks are well-known. An infielder who can no longer throw a baseball to first base, a pitcher who can’t find home plate, a basketball player who puts up an air ball from the foul line and competitive swimmers who fear drowning when on the starting block are examples.

The human brain can be divided into two parts. The diencephalon, or primitive brain, controls emotions and consists of the hypothalamus, thalamus and limbic lobe. The telencephalon makes up the thinking portion of the brain and includes the more highly developed cortical structures.

The “fight-or-flight response” is based on the perception of danger. It triggers an outpouring of adrenaline and the body responds with increased heart rate, rapid breathing, profuse sweating and increased muscle strength.

“When an athlete becomes anxious, the primitive areas of the brain hijack the regions that control coordinated movement, making simple learned skills impossible to perform,” reports Dr. John Sullivan, a sports psychologist in Rhode Island who works with amateur and professional athletes. Emotions always impact physical activity and the ability to balance this interaction will improve performance.

Dr. Jeffrey Anderson, a sports medicine specialist, believes that anxiety among young athletes is rising.

“We have created a youth sports system where there are no losers and everyone receives a trophy. As these athletes get to higher levels, they encounter the harsh reality that losses do occur. For many, the thought of losing is overwhelming,” said Anderson. He half-jokingly states that as a matter of principle, he allows his children an opportunity to fail on a regular basis.

Many athletes develop their own ways of dealing with anxiety.

John Paesani, a professional golfer in Norwich, competes regularly in regional and national tournaments. He deals with the inevitable anxiety all golfers experience on the first tee by following a routine that begins the morning of an event. He allows enough time to eat, stretch and practice to increase confidence in his performance.

Amber Holt, a star forward for the Connecticut Sun, also has devised a coping strategy.

“When I get to the foul line, I slow my breathing and just think about making the shot to avoid anxiety,” she said.

Lee Elci has had to deal with performance anxiety as both a professional baseball player and as an entertainer.

“In baseball, I was always confident that I could be successful against any pitcher. Entertainment was a different arena for me and dealing with anxiety was difficult and demanded a lot of time and practice.” Elci is now a top-rated radio talk show host and believes good preparation avoids a fear of failure.

Treating performance anxiety requires training athletes to connect their emotions with their physical strengths. This often requires professional help and sometimes medication.

Dr. Sullivan advises that an inordinate amount of anxiety in a young athlete is often the result of factors other than sports and early intervention can avoid serious psychiatric problems.

A successful performance depends on both emotional preparation and physical practice in any arena.

Bean balls have no place in baseball

On the same day recently, three major league baseball players were struck on the head by baseballs. Two of the incidents required hospitalization; all three raise the issue of safety improvement.

David Wright and Ian Kinsler were struck by baseballs thrown at high velocity. Hiroki Kuroda, a pitcher, was hit by a line drive back to the mound.

Although helmets provide some measure of safety, the impact of any projectile can cause skull fractures, bleeding into the brain and subsequent death. Even mild forms of traumatic brain injury like concussion carry repercussions of persistent headache, dizziness or cognitive impairment. In baseball, this is enough to end a promising career.

Athletes have become stronger and more proficient at their sports, necessitating better protective equipment. The need for improved batting helmets and designing helmets for pitchers is under discussion and supported by many sports medicine specialists.

The real problem in baseball lies beneath the surface. An unwritten rule in baseball is that a pitcher is expected to hit a batter in certain circumstances or be shunned by his teammates.

Organized baseball has tried to control “plunking” by giving umpires greater leeway in ejecting players. The legal question here is whether a baseball pitcher who uses his skill to intentionally harm another player should be charged with assault? In 2006, the Supreme Court of California ruled that baseball players assume the risk of being hit by baseballs even if thrown to intentionally cause injury.

Professional athletes must realize that their actions are imitated by youngsters. Intentionally throwing at an opponent is not the behavior of a sportsman. Hopefully it will not result in death.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at, or listen to his podcasts, comment on his blog or buy his book at

Bicycle police combine helping others with staying fit

Many occupations require workers to remain physically fit in order to complete their assignments. Sometimes it is possible to combine a love of sports with a means of earning a living. Police bicycle patrols permit many avid cyclists to accomplish this.

Bicycle police patrols became common in the 1890s. Police departments found bicycles effective for rapid response and the ability to traverse difficult terrain. Although motor vehicles have dominated law enforcement transportation, bicycles have undergone a resurgence with the use of mountain bikes.

Modern police bicycles have wide, deeply treaded tires and multiple gears. They allow officers to maneuver through confined spaces as well as off-road trails.

Police officers assigned to bicycle patrols are enthusiastic about riding. A typical patrol can require between five and fifteen miles of riding. A slow- paced ride will burn 400 calories per hour.

The International Police Mountain Bike Association (IPMBA) provides training that includes stretching and fitness along with riding skills. Courses last one week and are held nationwide.

Other than police, EMS personnel and security officers utilize bicycles.

“Bicycle patrols add to visibility and communication with pedestrians and business owners,” said Mark Gendron, a Connecticut State Trooper assigned to Hebron who is trained by the IPMBA. The stealth approach of bicycles have aided in drug arrests and crowd control. Trooper Gendron keeps a bike rack on his patrol car so that his bike is always available.

Backus Hospital and the Mohegan Sun Casino use bicycle patrols for security purposes in parking lots and to assist visitors. Lowell Yeager, a retired fireman, bikes approximately 1,500 miles per year in addition to the time he spends on bike patrol at Backus Hospital.

These patrollers are dedicated to helping others and are passionate about staying fit.

Ballroom dancing attracts athletes and creative types

Athletic activities take on many different forms and among the more recently popular are various types of dance. Television shows like “Dancing with the Stars” and “So You Think You Can Dance” have been major forces behind the growing numbers of dancers.

Dancing attracts men and women of all ages, fitness levels and cultural backgrounds. People dance socially, competitively or for the entertainment of others. Perhaps no other athletic activity is so universally accepted.

The physical demands of dancing vary greatly. The pace and rhythm of the dance will dictate the cardiovascular component. Caloric output can vary between 200 and 400 calories per hour depending on the pace of the dance.

Agility is important for dancing and participation -- even at a novice level -- will improve balance. As with all weight-bearing activities, muscles become stronger and bone density increases. Typical injuries include ankle sprains, knee injuries and a variety of strained muscles.

Ballroom dancing, which requires a partner, has become particularly popular.

Adult ballroom dancing camps are held around the world. A recent week-long camp at Mt. Snow, Vt., attracted 50 dancers from the United States and Canada. Ballroom Vermont owner Byron Siegal has seen a 40% increase in participation over the past five years and more than 50% are repeat customers.

“We both enjoy the physical as well as mental and social aspects of ballroom dancing,” said veteran campers Robert and Peggy Cassey. Peggi Morrow directs the camp and finds that campers fall into two broad categories: the analytical group where every movement demands careful study and the creative group who just start moving with reckless abandon.

Like any sport, success is based on timing, coordination and strength. Enjoyment is based purely on attitude.

Athletes are at risk for sunburn

Sunburn, an often-ignored sports injury, can result in immediate as well as long term injury. If exposure becomes chronic, it can lead to death.

Skin is the largest organ in the human body. An intricate network of blood vessels, nerves and glands provides a system for thermoregulation. It is responsible for protecting internal organs from the environment, leaving the skin susceptible to damage from the elements.

The sun produces invisible ultraviolet (UV) radiation. UVA and UVB rays can produce damage after excessive exposure.

Athletes whose sports require long hours of outdoor training are particularly susceptible to the sun. This includes runners, cyclists and surfers. Winter athletes are at risk due to reflection of sun rays on snow and ice, and because they typically compete at higher altitudes.

Protection from the sun involves several strategies:

- Timing. Sun exposure is minimized when workouts are scheduled before 10 a.m. and after 4 p.m.
- Clothing. Dark, tightly woven attire will block rays while light colors only scatter rays and loose weaves allow the rays to pass through. Modern fabrics allow athletes to remain cool while covered.
- Sunscreen. Athletes should use sunscreens specifically formulated as sweat resistant and waterproof. They should also have a sun protective factor (SPF) of 30-50. A high SPF lip balm is also recommended.

“Athletes often do not reapply sunscreen despite profuse sweating. It must be re-applied at least every two hours to be effective,” said Dr. Howard Rogers, a dermatologist at Advanced Dermatology in Norwich and member of the Backus Hospital Medical Staff.

He also believes instructing people to increase sun exposure to avoid vitamin D deficiency is misleading and that dietary supplements are the most efficient way of addressing this problem without unnecessary cancer risk.

Remember, you can never apply sunscreen too much or too often.

Athletes can improve performance with rest

Athletes are typically highly motivated and committed to their sports. Hard work as a means of improvement is a core value. Among the most difficult things a sports medicine physician must recommend to an athlete is rest.

An athlete’s response to a physician’s advice is not age-dependent. Older people often tragically ignore sound advice while younger athletes with a bright future may accept the verdict.

Inexperienced athletes perceive rest as a defeat and often ignore this recommendation. Their persistence to “work through the pain” often leads to a more severe, career-ending or life-altering injury.

More mature athletes understand that resting can be an opportunity to become better at their sport. They use the time to work on other aspects of their game and often emerge stronger and more competitive.

For example, a pitcher or golfer may realize after an injury that they can no longer rely on power and must add more finesse to their game.

Rest is an effective treatment for many injuries:
Muscle strain. Rest allows muscle fibers that may have small tears to repair themselves and perform more efficiently.
Sprains. These injuries involve ligaments that stabilize joints. Swelling and inflammation are a result of these injuries and rest gives the body an opportunity to resolve this response.
Concussions. Any brain injury requires cognitive and physical rest so that brain cells can heal. Any activity should be stopped until it can be done without a headache.

Rest does not mean total separation from sports. Rehabilitation involves activity without the use of an injured limb or joint. Bracing can often allow for limited, painless activity. A recovery plan should include the advice of a certified athletic trainer or physical therapist.

One common feature to these injuries is pain and a good rule to follow is that if it hurts, rest is in order.

Sports are good for autistic children

When a child is diagnosed with autism, parents are rightly concerned. Autism should not exclude anyone from participation in sports and in fact exercise and fitness should be encouraged as a form of therapy.

Autism is a group of developmental disorders now referred to as “autism spectrum disorders.” The range of symptoms varies greatly but the common element is difficulty communicating and interacting with others.

The causes of autism are highly controversial and diverse. Genetic causes along with environmental factors are currently being investigated. Complications during childbirth may also play a role.

Since the range of symptoms is so broad, no single treatment is effective for everyone. Medication has not been proven to play a major role. Most treatment plans include educational, creative and dietary therapies.

Sports play a role in treating autism by emphasizing coordination and body awareness. Dedication to improving a particular athletic skill will also increase confidence and support other therapies.

Team sports are generally not recommended because participation relies so heavily on communication with teammates. The best sports for children with autism include:

Track and Field. Running and throwing are very basic activities that require little verbal skill.
Swimming. The symmetry and the swim stroke improve body awareness. Propelling through the water is among the most soothing activities from the standpoint of sound and tactile sensation. A competitive element can be easily introduced if desired.
Horseback Riding. This is perfect for children who may have associated motor deficits prohibiting them from other sports.
Basketball. The repetitive act of shooting baskets is an activity with immediate gratification. Individual shooting games like “H-0-R-S-E” or “Around the World” provide fun competition.
Martial Arts. An outstanding way to improve balance and coordination.

Most importantly, when choosing an athletic activity for a child with autism, make sure it’s fun.

Socks are a key part of athletic attire

At one time, the only criteria for the purchase of athletic socks were that they be white and absorbent. A similar purchase today requires an advanced degree in materials management.

High quality athletic attire is often made from materials that have wicking and antimicrobial properties. Wicking materials are typically synthetics that lift moisture away from the skin. This creates a dry barrier between the body and garment. Names like “Dri-Lex” and “Dri-Fit” indicate that these wicking compounds are present.

Antimicrobial materials are designed to keep the article of clothing free of bacteria, fungi and mold. This reduces the chance for infecting any open wound. The use of silver-embedded fibers creates these antimicrobial capabilities.

Socks are among the articles of athletic attire that benefit most from these features. Constant friction between the foot and shoe will result in blisters. The combination of moisture and heat in a closed environment with an open wound will cause infection. Sharing unlaundered socks can cause spread of bacteria like MRSA.

“The key factors to choosing proper athletic socks are stitching and materials,” said Dr. Joseph Di Francesca, a Norwich podiatrist on the Backus Hospital Medical Staff.

The best socks are those that have no stitching since these serve as a source of irritation. He agrees that materials should be both wicking and antimicrobial. Di Francesca recommends socks made from merino wool since they have natural wicking properties and silver-based fibers that reduce infection and odor.

While these developments are the result of efforts to create a better athletic sock, the cross-over to non-athletic activities is easily understood. Many people who spend long hours on their feet, as well as those who suffer from chronic medical conditions such as diabetes and vascular disease, have also benefitted greatly.

While the purchase of athletic socks should not become a major life decision, there is more to it than just color.

Blind golf challenges and inspires

Sports fans love an underdog. The ability to overcome seemingly insurmountable odds has been a source of admiration since David took on Goliath.

After watching professional golfers at the US Open and Traveler’s Championship, some would say just playing the game of golf is sufficiently challenging. Most impressive is when the game is played by athletes who are legally blind.

Blind golf traces its roots in the United States to 1925 when Clint Russell began playing after losing his sight in an accident. The United States Blind Golf Association was established in 1947 and has since been sponsoring organized tournaments.

Interestingly, there is little variation from the traditional rules of golf. Blind golfers work with a coach who is responsible for aligning the club and giving information on distance and direction. The only other significant variation is the ability to ground the club in a hazard before making a shot.

A blind golfer’s coach is more than a caddy as their relationship involves a high level of trust.

Guiding Eyes for the Blind sponsors the Corcoran Cup Masters Invitational golf tournament at the Mt. Kisco Country Club in New York. The field consists of the top 16 blind golfers in the country.

“Sponsoring this tournament over the past 30 years has become a fundamental part of our mission to allow blind and visually impaired people to compete on an equal playing field,” said Michelle Brier, marketing manager at Guiding Eyes. The day following the tournament, blind golfers play in foursomes with sighted golfers as part of a fundraising event.

Golf requires athletic ability and skill. One of the fringe benefits for all golfers is the camaraderie of sharing the experience with others.

Although golf has a significant “visual” component, success is measured by the “sound” of the ball hitting the bottom of the cup.

Readers weigh in with innovative employee wellness programs

Two weeks ago there was a discussion of wellness programs implemented by employers. These programs have been proven to reduce health care expenses and absenteeism while improving morale. Since publishing that column, several employers have presented some innovative ways they have approached employee health and wellness.

American Ambulance of Norwich held a fitness challenge for employees where three teams of 13 were awarded points for making healthy lifestyle choices.

“This challenge was not about weight loss but was instead designed to promote healthy habits for staff and their families,” said Janet Welch, director of human resources. Some choices included tai chi classes and family ski trips.

Bruce Bumpus is a director of Web Industries Hartford and reports that they have a program titled “Step up to the Plate.” It is designed around a baseball format extending over nine weeks/innings. Teams score runs based on their cardiovascular workouts. They have been able to attain 91% employee participation.

Carl Mailhot posted a comment on this blog. His company, Eastern Connecticut Rehabilitation Center, has partnered with employers to design wellness and fitness programs. Their programs include pre-shift stretching, wellness education and worksite-safety. They also provide a physical therapist for consultation regarding ergonomic issues.

If your company has an innovative approach to wellness, send it along to

Another update: this week Governor M. Jodi Rell signed into law a bill requiring that an automatic external defibrillator be available at all scholastic sports activities.

This law is the result of the efforts of Lawrence and Evelyn Pontbriant in memory of their son, Larry. By joining forces with the Connecticut Athletic Trainers Association, they have been able to enact legislation that will save young lives. All parents owe them a debt of gratitude for their perseverance.

Employee fitness contributes to overall wellness

Controversy erupted in Hartford last week when gym equipment for employees to exercise was installed in a lunchroom. This step toward improving the health and fitness of city employees sparked outrage among several city council members.

Many companies and municipalities have been instituting health and wellness programs in an effort to control skyrocketing health costs. Results have shown that any investment in fitness yields benefits including decreased absenteeism, reduced medical costs and better morale.

In challenging economic times, wellness and other forms of preventive care should be viewed as a necessity rather than a luxury.

Several local employers, both large and small, provide a variety of opportunities aimed at keeping their work force healthy. Programs include smoking cessation and stress management, along with onsite fitness centers and discounted gym memberships.

The Electric Boat Division of General Dynamics provides multiple programs for employees.

“Maintaining and staffing an onsite fitness center is only part of our comprehensive health and wellness strategy,” said Alvin Ayers, Director of Health, Wellness and Disability Benefits.

Since 1985, EB has had a fully equipped fitness center open 24/7 and staffed by fitness specialists. Approximately 700 employees regularly utilize the facility that includes cardio and resistance equipment. Other programs include yoga, aerobics and nutrition. EB’s proactive commitment to health has paid off in morale and fitness of the workforce according to Ayers.

Dime Savings Bank provides a fitness facility at its main branch in Norwich but faces the challenge of involving employees at other branches in wellness programs.

“Dime provides discounted local gym memberships for all employees, as well as sponsoring competitive fitness challenges among the various branches,” reports Cheryl Calderado, Senior Vice President for Administration at Dime.

Frequently used fitness equipment is always a good investment, especially in tough economic times. If your company has a fitness center or unique approach to wellness, contact me at

Haitian Soccer Success

Four years ago the Haitian Health Foundation embarked upon a bold effort using participation in a girl’s soccer program as a reward for completing a course in responsible sexuality. The result has been a movement and the establishment of the first organized women’s soccer league in Haiti.

After first reporting this story in a Healthy Sports feature last year, many local citizens and institutions have provided assistance in the form of monetary donations and equipment. Thanks to this support, the program has spread to more remote areas of Haiti and nearly 1,700 girls are enrolled in this year’s course. When taking into consideration past graduates, there will be a total of 52 teams of girls ages 13-19 playing this summer.

What these athletes lack in equipment they make up for in desire and effort. In many villages it has become a source of parental pride to have a daughter play for a team. Empowerment and confidence are two of the attributes that are readily apparent when chatting with players.

Although this program has developed a healthy outlet for these women in regard to personal fitness, the question of whether or not it has resulted in healthier sexual practices remains. Studies comparing the incidence of sexually transmitted diseases and teenage pregnancy before the program and since are ongoing. Initial reports, although anecdotal, indicate both these parameters are declining since the program started.

Dr. Jeremiah Lowney is founder and president of the Norwich-based Haitian Health Foundation. “Athletic participation is always a positive distraction for young people. The girl’s soccer league in rural Haiti will result in a healthier population of future mothers. They also receive health information to pass onto their daughters. This program will span generations,” said Lowney.

If you wish to find out more about the HHF soccer program or make a financial or equipment donation, the blog is and the website is

Make way for roller derby resurgence

Competitive sports are among the most popular forms of entertainment in the world.

Sometimes a sport is more heavily weighted on the entertainment aspect rather than competition. In either situation, the physical demands on participants can be dramatic. This is certainly the case with roller derby.

Originating in the mid-western United States in the 1920s, roller derby is now undergoing a resurgence among fitness-minded women who demand excitement as part of their work outs. The athletic aspect of the sport demands excellent balance, strength and stamina. The entertainment side is pure fun for participants and audience.

A team consists of five “derby girls” on the track at any time. Points are scored when a player who is designated as a jammer is able to lap opposing players. This can only be done during a two minute period known as a jam.

Like all skating sports, core body strength is essential for success in roller derby. Each hour of participation burns approximately 400 calories. In addition to leg strength required for skating, upper body fitness is necessary to block opponents.

Cardiovascular stamina is a big factor in withstanding the 20-minute periods of skating, blocking and maneuvering. Strategy plays an important role in success. Players must be aware of offensive and defensive opportunities.

Debra Frank is a nurse from Mystic who recently decided to follow a childhood dream of joining a roller derby team. She began by trying out for the Connecticut Roller Girls this spring and is one of only seven new recruits.

“Roller derby attracts people from all walks of life, levels of education and ethnicities who wish to participate in a sport that allows you to step out of your current existence and into an alter ego,” said Frank.

Roller derby is certainly not a conventional sport, but it provides an excellent outlet for women to get in shape, relieve life’s frustrations and enjoy the
camaraderie of others.

As outdoor activities increase, so does tick risk

Spring has finally arrived in New England and opportunities for outdoor activities abound. Along with many of these, there is increased exposure to tick-borne illnesses.

Tick-borne illnesses include a variety of infections transmitted among animals (including humans) by ticks.

A tick will feed on an infected animal, the tick then becomes infected and passes the bacteria along by lodging itself in the skin of other animals and humans.

Rocky Mountain Spotted Fever is the most common tick-borne illness in the United States. In the northeast, Lyme disease is the most well-known. Diseases such as Ehrlichiosis and Babesiosis, while still rare, are gradually becoming more recognized.

Hiking, mountain biking, fishing and golf are among the activities where participants are most vulnerable to tick bites and potential Lyme disease. Following some basic rules can prevent infection:

• Stay on trails and avoid walking through high grass. This warning is especially important for golfers who invariably find themselves searching for an errant golf ball.
• Minimize exposed skin. Although it is recommended that long trousers and sleeves be worn, this is often not practical. Insect repellent should be applied liberally on any exposed area. Carefully read the label and be sure that it contains DEET and will be effective against ticks.
• Self-examine every three hours while in the field and more thoroughly after the activity. Showering to remove any residue from repellents is crucial and a good opportunity to search for ticks. Children must also be vigilantly examined, especially on the scalp.
• Four-legged companions are also susceptible and repellents such as “Frontline” are recommended by many veterinarians. Brushing with a fine comb after a hike can often find hidden ticks.
• Immediate removal of a tick is imperative. A tweezer works best and the area should be cleansed with antiseptic after removal.

When out on the golf course, pause before going into the deep grass to retrieve your ball or a newly found treasure.

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

“Brain gyms” can build intellectual muscle

Physical exercise is well-known to help brain function. A regimen of regular exercise has been shown to slow the progression of neurologic diseases like Parkinson’s and Alzheimer’s. There is now information suggesting that improved cognitive ability may result in more competitive athletic performance.

Previously it was believed that the brain could not repair or reorganize the networks contained within it. More recently, terms like “neural plasticity” and “cortical reorganization” have been used to describe these mechanisms of recovery. They are witnessed after stroke or brain trauma and result from early intervention in the form of aggressive physical, occupational and speech rehabilitation.

People beginning to experience memory deficits and difficulty completing complex tasks they previously found easy are turning to so called “brain gyms.”

Facilities such as Vibrant Brains, Nifty after Fifty and Sparks of Genius set up mental workouts for patrons on a variety of computer programs. These workouts are designed by trainers and are based on cognitive weaknesses.

“Cognitive rehabilitation has always emphasized improvement of attention skills,” said Dr. Christopher Tolsdorf, a neuropsychologist who specializes in neuropsychometric testing in his Norwich office. “This is best accomplished by memorization. This alone will improve the ability to attend, concentrate and focus.”

Tolsdorf is a fan of teaching children rote memorization of academic material.

Tolsdorf also believes that focusing on one skill like crossword puzzles or Sudoku will only make someone better at those games. Variety is an important factor in rebuilding cognition.

Several brain gyms combine mental and physical exercise with classes on improved nutrition. Many participants have attributed improved athletic performance in sports like tennis and golf to their increased attentiveness.

While the benefits of brain gyms are based on conjecture and theory rather than accepted scientific proof, the concept that diet and physical exercise improve brain function is well-documented in scientific literature.

You may want to quickly memorize a sonnet as part of your warm-up on the driving range.

YMCA closure limits fitness options when they are needed most

Diet and exercise are critical to reducing chronic illness. Any program that incorporates these elements demands discipline. During challenging economic times establishing good health habits becomes more difficult since there are increased demands on time. Another unanticipated obstacle is that affordable, easily accessed opportunities for fitness are more difficult to find.

Many small cities and towns have been able to offer community facilities where people can participate in activities such as swimming, team sports and athletic classes at minimal cost. These facilities typically rely on a precarious combination of public funding, donations and membership fees to meet their obligations. In the past year many have experienced a decline in all three revenue sources while being faced with increasing expenses. These facilities are now closing their doors -- leaving many without access to a variety of activities.

In Norwich, it has been the YMCA that has provided an indoor pool where infants and toddlers learn to swim. The elderly participate in aquatic exercise programs to ease the excess strain on arthritic joints. A licensed daycare facility helps relieve some of the pressure on working families while providing a sports diversion to many young people. Unfortunately, the Norwich YMCA will be closing this week.

“No program at the YMCA is designed to make money,” said Attorney Michael Lahan, who serves as chairman of the volunteer board responsible for managing the Norwich branch of the YMCA. “All membership fees go directly to supporting programs that help others. The physical plant at the downtown location is an integral part of the city and the only way to survive will be through a coalition of organizations.”

It is no secret that health costs are rising rapidly in the United States. Much of those dollars go to treating chronic problems like obesity, hypertension and diabetes. It’s time we begin to invest these resources for prevention rather than treatment.

New test needed for boxing safety

Professional sports organizations are constantly searching for ways to improve the safety of competitions. Sports involving unarmed combat like boxing and mixed martial arts can face immense challenges since the ultimate goal is to neurologically impair an opponent in the form of a knock-out.

The pre-fight evaluation is crucial in avoiding permanent neurologic injury and death. Each state and all sovereign tribal nations that allow these sports have their own boxing commissions.

Connecticut has three commissions: The Connecticut State Boxing Commission, the Mohegan Tribal Department of Athletic Regulation and the Mashantucket Pequot Tribal Boxing Commission. Connecticut is among the most heavily regulated states in terms of safety.

Electroencephalography (EEG) is a diagnostic test where wires are taped to the skull and electrical impulses generated by the brain are recorded. Normal brain cells (neurons) produce patterns of rhythmic discharges. Variations in these rhythms are indicative of different types of brain abnormality.

EEGs were routinely used as a screening test in many states to determine whether a boxer could participate in an event. After several years, a review of 98 EEGs, performed on 86 boxers, who had participated in a total of 5,809 fights showed no significant abnormality. No fighter was prohibited from boxing based on the EEG.

These results demonstrated that EEG is not an appropriate test to assess chronic brain injury. This information will be presented next week at the annual meeting of the American Academy of Neurology (AAN).

The AAN represents over 21,000 neurologists. The information accumulated in Connecticut may help in evaluating patients with traumatic brain injury including returning service personnel.

Most importantly, the boxing commissions in Connecticut changed and are now requiring annual neurologic history and examination before boxing events.

“Boxing commissioners must be willing to change regulations in order to keep unarmed combatants safe,” said Peter Timothy. commissioner for the Mashantucket Pequot Tribal Athletic Commission.

The ability for sports organizations to institute changes despite time-honored traditions is crucial to maintaining a safe contest for participants.

Triathlons possible even for those with physical limitations

Triathlons typically consist of swimming 2.4 miles, bicycling 112 miles, and running 26.2 miles in succession. This format became popularized by the Iron Man event held annually in Hawaii.

Recently, shorter variations of this format have made triathlons accessible to mere mortals who wish to train and compete but also have a job and family that get in the way.

The challenge of completing a triathlon is intoxicating for many athletes. Katherine Downes is a young woman originally from Glastonbury and now living in New York City. An accomplished swimmer, in 2006 she began to notice symptoms of diminishing stamina. Even short walks became a struggle.

Katie was born with an atrial septal defect (ASD), a hole between the right and left atria of the heart, which did not become symptomatic until her 20s. As a result of the ASD, the normal cardiac bloodflow is reversed and overloads the right ventricle and lungs.

After several attempts the ASD was repaired, giving Katie a new appreciation of sports. With her physician’s approval, she joined a group called “Team in Training” that prepares athletes for participation in triathlons with the goal of raising money for the Leukemia and Lymphoma Society.

Katie is set to compete in her first triathlon on April 26 in St. Petersburg, Fla. “Pushing yourself to accomplish an athletic feat despite physical obstacles makes reaching that goal even more special,” Downes said.

Recent studies have emphasized the risk of participation in triathlons. Many athletes are not accustomed to swimming in often frigid, open water. It is imperative that before participating in these events, clearance be obtained by a physician and an adequate amount of time invested in training.

When an athlete participates in any event with the goal of raising money for the less fortunate, the accomplishment becomes doubly rewarding.

If you wish to support Katie’s effort, donations can be made by going to

Mouthguards aren’t just for dental safety anymore

Spring training provides a great opportunity to catch up with colleagues and discuss new innovations in sports equipment.

Mouthguards have long been accepted as the best way to avoid dental injuries. In recent years, they have also become a fashion statement with various colors and designs adorning the mouths of football, hockey and lacrosse players.

This year, mouthguards are being marketed as a way to improve athletic performance. They are now worn by golfers, as well as baseball and tennis players, as a means to relax muscle tension and maintain posture.

Several baseball players have appeared at spring training with mouthguards produced by PPM and Edge. Most notably, Manny Ramirez has begun to use a Pure Power Mouthguard.

The theory behind this teaching is that relaxed jaw muscles will allow a more relaxed posture and more power being generated. This theory is based on anecdotal evidence rather than any scientific study. In the past, golfers have found that chewing gum often relaxes the grip and swing.

Another product of recent interest is the “Brain Pad.” The brain pad is a mouthguard that is advertised as a way of diminishing the serious effects of traumatic brain injury. This theory is based on an isolated study performed in the 1960s that postulated a relaxed jaw served as a “shock absorber” for the brain. Although never proven, this belief has become part of sports medicine lore.

Despite the lack of scientific support, no one will argue with either of these practices. They result in athletes wearing mouthguards that at a minimum provide dental protection.

Cost is another issue since the Edge and PPM products range from $900-$2,000, while the Brain Pad and other fitted mouthguards cost $25.

No matter what logic is applied, mouthguards are a great idea even if you’re only trying to avoid damage from an errant tennis ball.

As baseball season begins, think safety

The principal goal of anyone involved in sports medicine is to assure the safety of an athletic event for all the participants. Safety measures in sports like baseball and softball can have dramatic impact.

Recent conversations with Mike Turgeon, who has been teaching baseball skills in Norwich for 20 years, and the athletic training staff of the New York Yankees in Tampa have raised several safety issues worth noting:

Field conditions. Many baseball injuries are the result of a “bad hop” off a stone in the infield or stepping into an unexpected sink hole in the outfield. Municipalities must maintain athletic fields if they wish to continue youth sports programs.

Basic skills. Before allowing youngsters to play infield positions coaches must be sure that they possess the skill to handle a hard hit ball.

Bats. The longstanding controversy over the safety of metal bats continues. The best way to avoid injury from a hard-hit ball coming off a metal bat is by using protective equipment like mouth guards, helmets, masks and devices that protect the genitalia.

Automatic External Defibrillators (AEDs). “Commotio cordis” occurs when the heart begins to beat erratically or ceases to beat entirely after being suddenly struck by an object. An appropriate chest protector such as those worn by hockey players can avoid this injury. When this life-threatening situation presents itself an AED can be used to immediately shock the heart back to normal rhythm. This year the New York Yankees are leaving nothing to chance and have purchased eight AEDs so that when on the road each minor league team has an AED available at all times. This action should serve as an example for communities to make AEDs available at all athletic events not only for athletes but fans as well.

Baseball can only become safer if parents and communities take an active role.

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

Skiers should wear helmets

It often takes a tragedy to raise public awareness regarding safety. During an athletic event, there are only two ways in which an athlete can suddenly die: cardiac or neurologic. The latter is typically the result of a traumatic brain injury.

Actress Natasha Richardson experienced a seemingly minor fall on a beginner ski slope and struck her head. After some initial symptoms she felt better and did not see a need for medical attention. Shortly after, she lapsed into a coma and subsequently died.

This frightening scenario is a principal focus of attention for sports medicine specialists.

Traumatic brain injury is a general term describing a range of damage that includes relatively mild concussion to severe brain hemorrhage. Bleeding can occur within the brain itself (intracerebral hemorrhage), below the dural membrane surrounding the brain (subdural hemorrhage) or outside the dura (epidural hemorrhage).

Epidural hemorrhage can be the result of relatively minor trauma to the temporal portion of the skull resulting in a tearing of the superficial temporal artery. Arterial bleeding is rapid and increases pressure in the skull with the brain eventually being pushed downward through the skull base.

A period where symptoms improve after the initial hemorrhage can be seen in epidural hemorrhage such as that experienced by Richardson. This “lucid period” can vary anywhere from a few minutes to hours. It is during this period that medical personnel must rely on clinical suspicion and take action that may be life saving.

This tragedy has reinvigorated the discussion of mandating the use of helmets on ski slopes. Helmets have proven to be effective in reducing brain injury in cycling and other sports. Ski helmets have the additional benefit of being comfortable, warm and waterproof in addition to offering brain protection.

Hopefully, common sense will prevail and more skiers and snowboarders will begin to wear helmets, and there will not be a need to legislate safety.

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

Hip injuries are hip this year

It seems that every year when spring training rolls around, a new injury becomes the highlight of conversation. Last year, it was Curt Shilling’s shoulder and this year it is Alex Rodriguez’s hip. If this keeps up, baseball fans may forgo medical school and go right into an orthopedic residency. A-Rod has now surpassed Bo Jackson for having the most written about hip joint in sports.

The hip is a ball and socket joint. The head of the femur is a ball shaped structure that fits into the acetabulum, a socket in the pelvis. The joint is held together by several ligaments. The labrum is the cartilage that lines the acetabulum and allows smooth movement of the hip.

While allowing the leg an extensive range of motion, this joint is especially vulnerable to traumatic injury. Repeated pounding and twisting seen in most sports that require rapid starts and change in direction account for a majority of hip damage.

Treatment of hip injuries in athletes varies from a conservative approach including rest, anti-inflammatory medications and physical therapy to hip replacement. Arthroscopic surgery has become a minimally invasive approach that often delays or avoids a more radical procedure.

In 1991, Bo Jackson underwent total hip replacement after a fracture. He returned to play major league baseball. Alex Rodriguez recently underwent arthroscopic surgery to repair a torn labrum.

The common denominator in recovery from all hip surgeries is early rehabilitation often beginning immediately after surgery. Many orthopedic surgeons who treat athletes get their patients on a stationary bicycle two hours after surgery. Non-weight-bearing exercise continues for the first six weeks after surgery while the patient is on crutches. Strengthening exercises follow with hopeful return to running in ten weeks.

Much has changed from Bo Jackson’s “miraculous” return from hip surgery in 1991. These breakthroughs have carried over to non-athletes who can get back to an active lifestyle with minimal downtime.

Spring training is not just for baseball players

Now that spring is near, the need for physical preparation before enjoying competitive sports must begin.

Professional athletes establish a basic regimen that balances stretching, aerobic and resistance training. Workouts that focus on a specific sport branch out from that basic program.

Sport-specific workouts include hitting drills in a batting cage for baseball and softball, using a wind trainer for cycling or an indoor rower before getting out on the river.

One unique approach to training involves golf. Although not among the most physically demanding sports, professionals like Tiger Woods have proven that a program of diet and exercise can improve golf skills.

Derek Hooper and Sue Cart are PGA teaching professionals at the Lake of Isles Golf Academy in Mashantucket, Conn. Along with Terry Ditmar, a physical therapist, they have put together a program called “Fit Fore Golf.” The program consists of a three-dimensional golf swing analysis, a video study of the swing and designing an individualized workout routine to improve swing mechanics and avoid injury.

“The goal of the program is to improve the efficiency of the golf swing while reducing injury,” said Hooper.

After completing the initial assessment, participants should perform their individual routines for 20 minutes three times per week at a minimum. Six weeks later, the golfers reconvene for a second analysis comparing the initial information to any changes and to be sure they are performing the exercises correctly.

Individualized baseball instruction for improved hitting and pitching also has a big payoff. Local programs such as those offered by Mike Turgeon at his indoor baseball school in Norwich draw baseball and softball players of all ages.

“We work with 7-year-olds for whom this is their first baseball experience as well as seasoned professionals rehabilitating an injury before returning to the professional ranks,” said Turgeon.

The combination of indoor workouts with a solid year-round fitness program can jump-start a successful season in any sport.

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

Effective workouts include resistance training

The dramatic contrast between what equipment is used in a gym or fitness center by each gender is readily apparent. In general, women gravitate to aerobic machines like the treadmill, bicycle or elliptical with the goal of losing weight, while men prefer lifting weights to increase muscle bulk.

Unfortunately, neither approach alone is correct. Muscle burns more calories than fat, so it is easier to maintain a healthy weight by increasing muscle mass. Muscle bulk alone places added stress on the heart and lungs resulting in poor athletic performance.

Once adequate stretching and aerobic regimens are established, it is time to incorporate resistance training. Best defined as the use of resistance against the force of muscular contraction, resistance training can be implemented through the use of elastic bands, hydraulic cylinders or weights.

Gradually increasing the resistive force on specific muscles will increase strength as well as bone mass. Strength workouts are measured by the number of repetitions of each movement and the number of sets of each exercise.

“I encourage the use of low-weight dumbbells for three sets of 20-30 repetitions first, then moving on to a machine-based workout with more weight and 12-15 repetitions,” said Marc Nee, a local personal trainer and owner of Training with Heart. “The next step is to combine weights and the use of a physio ball for balance.”

One method of combining an aerobic and resistive workout is the use of a weight vest when walking. Weight vests can be worn comfortably with varying amounts of weight added. This will add core muscle strength allowing for a natural walking motion. Ankle and wrist weights poorly distribute added weight and can cause excess strain on an extremity.

Establishing a basic workout regimen that includes stretching, aerobic and resistive components is crucial before moving on to sport-specific programs in preparation for spring sports.

Aerobic exercise is key to fitness

Aerobic exercise is best defined as activity that improves the use of oxygen by the human body.

The term was first popularized by Dr. Kenneth Cooper, an Air Force physician, who published a book in 1968 titled “Aerobics.” His book was the result of research explaining why people with excellent physical strength could not perform well on tasks involving running, swimming and bicycling.

The target organs for this part of an exercise program are the heart and lungs. Increasing the ability for these organs to better utilize oxygen will impact all phases of human performance.

The human brain especially benefits from improved aerobic capacity. Studies have now demonstrated increased cognitive abilities along with benefits for patients suffering from migraines. The progression of degenerative diseases such as Alzheimer’s and Parkinson’s is slower in those who are aerobically fit.

Aerobic exercise involves the use of large muscles in repetitious and rhythmic movement. Walking is probably the best example and a great way to start. After consulting with a physician, gradually increasing speed and distance will lead to weight loss, improved mood and better stamina.

“The key to an effective aerobic regimen is variety,” said Marc Nee, a local personal trainer and owner of Training with Heart who works with clients of all ages and abilities. “Each workout should include three different aerobic activities such as biking, walking and stairs for ten minutes each. Variety combats boredom and allows athletes to use different muscles.”

Pedometers are an inexpensive way to measure the number of steps taken during the course of a day. A goal of 10,000 steps is the equivalent of five miles.

Although 30 minutes three times per week is recommended, all experts agree that any movement is an important start. While aerobic exercise is a critical part of any workout, weight training is an important component to be discussed in next week’s column.

The complete workout: Stretching, aerobics and resistance training

Designing a workout regimen involves three basic components: stretching, aerobic activity and resistance training. Balancing these elements properly results in a workout that yields the greatest results in the least amount of time.

Over the course of the next three weeks, each element will be discussed and suggestions for putting together an efficient workout outlined.

The goal of stretching is to warm up the muscles that are about to be stressed. The term “warm-up” actually refers to increasing blood flow to the muscle.

Muscles are the engines of the human motor system. They are attached to bones by tendons at each end. Tendons become frail with age and disuse. Stretching refreshes elasticity before exercise. Immediate stress on a tendon often results in tearing.

Contracting a muscle moves a joint and places the body in motion. The muscle itself consists of a series of fibers that rely on blood and nerve supply for energy and direction. Increasing the supply of necessary nutrients before activity allows for a smoother transition from idle to active.

Static stretching is the type that includes going into a stretched position and holding it for 20-30 seconds. Dynamic stretching involves stretching muscles while moving.

Muscle physiologists have demonstrated that static stretching alone will result in muscle fatigue and loss of power. It also facilitates an inhibitory impulse from the nervous system. Dynamic stretches increase power, flexibility and range of motion while eliciting an excitatory neurologic stimulus.

“I recommend older athletes begin a workout with a walk or light jog,” said Marc Nee, a local personal trainer and owner of Training with Heart. “Younger, more aggressive athletes should combine dynamic and static stretching through lunging movements performed slowly and held for several seconds.”

Repetition of an activity such as a tennis serve or baseball swing before competing is a very effective way of stretching.

Careful stretching before each workout is an important and often overlooked component of an effective workout regimen.

Mountain rescuers there when needed

Winter mountain sports include a wide variety of activities. Skiing, snowboarding, snowshoeing, snowmobiling and ice climbing require understanding of the terrain, adequate training and the participant’s physical limitations.

Unfortunately, even with the best preparation, serious accidents can occur and the intervention of outdoor rescue specialists is needed. These rescues can vary greatly and include searching for avalanche survivors, getting injured participants off a mountain and administering medical care in the cold wilderness.

Ted Grave of Cheshire, Conn. directs the Mount Snow ski patrol in Vermont. The staff consists of 80 members, 60 of whom are volunteers. Although many have some medical background, all share a love of the outdoors and a willingness to risk their personal safety for others.

“The most important requirement of the National Ski Patrol is excellent skiing or snowboarding skills; the medical information can be taught,” said Graves. Each staff member must successfully complete a course in outdoor emergency care.

Sally Grave, Ted’s wife, manages the base unit that is attached to an urgent care center staffed by physicians and physician assistants. Serious injuries may require helicopter evacuation to a trauma center.

Although the most common injuries continue to be fractures and sprains of the extremities, automated external defibrillators (AEDs) are available on the mountain in case of cardiac arrest.

Adequate preparation is crucial for winter mountain safety:

• Participants should be in good general health before venturing into the wilderness.
• Helmet use is essential for winter activities that include moving at high speeds.
• Appropriate equipment including GPS devices, radios and clothing can be crucial in a crisis.

All mountain safety experts agree that the most important safety factor is good judgment. Knowing the abilities and limitations of yourself and others in your party is imperative to avoiding tragedy.