ACL tear highlights a problem but also true sportsmanship

In April, sports fans witnessed an event that warmed everyone’s hearts and highlighted the true meaning of sportsmanship. It also emphasized a common sports injury.

Western Oregon and Central Washington Universities are Division II NCAA schools. Sara Tucholsky, a Western Oregon senior, hit the first home run of her softball career. She over ran first base and had to reverse direction to step on the bag. That sudden movement caused her right leg to collapse and left her writhing in agony. The umpire ruled that if she could not complete her home run trot, her effort would be recorded as a single.

Two players then lifted Tucholsky and carried her to each base so the home run would be recorded. The inspiring part of this story is that they were members of the opposing team and performed this unselfish act without a second thought. Tucholsky’s injury was a torn anterior cruciate ligament (ACL), the most common serious injury in women’s athletics.

The ACL is one of four major ligaments in the knee joint. It limits movement of the lower leg and stabilizes the knee’s front-to-back movement. It is often injured when an athlete suddenly stops running or pivots on a planted foot, twisting or overextending the knee.

Dr. Thomas Trojian, team physician for UConn women’s basketball, recently published a medical review of injuries in women’s basketball and cites the reason for increased ACL tears in women as multifactorial. Proper landing techniques, imbalance between quadriceps and hamstring muscle development, and hormonal influences have all been cited as contributing causes.

Treatment is surgical for those who wish to return to activities which involve pivoting. Rehabilitation is demanding and involves strengthening hamstring muscles to avoid further injury.

New physical training and conditioning regimens will hopefully reduce the incidence of ACL tears in women’s sports. No physical program can prepare an athlete to demonstrate sportsmanship the way it was in April. That training comes from great role models and coaches who truly understand what sports are all about.

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 aalessi@wwbh.org. If you wish to learn more about this column or other sports health topics – listen to the podcast or go to the Healthy Sports blog at backushospital.org.

Chilly spring air can lead to injuries

In the early weeks of baseball season, cold weather can cause a sudden rise in muscle injuries. This year we have seen several well-known players spend time on the disabled list due to hamstring and quadriceps injuries. Most surprising is that it is late May and players in New England are still facing this problem.

In general, large muscles such as those in the lower extremities require increased circulation to maintain function. Cold exposure results in constriction of blood vessels and diminished blood supply. Sudden activity in this state may result in muscle tears. These injuries are not the result of poor conditioning. The goal is to maintain a high volume of blood supply despite cold exposure.

The challenge is particularly difficult in sports where there are long periods of rest alternating with the need for sudden bursts of speed. Baseball athletic trainers, especially those working for teams in colder climates, must directly face this obstacle.

Dustin Luepker is the certified athletic trainer assigned to the Connecticut Defenders. Despite the pungent smell, he recommends the use of oil of wintergreen on affected limbs, along with warm clothing and a heat pack placed in the back pocket of the throwing hand. Tim Lentych, the Trenton Thunder athletic trainer, suggests generous application of baby oil covered by tight, cold gear clothing.

This problem of keeping players warmed up is especially difficult in the American League where designated hitters wait several innings before getting a turn at bat. Athletic trainers will often send these players to the clubhouse to use a stationary bicycle.

Many people prefer workouts in the early morning when there is still a chill in the air. These regimens may include running, biking, or an early golf tee-time. It is important to take the time to stretch despite the temptation to begin immediately.
The consequences of a torn muscle include extended rehabilitation and time away from a much-enjoyed activity.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org. If you wish to learn more about this column or other sports health topics – listen to the podcast or go to the Healthy Sports blog at www.backushospital.org.

Athletes are not immune to psychiatric issues

Psychiatric illness in sports is rarely discussed openly. The 1956 movie, “Fear Strikes Out” describes the struggle of Boston Red Sox player Jimmy Pearsall, who suffered from depression and anxiety. He eventually required hospitalization for his condition. That film may represent the first public testimonial of mental illness in an athlete.

Recently, former football great Herschel Walker wrote a book about his battle with a condition known as Dissociative Identity Disorder (DID). This is more commonly known as Multiple Personality Disorder. Although this condition has been dramatized in books and movies, it is now often diagnosed in conjunction with other psychiatric disorders. DID is defined as a state where two or more distinct personalities exist in an individual. As in all medical illnesses, there is a range of severity varying from mild to one requiring hospitalization.

DID is typically associated with stress, depression, and anxiety. Symptoms of physical abuse during childhood are a common finding. There are no specific medications to treat DID, but long-term psychotherapy has been successful in many instances.

The fact that athletes experience psychiatric conditions is not surprising. The demands placed on athletes, especially at the professional level, are astounding. They are expected to perform competitively, represent themselves and their team well. Many must also maintain a family life. They must do this while on the road for much of the year, away from family and support systems. It is impressive that psychiatric disorders are not more widespread in sports.

Dr. James O’Dea, Administrative Director of Psychiatric Services at Backus Hospital, agrees that the existence of psychiatric disorders shouldn’t be surprising. “It is crucial for athletes to overcome the stigma of mental illness and seek treatment,” O’Dea said.

Psychiatric disease is probably more common in sports than is at first apparent. This can be dangerous in athletes who are placed under extreme pressure and in hazardous situations. They may have access to narcotic medications due to sports injuries and this is always a troubling combination. Coaches, athletic trainers, and team physicians must carefully monitor athletes’ behaviors and be vigilant for signs of psychiatric illness.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org. If you wish to learn more about this column or other sports health topics – listen to the podcast, view the video or go to the Healthy Sports blog at www.backushospital.org.

Stroke can hit athletes

Stroke is defined as a condition resulting from a lack of blood supply to an area of the brain. It is typically associated with elderly patients who have weakened or hardened blood vessels. That’s why so many people were shocked when in February 2005, 31-year-old NFL linebacker Tedy Bruschi was suddenly stricken with a stroke.

At this year’s American Academy of Neurology meeting, Bruschi received the Public Leadership Award for his work in the field of stroke awareness. The story of how his stroke evolved and his recovery is an important lesson.

He awakened on the morning of February 15, two days after playing in the Pro Bowl, with numbness and weakness of his left arm and leg. He described a severe headache with an inability to see objects on his left side. While he was inclined to ignore his symptoms, his wife called her father, a physician’s assistant, who advised them to get to a hospital. An MRI showed that he’d suffered a stroke in the back of the right side of his brain.

An ultrasound of Bruschi’s heart showed that he had a hole between the upper chambers of his heart known as a patent foramen ovale. This condition allowed free passage of a small clot from the right side of his heart to his brain, resulting in stroke. Placing a patch over the hole through a catheter sealed the hole. Unfortunately, he was left with left-sided weakness and visual loss.

Three months of intense physical therapy followed. He worked with therapists specially trained in rehabilitation of neurological disorders. During that time, Bruschi had to summon all of the toughness and drive he had acquired from his years of competitive sports.

By late spring, the cause of his stroke was treated and he had regained sufficient physical function to transition from rehabilitation to actual football workouts. Bruschi’s comeback culminated with a return to the NFL on October 15, 2005.

Tedy Bruschi’s story shows us that the combination of modern medical care, a strong will, and hard work can overcome the obstacle of a stroke. Even to the point of returning to the highest level of sports.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org. If you wish to learn more about this column or other sports health topics – listen to the podcast or go to the Healthy Sports blog at Backus Hospital.

Preparing for the ride

Training with a specific goal is an important element for a successful workout program. The goal may be weight loss for a reunion, improved lab values, or completion of an athletic endeavor like a marathon or triathlon. Charity fundraising events often require walking or cycling long distances for pledged support of a worthy cause.

Before taking on physical challenges, careful preparation is crucial for success. Stretching and adequate warm-up is necessary to avoid injury. Marc Nee, personal trainer and owner of “Training With Heart,” recommends jumping jacks or squats to increase circulation to large muscle groups before stressing the muscle during activity. Inadequate stretching can result in strained or torn muscles.

During a cycling event it is wise to set the gears on low resistance and high revolutions when first starting out. After a long-distance run or bike, a warm bath increases circulation and relieves tightness and cramping.

Diet plays a big role in getting in shape. It is also important for completing any physical goal. Chris Warren, a registered dietician at Backus Hospital, suggests increasing the amount of dietary carbohydrates to 80% for one to three days before a challenge. The last meal should be more than four hours prior. A cup of coffee and a light snack before beginning a morning race is appropriate. Warren recommends refraining from any high fiber or high fat foods before or during an event. Fruits such as oranges or bananas contain simple sugars and potassium which are helpful during competition. Jelly beans are often eaten during and after long distance training.

Adequate hydration in the form of water and electrolyte drinks is crucial to success. This will avoid muscle cramps.

A tandem was my chosen vehicle for the “The Five Boro Bike Tour” in New York City this spring. Tandem cycling is a unique approach to a cycling event. It requires a captain (front rider) and a stoker (rear rider). The most important duty of a captain is to be sympathetic to the stoker who has no control of the bicycle, yet works diligently with blind faith. The New York City event has become so popular, registration is capped at thirty thousand participants. Cycling through New York with riders of all ages on a beautiful day was very encouraging.

Each year it seems more people appreciate the joys of exercise and good health.

Exercising and saving gas is as easy as riding a bike

Riding a bicycle in spring brings back fond childhood memories. Learning to bike ride is a satisfying accomplishment. Many people can recall receiving their first adult bike. Today, this simple activity has taken on new meaning. It now carries significant fitness, environmental, and economic implications.

Cycling is an outstanding physical activity. It requires the use of large lower extremity muscle groups as well as core muscle training for the low back and hips. Cycling can be both an aerobic and anaerobic activity, depending on the terrain. When riding in a group, it is also a great way to socialize with others.

Over the course of the past 20 years, cycling equipment has changed dramatically. There are now many varieties of bicycles including road bikes, mountain bikes, hybrids, tandems, and folding bikes. A hybrid bicycle is a combination of a road bike and a mountain bike. It is currently the most popular due to light weight, versatility, and comfort.

Tom Girard is the retail manager of Zane’s Cycles in Branford, Conn. Worldwide, they are the largest dealer of Trek Bicycles. Girard notes that the latest trend in sales has been toward commuter bikes similar to those sold for many years in Europe. These are hybrids with fenders and safety lights. Girard believes this is a reaction to increasing gas prices and concerns about air pollution.

In an effort to encourage more bicycle commuting, municipalities are incorporating bike lanes into urban plans.

Once a rarity, helmets are now commonly used and have cut back on the number of head injuries among cyclists. The latest bicycle seats are gel-padded and designed to protect the prostate in men, making long rides more comfortable.

Many fundraising efforts now involve participants who cycle long distances for the promise of pledges. Some examples are the “MS Ride” and “Bike New York.” In next week’s column, I will report on how to adequately prepare for these long distance cycling journeys to make them most enjoyable.

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 aalessi@wwbh.org. If you wish to learn more about this column or other sports health topics – listen to the podcast or go to the Healthy Sports blog at www.backushospital.org.

Physical Education helps kids learn

Physical education classes have not traditionally been considered necessary for a successful academic career. Standardized tests now used in elementary schools emphasize reading and math to determine educational success.

A study just published in the Journal of American Public Health demonstrates that it is time to rethink this approach to education. The study showed that reading and math scores for female students between kindergarten and fifth grade were higher in those who spent 70 to 300 minutes per week in physical education classes. Scores were much lower for students who received less than 35 minutes per week.

Interestingly, the benefit was not seen in the student’s male counterparts. It is believed that boys are more active than girls in sports and may require even more time in physical education classes to realize a benefit.

The goal of the Healthy People 2010 federal health initiative is 30 minutes of physical education daily for all students. The hope is this will become part of each student’s lifestyle and carry over into adulthood. Currently less than 13% of students meet this target.

Many school districts have been under pressure to increase class time for math and reading in order to comply with the federal No Child Left Behind law. Most often this is done at the expense of art, music, and physical education classes.

Previous studies have shown that test scores can improve by changing class schedules to allow for sufficient sleep. Proper nutrition also enhances academic performance.
Educating children involves exposing them to a broad range of experiences, not just how to pass a test.

Physical education is an important part of the educational experience and cutting back shortchanges our children. We now have proof that reducing time in physical education class sets them up for failure in other areas.

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 aalessi@wwbh.org. If you wish to learn more about the benefit of physical education for kids – or other sports health topics – listen to the podcast or go to the Healthy Sports blog at www.backushospital.org.

Disc Golf a fun way to get exercise

While traditional golfers throughout the northeast begin to dust off their clubs and clean their spikes in preparation for another season, there is another group of golfers readying themselves for competition.

These people play a game called disc golf.

Disc golf first began in the 1970s. It was the brainchild of Ed Headrick who invented the Frisbee. The discs used in disc golf are a variation of the Frisbee. The shape is more aerodynamic with pointed edges to allow for longer flight. These edges make playing catch uncomfortable.

Much like traditional golf, there are different discs for the drive, mid-range and putting tosses. The discs are carried in a lightweight pouch that is typically worn around a player’s waist.

The object of the game is to throw a golf disc into a target. This is typically a “pole hole” or a basket with a pole in the middle and chains hanging from it. A typical disc golf course consists of nine to 24 holes varying from 150 to 500 feet each. The holes are designed to utilize the natural beauty of the parks where they are laid out. Hazards are thick brush, trees, and water.

Disc golf is a walking sport. There are no carts and average players can easily rack up a sufficient number of steps to meet the daily American Heart Association requirement of 10,000 steps. Novice players will get in a lot more steps. Players can set their own pace.

It is a very social game and allows time for laughter.

As in all other sports, there are those who are serious about the game. The Professional Disc Golf Association has about 14,000 members who compete in professional tournaments. There are an estimated 2,100 courses in the United States, most in public parks that do not charge for play. In Connecticut there are four courses that can be found by logging onto www.discgolf.com.

Disc golf is a lighthearted way to get out of the house and exercise. It also allows for a peaceful way to enjoy the natural beauty that surrounds us.

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 aalessi@wwbh.org. If you wish to learn more about disc golf – or other sports health topics – listen to the podcast or go to the Healthy Sports blog at www.backushospital.org.

Ultimate Fighting is not for children

In the field of sports medicine, rarely does a topic arise that requires immediate comment and action.

The participation of children in the sport of ultimate fighting is one such topic. Placing children in a cage to grapple with and strike each other until a winner is declared is wrong on many levels.

An ultimate fighting event involves adult, unarmed combatants entering a ring or cage where they pummel each other. Typically the participants are boxers, wrestlers, or mixed martial artists.

Its popularity has steadily increased over the past 10 years, appealing primarily to a young male demographic. Today’s version is much less brutal than its original form which was subsequently outlawed in many states.

Unbelievably, there are now clubs in Missouri where children as young as six are “taught” ultimate fighting. The protective gear worn by the participants is ineffective since it is not designed for the type of punishment inflicted.

There are many dangers in subjecting children to ultimate fighting:
• Striking (repetitive blows to the head) will cause permanent damage to a developing brain. It results in persistent headaches, dizziness, and learning difficulties.
• Grappling (bending an opponent’s limb to cause submission) can result in crippling a participant’s extremity, most commonly the shoulder, elbow or knee.
• Psychologically, it is never healthy to encourage aggressive behavior in children.

The parents of these children maintain that ultimate fighting is a vehicle for improved self-discipline. There are many healthier ways to achieve discipline and athleticism. Traditional martial arts including karate, judo, and kung fu all improve balance and coordination, which are crucial for the developing nervous system. The spiritual aspect of these sports provides a structure for discipline and self-respect.

Missouri is currently the only state that allows children to participate in ultimate fighting. In many states, an activity such as this is a criminal offense.

Children rely on parents and other adults for guidance. Clearly, some children have been mislead.

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 aalessi@wwbh.org. If you wish to learn more about children and ultimate fighting – or other sports health topics – listen to the podcast or go to the Healthy Sports blog at www.backushospital.org.

Take a lesson from the pros: establish a daily routine

The Healthy Sports “Spring Training Tour” is now in the Florida swing.

Tampa is a leading center for competitive sports. It is not only the spring training home of the New York Yankees, but will also serve as host to the NCAA Women’s Basketball Final Four, the first round of the Men’s NCAA Basketball Tournament and the 2009 Super Bowl.

Access to players, coaches and staff is an added attraction to a spring training vacation. This year I had an opportunity to spend time with Billy Connors and Frank Howard.

Connors is a former major league pitcher and current Yankees vice president of player development. Howard was a major league slugger and now serves as a Yankees spring training instructor.

One conversation centered on the topic of ritualistic behavior by players.

Often these actions are misconstrued as superstitious. Eating the same meal before a game or fielding the same number of ground balls to each side during warm-ups are typical examples. Pre-shot routines are common in basketball when shooting foul shots or in golf before making putts.

In actuality, these actions are not superstition but part of careful preparation and result in added confidence. Following a set routine before each effort leaves fewer opportunities for error. Any successful performer spends many hours practicing so that the final performance seems natural and unrehearsed.

Similarly, a steady routine of daily activities can be beneficial for anyone. Many illnesses can be kept in check by maintaining a regular routine of eating, sleeping, and exercising. This is especially effective when treating migraine headaches, diabetes, and sleep disorders.

A well-established program can often improve cognitive disorders.

Many middle-aged patients present with a fear of Alzheimer’s disease due to simple forgetfulness. This is most often due to multi-tasking. These patients typically do not make lists of necessary tasks and are easily distracted.

A carefully designed routine, including rehearsal and review of daily activities, can significantly improve efficiency and reduce errors. It is worth the investment in time despite possibly being mistaken as superstitious.

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 aalessi@wwbh.org. If you wish to learn more about the Healthy Sports Tour or other sports health topics, listen to the podcast or go to the Healthy Sports blog at Backus Hospital.