Concussions now a big part of retirement decisions

Wrestling fans are excited about the recent return of Daniel Bryan to the ring. Bryan, a star performer, was forced to retire two years ago due to multiple concussions. His return after multiple, comprehensive neurological evaluations has raised many questions regarding the criteria for medical retirement from sports after concussion.

Concussion is best defined as a group of neurologic symptoms that arise after a force is applied to the brain. Recovery from these symptoms can vary but the general accepted time frame is 10 days. This is often longer in children. The persistence of these symptoms is associated with post-concussion syndrome.

Repeated blows to the brain can result in permanent impairment with persistent headaches, cognitive difficulties, sleep abnormalities, emotional disturbances and other neurologic symptoms.

The often-asked question is: "How many blows can the brain tolerate before resulting in permanent damage?"

The human brain is a highly individualized organ. It consists of a mass of nerve cells that each has a threshold for injury. The challenge for physicians is to determine that threshold based on the symptoms suffered and the length of the recovery period.

There are some basic rules that indicate the need to retire from participation in high-velocity collision or combat sports. These include:

1. Persistent abnormalities on cognitive and psychological testing that can be linked to concussion
2. Structural abnormalities found in the brain that may be related to trauma or predispose the athlete to permanent injury
3. A demonstrated decreased threshold for injury over multiple, successive concussions

Another recent change in the presentation of sports-related concussion has been the desire to voluntarily withdraw from high-risk sports. Athletes, even at the highest levels of sport, are choosing that the risks outweigh the benefits.

In the case of Bryan or any other athlete, it is worth the time investment to seek out a highly qualified physician who works with 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

NFLPA draws up a playbook for player safety

A playbook is a collection of strategies that allows a team to deceive their opponent at crucial times during the course of a contest. Football players are aware of the importance of their playbook and the secrecy that surrounds its contents. The National Football League Players Association (NFLPA) has taken the playbook concept and applied it to improving the health of all its members and their families.

The recently released NFLPA Health Playbook is a compendium of easy-to-understand health information that addresses common illnesses facing both active and former players. It was designed and written by members of the NFLPA Mackey-White Health and Safety Committee. It is divided into four broad sections:

1. Performance
2. Medical diseases and conditions
3. Orthopedics and musculoskeletal conditions
4. Neurology and neurotrauma

Specific topics were chosen based on information obtained through research conducted as part of the Football Player Health Study at Harvard University.

The performance section discusses the evaluation and treatment of sleep disorders, as well as a variety of mental health disorders. Among the medical conditions, diabetes mellitus and the potential complications from it are explained along with a variety of treatments. This section also addresses hypertension, hypercholesterolemia and peripheral neuropathy. The chapters covering neurologic conditions and concussions are highly informative.

“The NFLPA is committed to ensuring that our player members receive the best medical care in the world,” reports Sean Sansiveri, NFLPA vice president of business and legal affairs. “This playbook serves as our latest effort to equip players and their families with the knowledge and resources necessary to achieve overall wellness for their betterment as people and patients.”

Although the NFLPA Health Playbook provides a concise, thorough review of health topics designed to support active and former football players, it is actually an excellent guide for all athletes and the general public.

Like other playbooks, the health playbook will be continually updated as new medical issues and treatments develop. The full publication is available online as a courtesy of the NFLPA, and can be found by searching “NFLPA Health Playbook.”

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