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.
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.
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.
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 (www.KJLife.org) 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.
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 (www.KJLife.org) 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.
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.
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.
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.
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 aalessi@wwbh.org, or listen to his podcasts, comment on his blog or buy his book at www.backushospital.org.
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 aalessi@wwbh.org, or listen to his podcasts, comment on his blog or buy his book at www.backushospital.org.
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