Regular exercise should be part of any New Year resolution

The human body works most efficiently when it can attain a regular rhythm. A daily pattern should consist of sufficient sleep, regular nutritious meals and periods of exercise. This last component has become increasingly important in maintaining good general health. More recently, exercising regularly has been shown to possibly avoid several chronic conditions.

The definition of "regular" exercise also has presented a dilemma. Recommendations have varied in regard to the amount of time, intensity and type of activity.

Aerobic activities include walking, swimming, running and biking. Resistance fitness consists of lifting weights, using stretch bands or using body resistance. Walking or swimming at a slow pace is considered moderate exercise while running is classified as intense.

The current federal recommendations suggest 150 minutes of moderate exercise each week or 75 minutes of intense exercise as a maintenance amount for fitness. Those numbers should double if weight loss is a goal.

In addition to medication, regular exercise has been part of the prescription for patients suffering from type 2 diabetes, hypertension and heart disease. The latest data indicates that these disorders can actually be avoided through regular exercise even in patients who have a family history.

Among the most feared chronic illnesses is dementia. Current estimates indicate that 5.1 million Americans suffer from Alzheimer's disease. This number continues to grow as baby boomers age. Several recent studies have demonstrated that Alzheimer's disease and other cognitive conditions may be avoided through regular exercise.

The protective mechanism is both a direct effect as well as a secondary benefit of increasing blood flow to the brain. Ideally, a regular fitness regimen should begin in mid-life or sooner for maximum benefit.

The arrival of a new year encourages many people to begin a weight loss regimen. Adding an exercise component to that regimen for any length of time may have an added longevity benefit.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Early recognition can help prevent serious eye injuries

Approximately 20 percent of all eye injuries are sports-related. These account for 42,000 emergency department visits in the United States each year. Prevention and early recognition can avoid permanent visual impairment.

The eye is divided into the anterior and posterior segments. The major components of the anterior segment, including the lens, pupil, iris and cornea, serve to focus an image on the posterior segment. It accomplishes this by changing the shape of the lens and allowing adequate amounts of light into the eye.

The posterior segment receives the image on the retina and transmits the information via the optic nerve to the brain where it is identified.

Excessive exposure to sunlight is common in athletes who participate in outdoor sports. Ultraviolet light exposure will damage the anterior segment of the eye and cause premature cataracts.

Blue light frequencies of sunlight will penetrate further into the eye resulting in damage to the posterior segment and potentially causing permanent visual loss from conditions such as macular degeneration.

Sunglasses with the appropriate filtering mechanism should be worn whenever possible to avoid these conditions.

Lacerations involving the eyelid have attracted recent attention due to their severity and potentially successful treatment. The eyelid contains a system of intricate glands, ducts and blood vessels that protect and nourish the eye.

"A laceration involving the margin of the eyelid or the tear drainage system should ideally be repaired by a physician with expertise in reconstructive surgery of the eyelid," reports Dr. Kira Segal, an ophthalmologist specializing in oculoplastic surgery at the University of Michigan. "If a specialist is not immediately available, simply place antibiotic ointment and a patch over the laceration. Repair can be delayed up to 72 hours from the time of injury as the eyelid's highly vascular structure decreases the risk for infection."

Serious eye injuries can be prevented with appropriate protective eyewear. Every eye injury should be taken seriously.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN.  He is director of UConn NeuroSport and can be reached at

Athletes particularly susceptible to migraine headaches

Approximately 38 million Americans suffer from migraine headaches. These episodes often interfere with work and social activities. Athletes are not immune from this disabling condition.

Migraine headaches are best defined as throbbing headaches that last from four to 72 hours, often accompanied by additional symptoms including nausea, vomiting, visual disturbances, light sensitivity and sensitivity to sound.

These headaches may be preceded by periods of neurologic impairment lasting approximately 30 minutes before the actual pain begins. These symptoms are often referred to as an aura and may include loss of vision, weakness and numbness on one side of the body and difficulty with speech. Due to the nature of these symptoms, the episodes can be confused with the onset of a stroke. 

Changes in sleep schedule, diet, frequent travel or changes in climate can trigger a migraine, making athletes particularly susceptible. Contact sport athletes face the additional complication of head trauma.

Headaches can develop with exertion, independent of head trauma. These headaches typically last from five minutes to 24 hours. Head trauma can precipitate a migraine in a migraine-prone individual. The onset of any headache during competition in a contact sport can create confusion with whether it is contact-related and necessitates removal from a contest and a prolonged return-to-play protocol. 

Treatment of migraine headaches in athletes can involve symptomatic treatment with medications taken at the onset of headache or preventive treatment with medications taken on a regular schedule. Unfortunately, the list of medications that can be used in athletes is limited by effects they may have on performance.

“Headache is well known to have serious effects on productivity. Absenteeism and even "presenteeism" (showing up for work but being far less productive) may have far greater implications for athletes than in the general population,” reports Dr. Vernon Williams, Director of Sports Neurology at the Kerman-Jobe Clinic. “The culture of competition and athletics typically doesn't tolerate headache as an acceptable excuse or explanation for poor athletic performance.”

Adequate evaluation and treatment of headaches can improve enjoyment and performance for athletes at all levels.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Insulin pumps becoming popular among diabetic athletes

Diabetes affects more than 29 million people in the United States. Often the most effective treatments consist of a combination of insulin, diet and exercise. Ironically, achieving a balance between insulin and exercise can often be a challenge, especially for high-level athletes.

Diabetes is classified as type 1 or type 2 based on the body’s response to insulin, a hormone produced in the pancreas. Insulin enters the bloodstream in response to variations in the blood glucose level. Insulin allows glucose to enter cells and produce energy.

Type 1 diabetes occurs when the pancreas can't produce enough insulin. It is typically identified in childhood or adolescence but can be seen at any age.

Type 2 diabetes occurs when the body becomes resistant to the insulin available or the pancreas cannot produce enough insulin to keep up with demand. This type is usually seen in adults who have become obese. Unfortunately, it is now being seen more often in adolescents.

The goal of diabetes treatment is to create balance in the blood glucose level. This is done by decreasing the intake of glucose, burning more glucose through exercise, increasing the sensitivity of cells to insulin and the administration of insulin by injection. Often a combination of these strategies is applied.

Any attempt to properly regulate blood glucose levels in diabetes requires daily planning, especially for athletes. Insulin pumps are becoming increasingly popular.

Insulin pumps are wireless devices that can be programmed to infuse insulin via a small tube placed under the skin. Athletes can adjust the rate based on their level of activity even during a long-distance event.

"The use of insulin pumps in athletes is a convenient and efficient way to deliver insulin to the body that more closely mimics the way insulin is produced in a normal pancreas,” states Dr. Deena Casiero, Head Team Physician at UConn. “Insulin pumps also tend to lead to more well-controlled blood sugars overall, which is important for any athlete.”

Hopefully, the use of insulin pumps encourages more diabetics to participate in sports at a high level. 

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Post-concussion syndrome keeping NHL star, Sidney Crosby, off ice

Sidney Crosby recently reported having suffered his third concussion to the Pittsburgh Penguins medical staff. As a result, he missed the first game of the season and remains on injured reserve. His admission has raised many questions regarding his future in the NHL.

Concussion was first described in writings by the ancient Greeks. It is best described as a group of neurologic symptoms that result from a biomechanical force applied to the brain. Although a great deal has been learned regarding the recognition of a concussion, there is no specific diagnostic test and no definitive treatment.

Millions of sports-related concussions are reported each year, the vast majority of which resolve over a period of days. The persistence of symptoms has been described as post-concussion syndrome (PCS).

Among the symptoms for PCS are headache, depression, fatigue, disordered sleep and poor memory. These symptoms are often considered part of the original injury and delay a return to athletics. In fact, specifically treating these conditions can allow for a safe return and avoid an extended absence from academics and sports.

Chronic Traumatic Encephalopathy (CTE) has recently become a fear among athletes who have suffered multiple concussions. The potential for developing violent behavior, depression and suicide has prompted early retirement from contact sports. It is important to note that CTE is only diagnosed post-mortem.

In their recently published book, “Back In The Game: Why Concussion Doesn’t Have to End Your Athletic Career,” Dr. Jeffrey Kutcher and Ms. Joanne Gerstner clarify much of the confusion surrounding the diagnosis and treatment of concussion. This is an authoritative text written in understandable terms. It is highly recommended for parents, athletes and coaches.

Sid Crosby’s potential return will be determined by his ability to increase activity without disabling symptoms. Most importantly, his injury was self-reported and that reflects some success in the area of education and awareness of concussion.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Careful judgment key when dealing with opiates

Opiate medications have been the basis for pain relief over thousands of years. Unfortunately, inappropriate use has lead to an addiction crisis affecting many people, including high-level athletes.

Opium is an extract from the seedpods of the poppy plant most commonly grown in middle and far eastern countries. The most active substance in opium is morphine. Currently, a variety of oral opiates have successfully alleviated pain but in some cases lead to lifelong addiction.

Opiates work by binding to receptors on nerve cell membranes in the brain. This action blocks the proliferation of neurotransmitters that cause pain. Over time, increasing doses of opiates are required to achieve pain relief. Unfortunately, this can lead to addiction and the search for alternative illegal narcotics.

There are very few industries where one hundred percent of your employees will suffer a work-related injury. Professional sports are among those industries. High-velocity collision sports and combat sports athletes are particularly vulnerable.

Injuries move through acute and chronic phases. Acute injuries last days to weeks while chronic injuries last months to years. Many of the injuries seen in sports also require surgical intervention necessitating post-operative pain relief.

“Opiates play a helpful role in pain control immediately following acute injury and postoperatively,” states Dr. Jeffrey Anderson, Medical Director of UConn Student Health Services. “They don’t have a legitimate role in the management of chronic pain in the competitive athlete.”

Fortunately, there are many effective, non-addicting, medications designed for chronic pain. Many of these medications typically act on the brain for other conditions including epilepsy and depression. 

The use of opiate analgesic medications must be offset by careful judgment and consideration of alternative medications.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Initiative aims to curb sports misconduct

Organized sports are a big factor in promoting better physical and mental health, higher grades and better social relationships among athletes. Unfortunately, it is estimated that one out of eight athletes under the age of 18 will be abused or assaulted.

The Safe Sport Initiative is the response of the Olympic community to recognize, reduce and respond to misconduct in sports at every level. Six primary forms of misconduct have been described. They include bullying, harassment and hazing as well as emotional, physical and sexual misconduct. 

Hazing and other rituals have long been a part of sports. More recently these rituals have sometimes taken on a more violent, destructive and sexual nature. Coaches and staff must be aware of any hazing practices and be sure that all athletes are adequately protected.

Bullying and harassment are typically directed to athletes who are different. Bullies target all athletes and their actions are often easily mistaken for good-natured teasing. Harassment is more offensive and often linked to discrimination. Targets of harassment are often different based on race, religion or sexual orientation. Sexual harassment has become pervasive in athletics. Some estimates report 57 percent of athletes have been sexually harassed. Both of these behaviors can be detrimental to the performance of a team as a whole.

Trust and power are the essential elements of the coach-athlete relationship. This relationship involves a delicate balance between encouragement and discipline that can easily be misused to an athlete’s detriment.

Grooming is the process where a coach or other potential abuser establishes sufficient trust with the athlete and parents that allows for an opportunity for abuse. Coaches can also establish what an athlete values most and use that as currency for abuse.

Child abuse is among the most heinous crimes. It is only through education and vigilance that it can be stopped.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Cupping therapy used by Michael Phelps is effective treatment

Ancient medical practices have been rediscovered by modern day athletes as potential tools to speed injury recovery. Among these is the practice of cupping that was recently in the headlines because of its adoption by the most decorated Olympic athlete, Michael Phelps.

Cupping therapy involves placing of cups that are made of a variety of materials over affected areas. These cups are then used to create a suction that draws increased circulation to the region. The goal is to diminish inflammation, reduce pain and provide relaxation through deep tissue massage.

To better understand how cupping works, it is important to know what happens after an injury. The earliest descriptions of acute inflammation use the terms tumor (swelling), rubor (redness), calor (warmth) and dolor (pain).

Swelling appears immediately to physically restrict the affected area from moving and potentially doing more damage. The redness and warmth are reflective of increased circulation. Pain is an important factor that limits activity of the injured muscle or joint.

Inflammation involves an intense cellular response and a cascade of chemical events at the site of injury. Specialized white blood cells called macrophages are responsible for the cleanup of tissue debris during the healing phase after an acute injury. Increasing circulation to an injured area increases the availability of macrophages.

“In various forms, cupping provides a stimulus that reduces tension in muscle, stretches connective tissue, increases blood flow to superficial tissue and may relieve pain,” states Dr. Craig Denegar, professor and department head of kinesiology at UConn. “As with many traditional treatments there is little research quantifying the benefits however, when properly administered, cupping appears to be safe.”

Cupping may be a good complementary treatment along with standard therapy for injured athletes.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Beware of heat as practice returns

Over six million children will soon be heading out to athletic fields across the country to participate in a variety of fall sports. Unfortunately, practice sessions begin during the warmest months of the year, subjecting these athletes to one of the most frequent causes of death in sports.

Heat-related illnesses are a spectrum of conditions. Muscle cramps and exhaustion are fairly common. Cramps are usually related to poor hydration and electrolyte imbalances. Many athletes have a genetic predisposition to cramping and may require salt supplements.

Heat exhaustion is a sense of fatigue that results when the demand for increased blood flow cannot be met due to dehydration and cardiac failure. This can lead to syncope (fainting) when blood supply to the brain is inadequate.

Exertional heat stroke is a medical emergency that can potentially lead to death in minutes. It involves the escalation of hyperthermia to the point that it leads to cardiac failure and coma. It must be identified and treated swiftly and aggressively.

Treatment of heat-related illnesses involves adequate hydration either orally or intravenously. Heat stroke is treated by immediate immersion into a cold bath. This is followed by emergency transport to a medical center for further evaluation, treatment and observation.

“Acclimatization is the process that allows an athlete’s body to perform in warm climates by gradually increasing the amount of exposure to extreme conditions,” reports Dr. Rebecca Stearns, Chief Operating Officer of the Korey Stringer Institute at the University of Connecticut. “Parents should be sure there is a heat acclimatization and weather policy that is followed by youth sports organizations before allowing their children to participate.”

First aid training for coaches and officials is crucial to identifying heat-related illnesses.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Performance-enhancing drug problem at new level

Among the biggest pre-Olympic stories has been the disqualification of athletes due to widespread use of performance-enhancing drugs (PEDs). Although PEDs have been a part of individual efforts to cheat, the revelation that there was a nationally sponsored program to hide the use of PEDs by Russia has taken this problem to a new level.

PEDs are medications approved to treat specific medical problems and instead are used outside of their approved use to improve athletic performance. These include anabolic steroids, banned supplements, amphetamines and diuretics.

Anabolic steroids, including testosterone, human growth hormone and androstenedione are taken to increase muscle size and strength. This will also result in improved endurance.

Many banned supplements are designed to increase muscle efficiency. Some include creatine, an essential muscle component. Another pitfall of supplements is that they are not FDA regulated and often contain unknown substances that may be banned.

Stimulants include amphetamines, caffeine and some cold remedies. These substances increase heart rate and blood pressure. Oddly, these substances can also have a negative impact on athletic performance.

Diuretics increase kidney function and urine output. This will help athletes lose weight and compete at a lower weight class in some sports. It can also result in dehydration during competition and lead to muscle cramps.

Diuretics have also been used as “masking” agents that dilute urine and make the detection of banned substances more difficult.

“The ability to avoid a positive test while using a PED has become a new science and has led to increasing competition among researchers on both sides of testing,” reports Dr. Jeffrey Anderson, Medical Director of UConn Student Health Services. His conclusions are based on his efforts to make professional and amateur athletics fair.

The incidents involving Russian athletes included a state-sponsored program to replace tainted urine with clean urine from other athletes at the time of testing.

Hopefully, this 31st Olympiad will represent a step closer to fairer play when it comes to PEDs.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Parents should take action to prevent youth concussions

More than 6.5 million children in the United States at the middle school level and younger will be participating in a high-velocity collision sport this year. Early recognition and treatment of children with head injuries can be lifesaving.

Traumatic brain injuries consist of a range of disorders with concussion being the most mild. Typical symptoms including headache, dizziness, confusion and visual abnormalities come on suddenly after a blow to the head.

Sports of the highest concern are football, hockey and soccer since they attract the highest numbers of participants in the fall and winter. This also coincides with the academic year and an injury may impede success in the classroom.

Children are a particularly challenging population given the increased vulnerability of young developing brains and a child’s inability to clearly express symptoms. Underlying medical problems including ADHD and migraine headaches are known to prolong recovery from head injury.

Early recognition of symptoms during a contest requires careful observation by coaches, parents and officials. Athletes who are slow to rise, have a staggering gait, hold their heads or hold onto another player for support after a forceful collision should be pulled from the contest for further evaluation. 

Among the most important steps parents can take to protect their children is to investigate what team they will be playing for. Meet the coaching staff to be sure their goals of promoting good health habits, team spirit and physical fitness are the same as yours. Youth sports are not boot camp and efforts should not be directed to “toughening” the participants.

Recent studies have shown that having a licensed health care professional associated with a team promotes early recognition, treatment and recovery from sports concussion.

If symptoms persist or worsen at anytime, a physician visit is warranted, preferably with someone who has special experience in treating neurologic injuries. 

Parenting a child who participates in a high-velocity collision sport requires effort.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Overuse knee injury affects young athletes

Knee pain affects many Americans. Chronic conditions including arthritis, cartilage damage and ligament tears are common. More striking is when knee pain affects athletically active adolescents. 

The knee is a complex joint consisting of bones, ligaments, tendons and cartilage. It is a weight-bearing joint that allows stable movement in multiple directions. It also provides shock absorption. 

Osgood-Schlatter disease is a painful condition affecting approximately 200,000 adolescents each year in the United States. It is the result of inflammation of the tendon connecting the knee cap (patellar) and the principal weight-bearing bone of the lower leg (tibia).

 The patellar tendon attaches to the upper end of the tibia on a portion of the bone known as the tibial tuberosity. Osgood-Schlatter disease is signified by painful swelling on the tibial tuberosity. It typically occurs in males between the ages of 13-14 and girls between the ages of 12-13.

 It is particularly common in young athletes who participate in sports that require running, jumping and rapid changes in direction. Sports such as basketball, volleyball, gymnastics, soccer and skating seem to have the highest numbers of cases. 

“Osgood-Schlatter disease is the result of a traction where two ends of bone intersect in a skeletally immature person,” reports Dr. Cory Edgar an orthopedic surgeon at UConn who specializes in sports-related injuries. “This is an overuse type of injury and should serve as a sign to rest and modify workouts.”

A common misconception is that Osgood-Schlatter will lead to a fracture or tendon rupture if untreated. It actually will cause chronic pain that will persist until the athlete’s skeletal structure matures.

Acute treatment consists of early diagnosis followed by rest, ice and anti-inflammatory medications. Stretching of the quadriceps muscle is an important part of rehabilitation.

Like other overuse injuries, moderation is key to a successful recovery.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Muhammad Ali displayed fortitude in Parkinson's fight

Muhammad Ali became one of the most recognizable people in the world. His recognition eclipsed the sports world and extended into politics, religion and human rights. His contribution to neurologic sciences may also garner recognition.

Ali was first diagnosed with Parkinson’s Disease in 1984 at age 42. Some experts believe he displayed some early signs of the illness at the time of his last fight against Larry Holmes in 1980. Typically, PD is diagnosed in an older population but a small percentage can be seen in younger adults.

PD is a neurodegenerative disease that primarily affects motor function.

It is the result of a chemical imbalance in an area of the brain known as the basal ganglia. These structures are responsible for the synthesis of dopamine. Dopamine is crucial to allowing for smooth movements. Treatment is based on replacing dopamine with L-dopa, a drug administered in a pill form.

The principal features of PD are a tremor that is most recognizable at rest, a slow, shuffled gait with susceptibility to falling as well as muscular rigidity. Approximately a million Americans suffer from PD and 60,000 new cases are diagnosed each year.

Motor activities to maintain motor function include swimming, yoga, ballroom dancing and ironically, boxing workouts.

Ali’s ability as a high-performance athlete made the loss of motor function particularly striking.

The goal of a boxing contest is to neurologically impair your opponent. Despite this, most neurologists believe that repeated head blows did not play a significant role in Ali’s condition.

Ali approached his disease with uncommon fortitude and acceptance to the point where he set an example for anyone who may be faced with a neurodegenerative disease.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Man vs. mosquito: What the Zika virus means for the Olympics

In 1947, an obscure virus was isolated in a rhesus monkey in the Zika Forest of Uganda. Today, after a recent outbreak in Brazil, that virus threatens the start of the 2016 Olympic games.

The Zika virus was first noted in humans in the 1950s as a result of transmission by mosquitoes. Due to the ease of worldwide travel, infectious diseases previously isolated to specific geographic regions can now spread worldwide.

Mosquitoes flourish in hot climates where there is standing water. This makes countries that do not have adequate sanitation in the form of sewers and drainage particularly vulnerable to diseases transmitted by mosquitoes.

Typical symptoms of Zika are fairly benign and consist of rash, fever and joint pain. The feature that makes Zika exceptionally dangerous is its tendency to attack the nervous system.

The human nervous system is divided into the central nervous system that is made up of the brain and spinal cord and the peripheral nervous system that consists of the nerves as they emerge from the spine and extend to the limbs and organs.

Women of childbearing age are specifically vulnerable since a fetus does not have adequate defenses to fight off this infection since it attacks the developing brain resulting in microcephaly with severe intellectual deficits. The virus can also attack the peripheral nerves in adults causing a paralyzing illness known as Guillain-Barre Syndrome.

Considering the demographics of Olympic participants where approximately 44% are women, many of whom are of childbearing age, hesitation regarding the risk of participation is understandable.

The best preventive measures include the liberal use of DEET-containing insect repellant and avoiding excessive skin exposure. Clothing should also be sprayed with repellant.

Oddly, the biggest competition in this year’s Olympics may the one waged between man and mosquito.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Technology allows amputees to reach athletic potential

The Invictus Games finished up recently in Orlando, Fla. The participants in this multi-sport event were all wounded military personnel. Along with the Paralympics, these events are a tribute to the human spirit and specifically the drive to compete.

Among the athletes facing the greatest challenges are those who have suffered amputations. Battlefield injuries may be the result of explosive devices. Although the torso can be adequately protected, the limbs and the brain are vulnerable to injury. There also have been more amputations as a result of earthquakes and other natural disasters.

Although the most obvious debility is the biomechanical disadvantage of losing an extremity, there are serious potential complications.

After amputation, adequate healing of the remaining stump can be a challenge. The general health of the patient is crucial to healing. Patients with complicating conditions, including diabetes and vascular disease, are more likely to require a longer recuperation for adequate healing.

Another challenge is phantom pain. The nervous system is a network of peripheral nerves that communicate by sending signals to the brain where those signals are recognized and a pattern of limb movement is initiated.

When that network is disrupted after an amputation, the pattern remains in place, creating the often painful phenomenon of a phantom limb.

Research principally conducted by the military has led to the development of modern prostheses consisting of a complex system of hydraulic joints. “New prosthetic limbs are realizing the promise of full functional restoration for patients everywhere,” reports retired United States Army Colonel, Dr. Geoffrey Ling, who is now a professor of neurology at the Uniformed Services University of the Health Sciences in Maryland.

The tragedy of war has prompted technological breakthroughs that allow athletes who have suffered amputations to continue to reach their athletic potential.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Wearable technology for the elite athlete

Wearable technology has already made its way into almost everyone’s life to some degree. Interestingly, Major League Baseball (MLB) has now allowed the use of these technologies to track players’ performance. Using the data provided by these new devices has a lot of implications. 

Smartphones can now track how far and how quickly a person can walk. The Fitbit, Apple Watch, Fuelband and other devices can collect and analyze more data about the wearer’s physiology and sleep habits.

In the case of competitive sports, wearable technology can give an athlete a big advantage in regard to training habits and injury prevention.

Two devices approved by MLB for use during games this season look at different activities. One device is a sleeve that measures stress on elbows. This is specifically designed to collect data that will hopefully decrease the number of Tommy John surgeries that seems to be growing rapidly. The information can help create better coaching techniques and improved arm mechanics at all levels of play.

The other piece of approved wearable technology is a bioharness that monitors heart rate and breathing patterns in real time. These basic physiologic measures can help athletes gain necessary feedback to reach peak performance in stressful conditions.

One area of interest is the field of hydration and electrolyte balance. Specifically, the ability to monitor these parameters and avoid sudden death has become a goal of many scientists.

“The wearable technology industry related to the assessment of hydration status, sweat composition and body temperature has exploded in the past few years,” reports Dr. Douglas Casa, Professor of Kinesiology and CEO of the Korey Stringer Institute at UConn. “As of now we still do not have a valid wearable sensor that can reveal real-time hydration status or provide an accurate estimate of core body temperature. I predict this will change within the next 5 years and will be of great value to the equipment-laden soldier, laborer or athlete who could benefit from this information while training, competing, or working.”

Although many athletes are concerned with the privacy of physiologic data, their concern may be offset by the lifesaving ability this technology can provide.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at 

Athletes, especially women, can fall prey to eating disorders

Eating disorders have become a serious health concern. Athletes are no exception and in fact may be particularly vulnerable to one of these conditions. 

Anorexia nervosa, bulimia nervosa and binge-eating disorder are the most commonly recognized disturbances of eating and weight regulation. The finding that anorexia is associated with the highest mortality rate of any psychiatric disorder emphasizes the seriousness of these disorders.

Young women who participate in gymnastics, cheer and running events are particularly vulnerable. It has been reported that between 15 percent and 62 percent of female college athletes have disordered eating. This wide variation is indicative of how little is known about the prevalence of these conditions.

Another area of confusion is whether an eating disorder developes as a result of participation in a particular sport or if a person with an eating disorder choses a sport that will allow for this behavior. 

The classic triad of low energy levels, delayed or absent menstrual periods and osteoporosis is a hallmark of these conditions. Considering 90 percent of bone development in women occurs before the age of 19, lifelong vulnerability to bone fractures are a consequence.

“Eating disorders are common in adolescent athletes training at a high-level. Some may go down a dangerous path trying to attain a supposed 'ideal' body type to enhance performance,” states Dr. Kathryn Ackerman, an endocrinologist specializing in conditions affecting female athletes. “While initial improvements in performance are often seen, these are unfortunately followed by more injuries, poorer recovery, more illnesses, and a decline in performance. Often the athlete struggles mentally and physically and the eating disorder that has developed gets overlooked.”

Denial on the part of athletes can play a big role in delaying diagnosis. Coaches and parents must be aware of early signs of an eating disorder and intervene immediately.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Allergic rhinitis can impede spring sports performance

Most competitive and participatory sports get underway in the spring. Many of these outdoor activities are played around a variety of grasses and trees that can trigger an allergic condition and interfere with athletic performance. 

The most common condition is allergic rhinitis or hay fever. Symptoms include sneezing, runny nose, coughing, postnasal drip, sore throat, eye irritation and a feeling of generalized fatigue. It is no surprise that these symptoms can be an obstacle to athletic success.

The allergic response is based on a series of events that are triggered by exposure to an allergen. In the case of allergic rhinitis the allergen is typically pollen, ragweed or a mold. After exposure, a cascade of actions follows. This cascade consists of a cellular response that includes inflammatory cells. 

Similar to other forms of inflammation, swelling of tissues and pressure-like pain are common. Treatment is directed toward desensitizing the body against reactions to a particular allergen or interrupting the inflammatory response at several levels.

Antihistamines are the most commonly used medications to reduce irritation of the eyes and nasal membranes. Often these are combined with a decongestant that may be sedating and should be avoided by athletes. Nasal and oral steroids can reduce the overall response to allergens but may be among banned substances for competitive athletes and would require a therapeutic exemption.

Newer drugs originally designed to treat asthma, like Singulaire, block inflammatory chemicals and are a very effective treatment for allergic rhinitis in athletes.

“Untreated allergies can lead to worsening of nasal congestion and reactive airway disease or asthma which can impair breathing and oxygen absorption,” reports Dr. Gregory Lesnik, a Norwich ear, nose and throat specialist. “Additionally, untreated allergies can result in an overall decline in energy levels causing suboptimal athletic performance.”

Effective treatment of seasonal allergic rhinitis can provide a needed boost toward achieving athletic goals before taking the field.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Exercise may help with Parkinson’s symptoms

Parkinson’s Disease is among the most common movement disorders. It affects approximately 10 million people worldwide. Although there are many new pharmacologic therapies available, it appears that regular exercise may be among the most effective.

Movement disorders are a general category of illnesses that consist of involuntary movements that range from a mild tremor to violent spasms.

Parkinson’s disease is a constellation of symptoms and physical findings. The hallmark on examination is a combination of a tremor at rest, slowed movements, rigidity and postural instability.

The pathology is based on decreased production of dopamine, a neurochemical produced in the brain that regulates movement.

Patients will often present with complaints of falling and noticeable changes in handwriting. Sudden falls often lead to broken bones and lengthy hospitalizations.

Medical treatment has been available for approximately 50 years in the form of medication that can increase the declining levels of dopamine. There are now medications that can slow the metabolism of dopamine that has been produced.

“Regular physical activity has been associated with neuroprotection and has shown to improve gait and balance in Parkinson's disease,” reports Dr. Bernardo Rodrigues, a neurologist specializing in movement disorders at the University of Connecticut.

Programs that promote active motion such as “Big and Loud” physical therapy and aerobic exercise for 30 minutes three or more days per week are the key to the effectiveness of the neuroprotective factors produced in the brain.

Recent research has shown that patients with Parkinson’s disease who participate in Latin dancing programs have better outcomes regarding mobility when compared to those who did not participate. This may be related to the physical as well as mental demands of this activity.

Exercise can be a crucial element of a rehabilitation program for Parkinson’s disease.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Safety of artificial turf needs further study

The feel and smell of natural turf has been a big part of the pleasure derived from outdoor sports. Increasingly over the past 50 years, that aspect of sports participation has been replaced with various artificial materials. Today, the safety of those materials has come into question.

The original Astroturf field consisted of nylon strands woven into a carpet and was designed for an indoor stadium like the Houston Astrodome. A subsequent version was made up of a tighter weave and more compact surface. These forms resulted in injuries from impact with a firm surface and friction burns.

This led to the current generation of artificial turf fields consisting of longer, softer synthetic strands filled with granulated recycled rubber. These fields now provide a softer surface with improved traction for cleated footwear.

Despite these innovations, an increase in the frequency of lower extremity injuries can be related to the change from natural to artificial surface. Among these injuries are turf toe, a painful condition that results from injury to the ligaments supporting the great toe. An increase in anterior cruciate ligament knee injuries is also believed to be related to the change in playing surface.

“The evidence suggests that synthetic turf increases the chance for injury, and at best the more natural the surface the less increase in injury — especially for the football player,” reports Dr. Stephanie Mazerolle, Assistant Professor of Kinesiology at the University of Connecticut. “I think when considering playing surface, natural surfaces (i.e. grass) may offer a more favorable environment when it comes to the safety of the student-athlete.”

More recently, ESPN’s “Outside the Lines” and others have called for further investigation into anecdotal reports of increased cases of cancer in athletes who have high exposure to the so-called “crumb rubber” fields. Soccer goalies are particularly vulnerable given their exposure to the rubber particles especially when playing indoors. The principal forms of reported cancers are blood related such as leukemia and lymphoma.

Despite the economic advantages of artificial turf, more investigation regarding safety must be carried out.  

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Education is key to preventing concussions

Eleven high school students died in 2015 while playing football. Seven of those players lost their lives to brain injuries. The question now facing parents, physicians, athletes and coaches is whether more can be done to avoid severe brain injuries. Potential solutions may be centered on education, legislation and rule changes.

In 2009, the state of Washington approved the Lystedt Law. It is named for Zachery Lystedt, a 13-year-old junior high school football player who suffered permanent brain damage after being allowed to return to a game shortly after a concussion. Since then, all 50 states have passed some variation of this law requiring that a player suspected of having suffered a concussion must be removed from a contest and not allowed to return until cleared in writing from a medical professional.

These laws typically require all scholastic coaches to complete an education program that addresses the signs of concussion. Unfortunately, these laws only address coaches at the high school or higher level.

Ironically, despite best efforts at education, the most vulnerable brains are at the youth level where there are approximately 3 million football players, 3 million soccer players and another 500,000 hockey players. This also is the level where there are the least experienced coaches and often no athletic trainers.

Rule changes at every level have been met with resistance from traditionalists. Interestingly, many professional coaches and former players believe that contact is not necessary to teach the necessary skills to advance in these sports.

Recent studies looking at the effectiveness of these laws have demonstrated increased reporting of concussions but no firm direct correlation with the educational efforts associated with them.

“As a pediatric neurologist, I am acutely aware of the importance of physical activity and sports for the developing brain and body,” said Dr. Meeryo Choe, a pediatric sports neurologist and assistant professor at UCLA Mattel Children’s Hospital. “Playing a team sport can teach children about teamwork, responsibility and sportsmanship. As children progress through years of participation, they may also learn leadership skills in a unique way. Participation in sports should always begin with education on not only the rules of the game, but how to play the game safely, no matter the sport.”

The remedy for any public health problem is education and concussion is no exception.  

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Popularity of combat workouts skyrocketing

Combat sports have provided a major entertainment diversion throughout history. Today, boxing and martial arts have become popular participation sports for many who are on the road to fitness.

Records dating back to 4000 B.C. recount “pankration,” a predecessor to what we now know as mixed martial arts (MMA). Historically, this sport developed in parallel to boxing. Participants were typically slaves or criminals who fought for their freedom.

Both sports were eventually banned by the Emperor Theodisius when he felt that they provided too much diversion. The earliest recorded boxing match was in 1681 when the Duke of Abermarle waged a match between his butcher and butler.

Modern era combat athletes are among the best-trained in the world. Fighting demands stamina, strength and agility. Those who are successful have mastered those skills and possess the ability to concentrate and plan strategy under severe conditions.

Combat athletes’ work outs consist of intense roadwork to build cardiovascular endurance. A normal average resting heart rate is between 60 and 100 beats-per-minute. The resting heart rates of combat athletes are often in the 40 beats-per-minute range. This is reflective of superior cardiac efficiency.

Strength is improved by resistive exercise with weight training and repetitively hitting a heavy bag. Superior coordination is attained by drills that require timing such as jumping rope and hitting a speed bag.

“Boxing provides a great workout due to the variability of the fitness skills,” reports Jody Sheely, boxing trainer at Strike Force gym in Norwich and former boxer.

 Interestingly, many of the activities utilized for combat sports training do not require striking or choking an opponent and may be an essential part of a new fitness regimen for many who will never get in a ring or cage.  

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Don't neglect working out your brain along with your other muscles

Athletes spend many hours honing skills in their particular sports while building strength and stamina. More recently, they are devoting time toward establishing more efficient thought processes and better performance.

The human brain is made up of nerve cells that are organized in networks that interact to perform specific functions. These specialized networks influence all activities.

The simplest action is a reflex. A reflex consists of movement that doesn’t require any thought. The neurons necessary communicate directly through the spinal cord without any cognitive input.

One goal of training is to eliminate as many variables as possible while performing the specific task. This type of mental training can take several forms and coaches are now employing a variety of professionals to work with their teams.

Visualization is probably the best-known technique. Visualization involves repeatedly anticipating an outcome or situation before it occurs. Kickers see the ball going through the uprights, golfers visualize a perfect shot and football defenders see themselves making a crucial tackle.

Mindfulness is a technique used to relax the mind. It is essentially a skill used to eliminate all interfering thoughts and allowing concentration only on the task at hand.

Like most athletic skills, these techniques become most effective when they are practiced. Repeatedly applying visualization and mindfulness with a discipline such as yoga can dramatically improve performance.

“Yoga and mindfulness are a powerful combination of physical, mental and spiritual skill work that compliments and enhances sport-specific conditioning,” states Carol Pandiscia, a yoga and mindfulness instructor who works with high-level athletes.

Although these skills have been frequently applied in sports, they are effective instruments for success in any profession.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at