Healthy Sports

Violent collisions can cause cervical spine injuries

2009-12-01T08:38:00.000-08:00

New York Giants linebacker Antonio Pierce suffered a neck injury during a game on Oct. 25. He was reported to have symptoms of neck pain and a burning sensation radiating to his arm. After his symptoms subsided over the next few days, he returned to his normal activity. When neck pain returned weeks later, an MRI revealed a bulging disc in the cervical spine, placing him on the disabled list.

Pierce’s situation is not that uncommon, especially for a linebacker. The cervical spine consists of a series of seven bony vertebrae designed to protect the fragile spinal cord and nerve roots. This area of the nervous system is responsible for sensation and movement of the upper extremities.

Sandwiched between each of the vertebrae is a cartilaginous disc. The center of the disc consists of soft, moist material to cushion any impact.

In a situation where there is repeated trauma to the head and neck causing compression, the discs become brittle and susceptible to fracture and eventual herniation (bulging). A disc that is out of place can irritate the nerve roots and/or the spinal cord.

Football players who use their heads when blocking and stretch their necks to one side tackling are particularly susceptible to these injuries. An MRI scan of a linebacker’s cervical spine typically shows bony arthritic changes and compressed discs consistent with that seen in an elderly person.

Treatment for these injuries can be conservative with physical therapy, anti-inflammatory medications and rest. Surgical intervention may include simply removing the herniated portion of disc alone or in combination with fusing the vertebrae for stability.

Cervical spine injuries can be avoided by strengthening supporting neck muscles, wearing a protective collar and most importantly, utilizing proper blocking and tackling techniques.

Athletes with sickle cell must be cautious

2009-11-24T07:56:00.000-08:00

Two years ago, Ryan Clark of the Pittsburgh Steelers nearly died after playing in Denver. He required emergency surgery to remove his spleen and gall bladder. Ryan, along with one in 12 African-Americans, has sickle cell trait and must be cautious about competing at high altitudes.

Sickle cell disease affects the ability of red blood cells to carry oxygen. It is an evolutionary adaptation that provides resistance to malaria and is found in people who come from areas where malaria is endemic like Africa, the Middle East, South America as well as the Mediterranean, Caribbean and other areas. The decreased oxygen-carrying ability of hemoglobin results in damage to a variety of organs including the brain, lungs and spleen.

Sickle cell disease differs from sickle cell trait. The trait is found in those who have both a normal and a sickle component to hemoglobin. During intense exertion, dehydration or conditions that decrease oxygen, red blood cells change their shape and clog blood vessels throughout the body.

The condition can also result in a potentially lethal breakdown of muscle known as acute exertional rhabdomyolysis.

While it is generally safe for athletes with sickle cell trait to compete, certain precautions must be followed:

• Athletes from at-risk groups must be tested before participation.
• When competing at high altitudes, sufficient time must be spent adapting to the new environment.
• Adequate hydration is crucial.
• Symptoms of fatigue, shortness of breath and abdominal or leg pain are often a hallmark of impending crisis.
• Workouts in extreme heat must be modified.

There is some controversy that finding the gene may potentially adversely impact an athlete’s financial value in professional sports. While this is highly unlikely, it must be weighed against the potential loss of life.

Boxing needs safety measures

2009-11-17T10:50:00.000-08:00

Last week, HBO viewers and those attending championship boxing at the XL Center in Hartford witnessed one of the most horrific knockouts in recent memory.

In the third round of the co-feature match between Harry Joe Yorgey and Alfredo Angulo, it became apparent that Angulo was the dominant fighter. Yorgey was rendered unconscious, and reminded all present of the brutality of this sport.

In an age when awareness of head injury in sports has been heightened, something must be done about the sport of boxing where the only way to score points is to neurologically impair the opponent.

Attempts to ban boxing have been misguided and have failed miserably. Boxing is a not just a sport, it is part of the American cultural fabric. Boxing can represent a vehicle for young men to gain respect in their communities while avoiding negative peer pressure.

Safety measures must be instituted nationally to reduce permanent neurological injury to boxers:

• Every professional fighter (both boxers and mixed martial artists) must have a complete annual neurological examination.
• Exposure to head blows must be limited during a fighter’s career. This can be done by regulating the number of rounds fought, the total number of fights and/or age of the fighter.
• A system of national regulation must be put in place similar to other sports. The current statewide commission system offers too much variability and federal regulation may be cumbersome.

This week, the Connecticut Boxing Hall of Fame will induct new members at the Mohegan Sun Casino. As at most similar affairs, there will be a lot of discussion about “the good old days.” Wouldn’t it be great if the legacy left behind by these brave men was to make their sport safer?

Athletes have make-up to overcome physical and mental challenges

2009-11-10T07:39:00.000-08:00

The 2009 baseball season has officially closed. After a season filled with late-inning comebacks and walk-off home runs, a World Series champion has been crowned.

Two stories of baseball comebacks deserve some extra attention while we await the spring arrival of pitchers and catchers:

• In August, Jerry Remy returned to the Red Sox broadcast booth after an extended illness. He was diagnosed with lung cancer the previous fall and underwent surgery. An infection followed but after going through appropriate treatment, it was depression that crippled him. Remy then stepped forward to make people aware of the scope of the problem. He now openly encourages those suffering from depression to get help in the form of medication and psychotherapy. His bold admission helps remove any stigma associated with psychiatric diseases.

• Aaron Boone underwent open heart surgery in March at the age of 36. The surgery repaired a chronic problem with his aorta that included replacement of the aortic valve. He impressively returned to major league play in September with the Houston Astros. His recovery included standard cardiac rehabilitation in addition to extensive work aimed at regaining his baseball skills.

Both stories highlight some essential personality traits necessary for success in athletics. Athletes do not fear challenges, even in the face of insurmountable odds. Successful athletes have a dedication to training that distinguishes them from others. The burden of not trying to return far outweighs any embarrassment associated with being unsuccessful in that effort.
Aaron Boone may never play another major league game and Jerry Remy may still have to deal with depression, but both know that their stories have helped many others face physical and mental challenges.

UConn homicide shows how athletes cope with loss

2009-11-03T12:26:00.000-08:00

Grief, bereavement and mourning are terms that define the intense feeling of sorrow over the loss of a beloved person. While these sentiments are apparent in many situations, the loss of a favorite athlete or performer seems to attract great attention.

Two weeks ago, tragedy struck the University of Connecticut football team when Jasper Howard was murdered. The response to this event by players, fans and opposing teams is what makes this situation remarkable.

In 1969, Dr. Elisabeth Kubler-Ross described the five stages of grief:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

Every individual works through these stages at a different pace and uses a variety of mechanisms to deal with each. Athletes tend to revert to what they know best by immersing themselves in athletic competition while dealing with their loss.
Two goals of grieving involve finding a way to cope with loss and living on in the face of that loss. Sports are a very physical and instrumental way of coping for many people. Some prefer other outward signs such as dedication to a cause, starting a charitable foundation or even wearing a tattoo.

“Grieving helps meet the challenge of resuming life in the face of loss; we must respect the different ways people cope with loss,” said Dr. Kenneth J. Doka, a professor at the College of New Rochelle and consultant to the Hospice Foundation of America. Death of a teammate is no different than any other death in the workplace. It must be recognized and all involved should be supportive in continuing on.

Jasper Howard’s death has brought so many people together to mourn and hopefully work together to stop the senseless violence that ended his life too soon.

Marathon Walking

2009-10-27T13:37:00.000-07:00

Walking has been an essential function in human evolution. This form of mobility allowed early man to hunt, gather and defend.

As more sedentary lifestyles have emerged, walking is proving to be an effective means of increasing longevity. The American Heart Association recommends 10,000 steps per day (five miles) to reap the full health benefit. Although this may be a lofty goal, after consulting with a physician, any distance is movement in the right direction.

Benefits include:
• Lower blood pressure
• Weight reduction
• Better stamina

The increased popularity of fitness walking has given rise to many walking events including race walking, charity walks and more recently, marathon walks. As opposed to race walking, where speed and form are crucial, marathon walking is a distance event extending 26.2 miles.

Like any marathon, preparation and support are crucial. Training includes progressively increasing distances, nutrition and using proper equipment.

Hundreds of walkers recently participated in a marathon walk from Old Saybrook Point to Harkness Memorial Park in support of the Terry Brodeur Breast Cancer Research Foundation. Participants were required to complete the walk in an allotted period of time. Training and race day support was provided by the foundation.

Deb Hinchey of Norwich was one of the participants. She trained with a group of seven adult women over a period of months. “We all attained a great feeling of accomplishment when finishing and realized we could go well beyond anything we thought our bodies could do,” said Hinchey. Other than fatigue, the biggest obstacle was avoiding blisters. Many participants purchased shoes a full size larger than normal to accommodate swelling.

In addition to becoming more fit, charity marathon walk participants gain a great feeling of knowing they helped a worthwhile cause.

Experts explore connection between contact sports and dementia

2009-10-19T12:21:00.000-07:00

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

2009-10-13T10:32:00.000-07:00

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.

Study: Football can damage the body and mind

2009-10-08T13:47:00.001-07:00

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.

Hand hygiene and shots can help athletes win against swine flu

2009-09-28T12:42:00.000-07:00

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.

Young athletes need good role models

2009-09-22T06:49:00.000-07:00

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.

Athletes require a team of physicians

2009-09-15T13:04:00.000-07:00

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.

Sports medicine involves a wide range of specialists

2009-09-08T08:04:00.000-07:00

“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.

Don't be sidelined by stress fractures

2009-08-31T08:00:00.000-07:00

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.

Preparation can help ease sports anxiety

2009-08-25T11:41:00.000-07:00

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.

Bean balls have no place in baseball

2009-08-19T04:32:00.000-07:00

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.

Bicycle police combine helping others with staying fit

2009-08-10T09:52:00.000-07:00

Many occupations require workers to remain physically fit in order to complete their assignments. Sometimes it is possible to combine a love of sports with a means of earning a living. Police bicycle patrols permit many avid cyclists to accomplish this.

Bicycle police patrols became common in the 1890s. Police departments found bicycles effective for rapid response and the ability to traverse difficult terrain. Although motor vehicles have dominated law enforcement transportation, bicycles have undergone a resurgence with the use of mountain bikes.

Modern police bicycles have wide, deeply treaded tires and multiple gears. They allow officers to maneuver through confined spaces as well as off-road trails.

Police officers assigned to bicycle patrols are enthusiastic about riding. A typical patrol can require between five and fifteen miles of riding. A slow- paced ride will burn 400 calories per hour.

The International Police Mountain Bike Association (IPMBA) provides training that includes stretching and fitness along with riding skills. Courses last one week and are held nationwide.

Other than police, EMS personnel and security officers utilize bicycles.

“Bicycle patrols add to visibility and communication with pedestrians and business owners,” said Mark Gendron, a Connecticut State Trooper assigned to Hebron who is trained by the IPMBA. The stealth approach of bicycles have aided in drug arrests and crowd control. Trooper Gendron keeps a bike rack on his patrol car so that his bike is always available.

Backus Hospital and the Mohegan Sun Casino use bicycle patrols for security purposes in parking lots and to assist visitors. Lowell Yeager, a retired fireman, bikes approximately 1,500 miles per year in addition to the time he spends on bike patrol at Backus Hospital.

These patrollers are dedicated to helping others and are passionate about staying fit.

Ballroom dancing attracts athletes and creative types

2009-08-04T13:06:00.000-07:00

Athletic activities take on many different forms and among the more recently popular are various types of dance. Television shows like “Dancing with the Stars” and “So You Think You Can Dance” have been major forces behind the growing numbers of dancers.

Dancing attracts men and women of all ages, fitness levels and cultural backgrounds. People dance socially, competitively or for the entertainment of others. Perhaps no other athletic activity is so universally accepted.

The physical demands of dancing vary greatly. The pace and rhythm of the dance will dictate the cardiovascular component. Caloric output can vary between 200 and 400 calories per hour depending on the pace of the dance.

Agility is important for dancing and participation -- even at a novice level -- will improve balance. As with all weight-bearing activities, muscles become stronger and bone density increases. Typical injuries include ankle sprains, knee injuries and a variety of strained muscles.

Ballroom dancing, which requires a partner, has become particularly popular.

Adult ballroom dancing camps are held around the world. A recent week-long camp at Mt. Snow, Vt., attracted 50 dancers from the United States and Canada. Ballroom Vermont owner Byron Siegal has seen a 40% increase in participation over the past five years and more than 50% are repeat customers.

“We both enjoy the physical as well as mental and social aspects of ballroom dancing,” said veteran campers Robert and Peggy Cassey. Peggi Morrow directs the camp and finds that campers fall into two broad categories: the analytical group where every movement demands careful study and the creative group who just start moving with reckless abandon.

Like any sport, success is based on timing, coordination and strength. Enjoyment is based purely on attitude.

Athletes are at risk for sunburn

2009-07-27T12:44:00.000-07:00

Sunburn, an often-ignored sports injury, can result in immediate as well as long term injury. If exposure becomes chronic, it can lead to death.

Skin is the largest organ in the human body. An intricate network of blood vessels, nerves and glands provides a system for thermoregulation. It is responsible for protecting internal organs from the environment, leaving the skin susceptible to damage from the elements.

The sun produces invisible ultraviolet (UV) radiation. UVA and UVB rays can produce damage after excessive exposure.

Athletes whose sports require long hours of outdoor training are particularly susceptible to the sun. This includes runners, cyclists and surfers. Winter athletes are at risk due to reflection of sun rays on snow and ice, and because they typically compete at higher altitudes.

Protection from the sun involves several strategies:

- Timing. Sun exposure is minimized when workouts are scheduled before 10 a.m. and after 4 p.m.
- Clothing. Dark, tightly woven attire will block rays while light colors only scatter rays and loose weaves allow the rays to pass through. Modern fabrics allow athletes to remain cool while covered.
- Sunscreen. Athletes should use sunscreens specifically formulated as sweat resistant and waterproof. They should also have a sun protective factor (SPF) of 30-50. A high SPF lip balm is also recommended.

“Athletes often do not reapply sunscreen despite profuse sweating. It must be re-applied at least every two hours to be effective,” said Dr. Howard Rogers, a dermatologist at Advanced Dermatology in Norwich and member of the Backus Hospital Medical Staff.

He also believes instructing people to increase sun exposure to avoid vitamin D deficiency is misleading and that dietary supplements are the most efficient way of addressing this problem without unnecessary cancer risk.

Remember, you can never apply sunscreen too much or too often.

Athletes can improve performance with rest

2009-07-20T09:08:00.000-07:00

Athletes are typically highly motivated and committed to their sports. Hard work as a means of improvement is a core value. Among the most difficult things a sports medicine physician must recommend to an athlete is rest.

An athlete’s response to a physician’s advice is not age-dependent. Older people often tragically ignore sound advice while younger athletes with a bright future may accept the verdict.

Inexperienced athletes perceive rest as a defeat and often ignore this recommendation. Their persistence to “work through the pain” often leads to a more severe, career-ending or life-altering injury.

More mature athletes understand that resting can be an opportunity to become better at their sport. They use the time to work on other aspects of their game and often emerge stronger and more competitive.

For example, a pitcher or golfer may realize after an injury that they can no longer rely on power and must add more finesse to their game.

Rest is an effective treatment for many injuries:
• Muscle strain. Rest allows muscle fibers that may have small tears to repair themselves and perform more efficiently.
• Sprains. These injuries involve ligaments that stabilize joints. Swelling and inflammation are a result of these injuries and rest gives the body an opportunity to resolve this response.
• Concussions. Any brain injury requires cognitive and physical rest so that brain cells can heal. Any activity should be stopped until it can be done without a headache.

Rest does not mean total separation from sports. Rehabilitation involves activity without the use of an injured limb or joint. Bracing can often allow for limited, painless activity. A recovery plan should include the advice of a certified athletic trainer or physical therapist.

One common feature to these injuries is pain and a good rule to follow is that if it hurts, rest is in order.

Sports are good for autistic children

2009-07-14T09:43:00.000-07:00

When a child is diagnosed with autism, parents are rightly concerned. Autism should not exclude anyone from participation in sports and in fact exercise and fitness should be encouraged as a form of therapy.

Autism is a group of developmental disorders now referred to as “autism spectrum disorders.” The range of symptoms varies greatly but the common element is difficulty communicating and interacting with others.

The causes of autism are highly controversial and diverse. Genetic causes along with environmental factors are currently being investigated. Complications during childbirth may also play a role.

Since the range of symptoms is so broad, no single treatment is effective for everyone. Medication has not been proven to play a major role. Most treatment plans include educational, creative and dietary therapies.

Sports play a role in treating autism by emphasizing coordination and body awareness. Dedication to improving a particular athletic skill will also increase confidence and support other therapies.

Team sports are generally not recommended because participation relies so heavily on communication with teammates. The best sports for children with autism include:

• Track and Field. Running and throwing are very basic activities that require little verbal skill.
• Swimming. The symmetry and the swim stroke improve body awareness. Propelling through the water is among the most soothing activities from the standpoint of sound and tactile sensation. A competitive element can be easily introduced if desired.
• Horseback Riding. This is perfect for children who may have associated motor deficits prohibiting them from other sports.
• Basketball. The repetitive act of shooting baskets is an activity with immediate gratification. Individual shooting games like “H-0-R-S-E” or “Around the World” provide fun competition.
• Martial Arts. An outstanding way to improve balance and coordination.

Most importantly, when choosing an athletic activity for a child with autism, make sure it’s fun.

Socks are a key part of athletic attire

2009-07-06T13:11:00.000-07:00

At one time, the only criteria for the purchase of athletic socks were that they be white and absorbent. A similar purchase today requires an advanced degree in materials management.

High quality athletic attire is often made from materials that have wicking and antimicrobial properties. Wicking materials are typically synthetics that lift moisture away from the skin. This creates a dry barrier between the body and garment. Names like “Dri-Lex” and “Dri-Fit” indicate that these wicking compounds are present.

Antimicrobial materials are designed to keep the article of clothing free of bacteria, fungi and mold. This reduces the chance for infecting any open wound. The use of silver-embedded fibers creates these antimicrobial capabilities.

Socks are among the articles of athletic attire that benefit most from these features. Constant friction between the foot and shoe will result in blisters. The combination of moisture and heat in a closed environment with an open wound will cause infection. Sharing unlaundered socks can cause spread of bacteria like MRSA.

“The key factors to choosing proper athletic socks are stitching and materials,” said Dr. Joseph Di Francesca, a Norwich podiatrist on the Backus Hospital Medical Staff.

The best socks are those that have no stitching since these serve as a source of irritation. He agrees that materials should be both wicking and antimicrobial. Di Francesca recommends socks made from merino wool since they have natural wicking properties and silver-based fibers that reduce infection and odor.

While these developments are the result of efforts to create a better athletic sock, the cross-over to non-athletic activities is easily understood. Many people who spend long hours on their feet, as well as those who suffer from chronic medical conditions such as diabetes and vascular disease, have also benefitted greatly.

While the purchase of athletic socks should not become a major life decision, there is more to it than just color.

Blind golf challenges and inspires

2009-06-30T06:55:00.000-07:00

Sports fans love an underdog. The ability to overcome seemingly insurmountable odds has been a source of admiration since David took on Goliath.

After watching professional golfers at the US Open and Traveler’s Championship, some would say just playing the game of golf is sufficiently challenging. Most impressive is when the game is played by athletes who are legally blind.

Blind golf traces its roots in the United States to 1925 when Clint Russell began playing after losing his sight in an accident. The United States Blind Golf Association was established in 1947 and has since been sponsoring organized tournaments.

Interestingly, there is little variation from the traditional rules of golf. Blind golfers work with a coach who is responsible for aligning the club and giving information on distance and direction. The only other significant variation is the ability to ground the club in a hazard before making a shot.

A blind golfer’s coach is more than a caddy as their relationship involves a high level of trust.

Guiding Eyes for the Blind sponsors the Corcoran Cup Masters Invitational golf tournament at the Mt. Kisco Country Club in New York. The field consists of the top 16 blind golfers in the country.

“Sponsoring this tournament over the past 30 years has become a fundamental part of our mission to allow blind and visually impaired people to compete on an equal playing field,” said Michelle Brier, marketing manager at Guiding Eyes. The day following the tournament, blind golfers play in foursomes with sighted golfers as part of a fundraising event.

Golf requires athletic ability and skill. One of the fringe benefits for all golfers is the camaraderie of sharing the experience with others.

Although golf has a significant “visual” component, success is measured by the “sound” of the ball hitting the bottom of the cup.

Readers weigh in with innovative employee wellness programs

2009-06-23T07:45:00.000-07:00

Two weeks ago there was a discussion of wellness programs implemented by employers. These programs have been proven to reduce health care expenses and absenteeism while improving morale. Since publishing that column, several employers have presented some innovative ways they have approached employee health and wellness.

American Ambulance of Norwich held a fitness challenge for employees where three teams of 13 were awarded points for making healthy lifestyle choices.

“This challenge was not about weight loss but was instead designed to promote healthy habits for staff and their families,” said Janet Welch, director of human resources. Some choices included tai chi classes and family ski trips.

Bruce Bumpus is a director of Web Industries Hartford and reports that they have a program titled “Step up to the Plate.” It is designed around a baseball format extending over nine weeks/innings. Teams score runs based on their cardiovascular workouts. They have been able to attain 91% employee participation.

Carl Mailhot posted a comment on this blog. His company, Eastern Connecticut Rehabilitation Center, has partnered with employers to design wellness and fitness programs. Their programs include pre-shift stretching, wellness education and worksite-safety. They also provide a physical therapist for consultation regarding ergonomic issues.

If your company has an innovative approach to wellness, send it along to aalessi@wwbh.org.

Another update: this week Governor M. Jodi Rell signed into law a bill requiring that an automatic external defibrillator be available at all scholastic sports activities.

This law is the result of the efforts of Lawrence and Evelyn Pontbriant in memory of their son, Larry. By joining forces with the Connecticut Athletic Trainers Association, they have been able to enact legislation that will save young lives. All parents owe them a debt of gratitude for their perseverance.

Employee fitness contributes to overall wellness

2009-06-08T11:55:00.000-07:00

Controversy erupted in Hartford last week when gym equipment for employees to exercise was installed in a lunchroom. This step toward improving the health and fitness of city employees sparked outrage among several city council members.

Many companies and municipalities have been instituting health and wellness programs in an effort to control skyrocketing health costs. Results have shown that any investment in fitness yields benefits including decreased absenteeism, reduced medical costs and better morale.

In challenging economic times, wellness and other forms of preventive care should be viewed as a necessity rather than a luxury.

Several local employers, both large and small, provide a variety of opportunities aimed at keeping their work force healthy. Programs include smoking cessation and stress management, along with onsite fitness centers and discounted gym memberships.

The Electric Boat Division of General Dynamics provides multiple programs for employees.

“Maintaining and staffing an onsite fitness center is only part of our comprehensive health and wellness strategy,” said Alvin Ayers, Director of Health, Wellness and Disability Benefits.

Since 1985, EB has had a fully equipped fitness center open 24/7 and staffed by fitness specialists. Approximately 700 employees regularly utilize the facility that includes cardio and resistance equipment. Other programs include yoga, aerobics and nutrition. EB’s proactive commitment to health has paid off in morale and fitness of the workforce according to Ayers.

Dime Savings Bank provides a fitness facility at its main branch in Norwich but faces the challenge of involving employees at other branches in wellness programs.

“Dime provides discounted local gym memberships for all employees, as well as sponsoring competitive fitness challenges among the various branches,” reports Cheryl Calderado, Senior Vice President for Administration at Dime.

Frequently used fitness equipment is always a good investment, especially in tough economic times. If your company has a fitness center or unique approach to wellness, contact me at aalessi@wwbh.org.