Healthy Sports

Create your own ‘triathlon’

2008-07-01T09:10:00.000-07:00

Since ancient times, multi-sport athletes have always been considered superior in terms of overall fitness. This sentiment has continued to the modern Olympics, where the decathlon champion is considered the world’s greatest athlete. The decathlon consists of 10 track and field events completed over a period of two days.

Cross training brings together a workout where athletes use multiple sports to achieve a higher level of fitness. Many participate in triathlons. Recently made popular by the Hawaiian Ironman event, triathlons consist of various combinations of swimming, cycling and running. The ironman distances include a 2.4-mile swim, 112-mile bike, and 26.2-mile run. In an effort to gain more participation, many shorter variations of triathlons have been established.

Swimming is always the first competition since exhaustion during the swim can lead to catastrophe. This event is held in open water where water temperature, waves and limited visibility are obstacles. Wet suits are often used for warmth.

The bike portion can be grueling and is the only event which depends not only on fitness, but the quality of equipment. A mechanical breakdown will really leave a participant behind. The running segment is last and is always the true test of endurance.

Triathlons are a great way to incorporate three cross training sports into anyone’s workout. There are no rules regarding which three sports must be used to create a friendly competition, or to just challenge yourself.

Try choosing three events you most enjoy. These sports may change with the season, using all indoor sports during winter (stationary bike, treadmill, and rower) or a combination of indoor and outdoor events in summer (running or walking, swimming, and rollerblading). The events should use different muscle groups. Work on at least one different segment each day and if possible try two. Allocate enough time to go through all three events during one long workout each week and keep track of time and distance.

Creating your own triathlon will add variation to your exercise routine and help limit overuse of certain muscles, while eliminating potential boredom.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. He can be emailed at aalessi@wwbh.org. You can listen to a podcast of this column at www.backushospital.org.

Amputee sports

2008-06-24T07:21:00.000-07:00

Disabled athletes face many challenges in their efforts to participate in competitive sports. Playing with or against a physically challenged athlete adds a new dimension to sports.

Several years ago, I had the opportunity to golf with a gentleman who had lost his leg to cancer. The level of his amputation was in the pelvis so he could not wear a functional prosthesis. He played every shot while balanced on one leg, including getting out of sand traps. He shot an 84 on a course he’d never played before and never slowed the pace of the game.

The human body has a tremendous ability to adapt to conditions as they are presented. This function is much more efficient in people who are in good general health. In the case of a lower extremity amputation, the nervous system adapts by refining the neurologic network of the cerebellum, inner ear, and peripheral nerves to improve balance. Often the biggest obstacle is fear and a lack of confidence.

Dr. James Leonard, a physical medicine and rehabilitation specialist at the University of Michigan, works extensively with amputees. “Young amputees adapt quickly and those who were athletes before their amputation seem to have a better understanding of their body than non-athletes and thus fair better,” Leonard said.

Oscar Pistorius is a double amputee born without supporting leg bones between his knees and ankles. This year he will be allowed to compete in track events at the Beijing Olympics. Several protests have been registered, complaining that his prosthetic legs give him an unfair advantage over able-bodied runners. After completing tests at the MIT laboratories, no advantage was found.

Amputees are unfortunately growing in numbers as a result of the wars in Iraq and Afghanistan. Many were accomplished athletes before their injuries and have a tremendous desire to return to sports. The Wounded Warrior/Disabled Sports Project establishes programs for wounded veterans to get back to competition.

While we tend to focus our interests in sports on famous, well-paid athletes, it is comforting to know that the athletic spirit is alive and well at other levels of sports.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. He can be emailed at aalessi@wwbh.org. You can listen to a podcast of this column at www.backushospital.org.

Exercise is important for pregnant women

2008-06-17T11:13:00.000-07:00

Throughout life, the human body undergoes various changes. These may be related to normal growth, aging, or illness. Among the most dramatic changes are those associated with pregnancy. Just as the body changes, the basic requirement of regular exercise also changes. Often the need for activity increases rather than decreases.

Many women do not feel like working out during pregnancy and may use that time as an excuse not to exercise. Studies have shown that regular exercise while pregnant is beneficial to both mother and child.

Dr. Stephen Briggs, an Ob/Gyn on The William W. Backus Hospital Medical Staff, has found that patients involved in a regular exercise program have “more efficient labor.” He defines this as requiring fewer pain medications, having shorter labor, with an overall better delivery.

After checking with your physician, an exercise plan can be implemented with the help of a personal trainer or local gym that sponsors fitness classes for pregnant women. Any program should be specific for the different stages of pregnancy. Contact sports, scuba diving, and vigorous weight training should be avoided. Any sports requiring balance such as skiing, skating, or cycling can lead to falls due to a shifting center of gravity and are also discouraged.

Exercise goals should not be set toward improving overall endurance and the “no pain, no gain” philosophy is the wrong approach. Heart rate, fluid intake, and body temperature should be monitored.

The best fitness program incorporates yoga and pilates-style exercises to improve flexibility. Walking is excellent and can easily be added to a swimming component. The buoyancy of a swimming pool alleviates the strain from additional weight in the last trimester. Regular use of a stationary bicycle is another outstanding way to stay fit.

Following an exercise program, along with proper nutritional requirements, is a great way to work through the life-changing experience of pregnancy. It may also be a good idea to get the coach involved in the program to make it a family affair.

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

Exercise can help your memory

2008-06-13T08:59:00.000-07:00

Among the most frequent human fears is the loss of memory. Whether it is the result of Alzheimer’s disease or its recently identified predecessor, Mild Cognitive Impairment (MCI), the inability to recognize loved ones and remember recent events vastly diminishes quality of life.

MCI represents a transition state between cognitive impairment from normal aging and Alzheimer’s disease. People with MCI are more likely to develop Alzheimer’s than the normal aging population.

There is now an expanding body of data indicating that moderate, regular exercise will help avoid this tragic situation.

At this year’s meeting of the American Academy of Neurology, several research presentations addressed Alzheimer’s and MCI.

One of the most intriguing reports was presented by researchers from the Mayo Clinic. They studied 868 individuals between the ages of 70 and 89. They looked at the exercise habits of these people during the ages of 50 through 65. The study found that those participants who exercised moderately (30 minutes or more) two to five times per week were less likely to develop MCI in later years.

Another proposed strategy for diminishing the likelihood of developing MCI emphasized the incorporation of an intellectually stimulating activity while exercising. This can be done by performing various mathematical problems while monitoring activity such as heart rate, miles, or steps per minute.

Other presentations dealt with the early onset of Alzheimer’s disease in heavy drinkers (more than two alcoholic beverages per day) and smokers. High cholesterol levels in 40 to 50 year olds were also cited as precursors to Alzheimer’s disease. It is unknown if exercise stimulates the emission of a protecting substance that reduces the incidence of Alzheimer’s, or if it is one element in an overall healthier lifestyle necessary for better cognitive outcomes.

Based on these studies we can conclude that the combination of moderate exercise, no tobacco, a healthy diet limiting fats and alcohol, and intellectually stimulating activities will diminish the risk of severe cognitive impairment and improve our quality of life in later years.

ACL tear highlights a problem but also true sportsmanship

2008-06-06T10:03:00.000-07:00

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

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

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

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

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

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

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

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

Chilly spring air can lead to injuries

2008-05-27T10:12:00.000-07:00

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

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

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

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

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

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

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

Athletes are not immune to psychiatric issues

2008-05-22T14:00:00.000-07:00

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

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

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

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

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

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

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

Stroke can hit athletes

2008-05-16T13:07:00.000-07:00

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

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

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

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

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

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

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

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

Preparing for the ride

2008-05-16T13:00:00.000-07:00

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

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

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

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

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

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

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

Exercising and saving gas is as easy as riding a bike

2008-04-29T08:24:00.000-07:00

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

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

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

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

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

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

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

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

Physical Education helps kids learn

2008-04-16T06:17:00.000-07:00

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

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

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

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

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

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

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

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

Disc Golf a fun way to get exercise

2008-04-08T13:57:00.000-07:00

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

These people play a game called disc golf.

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

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

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

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

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

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

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

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

Ultimate Fighting is not for children

2008-04-01T14:00:00.000-07:00

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

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

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

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

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

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

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

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

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

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

Take a lesson from the pros: establish a daily routine

2008-03-25T12:58:00.000-07:00

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

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

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

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

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

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

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

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

A well-established program can often improve cognitive disorders.

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

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

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

Opinions vary on rotator cuff injuries

2008-03-20T11:55:00.000-07:00

Baseball season has arrived!

It’s time to put away the 409-page Mitchell Report and any pharmacology texts fans may have been consulting. Box scores will now move to the top of the sports page.

Despite this good news, controversy still abounds.

This season, one issue surrounds the need for surgical repair of Curt Schilling’s ailing right shoulder. Rarely does the public see such divergent opinions among highly regarded sports medicine specialists as in this situation.

Dr. Thomas Gill, the Red Sox team physician, advocates non-surgical treatment with rehabilitation and return to pitching this season. Dr. Craig Morgan, who operated on Schilling’s shoulder in 1995 and 1999, recommends surgical repair with resuming action late in the season. A third opinion from Dr. David Altchek, Mets team physician, suggests surgery. The final decision has been no surgery and a possible return in several months.

Shoulder injuries are common in throwing sports and usually involve the rotator cuff. The rotator cuff refers to the system of tendons and muscles that support the most moveable joint in the body.

Common symptoms of injury are aching pain and weakness when attempting to raise the arm overhead. The principal issue when considering surgery is whether or not a tear is present or just inflammation. These conditions respectively require surgery with rehabilitation and rehabilitation alone.

The “Healthy Sports Spring Training Tour” is currently visiting the Connecticut Defenders at their preseason camp in Scottsdale, Ariz.

Dr. Stephen Scarangella of Willimantic is an orthopedist and Connecticut Defenders’ team physician. He reports that many pitchers respond well to surgery after rotator cuff tears. Although success depends on the extent of injury, tears are usually discovered early in pitchers and are small in size.

Anthony Reyes is the former Defenders’ athletic trainer and is now responsible for the San Francisco Giants’ Triple A Fresno club. His focus is on the prevention and rehabilitation of rotator cuff injuries. He allows a full year for recovery after rotator cuff surgery for a pitcher. This permits full healing and any changes the player must make in pitching mechanics.

The current controversy involving Curt Schilling’s injury will be played out over the next few months. When dealing with a shoulder injury, seek out multiple opinions from qualified specialists before deciding on a course of action. It’s what the pros do.

If you wish to learn more about shoulder injuries in sports, listen to the podcast or go to the Healthy Sports Blog at Backus Hospital.

Healthy Sports Arizona 2

2008-03-14T07:23:00.000-07:00

Scottsdale, Ariz., is a growing suburb of Phoenix. Judging from the number of high-end car dealerships, including Rolls Royce and Ferrari, the average income is well above the poverty level. The sun is always shining and there seems to be no bugs. It is home to Arizona State University and serves as the spring training base of the San Francisco Giants.

Don and Charlie’s is a restaurant in Scottsdale known for good food, sports memorabilia, and famous patrons. Knowing this, it was still shocking when my party was seated at a table next to a group that included Muhammad Ali.

Despite being afflicted with Parkinson’s disease, his personality still captures the attention of all. Unable to sign autographs, after finishing his meal he spent time posing for pictures with young children who will certainly one day appreciate the importance of that moment. When Ali finally rose to exit the restaurant, every patron stood and respectfully gave a standing ovation.

Many years of intense physical training will reduce the chance of disease but will not impart immunity. Neurologic diseases like Parkinson’s, Multiple Sclerosis and Lou Gehrig’s disease will seriously impair motor function.

Some patients, especially those who have spent much of their lives in the limelight, may retreat to a solitary existence when faced with chronic illness. Much has to do with vanity over their more frail appearance. Others transcend their physical infirmities and continue to contribute to society in a different role. So often, those with strong personalities won’t allow themselves to take a step back. Studies have shown these groups of people always have better outcomes when fighting disease. When polled, they also report a better quality of life.

As in all professions, sports has its heroes and villains. On this night in Scottsdale, Muhammad Ali once again rose up and demonstrated to all present why he is still “The Greatest.”

If you wish to learn more about the Healthy Sports Tour, listen to the podcast or go to the blog at The William W. Backus Hospital or norwichbulletin.com.

Healthy Sports Arizona

2008-03-14T07:14:00.000-07:00

The Healthy Sports “Spring Training Tour” is now in the midst of the Arizona swing.

A visit to the San Francisco Giants/Connecticut Defenders training camp reveals many former Defenders players now enjoying Major League status. Dan Ortmeier, Matt Cain and Travis Ishikawa are all currently in Major League camp and hoping to make it to the big league.

But the real story lies in the workout regimen of the coaches, trainers and instructors.

Their day begins at 5 a.m. in the workout room. This early hour is the only opportunity staff will have to complete their personal workout programs before a hectic day of staff meetings, instruction and games.

In an effort to keep up with my own workout schedule while on the road, the Giants afforded me the opportunity during my stay to join this early morning fraternity. Like most gyms, there is a wide variety of well-maintained equipment and a big screen TV (always tuned to ESPN). There are also many iPods in use. Discussion is centered on player performance, drills for the day, and upcoming games in the afternoon. A lot gets done during these sessions.

Many patients feel that the walking involved in their jobs is a sufficient workout. Coaches and staff are constantly walking, swinging, and throwing for eight hours over multiple fields, encompassing several acres, yet they still see the need to hit the aerobic machines and weights each morning. This is a model that many industries outside of sports are trying to replicate as a means to promote better health, lower health costs, and provide a sense of camaraderie.

A quick trip to Surprise, Ariz., the spring training home of the Kansas City Royals, presented an opportunity to meet with former Norwich Navigators manager and now first-year manager of the Royals, Trey Hillman. Sitting and reminiscing in his new office, it is apparent that the leadership skills he developed in Norwich and later in Japan are going to pay off big for Kansas City this year. It will be interesting to follow his success in the major leagues.

If you wish to learn more about the Healthy Sports tour, listen to the podcast or go to the blog at The William W. Backus Hospital or norwichbulletin.com.

Exercise can help with Parkinson’s disease

2008-03-07T10:30:00.000-08:00

Parkinson’s disease is a progressive, degenerative disease of the nervous system which primarily affects motor function. Its victims have uncontrollable tremors, rigid joints and slowed movements. It was previously considered highly unlikely that a Parkinson’s patient could maintain an exercise regimen.

Thanks to the development of neuro-modulating medications, many people now suffering from Parkinson’s disease remain active. Exercise directly impacts Parkinson’s disease through prevention and better outcomes for those suffering from Parkinson’s disease.

Researchers from Harvard University presented data at the annual meeting of the American Academy of Neurology. The studies showed that people who exercise moderately to vigorously for 30 minutes each day are less likely to develop Parkinson’s disease.

After being diagnosed with Parkinson’s disease, patients who exercise regularly have a higher level of physical function and quality of life. An exercise program should be customized for each patient. The structure of the program requires the input of physical and occupational therapists as well as the patient’s physicians.

The goals of any exercise regimen include:

• Increased cardiopulmonary stamina
• Greater joint range of motion
• Better muscle strength
• Preservation of walking ability
• Improved posture and balance

Since Parkinson’s disease primarily affects motor function, maintaining posture, balance, and coordination are crucial. Many Parkinson’s patients die from the effects of falls, including broken bones or pneumonia which results from immobility.

Dr. Anna Hohler is a movement disorder specialist who treats many Parkinson’s patients at Boston University Medical Center.

“Exercise is vital to optimization of care; medication alone is not enough,” Hohler said.

She obtains a formal gait assessment performed by an occupational therapist for all her patients. Her institution offers a yoga program specifically designed for patients with Parkinson’s disease. Tai chi is also very effective in improving balance and flexibility.

Parkinson’s is now among a growing number of diseases that can be improved with regular exercise both before and after diagnosis.

Cheerleading a much more dangerous sport these days

2008-02-28T13:20:00.000-08:00

Cheering during sporting events has changed radically over the past ten years. Young girls no longer wave pompoms while leading rhythmic cheers for their team.

Cheerleading has become a performance that captures the attention of the entire audience. Tumbling, jumping and spectacular human formations are now the norm.

Participants consist of powerful men and women who provide a base for the formations, as well as petite “flyers.”

Cheerleading is a collegiate scholarship sport and not just a sideshow.

As the sport has become more athletic and spectacular, the frequency and severity of injuries related to cheerleading have also climbed.

A recent study in the medical journal Pediatrics documented over 200,000 emergency room visits for cheerleading injuries. This study covered a period of 13 years with most injuries involving teenage girls. Since the study only looked at injuries requiring hospital care, it is believed the injury rate is much higher when considering visits to physician offices and urgent care centers. The principal injuries are musculoskeletal but neurologic injuries like concussion and spinal trauma are increasingly common.

In some states, cheerleading is not a sanctioned sport. This often leaves cheerleaders without medical support and safety requirements like in other competitive sports.

Martha Davis is a cheerleading parent whose 11-year-old daughter, Morgan, has been competing for the past four years with the Impact All-Stars. Practice requires about 12 hours per week in addition to competitions. Some cheerleaders begin as young as age four.

A major factor contributing to the high rate of injury in cheerleading is the increased level of risk associated with the stunts performed. Since becoming more competitive and drawing national TV coverage, the performances have become more breathtaking and dangerous.

Some basic guidelines for parents and athletes:

• Make sure your cheerleading coach is certified and properly trained. This training should include first aid certification.
• Practice stunts in a gym with proper supervision and equipment.
• Get a physical before participating.

This weekend the best regional cheerleading squads will be competing at the Mohegan Sun Arena. Participants range from the very young to highly competitive collegians. It promises to be an exciting and safe performance.

If you want further information on cheerleading, listen to the podcast at Norwich Bulletin or Backus Hospital. Post any comments you have on this blog.

Carotid Laceration

2008-02-19T07:53:00.000-08:00

Richard Zednik is a professional hockey player for the Florida Panthers. On February 10th, while competing against the Buffalo Sabres, he collided with a teammate whose skate accidentally cut Zednik’s right carotid artery.

All who have seen the video of this incident have been both horrified by the event and impressed by the medical response to this life-threatening injury. The fact that Zednik was discharged from Buffalo General Hospital in less than a week with no apparent permanent injury is amazing.

The carotid arteries are the two main arteries responsible for blood flow to their respective halves of the brain. Any prolonged deprivation of blood flow will result in a stroke with symptoms of weakness, numbness, and possible loss of speech. Anatomically, muscles protect the carotid artery. An injury requires great force and a very sharp blade.

Since Zednik was in superior general health, crucial minutes were added to the time frame during which a safe repair could be performed. The proximity of the arena to a hospital where an experienced surgeon was available also helped Zednik’s situation.

Locally, the Backus Hospital Trauma Center provides this service to sports venues including Mohegan Sun Arena, Foxwoods Casino, and Dodd Stadium.

This incident raises the issue of NHL players using more protective equipment.

Facial lacerations and eye injuries have steadily increased in frequency and severity. Hockey players have become bigger, faster, and stronger as compared to the “good old days” when no one would be seen wearing a now-required helmet. Protective collars are mandated by all junior hockey organizations. Some are made of lightweight Kevlar for maximum neck protection. Visors are also considered essential at the junior level and provide necessary eye protection without impeding performance.

Many professional athletes have come to the realization that by training harder and avoiding injury, they can extend their longevity in professional sports and earn more money. Hopefully, they will all soon realize that taking a more mature, business-like approach to sports includes the use of protective gear.

If you wish to learn more about carotid artery injuries or protective equipment in hockey, listen to the podcast or go to the Healthy Sports Blog at Norwich Bulletin or Backus Hospital.

A balanced diet is a key for athletes

2008-02-18T10:32:00.000-08:00

Shopping catalogs advertising the latest swimwear are among the earliest signs of spring.

This automatically triggers intense fear that a body that may have put on several pounds during the holiday season needs to soon look presentable in swim attire. Following that is a feeling of confident resolve that the task of getting in shape before exposing ourselves to public scrutiny can be accomplished.

Current and former athletes typically face the dilemma of increased body weight by beginning a program of vigorous exercise. This may include running, fitness classes, or weight training. Any successful weight loss plan includes diet changes.

When engaging in an intense physical regimen, a balanced diet is essential to avoid serious health problems.

A nutritional plan for an athlete should be customized based on body type and size. Consulting a registered dietician is advised. Relying on someone you met at a gym or who happens to work in a vitamin store is a mistake. Online advice through sites that sell supplements could lead to trouble.

The basic human diet consists of three essential components:

• Carbohydrates are the main source of energy for muscle. They are broken down into sugars for immediate energy and stored in muscle as glycogen for later use.

• Proteins are essential for building and repairing muscle that breaks down during exercise. Proteins also help store glycogen in muscle. Proteins themselves are not easily stored and must be consumed daily for a healthy diet.

• Fats provide the highest concentration of energy. They are the main fuel source for any long duration (greater than 60 minutes) of sports activity.

Many weight-loss diets emphasize either carbohydrates or proteins as a foundation. While this may be effective for weight loss alone, it could lead to disaster for anyone engaging in intense workouts. Aerobic athletes taking a high-protein, low-carbohydrate diet are at risk for kidney failure.

Vegetarian athletes face the challenge of meeting nutritional demands without meat, fish, or eggs as a source of protein. Milk, tofu, yogurt, cheese, and peanut butter are great dietary alternatives.

Whitney Bundy, a registered dietician and Director of the Food and Nutrition Department at The William W. Backus Hospital, said that distance athletes must be sufficiently hydrated before, during, and after a workout. Peanut butter is an excellent pre-workout meal.

Isn’t it ironic that with so many commercially available energy bars, a childhood favorite like PB&J can sufficiently fuel a great athletic performance?

If you wish to learn more about sports nutrition, listen to the podcast at Norwich Bulletin or Backus Hospital.

Anthony G. Alessi, MD, is a member of The William W. Backus Hospital Medical Staff and a neurologist in private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Dr. Alessi at aalessi@wwbh.org.

Fans can't forget their own health

2008-02-15T12:41:00.000-08:00

Sports medicine professionals are responsible for the safety of athletes. Sometimes that obligation extends to sports fans.

A study published in this week's New England Journal of Medicine reported an increase in cardiac emergencies during the 2006 World Cup Soccer Championship at more than twice the normal rate. The study took place in Munich when the German national team was competing in the semi-finals.

Another study performed at the University of Maryland in 2006 showed a 50% rise in emergency department visits after professional football games as opposed to during the game.

Dr. Robert Sidman, Chief of Emergency Services at Backus Hospital, confirmed in an online article at Backus Hospital, that these patterns of behavior apply locally. Fans tend to delay getting emergency care despite the urgent nature of cardiac and stroke interventions.

All of these reports set off an avalanche of cautionary alerts throughout the media in preparation for the Super Bowl. These recommendations include:

• Avoid tobacco
• Don’t overeat
• Limit alcohol
• Take prescribed medications
• Try to stay calm
• If you have cardiac symptoms, get to a hospital immediately

Sports fans around the world consider the days on which major sporting events are held as holidays. Unfortunately, this changes their behavior to “holiday mode” similar to Christmas, Thanksgiving, and Easter where none of the recommendations listed above apply.

The typical scenario for disaster at a party or sporting event occurs when participants don’t take prescribed medications, especially diuretics that cause increased urination. This is followed by eating every food item available, drinking immoderately and getting caught up in the intense excitement of a competitive game.

Ignoring the signs of an apparent heart attack or stroke may further worsen the situation.

Many people who are not involved in sports consider the excitement over a game as craziness. However, passion for a sport or a team is a healthy outlet for stress. The way to avoid a catastrophe lies in moderation. Fans need to pace themselves and avoid this “holiday mode” mentality. As in all sports, safety is key and remember: your team needs you.

If you wish to learn more about spectator safety, listen to the podcast at Norwich Bulletin or Backus Hospital.

Originally published February 5, 2008.

Stay active this winter, but avoid frostbite

2008-02-15T12:37:00.000-08:00

Winter activities are now in full swing. In frigid climates, they include skiing, snowshoeing, and snowboarding. Many will try to keep up with outdoor walking, running, or cycling programs.

These sports now add the challenge of staying warm while being active. The goal is to avoid the serious damage of frostbite.

Frostbite results when skin becomes exposed to extreme cold. Prolonged exposure leads to freezing the skin and tissue below. Typically, frostbite affects the hands, feet, nose and ears. These body parts are furthest from the heart and most vulnerable to cold.

Physiologic conditions that lead to impaired circulation increase susceptibility to frostbite. Peripheral vascular disease and diabetes as well as caffeine and tobacco use can make people vulnerable to frostbite.

A condition known as Raynaud Phenomenon can be particularly dangerous with exposure to cold. This condition causes vasospasm in the small blood vessels of hands and feet in those affected. Cold will precipitate the spasm, resulting in diminished blood supply to tissues involved.

Frostbite can appear in two forms: superficial and deep. The superficial form causes burning, tingling and numbness. The affected areas appear white and frozen. The tissues retain some elasticity when pressure is applied. In deep frostbite, blood-filled blisters are found over hard frozen skin.

Frostbite can be avoided by dressing in layers and being certain to cover all exposed surfaces. New devices such as heated gloves and socks are very effective. Activated charcoal heat packets can be placed in gloves and shoes.

Treatment consists of warming the affected area and keeping it elevated to avoid swelling. Never warm a limb if there is a chance it will freeze again. Do not rub the skin since friction can cause further tissue damage. Bathing the injured area in warm water is the most effective method of rewarming.

Before heading out for a cold weather workout, be sure attire is appropriate. Don’t be fooled by football linemen who wear short sleeves while playing in arctic cold. Even they retreat to heated benches in between series of plays.

If you wish to learn more about frostbite, listen to the podcast at Norwich Bulletin or Backus Hospital.

Originally published January 29, 2008.

Medicine plays role in strength contests

2008-02-15T12:33:00.000-08:00

Historically, the earliest competitions among humans were feats of strength. Biblical and mythical figures are often admired for their physical prowess. George Costanza, of Seinfeld fame, popularized the “feats of strength” as part of his Festivus celebration.

Over the past 30 years, strength athletics has grown under the banner of World’s Strongest Man.

World’s Strongest Man and World’s Strongest Woman competitions are international events. Each competition consists of lifting, pulling, pushing, and running with tremendous amounts of weight. The weight is in the form of vehicles (usually buses or cars), large stones, tires, or concrete blocks.

There are approximately 400 active participants in strength events like those that appear annually at the Mohegan Sun Arena. They range from 22-56 years old. The youngest strength athlete is Massachusetts resident Kevin Nee, who began his career at the age of 18.

Liane Blyn is a certified athletic trainer and strength coach who works with many strength athletes.

“Principal injuries include torn tendons which result from overuse and the increased pressure on joints. Average active longevity is only 4-6 years,” Blyn said. “Training for these competitions consists of performing each event to gain strength and better technique.”

Strength athletics is very interesting from the standpoint of cardiovascular and cerebrovascular physiology, thanks to an Italian anatomist named Antonio Valsalva.

In the 18th century, he described what has come to be known as the “Valsalva maneuver.” It occurs when a person forcefully contracts their muscles against a closed airway. This increases pressure in the chest and middle ears. Due to the increase in pressure, blood flow to the heart is diminished and the pulse slows. Subsequently, blood flow to the brain also decreases, followed by a loss of consciousness. When the muscles involved relax, pressure diminishes and the heart rate speeds up, thus restoring adequate blood flow.

This maneuver can be seen sometimes during prolonged coughing or defecation, and in the case of strength athletes, when lifting large amounts of weight. Participants will try to divert blood flow from their muscles to their hearts and brains by wearing very tight neoprene suits during the dead-lift competition.

Since 1977, World’s Strongest Man competitions have attracted the attention of millions of fans around the world, including the watchful eye of the sports medicine physician in attendance.

If you wish to learn more about World’s Strongest Man events, listen to the podcast at Norwich Bulletin or Backus Hospital.

Originally published January 22, 2008.

Use of performance enhancing drugs defies logic

2008-02-15T12:18:00.000-08:00

Hot stove baseball season should be at its peak this month. “Hot stove baseball” is a time-honored tradition where baseball fans discuss and often argue about trades their favorite team should be making in the off-season.

In New England, the issues typically revolve around the Yankees’ and Red Sox’ preparations for the upcoming season. These discussions take place in bars, at work, and often on sports radio stations where fans call in at all hours of the night to advocate for a big trade.

This year, these colorful arguments have unfortunately been replaced by a media blitz involving players suspected of injecting their bodies with performance enhancing drugs.

The latest culprit in this scandal is Human Growth Hormone (HGH). Many questions have been raised regarding its use:

What is HGH?

HGH is a substance produced by the pituitary gland in the brain. It promotes growth in childhood and supports tissues and organs throughout life. It is an integral part of a complex series of hormonal interactions which make up the endocrine system.

Why is it used?

Synthetic HGH is approved for use in children with short stature or kidney failure. It is also used for adults with muscle wasting from AIDS.

Why would an athlete use HGH?

Athletes use HGH to increase muscle mass and reduce body fat. It will also increase exercise capacity. Interestingly, a recent study demonstrated increased muscle mass in healthy adults but no increase in strength.

What are the dangers of HGH?

There are many risks to using HGH including high blood pressure, diabetes, hardening of the arteries, and muscle pain.

Use of HGH is against the rules in many sports. Currently, it can only be found in a blood sample. HGH may not provide an athlete much of a physical advantage and will put users at risk for life threatening chronic illnesses. After assessing the risks and benefits, using HGH as a supplement defies logic.

The turmoil created by these latest accusations has left fans in search of the truth listening to interviews and testimony by their favorite players. Many never thought they’d see the day when they missed hearing “John from the Bronx” or “Mike from Springfield” calling in to tell Theo Epstein and Brian Cashman how to do their job.

If you wish to learn more about human growth hormone, listen to the podcast at Norwich Bulletin or Backus Hospital.

Originally published January 15, 2008.