Hockey coaches must know signs of concussions

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

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

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

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

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

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

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

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

Elliptical trainers can help keep the pounds off during holiday season

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

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

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

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

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

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

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

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

Physical activity helps those with Parkinson’s disease

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

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

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

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

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

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

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

Football safety debate could benefit from local examples

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

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

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

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

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

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

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

Maybe there is something to be learned.

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

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

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

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

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

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

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

Swimmer’s death a reminder that we all have limits

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

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

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

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

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

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

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

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

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