As baseball season begins, think safety

The principal goal of anyone involved in sports medicine is to assure the safety of an athletic event for all the participants. Safety measures in sports like baseball and softball can have dramatic impact.

Recent conversations with Mike Turgeon, who has been teaching baseball skills in Norwich for 20 years, and the athletic training staff of the New York Yankees in Tampa have raised several safety issues worth noting:

Field conditions. Many baseball injuries are the result of a “bad hop” off a stone in the infield or stepping into an unexpected sink hole in the outfield. Municipalities must maintain athletic fields if they wish to continue youth sports programs.

Basic skills. Before allowing youngsters to play infield positions coaches must be sure that they possess the skill to handle a hard hit ball.

Bats. The longstanding controversy over the safety of metal bats continues. The best way to avoid injury from a hard-hit ball coming off a metal bat is by using protective equipment like mouth guards, helmets, masks and devices that protect the genitalia.

Automatic External Defibrillators (AEDs). “Commotio cordis” occurs when the heart begins to beat erratically or ceases to beat entirely after being suddenly struck by an object. An appropriate chest protector such as those worn by hockey players can avoid this injury. When this life-threatening situation presents itself an AED can be used to immediately shock the heart back to normal rhythm. This year the New York Yankees are leaving nothing to chance and have purchased eight AEDs so that when on the road each minor league team has an AED available at all times. This action should serve as an example for communities to make AEDs available at all athletic events not only for athletes but fans as well.

Baseball can only become safer if parents and communities take an active role.

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, or listen to his podcasts, comment on his blog or buy his book at

Skiers should wear helmets

It often takes a tragedy to raise public awareness regarding safety. During an athletic event, there are only two ways in which an athlete can suddenly die: cardiac or neurologic. The latter is typically the result of a traumatic brain injury.

Actress Natasha Richardson experienced a seemingly minor fall on a beginner ski slope and struck her head. After some initial symptoms she felt better and did not see a need for medical attention. Shortly after, she lapsed into a coma and subsequently died.

This frightening scenario is a principal focus of attention for sports medicine specialists.

Traumatic brain injury is a general term describing a range of damage that includes relatively mild concussion to severe brain hemorrhage. Bleeding can occur within the brain itself (intracerebral hemorrhage), below the dural membrane surrounding the brain (subdural hemorrhage) or outside the dura (epidural hemorrhage).

Epidural hemorrhage can be the result of relatively minor trauma to the temporal portion of the skull resulting in a tearing of the superficial temporal artery. Arterial bleeding is rapid and increases pressure in the skull with the brain eventually being pushed downward through the skull base.

A period where symptoms improve after the initial hemorrhage can be seen in epidural hemorrhage such as that experienced by Richardson. This “lucid period” can vary anywhere from a few minutes to hours. It is during this period that medical personnel must rely on clinical suspicion and take action that may be life saving.

This tragedy has reinvigorated the discussion of mandating the use of helmets on ski slopes. Helmets have proven to be effective in reducing brain injury in cycling and other sports. Ski helmets have the additional benefit of being comfortable, warm and waterproof in addition to offering brain protection.

Hopefully, common sense will prevail and more skiers and snowboarders will begin to wear helmets, and there will not be a need to legislate safety.

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, or listen to his podcasts, comment on his blog or buy his book at

Hip injuries are hip this year

It seems that every year when spring training rolls around, a new injury becomes the highlight of conversation. Last year, it was Curt Shilling’s shoulder and this year it is Alex Rodriguez’s hip. If this keeps up, baseball fans may forgo medical school and go right into an orthopedic residency. A-Rod has now surpassed Bo Jackson for having the most written about hip joint in sports.

The hip is a ball and socket joint. The head of the femur is a ball shaped structure that fits into the acetabulum, a socket in the pelvis. The joint is held together by several ligaments. The labrum is the cartilage that lines the acetabulum and allows smooth movement of the hip.

While allowing the leg an extensive range of motion, this joint is especially vulnerable to traumatic injury. Repeated pounding and twisting seen in most sports that require rapid starts and change in direction account for a majority of hip damage.

Treatment of hip injuries in athletes varies from a conservative approach including rest, anti-inflammatory medications and physical therapy to hip replacement. Arthroscopic surgery has become a minimally invasive approach that often delays or avoids a more radical procedure.

In 1991, Bo Jackson underwent total hip replacement after a fracture. He returned to play major league baseball. Alex Rodriguez recently underwent arthroscopic surgery to repair a torn labrum.

The common denominator in recovery from all hip surgeries is early rehabilitation often beginning immediately after surgery. Many orthopedic surgeons who treat athletes get their patients on a stationary bicycle two hours after surgery. Non-weight-bearing exercise continues for the first six weeks after surgery while the patient is on crutches. Strengthening exercises follow with hopeful return to running in ten weeks.

Much has changed from Bo Jackson’s “miraculous” return from hip surgery in 1991. These breakthroughs have carried over to non-athletes who can get back to an active lifestyle with minimal downtime.

Spring training is not just for baseball players

Now that spring is near, the need for physical preparation before enjoying competitive sports must begin.

Professional athletes establish a basic regimen that balances stretching, aerobic and resistance training. Workouts that focus on a specific sport branch out from that basic program.

Sport-specific workouts include hitting drills in a batting cage for baseball and softball, using a wind trainer for cycling or an indoor rower before getting out on the river.

One unique approach to training involves golf. Although not among the most physically demanding sports, professionals like Tiger Woods have proven that a program of diet and exercise can improve golf skills.

Derek Hooper and Sue Cart are PGA teaching professionals at the Lake of Isles Golf Academy in Mashantucket, Conn. Along with Terry Ditmar, a physical therapist, they have put together a program called “Fit Fore Golf.” The program consists of a three-dimensional golf swing analysis, a video study of the swing and designing an individualized workout routine to improve swing mechanics and avoid injury.

“The goal of the program is to improve the efficiency of the golf swing while reducing injury,” said Hooper.

After completing the initial assessment, participants should perform their individual routines for 20 minutes three times per week at a minimum. Six weeks later, the golfers reconvene for a second analysis comparing the initial information to any changes and to be sure they are performing the exercises correctly.

Individualized baseball instruction for improved hitting and pitching also has a big payoff. Local programs such as those offered by Mike Turgeon at his indoor baseball school in Norwich draw baseball and softball players of all ages.

“We work with 7-year-olds for whom this is their first baseball experience as well as seasoned professionals rehabilitating an injury before returning to the professional ranks,” said Turgeon.

The combination of indoor workouts with a solid year-round fitness program can jump-start a successful season in any sport.

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, or listen to his podcasts, comment on his blog or buy his book at

Effective workouts include resistance training

The dramatic contrast between what equipment is used in a gym or fitness center by each gender is readily apparent. In general, women gravitate to aerobic machines like the treadmill, bicycle or elliptical with the goal of losing weight, while men prefer lifting weights to increase muscle bulk.

Unfortunately, neither approach alone is correct. Muscle burns more calories than fat, so it is easier to maintain a healthy weight by increasing muscle mass. Muscle bulk alone places added stress on the heart and lungs resulting in poor athletic performance.

Once adequate stretching and aerobic regimens are established, it is time to incorporate resistance training. Best defined as the use of resistance against the force of muscular contraction, resistance training can be implemented through the use of elastic bands, hydraulic cylinders or weights.

Gradually increasing the resistive force on specific muscles will increase strength as well as bone mass. Strength workouts are measured by the number of repetitions of each movement and the number of sets of each exercise.

“I encourage the use of low-weight dumbbells for three sets of 20-30 repetitions first, then moving on to a machine-based workout with more weight and 12-15 repetitions,” said Marc Nee, a local personal trainer and owner of Training with Heart. “The next step is to combine weights and the use of a physio ball for balance.”

One method of combining an aerobic and resistive workout is the use of a weight vest when walking. Weight vests can be worn comfortably with varying amounts of weight added. This will add core muscle strength allowing for a natural walking motion. Ankle and wrist weights poorly distribute added weight and can cause excess strain on an extremity.

Establishing a basic workout regimen that includes stretching, aerobic and resistive components is crucial before moving on to sport-specific programs in preparation for spring sports.