Amber speaks about concussion in athletes with Anthony Alessi, MD and board-certified neurologist who specializes in neurology, neuromuscular diseases, EMG, and sports neurology. Dr. Alessi is a Clinical Professor of Neurology and Orthopedic Surgery and the Director of the NeuroSport program at the University of Connecticut, and neurologist for the New York Yankees and Connecticut State Boxing Commission. In this conversation, they discuss Dr. Alessi’s background in neurology and how he became the neurological consultant to the NFL Players Association, among other professional sports organizations. Dr. Alessi discusses the current science of concussions and traumatic brain injuries (TBIs), the challenges of working with athletes, the psychological impact of concussions, and the role of rehabilitation in recovery. Dr. Alessi debunks the myth that complete rest and avoiding screens is the best approach to concussion recovery, and shares what actually affects recovery time, including the role of exercise. He divulges insights about identifying concussions in race scenarios and emphasizes the need for awareness and action in protecting the brain health of athletes. He talks through symptoms and the steps for seeking treatment, including when to seek emergency care, what to look for in a specialist, and how to recognize if you need a different healthcare professional. He shares recommendations on how athletes, coaches, and parents can work with medical professionals and can exercise caution regarding unproven treatments and promises. Dr. Alessi highlights the plasticity of the brain and its ability to recover from injury with individualized treatment, including key considerations for treating athletes and guiding gradual return to activity. This conversation offers an in-depth look at the research, physiology, and real-world treatment of concussion in athletes, with actionable takeaways for anyone who works with athletes or regularly engages in sports or endurance activities. Dr. Alessi has offered to answer follow-up questions from listeners; send your questions for Dr. Alessi to amber@beagoodwheel.com. While this information comes from a medically trained professional specializing and actively working in the areas of neurology and sports medicine, this podcast is for informational purposes only and is not intended to replace professional medical advice.
This is an abridged version of the interview. To hear full-length and extended versions of every episode, subscribe to a membership on Ko-Fi. Memberships start at $3 per month and support the sustainability of the show. Check out all of the perks of membership at: https://ko-fi.com/beagoodwheel
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Mentioned in this episode:
- Summary of key points from this episode, with printable PDF here: https://beagoodwheel.com/dr-anthony-alessi
- Healthy Rounds - Dr. Alessi’s radio show discussing health topics with medical experts: https://podcasts.apple.com/us/podcast/healthy-rounds/id429232986
- Death of Natasha Richardson: https://en.wikipedia.org/wiki/Natasha_Richardson
- Study by D Thomas et al - active injury management (i.e. incorporating light exercise or cognitive engagement) compared to complete rest post-concussion: https://pubmed.ncbi.nlm.nih.gov/36252936/
- SCAT6 Sport Concussion Assessment Tool - intended for use by medical professionals and is mentioned in the episode as part of our discussion about generalized protocols: https://bjsm.bmj.com/content/bjsports/57/11/622.full.pdf
- CRT6 Concussion Recognition Tool - a similarly generalized tool intended for use by individuals without a professional healthcare background; as Dr. Alessi discusses, such a tool may not be needed if it’s clear an athlete needs to be professionally assessed (i.e. if they fell at high speed): https://bjsm.bmj.com/content/bjsports/57/11/692.full.pdf
- ImPACT Tests - cognitive tests that include baseline and post-injury testing; as Dr. Alessi discusses, this only tests for one dimension of many potential symptoms of concussion and is not itself diagnostic: https://impactconcussion.com/
- Early study by Dr. Ann McKee, PhD and Warren Distinguished Professor of Neurology and Pathology at Boston University School of Medicine - Tau protein in Chronic Traumatic Encephalopathy (CTE): https://pubmed.ncbi.nlm.nih.gov/19535999/ (discussion about CTE is included in extended version available to Ko-Fi subscribers)
Send your follow-up questions for Dr. Alessi to amber@beagoodwheel.com
00:00:00
The treatment of concussion has changed.
00:00:02
It changes all the time.
00:00:04
I had someone come to me in a situation
where I was giving a deposition on a case
00:00:09
and the lawyer said, well, you know,
doctor, we have it here that in 2015, this
00:00:15
is what you said.
00:00:17
Listen, this business changes every day.
00:00:20
What I said in 2015 certainly doesn't
apply to what I know today.
00:00:25
I mean, this is science.
00:00:26
I mean, but lawyers think that once it's
00:00:28
Once you've said it or they have a record
of it on a blog or on this podcast that
00:00:33
it's suddenly set in a tablet somewhere.
00:00:36
So anyhow, it's going to change.
00:00:39
And I think that's hard for a lot of
physicians unless this is something you do
00:00:43
want.
00:00:44
That's Dr.
00:00:45
Anthony Alessi, board certified
neurologist specializing in sports
00:00:49
neurology, speaking about how fast the
state of the science continues to advance
00:00:53
when it comes to understanding and
treating concussion in athletes.
00:00:56
And he would know.
00:00:58
He's the neurological consultant for the
New York Yankees and the Connecticut State
00:01:02
Boxing Commission.
00:01:03
He's been working with elite athletes
across a broad range of sports for more
00:01:07
than three decades.
00:01:09
He's seen a thing or two, not only about
the advances in research, but also in
00:01:14
terms of applying those advances in
research within the more complex context
00:01:18
of treating athletes as the unique
individuals they are, holistically taking
00:01:22
into account their personal stories and
circumstances when creating a plan for
00:01:26
treatment.
00:01:28
You're listening to the Be a Good Wheel
podcast, the show where we explore what it
00:01:32
means to be a good wheel by digging into
scientific research and personal stories
00:01:36
about human potential and performance.
00:01:39
I'm your host, Amber Pierce.
00:01:47
Our guest today is Dr.
00:01:49
Anthony Alessi, a board certified
neurologist specializing in neurology,
00:01:53
neuromuscular diseases, EMG, and sports
neurology.
00:01:57
Dr.
00:01:57
Alessi is a Clinical Professor of
Neurology and Orthopedic Surgery at the
00:02:01
University of Connecticut and is the
director of the UConn NeuroSport Program,
00:02:05
a comprehensive interdisciplinary program
for athletes who suffer from neurologic
00:02:09
injuries and persistent neurologic
conditions.
00:02:12
He has served as a consultant to many
professional and collegiate sports
00:02:15
organizations, including
00:02:17
the UConn Huskies, New York Yankees, NFL
Players Association, WNBA, U .S.
00:02:24
Ski Team, Professional Bull Riders, U .S.
00:02:27
Coast Guard Academy, Connecticut Boxing
Commission, and more.
00:02:30
He was named Ringside Physician of the
Year in 2009 by the American Association
00:02:35
of Professional Ringside Physicians for
his efforts in making boxing safer.
00:02:39
When I experienced the worst concussion
symptoms of my career, I went to UConn
00:02:44
Health to get checked out and could not
believe my luck when Dr.
00:02:47
Alessi walked in the office.
00:02:49
Here was a neurologist who not only knew
the physiology inside and out, but who
00:02:54
also understood the mind of an athlete.
00:02:56
I'll never forget how scared I was walking
into that appointment and how empowered
00:03:00
and hopeful I felt walking out after
speaking with him.
00:03:04
Dr.
00:03:04
Alessi's unique combination of medical
training, clinical practice, and work with
00:03:08
athletes across multiple sports makes him
uniquely qualified to speak about the
00:03:13
state of the science.
00:03:14
as well as the more nuanced considerations
of treating individual human beings like
00:03:18
me, who suddenly find themselves dealing
with frightening symptoms in a confusing
00:03:22
landscape of conflicting information about
concussion and brain injury.
00:03:27
With decades of experience helping
athletes navigate some of the most
00:03:30
vulnerable and challenging moments of
their lives, Dr.
00:03:33
Alessi is deeply sensitive to the unique
needs and stories of each patient and to
00:03:38
the complexities of applying theory and
research in real life.
00:03:42
Our conversation covers a lot of ground
and because this is such an important
00:03:45
topic, we've linked a summary of key
points in the show notes.
00:03:50
Of course, I should make clear that this
podcast is for informational purposes only
00:03:54
and is not intended to replace
professional medical advice.
00:03:59
My conversation with Dr.
00:04:00
Alessi includes questions submitted by our
newsletter subscribers.
00:04:03
If you want to get advance notice and
submit questions for our podcast guests,
00:04:07
go to beagoodwheel .com to sign up for our
newsletter.
00:04:11
I'm so pleased to welcome to the show
today Dr.
00:04:14
Anthony Alessi.
00:04:15
Thank you so much for joining us today,
Dr.
00:04:17
Alessi.
00:04:17
Thanks for having me.
00:04:19
We are going to try to cover a lot today.
00:04:23
I sent Dr.
00:04:24
Alessi a very ambitious list of interview
questions.
00:04:27
We had some really insightful questions
from listeners who wrote in, so we're
00:04:31
going to try to get to all of those.
00:04:33
And the way I want to start to kind of
talk about your background, Dr.
00:04:37
Alessi, and then from there folks, we'll
get into...
00:04:40
more of an overview of brain injury.
00:04:43
We'll get into some practical guidance in
terms of diagnosis, treatment, prognosis,
00:04:48
prevention.
00:04:49
And hopefully we'll be able to talk a
little bit more, dig in a little bit more
00:04:52
on the research of brain injury.
00:04:54
And yeah, we'll see how much we can get to
today.
00:04:58
But Dr.
00:04:58
Alessi, I want to start by asking you out
of curiosity, why neurology?
00:05:05
It's very interesting.
00:05:09
you brought up actually some old memories
of how I got started in sports, which was
00:05:14
really as an athletic trainer.
00:05:17
And I don't advertise myself as an
athletic trainer because back then I was
00:05:21
in high school and becoming an athletic
trainer was a correspondence course.
00:05:25
But I found that I was playing football in
high school and got injured and I just
00:05:33
started becoming involved in
00:05:35
the injury aspect in working with our
school athletic trainer who needed an
00:05:39
assistant.
00:05:40
And I suddenly realized that I had more
potential in the medical field than
00:05:45
playing football.
00:05:46
So that's how I got involved in sports.
00:05:49
But, you know, after going to medical
school, I really didn't have much contact
00:05:54
with it.
00:05:54
I chose neurology or neurology chose me.
00:05:58
I actually, you know, you go through these
things in
00:06:01
school, are you going to do this, that,
and the other.
00:06:03
I thought I was going to do ophthalmology
and came back to New York and I was doing
00:06:09
my internship in New Rochelle, New York.
00:06:12
And one day a nurse said to me, she said,
you know, why don't you ever go to think
00:06:17
of going into neurology?
00:06:19
She said, you do so well with these
patients in our ICU who have had stroke
00:06:22
and these other problems.
00:06:23
And I always loved neurology and I never
really thought of myself as a neurologist.
00:06:28
And I called around to places where
00:06:31
I might be able to apply.
00:06:33
And at the University of Michigan, they
just happened to have an empty slot.
00:06:37
Somebody canceled.
00:06:38
And they said, well, if you could be here
in six weeks.
00:06:41
And I said, yeah, I could be there.
00:06:43
And sure enough, I went from a small
community hospital in New Rochelle, New
00:06:49
York to the University of Michigan, where
I did my residency and fellowship and
00:06:54
eventually spent some time teaching.
00:06:56
So it was a great place to be.
00:06:58
So neurology kind of found me.
00:07:00
And actually,
00:07:01
I still stay in touch with that nurse.
00:07:03
I spoke to her a couple of weeks ago.
00:07:04
She's retired now.
00:07:05
But just an offhand comment to somebody,
kind of praising them.
00:07:11
I mean, even at an older age, sometimes
you can give somebody that little bit of
00:07:17
encouragement that changes their whole
perspective and their whole view of
00:07:22
themselves and obviously change my life
and my family's life because now I have
00:07:27
two daughters who are neurologists.
00:07:36
So I guess there's something to be taken
from that.
00:07:39
yeah.
00:07:40
I think it's easy to wonder about how much
of a difference a person can make as one
00:07:47
individual in the world.
00:07:48
And it's so nice to hear examples like
that, where a really simple observation
00:07:53
with sincere intent can be a big
difference.
00:07:59
wasn't just an impact on your trajectory,
but everybody that you've treated.
00:08:04
And we'll get to more of that later.
00:08:05
But yeah, yeah.
00:08:07
Remember, folks, you have a lot of
potential to make impact for people in
00:08:12
ways that you might not even realize.
00:08:14
I am curious.
00:08:16
So in the introduction, we talked about
how you've been involved with a lot of
00:08:19
really major athletics organizations.
00:08:23
one of them, of course, I think when
people think concussion, they
00:08:26
automatically think about football.
00:08:28
And you have been involved with the NFL
Players Association.
00:08:31
How did you end up involved with the NFL
Players Association?
00:08:35
You know, this has been this real
evolution of a career that I didn't intend
00:08:41
to have.
00:08:43
In 1995, the New York Yankees moved their
AA affiliate to Norwich, Connecticut,
00:08:49
where I was in practice.
00:08:51
And
00:08:52
started working with the team.
00:08:54
They would call me for things, whatever
needed to get done, and developed a
00:08:59
relationship just working with them.
00:09:02
And they invited me to come to spring
training and said, you know, we've never
00:09:04
worked with a neurologist.
00:09:05
Now, you have to understand, 1995, we
weren't talking about concussion much.
00:09:10
A matter of fact, throughout my career in
medical school and in residency at the
00:09:15
University of Michigan, I never heard the
word concussion more than five times.
00:09:21
It's such a vague diagnosis.
00:09:23
We never use that term.
00:09:26
You know, it's not something you just nail
down.
00:09:30
And now, let's face it, we're doing a
podcast on concussion.
00:09:34
You can't open a magazine.
00:09:36
You can't watch a sporting about what
somebody talking about a head injury or a
00:09:40
concussion protocol.
00:09:41
So the word concussion itself is such a
vague term.
00:09:46
But yet the Yankees said, you know, we've
never worked with a neurologist.
00:09:50
And
00:09:51
we started working together back then.
00:09:53
Shortly after that, as I said, I was in
Norwich, Connecticut, and we were close to
00:09:59
the Foxwoods Casino and Mohegan Sun
Casino, and they hosted a lot of fights
00:10:05
like other casinos.
00:10:08
So they asked me to come down and go to a
fight.
00:10:11
Now, this was pretty weird because I'm a
neurologist, and I'm going to watch two
00:10:15
people beat each other up.
00:10:17
But I went to the first one and the
commissioner said, well, what do you
00:10:21
think?
00:10:21
And I said, well, I said, I don't really
mind helping you, but do I get to end the
00:10:27
fight?
00:10:27
And he said, yeah, that's your job.
00:10:29
He says, you think the fight's over, you
just get up and end it.
00:10:32
I said, then I'm your guy, as long as
you're OK with it.
00:10:37
So suddenly, I was in a situation where I
was watching and watching brain injury.
00:10:46
I say it's almost like having a lab.
00:10:48
I mean, let's face it, these are cruel
sports.
00:10:51
I mean, if we put two animals in there,
they'd be taking me off to jail.
00:10:55
But if you put two poor people in there
who need a check to beat each other up and
00:11:01
neurologically impair each other, that's a
sport.
00:11:04
So it's pretty weird from that standpoint.
00:11:09
So I saw myself and continue to see myself
as an advocate for the fight.
00:11:15
the person in there.
00:11:17
Because in boxing, just think about it.
00:11:21
I mean, in boxing, the object of the sport
is to neurologically impair your opponent.
00:11:27
There's no other sport like it.
00:11:29
In hockey, football, you still have to
score points.
00:11:32
But not in boxing.
00:11:34
You win by impairing neurologically your
opponent.
00:11:39
So I found that that would be a great
challenge to try and make
00:11:45
boxing safer.
00:11:46
And I've worked with and continue to work
with excellent people who understand that.
00:11:53
So a lot of what we do in boxing is
eliminate fights ahead of time based on
00:11:59
their pre -fight examination.
00:12:02
So we will bag them before they get in,
especially if we think it's a mismatch.
00:12:07
It depends on what you're doing.
00:12:09
Now, even in MMA, you can get a hold on
somebody and still win the fight.
00:12:14
without neurologically impairing them.
00:12:16
So, boxing was a particular challenge.
00:12:19
And the reason I bring that up is because
in 2011, DeMaurice Smith, who was then the
00:12:25
executive director for the NFLPA, reached
out to me and said, we're getting ready
00:12:30
for our collective bargaining agreement,
and I'd like you to come on board and work
00:12:36
with us.
00:12:37
Now, I'd never worked in professional
football.
00:12:39
I did work at the University of
Connecticut at the time on their sideline.
00:12:44
said, well, why me?
00:12:45
I mean, I have no contact with this.
00:12:48
And he said, because in 2009, you would
name the ringside physician of the year.
00:12:55
And he said, we don't want our sport to
become boxing.
00:13:01
Again, think about it.
00:13:02
He didn't want his sport to become a sport
where mothers don't want their kids to
00:13:08
play.
00:13:09
And in 2011, that collective bargaining
agreement
00:13:12
So much of it was based on safety.
00:13:15
Right away when you hear collective
bargaining, it's about the money.
00:13:17
He didn't make it about the money.
00:13:20
Also, think back then.
00:13:22
The NFL back then was still working on the
premise that concussion is not an issue in
00:13:28
the sport of football.
00:13:29
They would tell me that to my face in
meetings, which were not very pleasant.
00:13:35
But so we went in 2011 to where we are
today.
00:13:40
in promoting safety.
00:13:41
And the NFL Players Association continues
to drive that position.
00:13:47
So it's kind of a long answer to your
question, but it's interesting how
00:13:52
everything started linking together,
especially with respect to the NFLPA and
00:13:58
the insight of a brilliant man like
DeMaurice Smith.
00:14:02
That's so, I mean, what foresight, right,
to be able to see that coming and to
00:14:07
address it as early as he did.
00:14:09
I love that you've taken this on to work
with athletes in so many different sports.
00:14:14
You've worked with professional bull
riders.
00:14:17
You've worked with Coast Guard Academy.
00:14:19
You've worked with WNBA.
00:14:20
What do you love about working with
athletes in particular?
00:14:23
Yeah.
00:14:24
What I love is the fact that I know
they're going to do what they have to do
00:14:31
to get better.
00:14:32
You know, there's this athlete mind, I
call it.
00:14:37
And it pertains to any illness.
00:14:41
I've had patients with Lou Gehrig's
disease.
00:14:45
It's going to be terminal.
00:14:48
And athletes take a different position.
00:14:51
And no matter how bad it is, a brain
tumor, Lou Gehrig's disease, they get back
00:14:56
to the point of, OK, yeah, all right.
00:14:58
Well, how do I get better?
00:14:59
They're not taking this thing that this is
terminal, this is over.
00:15:04
Never.
00:15:06
they just want to get back to the gym as
quick as they can and start working it
00:15:09
out.
00:15:10
And that's what I love because they're
going to listen to me.
00:15:13
First of all, they know how to take
information and guidance and digest it.
00:15:19
Whereas other patients kind of, and these
are, many of these are former athletes,
00:15:26
they're not even professional athletes,
but having that athletic background makes
00:15:32
them think, yeah, okay, I know what you're
telling me, but all right, what's the
00:15:36
for getting better.
00:15:36
I need a plan and I'm going to follow it.
00:15:39
And they do.
00:15:41
And I think it adds to their longevity.
00:15:44
It's that attitude.
00:15:47
And yeah, that's what gets me going.
00:15:49
Those are the people you want to work
with.
00:15:52
Is that also something that makes it
challenging to work with athletes?
00:15:56
Good point.
00:15:58
Well, let me explain why.
00:16:00
Okay.
00:16:01
I'm laughing, but let me explain why.
00:16:03
There are two types of athletes.
00:16:06
There are employed athletes, right?
00:16:08
So when I work with baseball players,
football players, they go on the IL,
00:16:14
right?
00:16:15
They're injured, they go on an IL, they're
still getting a paycheck.
00:16:21
Then there are self -employed athletes,
right?
00:16:24
So combat sports athletes, the bull
riders, cyclists, I'm sure again, you're
00:16:32
self -employed.
00:16:34
You're paying your own way.
00:16:35
You go down.
00:16:37
Nobody's paying your house bills.
00:16:39
Right.
00:16:39
So, you know, you have some sponsorships.
00:16:42
So here's the rule.
00:16:45
Employed athletes lie to me about half the
time when they're ready to go back.
00:16:51
Self -employed athletes lie all the time.
00:16:54
OK.
00:16:55
Because it's no play, no pay.
00:16:57
Right.
00:16:57
I mean, so I really have to figure out,
you know, who
00:17:03
who's running some jive by me here so they
can get back on the bike, right?
00:17:08
So you have to take that all into
consideration, and especially with boxing.
00:17:14
I mean, it's so funny.
00:17:16
I go back to boxing because it's that
extreme example, right?
00:17:20
I'm sitting there witnessing brain injury.
00:17:24
And I've learned a lot because I've
learned that the human brain is a very
00:17:29
resilient organ if you treat it right.
00:17:32
So if they get hurt, as long as they rest
it for a period of time, the brain will
00:17:38
repair itself.
00:17:39
It's when they keep going back and start
sparring a few days later, things like
00:17:45
that.
00:17:46
So in those situations, you learn an awful
lot about the athlete.
00:17:52
But also, again, we said boxing, these are
athletes who come from
00:17:58
When you look at the history of boxing,
it's always people in the lowest
00:18:02
socioeconomic level, right, who have to do
that.
00:18:05
I mean, nobody, I mean, we look at these
higher level athletes, but that's few and
00:18:10
far between.
00:18:11
There are combat sports events going on
everywhere in the United States every day.
00:18:16
And many are people who are down on their
luck, may have just gotten out of prison,
00:18:22
and are trying to make a few hundred bucks
by going in a ring and getting beaten up.
00:18:27
So.
00:18:28
Again, that's where you have to be really
careful with a sport and advocate for the
00:18:35
fighter.
00:18:36
Yeah.
00:18:37
Yeah.
00:18:37
I think the advocation for the athlete is
so big, and that's one of the things that
00:18:41
I really appreciate that comes through in
all of the research I've done, all the
00:18:44
interviews, and of course, our work
together.
00:18:46
I want to expand on that for just a minute
because I think there are definitely the
00:18:50
financial incentives, but also from a
psychological perspective.
00:18:55
You don't get to a high level of sport
without loving the sport and really having
00:18:59
committed yourself to it for a really long
time.
00:19:01
So there's financial risk, but there's
also a really deep psychological risk,
00:19:06
right?
00:19:07
To loss of identity and this idea that
you've put all of this time and effort
00:19:13
into pursuing maybe your life's dream and
it's become your life's work.
00:19:19
And the idea that you might need to take
time out from that or you might not be
00:19:22
able to...
00:19:24
know, enter the renex race, or you might
have to sit out the season.
00:19:27
Those are not things that really any
athlete wants to hear at any level.
00:19:32
Absolutely.
00:19:33
So, you know, that's where the rehab piece
comes in, I think.
00:19:37
Let's get into that.
00:19:39
Let's talk about a high -level overview of
brain injury.
00:19:43
I think most of our audience, they've
heard of concussion, they've heard of TBI,
00:19:49
traumatic brain injury, but let's kind of
establish some definitions for the
00:19:53
purpose of discussion.
00:19:54
So is there a difference between
concussion and a traumatic brain injury,
00:19:58
and if so what is that difference?
00:20:01
And I know you mentioned in your questions
you sent me you know, I'm sure you want to
00:20:07
give some disclaimer about treating injury
and stuff.
00:20:11
Obviously, I'm not going to treat
anybody's specific injury over a podcast.
00:20:15
But I think today, as we move through
this, I hope to give every listener
00:20:20
actionable information.
00:20:23
information that will help them either
with respect to their current brain health
00:20:29
or recovery from a brain injury.
00:20:31
I think that's our goal from that
standpoint, and it can be done.
00:20:38
So, I really want to make that point.
00:20:40
As a matter of fact, by the time we're
done with the questions you asked, I think
00:20:44
most of your listeners, they will know
more than most physicians about a
00:20:49
concussion.
00:20:50
But we'll see.
00:20:50
That's wonderful and also scary.
00:20:53
Well, let's go right off the bat.
00:20:55
You asked about concussion and TBI.
00:20:58
So when you look at traumatic brain
injury, we're looking at a range of
00:21:02
injury.
00:21:03
So the most severe traumatic brain injury
is obviously a penetrating trauma, a
00:21:10
gunshot, a shrapnel wound to the brain.
00:21:12
That's the most severe.
00:21:14
The most mild in that range is a
concussion.
00:21:19
that's why some people refer to it as a
mild traumatic brain injury.
00:21:24
What makes it hard to diagnose this, as I
said, it's vague.
00:21:28
It's a functional disturbance.
00:21:31
So, it's not a disturbance where you're
going to see something on a CT scan or an
00:21:35
MRI or some outward sign.
00:21:39
It's a functional disturbance.
00:21:42
And to understand that, we need to take a
step back again and look at the brain.
00:21:47
What makes up the brain?
00:21:49
the brain is basically a network of wires.
00:21:52
When I give a slide presentation, I show
kind of like the traffic pattern, right?
00:21:57
You see where it's green, it's red.
00:22:00
Once you upset that network, everything
turns red because things are not talking,
00:22:05
things are clogged up.
00:22:06
That's a concussion.
00:22:07
And the question becomes, can you get it
back to working to where it was?
00:22:15
And if so, how?
00:22:18
And that's, I think, the important part of
what we're discussing today.
00:22:23
So when we think of a discussion, a
definition of concussion, it is a
00:22:29
syndrome, a group of symptoms that are
transient.
00:22:34
So it's transient neurologic syndrome as a
result of a biomechanical force applied to
00:22:41
the brain.
00:22:42
Now, that injury could be direct, such as
getting hit on the head.
00:22:47
or it can actually be indirect, such as a
whiplash type of injury or something of
00:22:55
that nature where the brain rattles within
the skull.
00:22:59
So again, that's the best working
definition.
00:23:03
Now, we used to say it was immediate and
transient, and it doesn't have to be
00:23:09
immediate.
00:23:10
Usually, at the most, it would take at
least 48 hours, okay?
00:23:15
Often it's immediate.
00:23:17
But sometimes you can see some delayed
symptoms of a concussion or a traumatic
00:23:22
brain injury.
00:23:23
So we take that into consideration with
the definition itself.
00:23:28
The difference with athletes is that when
someone hits their head in a car accident
00:23:34
or falls down the stairs, you don't assume
that they're going to fall down the stairs
00:23:38
or get in another car accident.
00:23:40
But when I see a cyclist, and I saw a
mountain biker the other day.
00:23:44
I'm pretty much assuming he or she is
going down again somewhere along the way.
00:23:49
So that's what makes the difference in
treating athletes is you have to have this
00:23:55
implicit understanding that, okay, this
happened now.
00:23:59
It may have happened in the past, but it's
going to happen again if they're going to
00:24:03
continue their sport.
00:24:04
So that's what really distinguishes the
treatment and definition of concussion
00:24:09
when you get to an athlete as opposed to
00:24:14
someone tripping and falling in a store or
something of that nature.
00:24:17
That makes sense.
00:24:19
One of the questions our listeners posed
was, can you sustain a TBI without hitting
00:24:22
your head?
00:24:24
And before you dive in to answer that, let
me just share, I remember when I came to
00:24:27
see you and one of the things I said to
you was like, I wasn't sure if it was
00:24:32
concussion because I didn't hit my head.
00:24:34
And you said, you don't have to hit your
head.
00:24:36
And I kind of, I don't mean to answer the
question for you, but I just remember in
00:24:39
that moment, I experienced
00:24:42
this whole montage of my career and all of
these hard falls that I'd had and realized
00:24:49
that I had been racing my bike for over 10
years with a very inaccurate assumption
00:24:57
that I had to hit my head to get a TBI.
00:25:00
So, with that, I'll let you answer the
question.
00:25:02
Yeah.
00:25:03
So, we see that quite a bit.
00:25:06
Also, you know, so we see that movement.
00:25:09
You have to understand.
00:25:10
So, when we think of
00:25:13
biomechanics of it, right?
00:25:15
So there's these linear vectors going back
and forth, and there's a rotational
00:25:20
vector.
00:25:20
And that's why in boxing or even in
football, the most punishing blow is an
00:25:26
uppercut, because you can impart not only
a linear, but a rotational vector, right?
00:25:32
So just think about that, because you
don't need to have a blow to the head,
00:25:38
especially in cycling, right?
00:25:40
To have -
00:25:41
an impact where the bike suddenly stops,
right, and you don't, all right, and
00:25:47
there's this rotational and linear vector
applied to the brain at high speed.
00:25:53
So with that, you don't, you clearly do
not.
00:25:57
Now another thing we often see is an
association with similar symptoms to
00:26:03
concussion, but they're coming from a neck
injury, and you don't want to miss the
00:26:08
neck injury.
00:26:09
So we call that
00:26:10
cervicogenic disease.
00:26:12
Okay.
00:26:13
So a headache and dizziness, right?
00:26:16
So headache, dizziness, vomiting, you
know, the whole thing, but can be coming
00:26:24
from the neck.
00:26:24
But you don't want to make that assumption
early on.
00:26:27
Acutely, you want to get it worked up as
if it's a concussion, but often we need to
00:26:33
focus on the neck in terms of our rehab.
00:26:36
That's interesting.
00:26:36
Yeah.
00:26:37
So if you focus too narrowly on
concussion, you might miss
00:26:40
neck injury that could, you know, cause
ongoing issues?
00:26:43
Absolutely.
00:26:44
And we see that very often.
00:26:46
We see that often in baseball, oddly
enough, because baseball is the hardest
00:26:52
sport to come back to after a head injury.
00:26:55
And you could imagine why, and
specifically hitting a baseball, because
00:26:59
you have to have such good eye -hand
coordination.
00:27:02
You have to pick up the spin of the ball
as it's coming and know when to react.
00:27:08
And
00:27:09
it's in such a short period of time, just
think if that network is not working in
00:27:15
its best situation, you're going to be in
trouble.
00:27:18
So often baseball players are the biggest
challenge and specifically hitting a
00:27:23
baseball to getting back to their full
participation.
00:27:28
That's so interesting.
00:27:29
So one of our listener questions before we
move on from this, they ask, what's the
00:27:34
difference between an innocuous bump on
the head and a concussion?
00:27:38
Great question.
00:27:39
Because we've almost created a concussion
paranoia out there, okay?
00:27:45
So everybody thinks we've all hit our
heads in the attic, right?
00:27:49
You got up too quick.
00:27:50
You were under a table doing something.
00:27:52
There's a big difference between hitting
your head and having a concussion.
00:27:56
Don't forget, as we said, the definition
of concussion is a syndrome, right?
00:28:00
So it's a group of symptoms.
00:28:03
Could be a loss of consciousness, but
doesn't have to be, right?
00:28:07
You could have nausea, dizziness,
persistent headache.
00:28:12
But the thing I look for the most, and
this is where we're getting into, I'm
00:28:20
going to make your listeners the smartest
people in the sports bar, okay, right now.
00:28:26
Because here I am at ringside, right?
00:28:29
And I'm watching a fight, and then
suddenly I get up and end the fight.
00:28:34
before the fighter has gone down before
they're bleeding.
00:28:38
Naturally, that's when everybody booze,
but I'll tell you what I'm looking for.
00:28:43
I'm looking at their feet.
00:28:46
I'm looking at their feet because if they
develop unsteady gait, that means their
00:28:53
feet are uncoordinated.
00:28:56
So if you're watching a fight in a sports
bar with your friends and you see a
00:29:00
fighter go down and gets up and he's
00:29:03
he or she are just not feeling their
balance.
00:29:06
They are so -called flat -footed.
00:29:09
That fight's going to end pretty quickly
and not well, because if they can't
00:29:13
coordinate their feet, they also can't
coordinate their hands.
00:29:16
And now I potentially have a defenseless
fighter.
00:29:20
So I'm looking at their feet.
00:29:24
The same holds true for other athletes.
00:29:28
So when I'm on the sideline watching a
game, I'm looking for three things.
00:29:33
And I think, again, your listeners should
bear this in mind.
00:29:36
Even if you're a parent at a soccer game
or so, we all should be observers, whether
00:29:43
it's your team, the other team, whatever
it is.
00:29:45
The three things to look for are, is it
taking the athlete longer to get up from
00:29:51
the ground than they should?
00:29:53
Did they need help getting up?
00:29:56
And after getting up, going back to the
huddle or playing, is their gait unsteady?
00:30:03
If you see those three things, it's time
to tell the coach to at least bring them
00:30:07
to the sideline and ask a couple of
questions to see what's going on.
00:30:11
You could see the same thing when someone
gets the wind knocked out of them.
00:30:15
You could see it in other circumstances.
00:30:18
But again, the possibility of that person
having a concussion is relevant.
00:30:26
The other problem with this is understand
when someone's been hit in the head,
00:30:30
they're not the best informant, right?
00:30:33
You've got an impaired informant.
00:30:35
So you're trying to get information from
someone who may have had some amnesia for
00:30:40
the event.
00:30:42
So that's what makes it pretty challenging
from that standpoint.
00:30:46
But those three things are key if you're
watching an event and especially if it's a
00:30:52
children's event.
00:30:53
where you may not have EMS, you don't have
athletic trainers.
00:30:58
You know, as parents and grandparents, we
all need to participate in the process.
00:31:03
I love that.
00:31:04
Yeah.
00:31:05
So a couple of follow -up questions for
you on that.
00:31:07
One is, so with cycling, for example,
there's kind of two scenarios that come up
00:31:12
in cycling.
00:31:13
One is during a competitive event, and one
is during training.
00:31:16
Training is a little bit, and there's
different constraints for each scenario.
00:31:19
So in a competitive event, you actually do
00:31:22
probably have more third party observers.
00:31:25
So you have, you know, team directors in
the cars following the race who might
00:31:29
either witness the fall or witness the
aftermath of the fall.
00:31:32
You have mechanics, you have other staff,
you have other riders who can observe the
00:31:37
athlete who may have fallen.
00:31:38
But what's interesting about the gait is
that once the athlete gets back on the
00:31:42
bike, their feet are clipped into the
pedals.
00:31:44
And so you're not necessarily going to see
a disruption in gait as they're pedaling
00:31:49
if they do get back on the bike.
00:31:51
Is that something like as a third party
observer in a race scenario, would you be
00:31:56
looking specifically for, okay, I need to
be really focused on watching this athlete
00:32:00
get up from the ground?
00:32:02
What would you suggest in that situation?
00:32:05
That's an interesting situation.
00:32:07
So it's interesting because when you bring
up cycling, we know that the first reflex
00:32:12
when a cyclist goes down is what?
00:32:15
Get back on the bike.
00:32:17
As fast as you can.
00:32:17
Get back on the bike.
00:32:26
Also, are they making good judgments?
00:32:29
Are they performing the way they should?
00:32:32
So in this case, again, you're not
watching their feet, but by the same
00:32:37
token, are they hesitant to get back on
the bike?
00:32:40
Meaning, are they scrambling to look for
parts?
00:32:43
Are they just not following the transition
sequence that we would expect?
00:32:50
right?
00:32:50
Because right away they're looking around,
they got the bike, they're getting ready
00:32:54
to clip in.
00:32:55
Is there that moment of pause where
they're not sure of where they are or what
00:33:01
they're doing?
00:33:02
So I would look for that acutely in a
cyclist.
00:33:05
That would be the best way to look at
that.
00:33:08
That makes sense.
00:33:10
The other thing that's complicated about a
race scenario, and I'm speaking
00:33:14
specifically about road cycling, that's
where my - I gathered that.
00:33:17
My experience is -
00:33:19
this can hold true for some mountain bike
races too, but they don't stop the race,
00:33:22
right?
00:33:22
So if there's a crash, the expectation is
that the race keeps going.
00:33:26
So if somebody hits the deck, it's up to
them to make the decision to get back on
00:33:30
the bike and get back in the race.
00:33:32
And the longer they take to make that
decision, the more, the higher the chances
00:33:36
that they're not going to, you know, be
able to reconnect with the race and, and
00:33:40
participate.
00:33:42
So the athlete, you know, they are
00:33:45
100%, I got to get back on the bike as
fast as I can, that adds an element of
00:33:51
complication.
00:33:52
Like there's no, you know, we don't get to
go to the corner of the ring.
00:33:55
There's no bench where we can sub somebody
in.
00:33:58
How risky is it to keep going if you have
sustained a concussion versus stopping in
00:34:05
that scenario?
00:34:06
Or is there a way to generalize that even?
00:34:08
Interesting.
00:34:10
It's an interesting question because
00:34:14
Well, let's get to the physiology because
I think that will explain it a little bit
00:34:18
better.
00:34:19
When we think of a concussion, it's a
cellular change that we've been able to
00:34:25
demonstrate.
00:34:27
So what happens is there's a breach in a
nerve cell wall in your brain, like many
00:34:34
of them.
00:34:35
The nerve cell is kept in balance by
calcium being outside the cell and
00:34:41
potassium being inside the cell.
00:34:44
When you breach that wall, calcium rushes
in and causes swelling and damage to the
00:34:52
cell.
00:34:53
So to use an analogy, if you had a leak in
your basement, there was a crack in the
00:34:58
wall, right?
00:34:59
Water's rushing in.
00:35:01
So what you have to do now is pump that
water out as fast as you can.
00:35:07
It's the same thing the cell is doing.
00:35:09
It has these little pumps in the membrane.
00:35:13
that require energy in the form of ATP to
drive them and get the calcium out.
00:35:19
What really happens is it's an energy
deficit.
00:35:22
So when you have this concussion and all
this going on, your brain demands more
00:35:29
oxygen, more circulation at a point where
it's getting less.
00:35:35
So what you're dealing with in the brain
is an energy deficit between the need for
00:35:41
energy
00:35:42
and your body's ability to produce that
energy.
00:35:47
So what will happen in the most extreme
case is you lose consciousness.
00:35:53
Your brain is saying, I can't keep up.
00:35:56
We're shutting down and rebooting this
thing.
00:36:00
So that's what's happening.
00:36:02
Now, when we talk about people who have
the second impact syndrome or things that
00:36:08
get worse, if you can imagine that you
have this crack,
00:36:12
you're trying to repair it and you go back
and you don't take yourself out of the
00:36:17
game and you get hit again.
00:36:19
Now you've got another crack, right?
00:36:22
So you've overwhelmed these cells with
swelling that can cause so much brain
00:36:28
swelling and eventually end in death.
00:36:31
Now to get back to your analogy, let's
think about it.
00:36:34
So you've had this head injury and you're
getting back on the bike.
00:36:38
So now your body is trying to repair
00:36:50
something has to give.
00:36:52
So what will happen is your neurologic
symptoms will worsen, whether they be
00:36:58
headache, nausea, in coordination, any of
the things I talked about.
00:37:05
And especially confusion, okay, because
your brain can't work properly.
00:37:11
And
00:37:11
can't work too well either.
00:37:14
So you're really at this energy...
00:37:16
So it becomes readily apparent that if
that's the case where you've had a
00:37:22
concussion and you're going to try and
keep going, you're not going to be very
00:37:26
successful.
00:37:27
Can't be.
00:37:29
So hopefully the athlete listening to this
podcast will understand that because now
00:37:36
you've amplified the damage.
00:37:38
So where you might have been able to shut
it down and come back the next day for the
00:37:43
next stage, right, you may be down for a
week now.
00:37:47
So you really have to understand the brain
and some of that basic physiology.
00:37:56
And it's something athletes can understand
because they understand oxygen, right?
00:38:00
Everybody's measuring their VO2 max,
right?
00:38:03
Everybody's got a ring or a watch.
00:38:06
Everybody's, they're into those numbers.
00:38:08
Well, those numbers don't lie when it
comes to the brain either.
00:38:12
So yeah.
00:38:13
Yeah.
00:38:13
I think your point about taking being out
for, you know, the rest of the day or a
00:38:19
day or a week versus, you know,
compounding that into weeks, months is a
00:38:24
really point, a point well taken.
00:38:26
And I can, you know, I'm thinking back on
my career, how many times I hit the deck
00:38:30
really hard.
00:38:31
And my, my thinking in the moment was, you
know, which I,
00:38:36
The concussion that I sustained when I
came in to see you, I'll never forget, I
00:38:41
hit the deck really hard.
00:38:43
But my first thought was, well, I didn't.
00:38:44
And that was a gravel race, right?
00:38:46
Exactly.
00:38:47
That was a gravel race.
00:38:47
No, because you're, listen, you have,
Amber, you have the rare distinction of
00:38:51
being the only gravel racer I've ever seen
in my career.
00:38:55
It's true.
00:38:57
That's funny.
00:38:58
So yeah, I hit the ground and I remember
thinking, okay, I didn't hit my head and I
00:39:02
did this kind of quick head to toe
assessment and thought,
00:39:05
If I can get on my bike, I should.
00:39:07
And my follow -up thought was, if there's
something really wrong, I'll deal with it
00:39:12
at the finish line.
00:39:13
Not thinking that the time between me
getting back on the bike and the finish
00:39:18
line could be that most important time
window of either exacerbating an issue or
00:39:27
giving me the opportunity to heal and
rehabilitate faster.
00:39:32
So, this is, to any athletes listening, I
think, learn from my mistakes.
00:39:39
It's the same mistake of many.
00:39:41
And it's part of that athlete mentality
that we talked about.
00:39:45
yeah.
00:39:46
I mean, I think, honestly, I think I must
have been in shock.
00:39:49
And in that race, the reason I stopped
wasn't because of cognitive impairment.
00:39:52
It was because I had hit my knee in the
fall and my knee started swelling.
00:39:56
And I thought, well, in my, and again,
this just goes to show the -
00:40:01
my lack of understanding in the moment, I
saw the knee swelling and I thought, well,
00:40:05
it's not worth it to me to finish this
race and have a lifelong knee injury, so
00:40:09
I'm going to stop.
00:40:10
But it never occurred to me to think, it's
not worth it to me to finish this race and
00:40:14
have a lifelong or season long brain
injury, so I'm going to stop.
00:40:20
And that just speaks to the visibility of
it, right?
00:40:22
Yeah.
00:40:22
Sure.
00:40:23
The inexperience and just general social
awareness and cultural awareness within
00:40:29
sport, I think, makes a big difference.
00:40:31
So this is one of the questions that came
up a lot, which was, how can I even tell
00:40:35
if I have a concussion?
00:40:37
So let's set the racing aside for a
moment.
00:40:39
A lot of people ride for fun, or even as a
competitor, I spent most of my time on
00:40:45
training rides, not necessarily in races,
where I may be riding alone.
00:40:50
I don't have a team doctor following me,
and maybe I hit the deck, and it's likely
00:40:57
if I do have a concussion that I'm
impaired,
00:41:01
is there a way that somebody could like
self -assess in the field, so to speak?
00:41:06
That's a tough one because you're already
impaired, right?
00:41:10
So, you know, you'll know.
00:41:13
I mean, when your head starts pounding,
you'll know something's wrong.
00:41:18
If you can't remember the circumstances
for which you went down, which retrograde
00:41:24
amnesia is not uncommon, you're going to
suddenly start to realize this while
00:41:30
you're on the ride.
00:41:31
or you're going to note that you're making
stupid mistakes, things that should be
00:41:38
automatic, like shifting, right?
00:41:40
I mean, for a racer, shifting is
automatic, right?
00:41:44
You know when you have to shift.
00:41:46
And if you find yourself in the wrong gear
or just things aren't working that
00:41:53
smoothly after you've had a fall, it's
time to reassess.
00:41:58
But again, it's hard to self -assess
00:42:01
after you've been impaired.
00:42:03
That's what makes it difficult.
00:42:05
But I think that as you get back on the
bike and you're riding and you're saying,
00:42:11
something's not right here, it's time to
shut it down.
00:42:17
Yeah.
00:42:17
And so at that point, let's say whether
you're in a race or you're in a training
00:42:20
ride and you've decided something's up and
you need to shut this down, what are the
00:42:26
steps for seeking treatment?
00:42:27
Who should you be speaking to and how do
you follow up on that?
00:42:32
So there's a succession of things.
00:42:35
So first of all, the question becomes, do
you need emergency care in terms of the
00:42:42
level of injury?
00:42:44
Do you need a CT scan?
00:42:46
Did you hit your head directly?
00:42:48
So the initial assessment is, do I need to
get to an emergency room?
00:42:51
Do I need to get that urgent care?
00:42:54
If you've been cycling at high speed and
you hit your head, you better get to the
00:42:58
emergency room.
00:42:58
Right.
00:43:00
And I almost hate to say this, but
00:43:02
they say, well, the radiation, the
radiation is minimal.
00:43:02
And I have a very low threshold in the
case of an acute injury to get a CT scan,
00:43:02
because it gives you so much information.
00:43:02
And you remember we talked about this
range of illness, right?
00:43:02
So, you know, you're going to have to go
to the doctor, you're going to have to go
00:43:02
to the doctor, you're going to have to go
to the doctor, you're going to have to go
00:43:02
to the doctor, you're going to have to go
to the doctor, you're going to have to go
00:43:02
to the doctor, you're going to have to go
to the doctor, you're going to have to go
00:43:02
to the doctor, you're going to have to go
to the doctor, you're going to have to go
00:43:02
to the doctor, you're going to have to go
to the doctor, you're going to have to go
00:43:02
to the doctor, you're going to have to go
to the doctor, you're going to have to go
00:43:02
to the doctor, you're going to have to go
to the doctor,
00:43:30
you know, when you're down here at
concussion at the lower end, getting a CT
00:43:34
scan isn't that big a deal.
00:43:35
But what you don't want to miss is the
other end and the so -called subdural
00:43:42
hemorrhage or hematoma or epidural
hematoma.
00:43:46
Now, the epidural hematoma is every
person's nightmare, every physician, every
00:43:53
athletic trainer's nightmare.
00:43:55
And to use the analogy of Natasha
Richardson.
00:43:59
that you've heard her story, and I've had
a similar story in the last few months
00:44:07
where I was called actually by a law firm
of all people.
00:44:11
And it was a situation where a young man
hit his head in a soccer match.
00:44:19
I think it was a head to knee collision.
00:44:21
They were in another state, and the
athletic trainer assessed them.
00:44:27
They didn't put him back in, but
00:44:29
dad was going to drive him home rather
than have him go to a hospital or
00:44:33
something of that nature.
00:44:34
And on the way home, he started to decline
rapidly.
00:44:39
And father had enough sense to get him
right to an emergency room and he had an
00:44:42
epidural hemorrhage.
00:44:43
He would have died, really.
00:44:45
And the fact that he's still alive
competing is fairly miraculous.
00:44:49
In the Natasha Richardson case was, you
know, she had been skiing, hit her head in
00:44:53
Canada and
00:44:55
went down, saw the EMS people.
00:44:57
They wanted her to go to the emergency
room to get a scan.
00:45:00
She refused.
00:45:01
The ambulance actually came to the
mountain and she still said, no, I'm
00:45:06
feeling fine.
00:45:07
Goes back to her condominium and dies.
00:45:11
So there's this clear period where
everything's back to normal, but there's
00:45:17
this hemorrhage coming from an artery in
the brain that eventually often leads to
00:45:23
someone's total demise.
00:45:25
So again, I have a low threshold for
getting a CT scan in those situations.
00:45:31
Now, outside of the emergency care, you
know, seeing your primary care physician
00:45:37
is fine, but it's, you know, you have to
understand also, somewhere around 90 % of
00:45:44
all concussions get better in two weeks,
right?
00:45:47
That's the beauty of it.
00:45:48
That's really encouraging.
00:45:50
here's what it is.
00:45:51
Everybody's got a concussion clinic.
00:45:53
I mean, we got everybody treating
concussions.
00:45:56
And I'll probably get some, I'll get
calls, but I mean, there are dentists who
00:46:00
have concussion clinics, chiropractic
concussion clinics, psychologists have
00:46:04
concussion clinics.
00:46:06
I mean, you don't have to be a Phi Beta
Kappa to take care of something that gets
00:46:08
better in two weeks, okay?
00:46:10
So, there is that period of time.
00:46:13
The real issue comes in is when it's not
getting better.
00:46:18
What I tell people who have not gone to
the emergency room,
00:46:21
is what we like to do is observe somebody
for a period of hours, four hours or
00:46:27
whatever, or if they go home, make sure
they're being observed because if they're
00:46:31
not getting better or getting worse, it's
time to get to the emergency room.
00:46:36
But in the long run, seeing a neurologist
who has expertise in seeing sports
00:46:43
injuries makes a big difference because of
the way we approach the brain.
00:46:51
from that standpoint.
00:46:52
But again, primary care sports, people do
a great job of it.
00:46:56
They see a lot of concussion.
00:46:57
You want to see a doctor who sees a lot of
concussion and athletes, as opposed to
00:47:04
just seeing concussion in the legal arena,
for lack of a better term.
00:47:10
Yeah.
00:47:11
So one of our listener questions that's
relevant to this is, why is it that most
00:47:15
doctors are not trained in the area of
concussion?
00:47:18
So I'm curious about that, because I do
think that
00:47:21
does seem to be a lag between kind of the
latest research and clinical application.
00:47:26
And if somebody is seeking care, you know,
not emergent care, but through maybe a GP
00:47:33
or somebody, why is it that most doctors
aren't trained in this area?
00:47:36
And then a follow -up question to that is
how can people advocate for themselves to
00:47:40
get to see somebody who would have this
background and this perspective?
00:47:45
Well, myself and my daughter Stephanie are
always available in terms of
00:47:52
we know where there are these pockets of
people who do it better than other people.
00:47:58
It's hard because it's a complicated, it's
not that simple.
00:48:02
Even though I said it gets better in two
weeks, the ones that don't get better are
00:48:08
difficult to manage.
00:48:10
So the question becomes, I think we've
made great strides with physicians
00:48:14
recognizing a concussion.
00:48:16
And if anything, the pendulum has swung in
the other direction.
00:48:20
in terms of recognition of concussion.
00:48:23
But by the same token, I'd rather it go
that way.
00:48:25
I'd rather people have a low threshold for
it, and then we clear it up.
00:48:29
Because we haven't even talked about the
features that make it worse.
00:48:35
Like, for example, if someone has migraine
headaches, guess what's going to happen if
00:48:39
you hit your head?
00:48:40
Probably going to get a migraine.
00:48:42
So is this, are we treating migraine now,
or are we treating a concussion?
00:48:47
People who have depression.
00:48:50
brought up the idea of someone who may
have some baseline depression now is taken
00:48:55
away from the one thing they love, their
sport.
00:48:58
What do you think is going to happen?
00:48:59
They start feeling more isolated.
00:49:02
That's why I like to have my athletes,
even after they have had a concussion,
00:49:06
still working out with their team.
00:49:09
Whether they're riding the bike on the
sideline, they have to be part of the
00:49:13
action.
00:49:14
You don't want to just leave them isolated
in a room or doing something else.
00:49:19
because they're going to fall into a
depression.
00:49:22
The mental health aspects of it are a
whole other thing, probably a whole other
00:49:27
podcast, but certainly something that you
need to take into consideration.
00:49:33
And the treatment of concussion, it
changes all the time.
00:49:37
I had someone come to me in a situation
where I was giving a deposition on a case
00:49:44
and
00:49:44
the lawyer said, well, you know, doctor,
we have it here that in 2015, this is what
00:49:50
you said.
00:49:51
Listen, this business changes every day.
00:49:54
What I said in 2015 certainly doesn't
apply to what I know today.
00:49:59
I mean, this is science.
00:50:00
I mean, but lawyers think that once you've
said it or they have a record of it on a
00:50:05
blog or on this podcast that it's suddenly
set in a tablet somewhere.
00:50:11
So anyhow.
00:50:11
it's going to change.
00:50:12
And I think that's hard for a lot of
physicians unless this is something you do
00:50:16
a lot.
00:50:17
Yeah.
00:50:17
Yeah, that makes sense.
00:50:18
And that speaks to the importance of
seeing a specialist who has this
00:50:21
experience and who is on top of that.
00:50:24
So what are some things that you would
look for if somebody came in to see you
00:50:28
with having had either, you know, direct
blow to the head or a hard fall?
00:50:33
What are some of the things that you would
be looking for in terms of diagnosis?
00:50:36
Well, a couple of things.
00:50:37
First of all, one of the key things in
neurology is
00:50:41
to just sit and listen to the patient.
00:50:43
Just listen to them because typically
they're going to paint a picture.
00:50:48
Now, the visit takes a long time.
00:50:50
I mean, you've got to be willing to sit
there for an hour because you've got to
00:50:55
get out of them exactly what has happened
and what they're describing.
00:51:00
You also need to go back into their past
history to have a good understanding of
00:51:04
that person.
00:51:04
Don't forget, I've never seen this person
before.
00:51:06
I'm not their primary care doctor.
00:51:08
I don't know what else is going on in life
and what their other problems have been,
00:51:14
what their genetics are, right?
00:51:16
So a lot of times getting a concussion
will provoke the first migraine they've
00:51:22
ever had in someone who has a strong
family history of migraine headaches.
00:51:28
So again, you know, I often say if you've
seen one concussion, you've seen one
00:51:33
concussion and that's truly the case.
00:51:35
And that's why I
00:51:37
I resent these protocols, right?
00:51:39
We've got protocols.
00:51:42
And maybe resent is a strong word, but
understand a protocol is designed for
00:51:49
research, right?
00:51:51
So that everybody involved in a research
project does everything the same way.
00:51:55
That's what a protocol is.
00:51:58
So what we've done is we've created
protocols for people who are not fully
00:52:04
trained as physicians or
00:52:07
or even as medical personnel to say, okay,
you hit your head, this is what you do to
00:52:13
get better, right?
00:52:14
Stay away from screens, no noise, you go
to sleep, you need to sleep this man.
00:52:19
Doesn't work.
00:52:21
Every person is different.
00:52:24
So, we have to recognize that right from
the beginning.
00:52:27
Now, having a protocol even to get someone
back to their activity is different
00:52:34
because it's different based on their
sport.
00:52:37
So we've tried to simplify things and
maybe messing it up because a lot of times
00:52:44
I'll see an athlete who's on this protocol
and they're out for two weeks and I'm
00:52:48
like, you can go back today.
00:52:52
This has got nothing to do with hitting
your head.
00:52:55
You know, you've got a migraine headache,
here's the medication, go back and play.
00:52:59
Or it's something totally different.
00:53:01
So I think people are surprised that when
they come to see me, and I noticed this
00:53:05
was
00:53:07
with the professional bull riders, right?
00:53:09
They, when we started seeing them, I think
there was this feeling that, no, no, no,
00:53:14
send him to see the neurologist, he's
going to end my career.
00:53:18
So they would fly them here to the
University of Connecticut.
00:53:21
And the first two folks we saw, we saw one
fellow who, really, he thought his
00:53:29
headaches were from hitting his head a
lot.
00:53:30
They were actually migraine headaches.
00:53:32
And we treated his migraine.
00:53:35
And the other fellow had ADHD, never knew
it.
00:53:39
He was always the slowest kid in the back
of the classroom and he couldn't focus.
00:53:45
So we treated both of those athletes and
they rose to being among the top 10 in the
00:53:50
world in their sport.
00:53:52
So suddenly we started getting the
feedback that, hey, you ought to go see
00:53:57
these folks because I got better, right?
00:54:01
So there's a brain health factor.
00:54:04
and again, misinformation.
00:54:06
So there are a lot lot different aspects
to seeing patients with this type of
00:54:11
problem from that standpoint.
00:54:13
We'll hear more from Dr.
00:54:14
Alessi after this quick break.
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00:54:43
And now back to our conversation with
sports neurologist, Dr.
00:54:47
Anthony Alessi.
00:54:50
I love your quote that if you've seen one
concussion, you've seen one concussion.
00:54:57
And I think that what people are trying to
achieve with the protocols is, you know,
00:55:03
in that crucial moment, like what do we
do?
00:55:05
And I know know cycling, the UCI, the
Union Cycliste Internationale our
00:55:10
International Federation uses the SCAT5
protocol.
00:55:14
But this is not something that you can do
roadside until you've decided that the
00:55:18
athlete is coming out of competition
because it just takes too long.
00:55:23
And I think, you know, at this point,
organizations feel like they have to have
00:55:29
a protocol or
00:55:31
they're not fulfilling their duty of care
for their athletes.
00:55:34
So what would you recommend for coaches or
trainers or staff members who want to
00:55:41
fulfill duty of care for their athletes?
00:55:44
What is the better option?
00:55:45
Is it to recommend that they see a
specialist?
00:55:48
Because to your point, the protocol is
generalized.
00:55:53
And what you're saying with one, if you've
seen one concussion, you've seen one
00:55:55
concussion is each case is different.
00:55:59
and very specific to the individual.
00:56:00
So how do we balance those two?
00:56:02
So of the protocols that are out there, of
the testing that's out there for non
00:56:08
-physicians, the SCAT-5 and SCAT-6 are the
best.
00:56:13
The problem we get into is when we start
administering the SCAT in the face of
00:56:19
acute injury, because don't forget, you're
asking somebody to remember five things
00:56:23
forward, numbers in reverse.
00:56:26
They're going to do things that they
really can't do.
00:56:28
If you think it's a concussion, so that
helps you if you're not sure it's a
00:56:32
concussion.
00:56:33
So then when we look at it, we look at
concussion, we have possible, probable,
00:56:39
and definite.
00:56:41
When you've got a definite concussion, why
do you need the test?
00:56:45
You're going to shut them down, right?
00:56:47
If it's possible, you're going to assess
other things to see if it is.
00:56:51
And again, that's where a physician comes
in to help you to say, yeah,
00:56:57
you're good to go.
00:56:57
I mean, that's what I do on the sideline
is I help determine if an athlete can go
00:57:02
back into a football game or other event.
00:57:06
And the probable is where it helps you.
00:57:09
But doing it acutely doesn't help a great
deal.
00:57:14
The thing we have a problem with are these
tests that are designed to say, okay, you
00:57:21
got a green light or red light or
whatever.
00:57:24
I mean, we had the impact test.
00:57:27
I think people still require the impact
test, but the impact test looks at a very
00:57:31
narrow psychological presentation in terms
of cognitive ability rather than the
00:57:38
entire patient.
00:57:39
I'm often called upon to assess an athlete
who has not passed the impact test but is
00:57:46
ready to go back, right, physically,
mentally.
00:57:49
And what's happened is they're so nervous
about taking the impact test that they
00:57:53
take too long to answer the questions.
00:57:56
So, I have to kind of overrule that part
of it, and I can do that.
00:58:03
So, that's where it becomes kind of an art
in terms of seeing the patient and trying
00:58:09
to treat them.
00:58:11
And there are a lot of different tests to
just base it on psychological tests.
00:58:15
I see that all the time.
00:58:16
So, they administer a variety of
psychological tests and determine the
00:58:20
athlete's not ready to go back.
00:58:22
But what did the psychological test look
at before?
00:58:26
Okay.
00:58:26
Did you have a baseline?
00:58:28
Often that's not the case.
00:58:30
So you have to work off of, there's no one
test that tells you the best.
00:58:35
It's really medical judgment for a medical
practitioner, not just a neurologist, but
00:58:42
a medical practitioner who has experience
in working with patients like this.
00:58:46
Yeah.
00:58:47
Let's say a coach assesses an athlete.
00:58:50
They've determined to take him out of the
sport, you know, at least temporarily to
00:58:55
seek treatment.
00:58:56
One of the things I hear a lot is, rest,
stay off screens, sit in a dark room,
00:59:01
especially in the first 48 hours.
00:59:04
How does that advice track with your
experience?
00:59:07
Totally wrong.
00:59:08
And I'll tell you why.
00:59:09
And believe me, that lawyer may have
quoted me correctly in 2015, but here's
00:59:15
what we have learned.
00:59:17
When we think of the human body, the human
body loves homeostasis.
00:59:23
If the human body could wake up the same
time every day, go to sleep the same time
00:59:27
every day, eat the same thing every day,
your cells are happy, happy campers.
00:59:33
But we know that's not practical.
00:59:35
We all have to deal with things.
00:59:37
And when you're a cyclist or any other
professional, you have to deal with
00:59:41
travel.
00:59:42
You have to deal with workout schedules.
00:59:46
But just think about it.
00:59:48
Your body loves homeostasis.
00:59:50
We've taken this athlete who's performing
at this level every day, and they hit
00:59:57
their head, and we bring them down to
zero.
01:00:00
Zero.
01:00:01
Lock them in a room.
01:00:02
It's dark.
01:00:03
No stimulation.
01:00:04
What does that do to homeostasis?
01:00:07
Right?
01:00:08
Screws it up pretty good.
01:00:10
So the studies that have been done by
Thomas and other researchers have shown
01:00:16
that the quicker you get an athlete back
01:00:19
to some level of aerobic activity.
01:00:22
So instead of dropping them down, just
bring them down to where they can tolerate
01:00:27
the activity, they will return to their
sport in half the amount of time as
01:00:34
someone who went to zero.
01:00:35
It's very interesting.
01:00:38
So what do we mean by that?
01:00:40
And what we mean is tolerated exercise.
01:00:43
So if they can get on the stationary bike
the day after an injury without
01:00:55
You don't have to get your heart rate up
over 100.
01:00:59
We just want you moving, okay?
01:01:02
And we'll work from there.
01:01:04
So I like to get athletes back into some
aerobic fitness activity within 48 hours
01:01:10
of a head injury, even if they're having
symptoms.
01:01:14
So it doesn't mean you got to shut down
until all your symptoms go away.
01:01:18
No.
01:01:19
you go back to the activity tolerated.
01:01:21
Same thing with screens.
01:01:23
Some people can't stand looking at a
screen after a concussion.
01:01:27
Others say, not so bad.
01:01:29
I can tolerate this.
01:01:31
I can watch TV.
01:01:32
Some people just can't take bright lights,
so they wear sunglasses, okay?
01:01:37
But so everybody is different in what they
can tolerate.
01:01:40
So again, that's where a protocol doesn't
fit.
01:01:43
You need to understand the athlete, but
specifically for athletes,
01:01:48
we can't have their level of activity
crashing like that.
01:01:52
That's going to work against us in the
long run in getting them back.
01:01:56
That's so interesting because that seems
counterintuitive when you're thinking
01:01:59
about what we talked about earlier when
you have that cellular damage happening in
01:02:04
the brain that's requiring this huge
amount of energy to address.
01:02:07
You're trying to fix a leak in the
basement.
01:02:09
It's taking a big amount of energy.
01:02:11
Why is it important to go back to some
level of activity rather than rest
01:02:17
completely?
01:02:18
given that energy demand that's happening?
01:02:21
Well, because the energy demand, that
analogy is in the acute phase, right?
01:02:25
So there's an acute, subacute chronic,
right?
01:02:28
When you're talking a day later, you're
into the subacute phase.
01:02:33
That's been repaired.
01:02:34
If you didn't repair that crack by then,
you're in big trouble, right?
01:02:38
So that has been repaired.
01:02:40
That's in the acute phase of injury, which
is typically in the first minutes to hours
01:02:46
after injury.
01:02:47
Now you have to deal with the subacute
phase and the chronic phase of recovery.
01:02:53
So even if you take that narrow window of
two weeks, right, you've got that period
01:02:58
to work with to get back.
01:03:01
So somebody who it takes two weeks versus
one week, that aerobic exercise could make
01:03:06
the difference.
01:03:07
That's really interesting.
01:03:09
Does it make a difference in terms of like
blood flow, lymphatic drainage, in terms
01:03:13
of the healing and the recovery process?
01:03:15
Absolutely.
01:03:16
Absolutely.
01:03:17
That's where the level of activity comes,
right?
01:03:19
Because your body is an athlete.
01:03:21
You're used to a certain amount.
01:03:23
You're used to blood pumping, right?
01:03:26
So to start shutting that down and then
think, okay, my headache's gone.
01:03:31
I'm ready to get back on the bike.
01:03:33
You're like, what happened here?
01:03:35
Yeah.
01:03:36
I remember one of the things that you said
when we worked together was that
01:03:40
concussions can cause a whole suite of
different types of symptoms.
01:03:53
I don't know if we want to call them
symptoms or, you know, functional
01:03:58
limitations that arise as the result of a
TBI.
01:04:02
Because it seems like there's been a lot
of progress on that front as well.
01:04:06
Yeah, great question.
01:04:07
Well, first of all, you have to narrow
things down to where the biggest symptom
01:04:11
is.
01:04:11
So if the symptom is cognitive, you know,
you're going to have to narrow it down to
01:04:16
where the biggest symptom is.
01:04:16
So, you know, you're going to have to
narrow it down to where the biggest
01:04:16
symptom is.
01:04:16
incorporate a neuropsychologist.
01:04:18
I have an excellent neuropsychologist who
works with athletes and could give me an
01:04:23
objective measure of is our problem here
related to hitting your head or is it
01:04:30
related to some other factor that has
become worsened, like a certain level of
01:04:35
anxiety that may have now become amplified
after this traumatic injury, in which case
01:04:42
we want to treat the anxiety, right,
because we want to get that under control
01:04:46
or we're never getting back to our sport.
01:04:48
So that would be the cognitive aspect of
it.
01:04:52
Some people, their predominant issue is
headache.
01:04:56
How is the headache behaving?
01:04:58
Is it more of a headache coming from the
back of the hand radiating forward like
01:05:02
occipital neuralgia, in which case you can
do some nerve blocks that would work
01:05:08
wonderfully for that type of headache?
01:05:10
Somebody with
01:05:12
migraine, right?
01:05:13
So now you have to get more aggressive in
treating their migraine.
01:05:17
You also want to look at, as we said, your
neck.
01:05:21
The vestibular symptoms are often very
difficult, right?
01:05:25
And that's where that sudden dizziness, if
you're turning to the side.
01:05:28
Imagine having vestibular symptoms and
trying to ride a bike, right?
01:05:31
It's not going to work.
01:05:32
I don't have to imagine.
01:05:33
I remember.
01:05:34
So we have to, right.
01:05:37
So we have to work with a
01:05:41
physical therapist who's specifically
trained in vestibular rehabilitation to
01:05:46
reprogram that connection of moving your
head and your brain knowing it.
01:05:52
So again, it becomes very specialized to
what your symptoms are.
01:05:58
And if you're already having symptoms and
already on medication, maybe altering
01:06:02
those medications and working within the
scope of that.
01:06:06
Yeah.
01:06:06
I remember
01:06:08
I think I just told you, I just feel off.
01:06:11
And I was actually embarrassed to share
that because it felt like such a, I felt
01:06:16
like as an athlete, yeah, I should have
the self -awareness and the body awareness
01:06:20
to give you a much more specific and less
vague suite of symptoms to describe how I
01:06:26
was feeling.
01:06:26
And that was as specific as I could get.
01:06:29
And I think a lot of that did have to do
with that vestibular and proprioceptive
01:06:34
system because I literally just...
01:06:37
wasn't exactly sure where I was in space.
01:06:39
It wasn't that I couldn't walk and
function, but I just felt off.
01:06:44
And it was a really odd, big, nuanced
sensation that really only became clear
01:06:50
with more time.
01:06:52
It's interesting.
01:06:52
So many people come to me and say, I think
I'm crazy, but, and they present symptoms
01:06:58
that make total sense to a neurologist.
01:07:00
So I want to encourage people not to be
intimidated to share.
01:07:05
I'm a little off, okay?
01:07:07
Well, let's expound upon that.
01:07:10
Or, you know, I feel tingling, like they
say, I feel like something's crawling on
01:07:14
my arm.
01:07:15
Well, that's called a paresthesia.
01:07:17
That's a distortion of sensation.
01:07:19
That makes a lot of sense to a
neurologist.
01:07:21
Whereas, you know, you start at two o
'clock in the morning, you think, wow,
01:07:25
man, I am really way out.
01:07:26
So, you know, you need to share those
symptoms with your neurologist when you're
01:07:31
doing that.
01:07:33
Yeah, I think it's funny that
01:07:34
In my head, it just seemed like such a
weird thing to say.
01:07:37
And to you, it was like, that's actually a
really helpful diagnostic.
01:07:43
So have you observed or are you aware of
differences in either the experience,
01:07:50
diagnosis, or treatment for concussion
between men and women according to age?
01:07:55
Are there any kind of general trends or
patterns along kind of demographic lines
01:08:00
that have emerged?
01:08:02
Yeah.
01:08:05
In general, it takes longer for children
to get better.
01:08:09
And that's why we're so cautious with
children, because their brains are not
01:08:13
fully developed, really until you're in
your early teens.
01:08:16
That's why playing tackle football for a
child under the age of 14 doesn't make any
01:08:23
sense.
01:08:24
It just does not make sense.
01:08:26
Some parents think that this youth
football, tackle football, is
01:08:33
the beginning of an NFL career.
01:08:36
And typically it's the end of an NFL
career because they'll have injuries that
01:08:40
will prevent them to getting to a higher
level.
01:08:43
Whereas now I'm so happy to see so many
people playing flag football.
01:08:48
And even they wear helmets for flag
football.
01:08:50
My grandson started playing, I couldn't
believe it.
01:08:51
It's like a headband with a cushion on the
back because they're going to fall back.
01:08:57
But Archie Manning never had his sons play
youth football.
01:09:03
Tom Brady didn't play youth football.
01:09:05
They played other sports and built those
skills.
01:09:09
So I would encourage parents to stay away
from that.
01:09:14
It takes children longer to get better for
the reasons that their brains have not
01:09:18
fully matured and could have greater
implication in the long run.
01:09:32
to get better.
01:09:34
Again, not sure.
01:09:36
But people with ADHD, depression,
migraine, headaches, again, these other
01:09:43
ongoing symptoms will also take longer to
get better.
01:09:47
Yeah, that was really interesting.
01:09:48
In my case, you ordered the neuropsych
evaluation.
01:09:51
I went in, we were looking for, you know,
01:09:53
any cognitive impairment as a result of
the concussion and come to find out that I
01:09:58
had undiagnosed ADHD, which was incredibly
helpful and life -changing for me.
01:10:04
And I think that one of the things that we
found in that was, as you had mentioned,
01:10:08
that I knew that I had previously
struggled with anxiety and it definitely
01:10:11
amplified with this injury.
01:10:14
And that was something that I was able to
work with my therapist on and super
01:10:18
helpful.
01:10:19
And I'm so happy that that's something
that you brought up because I think
01:10:23
is such an important component, not only
of the treatment and the prognosis, but
01:10:28
just mental health is a really key factor
in basic wellbeing, but also performance
01:10:35
for athletes.
01:10:36
Yeah.
01:10:37
Absolutely.
01:10:39
Absolutely.
01:10:39
Yeah.
01:10:41
And I'm curious about the age.
01:10:42
So I would have thought that it would take
kids less time to recover.
01:10:47
Is there a U -curve with that?
01:10:50
Is it just in terms of the -
01:10:52
development into early adulthood?
01:10:54
And then do you kind of have like a
plateau in terms of prognosis?
01:10:59
Does prognosis, does it take longer to
heal as you get like in advanced age?
01:11:04
I'm laughing because there is a curve.
01:11:06
It takes longer.
01:11:08
And then when you hit 40, it starts taking
longer again.
01:11:13
OK, so so there's this cycle of life where
we end up as children again.
01:11:19
So, yeah, as you get older, it also takes
longer.
01:11:25
So, recovery is best when you're in that
window, I think, more than anything.
01:11:31
That's basic physiology.
01:11:33
So.
01:11:33
So, what are some, aside from age, what
are some factors that affect prognosis or
01:11:39
might either shorten or lengthen the time
that it takes for somebody to feel normal
01:11:44
again or to return to play?
01:11:45
I think their underlying health.
01:11:53
there are always those other factors in
terms of it.
01:11:59
So I think good general health, and that's
again why I like eating habits, because
01:12:03
what are the basic things again?
01:12:05
Well, are you getting enough sleep?
01:12:07
Are you eating a good diet?
01:12:09
And are you hydrating?
01:12:10
This isn't rocket science, all right?
01:12:12
I mean, it really isn't.
01:12:14
we got to get back to that homeostasis
where you're meeting your body's demands.
01:12:21
And so that's why, you know, people trying
to sell you the next great powder or
01:12:29
treatment or device can sometimes be
frustrating overall.
01:12:34
Because - yeah.
01:12:35
You just need to get to the basics and
treat your brain right.
01:12:39
Overall health is important for prognosis.
01:12:43
Age can affect it.
01:12:44
Why is it, you know, this actually is
another question that comes from one of
01:12:48
the listeners, so I'll just read it
verbatim.
01:12:50
Why do some athletes say recovery lasts
months and months, and others a week or
01:12:55
two?
01:12:56
What are some of the things that kind of
feed into or influence these wildly
01:13:00
varying recovery times that we see?
01:13:03
So I think it's based on what you're
working with to begin with in terms of are
01:13:10
there these other factors?
01:13:12
As I said,
01:13:13
can imagine someone who is now going
through a period of depression after their
01:13:19
head injury, you've got to get them out of
that phase.
01:13:21
So that could take a while.
01:13:23
Just looking at it from a psychological
standpoint, someone who is having these
01:13:28
neurologic symptoms, but as a result of a
neck injury until you wrapped your arms
01:13:33
around that.
01:13:34
Some people, their vestibular symptoms
last a long time and the vestibular
01:13:39
therapy takes a while.
01:13:40
So
01:13:41
really depends on the degree of injury in
terms of how long it will take to recover.
01:13:46
So there's no way to predict.
01:13:48
Yeah, that's good to know.
01:13:50
So one of the things I was curious about
is my understanding, and I could be wrong
01:13:55
here, so please, this is a question for
you.
01:13:57
My understanding is that in the peripheral
nervous system, neurons can regenerate,
01:14:04
but in the central nervous system, brain
and spinal cord, damaged neurons don't
01:14:08
regenerate.
01:14:10
Is that still what the science is telling
us?
01:14:13
Absolutely not.
01:14:15
Interesting.
01:14:16
Do tell.
01:14:17
I'll use the analogy of stroke.
01:14:22
Right?
01:14:22
You used to think if someone had a stroke,
right, they clotted off a blood vessel
01:14:27
going through the brain, a piece of the
brain dies, and they would lose all
01:14:34
function.
01:14:39
That has changed a lot.
01:14:41
Funny story, and I almost hate to admit
this, but I've learned the most about
01:14:46
stroke from my mother -in -law who's now
deceased.
01:14:49
God love her.
01:14:50
When I first finished medical school, I
knew everything, right?
01:14:53
Everybody does when you first finish.
01:14:56
And my wife's uncle had a stroke and he
couldn't move one side of his body.
01:15:03
My mother -in -law was a nurse, old school
nurse, old school.
01:15:08
wore the hat, starched whites.
01:15:10
She would go to that rehab facility every
day and make him squeeze a ball.
01:15:17
And I'm telling my fiancee at the time, I
don't know what she's doing.
01:15:22
I mean, the guy's got dead brain.
01:15:24
I mean, nothing's coming back, right?
01:15:28
Fast forward 40 years, right?
01:15:30
And we understand now that
01:15:33
Certainly there is an area of that, if you
think of a bullseye, there's probably some
01:15:38
dead brain there.
01:15:39
But there's this other ring called the
penumbra.
01:15:43
And this penumbra are cells that can
either live or die.
01:15:49
And the way they live is by getting them
to exercise.
01:15:53
Interesting.
01:15:54
Because that uncle made a full recovery.
01:15:57
This guy went from not moving anything to
going back to
01:16:00
actually work.
01:16:01
I mean, he was retired.
01:16:02
He was back on his boat, lived absolutely,
you would not know he had a stroke.
01:16:07
Wow.
01:16:08
Right.
01:16:09
So that's why when people have a stroke,
we want them rehabbing again within 24
01:16:15
hours.
01:16:17
We want them trying to walk.
01:16:18
We want them trying to squeeze.
01:16:20
Some people actually take the person's
good arm and disable it.
01:16:27
Right?
01:16:28
They disable it.
01:16:28
They put it in a sling.
01:16:30
and just force them to use that paralyzed
arm, no matter how hard it is to move, to
01:16:37
get that penumbra back.
01:16:39
So again, my mother -in -law was right,
but for non -physiologic reasons, it just
01:16:44
took us a while to catch up to her.
01:16:46
And that's the beauty of neurology, is
that how much we're learning.
01:16:50
So stroke, the treatment of stroke has
just changed dramatically by the same
01:16:56
token after you've had a head injury or
01:16:59
even a concussion.
01:17:01
Do you have dead brain?
01:17:04
Probably not.
01:17:06
Now, even if you've had a hemorrhage,
again, there's still this penumbra around
01:17:12
it that can recover.
01:17:14
So, you've got to get on that.
01:17:16
So, it's totally changed.
01:17:18
When you look at other tissues, I mean,
I'm thinking about bone growth remodeling,
01:17:24
skin remodeling.
01:17:25
Sure.
01:17:26
in many other tissues, the remodeling
process is stress to the remodeling is
01:17:32
actually really beneficial for that
remodeling process because especially with
01:17:36
bone, it's going to grow stronger under
stress.
01:17:38
And I didn't realize that it was similar.
01:17:41
I mean, I'm assuming that this - Same with
the brain.
01:17:43
Yeah, I'm drawing an analogy.
01:17:44
Thank you.
01:17:45
You're absolutely right.
01:17:47
I think that's a perfect analogy, Amber.
01:17:49
I mean, yeah, that happens in the brain.
01:17:53
is.
01:17:54
And what happens also is in addition to
that penumbra, remember if we go back to
01:18:00
the analogy of this network and traffic,
right?
01:18:03
What happens when you're stuck in traffic?
01:18:06
You find another road to go around it.
01:18:09
The brain does the same thing.
01:18:10
So we used to think the old phrenology,
right?
01:18:13
You know, your speech center is here and
once you've affected that, you've lost
01:18:17
this, okay?
01:18:19
Not necessarily because your brain can now
remodel
01:18:23
and start using nerves from other areas,
other nerve cells to recover some of that
01:18:29
speech.
01:18:29
May not be perfect, but it'll recover.
01:18:33
So again, that network idea globally of
how the brain works is perfect for this.
01:18:41
And I want to frame this with the caveat
that this process still requires a lot of
01:18:47
energy.
01:18:48
So this isn't a situation where you're
going to go out and
01:18:51
train full gas and hammer and all of that,
that's not what we're talking about by
01:18:55
exercise or stress, allowing yourself to
bring that level of training stress down
01:19:02
so that you can divert that energy to
healing, but maintain some low level of
01:19:10
light, low intensity aerobic exercise.
01:19:13
Am I characterizing that correctly?
01:19:15
Absolutely.
01:19:17
So even if we take the analogy of
01:19:19
hitting a baseball again after a
concussion, right?
01:19:22
You don't just go in there and start
hitting fastballs, right?
01:19:24
So, you have them hitting off a tee,
right?
01:19:28
So, to gradually get that skill back
again, again, that remodeling.
01:19:33
You know, we've gone from a concussion
course to an entire residency in neurology
01:19:39
right now.
01:19:40
So, we're on a roll.
01:19:41
Everything you want to know about
neurology from Alessi in two hours.
01:19:47
It's going to be so, so helpful because
there are so many just, you know, even
01:19:51
like I've mentioned, you know,
misconceptions and assumptions that are,
01:19:55
you know, either were true five, 10 years
ago and are no longer.
01:19:59
So it's awesome.
01:20:02
So before we move on, one of the things I
want to just highlight is we talked about
01:20:09
exercise, screen time, to tolerance.
01:20:13
And that's a very subjective term.
01:20:16
And when it comes to athletes, especially
cyclists, I'll say, I think you could make
01:20:20
a strong argument that the sport of
cycling really comes down to training
01:20:27
yourself to tolerate more discomfort than
the competitor next to you.
01:20:33
So this is something that cyclists are
really, really good at is tolerating
01:20:37
discomfort.
01:20:38
So when you tell a cyclist to, or an
athlete, and sure, this is true for many
01:20:45
sports.
01:20:46
When you tell an athlete that they can
exercise to tolerance or they can use
01:20:51
screens to tolerance, what would you say
to them to ensure that they are
01:20:59
safeguarding and not overriding some
signals of discomfort that they should
01:21:04
maybe listen to?
01:21:05
One of the hardest things most human
beings have is listening to their body.
01:21:11
And we say that a lot, right?
01:21:13
We say that
01:21:14
with mindfulness training, we say that
psychological training, but we certainly
01:21:19
need to do that with physical training.
01:21:21
So when I think of cyclists, rowers, okay,
competitive rowers, okay.
01:21:28
Great example.
01:21:29
Right, so they, these are athletes who
train themselves to endure pain.
01:21:36
Marathoners, same deal.
01:21:39
So you have to listen to your body.
01:21:42
think most athletes know what I mean by
that.
01:21:45
You know that when your performance isn't
where it should be, there after an injury,
01:21:53
it's time to dial it back because it's not
going to get better.
01:21:58
It's not a no pain, no gain situation.
01:22:02
We know it's no pain, no gain because
that's what you do when you're training.
01:22:06
But after an injury, you have to really
listen
01:22:10
and look at your training, right?
01:22:12
Look at your data, right?
01:22:13
You're looking at your watch, you're
looking at all the different things you
01:22:17
do.
01:22:18
And if those numbers are just not there,
then it's time to dial it back and wait.
01:22:24
It'll get better.
01:22:25
Just wait.
01:22:26
Yeah.
01:22:26
And it seems like the sooner you can make
that decision, the shorter, potentially
01:22:33
the shorter your recovery time could be.
01:22:35
The same with everything.
01:22:36
Same with a knee injury.
01:22:37
I mean, we're not, this is not.
01:22:39
high level psycho dynamics here.
01:22:43
That's the way it is.
01:22:45
It's not rocket science.
01:22:49
So one of the questions that we got, it
connects back to, I'm fascinated that
01:22:54
there is the possibility for neuronal
regeneration in the brain.
01:22:57
That's not something that I was aware of.
01:22:59
And this question comes to us from one of
our listeners.
01:23:02
And the question is, what is the biggest
change in the scientific community's
01:23:05
understanding of concussions in the last
10 years?
01:23:08
And how was this discovered?
01:23:10
I think probably in the last 10 years, as
I mentioned, the work by Dr.
01:23:16
Thomas and several other doctors about
getting people back to aerobic activity is
01:23:22
probably the biggest change.
01:23:23
I think the other change is the fact that
we have recognized that when examining
01:23:30
someone, it was a good point, when you're
examining someone doing what we call
01:23:36
visual ocular motor screening.
01:23:39
So we know that of those networks we
talked about, probably the most
01:23:44
complicated is coordinating vision and
motion because it takes so many
01:23:51
connections in the brain, not just in the
eyes, occipital lobe, brainstem,
01:23:57
cerebellum.
01:23:58
You've got so many connections.
01:24:01
So with vestibular oculi...
01:24:14
I think that part of the examination has
changed the evaluation of concussion a
01:24:20
great deal.
01:24:21
Because you will bring, if someone is
having some subtle symptoms, you start
01:24:26
stressing them, moving their head like
that, and they're holding on to something.
01:24:30
So you know what you've got.
01:24:32
So again, you're going to have to be
careful about that.
01:24:33
And you're going to have to be careful
about that.
01:24:33
And I think that's a very important point.
01:24:33
And that part of the examination, I think,
has changed it, I would say, in the last
01:24:37
five years.
01:24:38
So, we're learning quite a bit from as we
start to do different tests and look at
01:24:45
different situations.
01:24:46
What are some of the constraints in terms
of conducting research in this area?
01:24:50
Because I imagine it's not exactly ethical
to recruit human subjects and induce
01:24:58
concussion or TBI.
01:24:59
So, it must be really difficult, I
imagine.
01:25:02
conduct research that is relevant to human
systems or human systems in vivo.
01:25:10
What are some of those constraints and
like what are maybe some of the types of
01:25:14
studies or experimental designs that give
us the best information?
01:25:17
Well, my daughter Stephanie's involved in
a project now she started actually looking
01:25:22
at high school football players before
they play football in high school doing
01:25:27
baseline examinations.
01:25:29
And now
01:25:31
following them throughout their career.
01:25:33
So if they get a concussion, reevaluating
them, comparing it to their previous exam,
01:25:40
and seeing how their exam progresses, how
long it takes them to recover.
01:25:45
So I think clinical studies such as that
are helpful.
01:25:51
Whenever you can do a controlled study,
you know, and this comes into when people
01:25:55
are looking at new treatments, various
devices,
01:25:59
and things such as that, again, you want
to make sure you're doing controlled and
01:26:05
blinded, if possible, studies where you're
comparing apples and apples to see if that
01:26:11
device or that intervention changes
things.
01:26:15
And in some respects, things have changed.
01:26:17
I'll use the example of people are hearing
about the Guardian Cap, right?
01:26:22
The Guardian Cap was a football device,
right?
01:26:24
It looks like a pillow put over the head
and athletes say, this looks silly and
01:26:29
you know, at first, it was one of those
things where I didn't have enough
01:26:34
information to recommend it or not
recommend it to a team.
01:26:38
Teams were using them.
01:26:39
You can't use them in a game.
01:26:41
So the National Football League Players
Association got together and what they did
01:26:46
was they looked at athletes using this and
compared it to athletes not using it.
01:26:54
So they had whole teams and came up with
01:26:58
the finding that it did reduce concussion
in certain players.
01:27:04
So, in the sport of football, we have
decided that everybody looks the same,
01:27:10
everybody has the same injury.
01:27:11
When you look at football, it's a lot of
different skills, right?
01:27:15
So, we all saw the two injury where he had
multiple concussions, the quarterback
01:27:21
fell, hit the back of his head.
01:27:23
So what we finally figured out is you need
to design different helmets for different
01:27:27
positions because they're going to have
different injuries.
01:27:30
So the Guardian cap works very well for
linemen.
01:27:35
Does it necessarily work very well for
safeties and speed or skilled athletes?
01:27:41
Because it adds extra weight to the helmet
on the neck.
01:27:46
So we were seeing athletes come up with
neck strain.
01:27:49
We saw some of that at the Coast Guard
Academy.
01:27:51
So again,
01:27:53
athletes who have to run quickly or catch
a ball now have this extra strain on their
01:27:59
neck.
01:28:00
Which brings us to the point, if people
want to try to resist concussion and avoid
01:28:04
concussion, the best thing you can do is
build up your neck, right, to avoid that
01:28:07
extra motion.
01:28:09
So from that standpoint, so again, so with
the Guardian Cap, it's something I
01:28:14
couldn't recommend or not recommend, but
now I feel like we have enough information
01:28:18
to say, yeah, if you're a lineman in
practice, it's worth using.
01:28:23
from that standpoint.
01:28:24
So the data kind of changed things as we
approach things.
01:28:29
People always ask me about supplements.
01:28:31
Is there a supplement?
01:28:32
And you brought up the creatine.
01:28:34
But what we do know is magnesium and
vitamin B2 after a concussion, for some
01:28:41
reason, if headache is the predominant
symptom, that will often help.
01:28:47
So a lot of the commercial things people
are selling these days are basically
01:28:52
magnesium and vitamin B2.
01:28:54
So I do use that in athletes.
01:28:58
Again, we have found that to be effective
in looking at studies.
01:29:02
That's so interesting.
01:29:03
So a lot of our audience are very
proactive.
01:29:07
They're keen to understand the latest
either because they're coaches or they're
01:29:11
parents.
01:29:12
They're highly educated.
01:29:13
They're not shy about going to PubMed, for
example, and looking up studies.
01:29:18
Sure.
01:29:19
Where are some good sources for people to
keep tabs on what are the latest advances,
01:29:25
what are the latest changes in our
understanding of the state of the science?
01:29:29
That's a good question.
01:29:31
I think, you know, it's hard, but I think
in the neurologic literature we're seeing
01:29:35
more and more of it, in the sports
literature.
01:29:37
But, you know, these studies are ongoing.
01:29:40
The biggest study is going on was, again,
funded by the National Football League
01:29:43
Players Association, the Harvard study
that has been an ongoing.
01:29:48
study that looks at a lot of different
aspects of football injuries.
01:29:52
So I don't have a single source for you on
that.
01:29:56
I think you'll see things coming up even
in the popular literature.
01:30:01
But again, it's worth asking someone who
is a trusted resource, an athletic
01:30:06
trainer.
01:30:07
Again, they're keeping up with it as part
of their continuing education.
01:30:12
So if you hear something, go to a trusted
source and say, hey, I read this
01:30:16
does it make sense before you start
engaging in it?
01:30:20
Or spending a lot of money.
01:30:21
Let me also explain, there are a lot of
people making a lot of money on things
01:30:26
because it's a cash payout and you may not
get the results that are being promised.
01:30:34
That's a really good point.
01:30:37
So in terms of this discrepancy between
clinical application and the latest
01:30:44
science, so I learned some
01:30:46
new things today, which I'm really
encouraged by.
01:30:49
And I'm sure that some people listening
who maybe heard the old go in a cave and
01:30:55
don't do anything advice, you know, are
surprised to learn that some light
01:31:01
exercise can be really beneficial.
01:31:03
When an athlete or a coach or a parent is
speaking with a provider or kind of in
01:31:09
this situation, how would you recommend
that they advocate for some of these newer
01:31:16
interventions or treatments if the
provider or the medical care team seems to
01:31:23
be recommending something else, or maybe
it's a coach recommending something else.
01:31:27
How would you recommend that people kind
of advocate for themselves in those terms?
01:31:31
You know, coaches coach.
01:31:34
They don't treat patients.
01:31:36
And I think that coaches need to know
their limitations as well.
01:31:42
And one of my frustrations is sometimes
when coaches
01:31:56
I don't know if all coaches understand
that that level of influence can adversely
01:32:03
affect an athlete as much as help them.
01:32:06
Only because I've dealt with these
situations where, you know, coach wants
01:32:10
what's best for their athlete and they
heard something from somebody else, and
01:32:15
they're like, well, I'm going to go with
that.
01:32:15
And I think that's a good thing.
01:32:15
And I think that's a good thing.
01:32:16
you need this or maybe you need that.
01:32:20
And there's already been a plan set out
for that athlete's recovery with their
01:32:26
physician.
01:32:28
And now we've thrown another variable into
it that ends up setting us back.
01:32:35
Does that make sense?
01:32:37
It really does.
01:32:38
Yeah.
01:32:39
I think coaches, before going to an
athlete with that suggestion, run it by
01:32:44
their doc.
01:32:45
run it by the team doctor and just say, I
heard this, do you think I should bring it
01:32:51
up?
01:32:51
I mean, I like coaches to be part of the
recovery team.
01:32:55
I don't like to say, hey, you know, stay
in your lane.
01:32:59
I want you to be part of the team, but I
don't want you going off and telling my
01:33:04
patients something that may hurt us in the
long run.
01:33:09
Recovery is a team aspect.
01:33:11
You need a physical fit for a high level
athlete.
01:33:15
need your coach on board, you need your
physical therapist on board, and you
01:33:19
certainly need a physician on board with
everybody having a say in what's best for
01:33:25
that athlete if you're going to get them
back.
01:33:27
That makes a lot of sense.
01:33:28
So it sounds like the best advice for a
coach would be to work closely with the
01:33:34
care team and make sure that they're
communicating constantly with the care
01:33:38
team and running any medical related or
recovery related suggestions by the care
01:33:43
team before the athlete.
01:33:45
just to avoid unintentionally maybe
introducing an idea that could be
01:33:51
counterproductive.
01:33:52
Yep, exactly.
01:33:54
That's great advice.
01:33:55
And for parents or staff members
advocating, is it similar there just
01:34:02
having a conversation with the physician
and the physical therapist and just being
01:34:07
a part of that conversation?
01:34:08
Sure.
01:34:09
Absolutely.
01:34:10
Absolutely.
01:34:12
know, and because there are people out
there trying to promise these, you know,
01:34:17
quick fixes, you know, and typically
they're cash pay.
01:34:24
You know, there's a reason why, you know,
not everybody's doing it.
01:34:29
Just don't believe somebody's got this
secret sauce because it could really mess
01:34:35
things up and hurt in the long run.
01:34:37
We see that all the time.
01:34:39
It's so tempting because
01:34:42
It would be so reassuring to have that
silver bullet answer, that secret sauce
01:34:48
that's going to make everything okay.
01:34:50
So it is hard not to want to buy into
those claims and those promises, but you
01:34:56
guys are hearing it from an expert here.
01:34:58
It's not the way to go.
01:35:00
I hear a new one every day.
01:35:02
I'm sure you do.
01:35:04
What do you hope our listeners will
remember from this conversation today?
01:35:08
I hope that they'll remember that
01:35:13
concussion is real.
01:35:15
It could be presenting in a lot of
different ways and that it's not something
01:35:20
that is hopeless, that you will get back
to your usual level of activity.
01:35:26
And if not, part of being an athlete is
knowing that there's another direction to
01:35:33
go in and you could also be successful.
01:35:37
One of the things I guess that in my work
with professional bull riders,
01:35:42
like most athletes, and I think maybe more
extreme with that because I've learned a
01:35:47
lot about Western sports athletes, and we
have now advocated for treating them as
01:35:54
athletes.
01:35:54
I don't think they were treated as
athletes.
01:35:57
They were treated as kind of an attraction
of some type, okay, and rodeo, and
01:36:03
gradually now they're starting to see
that, wait, you could make real money and
01:36:08
compete, but
01:36:10
What I try to explain to them is if your
career ends, and it's a short -lived
01:36:15
career, an old bull rider's 30 in their
30s, is that all is not lost when your
01:36:23
career ends, whether it be for medical
reasons or age -related, because as an
01:36:30
athlete, and especially a self -employed
athlete, you've learned how to run a
01:36:35
business.
01:36:36
You are a business.
01:36:37
That's so true.
01:36:38
It is true, especially in cycling.
01:36:40
you've run a business and you have
developed skills that are easily
01:36:47
transferable, either staying self
-employed or going to work for someone
01:36:54
else.
01:36:54
And I want athletes to understand that and
not feel hopeless when they've had a head
01:37:02
injury and they're having symptoms and if
they can't fully recover to their previous
01:37:06
level.
01:37:06
So I certainly want this to be
01:37:09
a hopeful discussion.
01:37:11
And I'm hoping we've given people some
idea of what the state of the art is in
01:37:19
neurology and sports neurology.
01:37:22
And as always, I'm available to you or
your listeners.
01:37:28
If I can be of help, you can put them in
touch with me.
01:37:32
And I'm happy to assist in either making a
referral or
01:37:38
being able to give them some helpful
advice.
01:37:41
that's incredibly kind.
01:37:43
So Dr.
01:37:43
Alessi has a radio show.
01:37:44
We'll put links to that in your website.
01:37:47
And anybody who does have follow -up
questions for Dr.
01:37:49
Alessi you can email me, amber at Be a
Good Wheel .com.
01:37:52
If you have questions about referrals, I
can pass those along to Dr.
01:37:55
Alessi.
01:37:56
I really feel hopeful after this
conversation.
01:37:58
I'm so encouraged by that plasticity of
the brain, its ability to heal.
01:38:04
I'm so encouraged by the progress.
01:38:06
that's being made in this area, in this
field.
01:38:08
And I'll never forget when I came to see
you, I felt so confused and scared and
01:38:16
vulnerable.
01:38:17
And at one point in our session, you asked
me, do you still want to race?
01:38:22
And it was a loaded question for me
because that year I had already planned to
01:38:25
retire from competitive sports.
01:38:26
You know, I planned to and hope to ride my
bike for the rest of my life, but not as a
01:38:30
competitive athlete.
01:38:31
But the concussion really like,
01:38:33
a spanner in the works.
01:38:34
I wasn't expecting that and I wasn't sure
if I wanted to continue racing or not
01:38:39
after that.
01:38:40
But I remember what you said to me was
there are so many different types of
01:38:45
concussions, but there are also as many
ways of treating them.
01:38:48
And what we'll do is we'll make sure that
whatever you decide to do is your
01:38:53
decision.
01:38:53
And it was the most profoundly hopeful and
encouraging thing anyone could have said
01:38:59
to me in that moment.
01:39:00
So
01:39:01
since you're here I just want to thank you
for that.
01:39:05
It was genuinely a life-changing moment
for me.
01:39:08
And thank you for sharing all of this
incredible insight and wisdom with all of
01:39:14
our listeners.
01:39:15
Amber it's my pleasure.
01:39:16
And it's great to see the evolution of
that over the course of the past six
01:39:17
years.
01:39:17
I'm always gratified when athletes get
back to me or come to me.
01:39:27
And sometimes they're now they're coming
with their children.
01:39:30
Okay, who have had concussions, so.
01:39:34
Which is probably telling me something
else, but anyhow.
01:39:40
With that, thank you.
01:39:42
Thanks for having me.
01:39:43
Thank you, Dr.
01:39:44
Alessi.
01:39:48
Dr.
01:39:49
Alessi has a pretty packed schedule, and
I'm thrilled we were able to have such an
01:39:53
in -depth conversation on this topic.
01:39:55
I raced bikes professionally from 2016
until 2018.
01:40:00
In that time, I hit the pavement hard
enough to break bones on five different
01:40:04
occasions.
01:40:05
Among other crashes, forceful enough to
break equipment or leave me with
01:40:08
substantial road crash.
01:40:10
In all of that time, the closest I came to
being properly assessed for a concussion
01:40:14
was to be asked if I'd hit my head.
01:40:17
In many cases,
01:40:18
No one even posed that question.
01:40:20
Honestly, I'm very lucky.
01:40:22
Not everyone gets through a career that
long without sustaining worse or more
01:40:26
permanent damage.
01:40:27
But I wish I had known more about
concussion from the start.
01:40:30
At the very least, I would have been
empowered to ask better questions and
01:40:34
advocate for the appropriate assessments
and care.
01:40:36
Of course, our understanding of the brain
and brain injuries has come a very long
01:40:40
way over that span of time.
01:40:42
Dr.
01:40:43
Alessi pointed out how quickly both the
science and clinical practice can change.
01:40:47
and how important it is to seek care from
professionals who treat a lot of
01:40:50
concussions and work with a lot of
athletes.
01:40:55
If you just thought to yourself, well, I'm
not really an athlete.
01:40:59
Let me remind you of what Dr.
01:41:01
Alessi said about homeostasis.
01:41:03
The body loves this state of stable
physiological conditions.
01:41:07
If you ride on a regular basis, that
regular aerobic activity is part of your
01:41:12
body's baseline for normalcy.
01:41:15
In other words, it's part of those
physiological conditions that make up your
01:41:19
body's experience of homeostasis.
01:41:21
And that's a really important part of
determining the best plan of treatment for
01:41:25
you.
01:41:26
And another reason is worth seeking out a
physician who understands that dimension
01:41:30
of treating concussion.
01:41:31
Two takeaways really stood out for me.
01:41:34
The first is how important it is to work
with a qualified professional to get
01:41:38
assessed and create an individualized
treatment plan as soon as possible if you
01:41:43
know or suspect you've had a concussion.
01:41:45
Doing so can enable you to heal and get
back to normal much faster.
01:41:50
For some athletes, this can make the
difference between missing a couple of
01:41:53
days or weeks compared to being out for a
whole season or worse.
01:41:58
This also means you have a qualified
professional guiding your plan for
01:42:02
rehabilitation and return to your sport,
which can make all the difference if you
01:42:06
need someone to advocate for you with a
team coach, director, or manager.
01:42:10
Not everyone has the same understanding of
concussion.
01:42:12
and having a well -informed expert to back
you up can make a real difference.
01:42:17
The second thing that really stood out to
me is this.
01:42:19
As important as it is to avoid
underestimating a potential concussion,
01:42:23
it's equally important to avoid becoming
overly fearful about concussion.
01:42:28
A concussion is a treatable injury.
01:42:31
And our understanding of and ability to
treat concussion has never been better.
01:42:35
Thankfully, this will continue to be true
as the medical field continues to advance.
01:42:40
No one rides bikes with the intention of
falling down, just like no one gets in
01:42:44
their car anticipating an accident.
01:42:46
Things happen.
01:42:47
But that doesn't keep you from driving to
the grocery store.
01:42:50
The benefits of riding bicycles and
engaging in sport far outweigh the risks
01:42:55
of injury or accident.
01:42:57
And as Dr.
01:42:58
Lessey pointed out, most concussions
resolve within two weeks.
01:43:02
Consider the lifelong benefits of riding.
01:43:04
Riding improves almost every aspect of
well -being, physical, social, cognitive,
01:43:09
emotional.
01:43:10
These not only span years, but have been
shown to persist into old age.
01:43:15
Yes, it's important to take concussions
seriously, and as much as I don't ever
01:43:19
want to get injured, I'll gladly accept
the risk of a skinned knee or a couple
01:43:23
weeks to rehab a concussion when it means
I get to experience the transformative
01:43:27
impact on quality of life that comes with
riding bikes.
01:43:32
Plus, empowered with what we've learned
from Dr.
01:43:34
Alessi today, we can feel confident that
in the case of a concussion,
01:43:39
Getting care from a qualified professional
in a timely manner gives you the best
01:43:43
probability for a quick and complete
recovery.
01:43:47
Dr.
01:43:47
Alessi has generously offered to answer
follow -up questions and to offer
01:43:51
suggestions for how to find specialists
where you are.
01:43:54
You can email your questions for Dr.
01:43:55
Alessi to me, amber at beagoodwheel .com.
01:44:00
You can find this and more information,
including key points and references from
01:44:05
our conversation in the show notes for
this episode.
01:44:10
Thank you for joining us for today's
episode.
01:44:13
This is an abridged version of the full
interview.
01:44:16
To get full length and extended versions
of each episode, sign up for a membership
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01:44:22
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01:44:25
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01:44:29
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01:44:35
The Be A Good Wheel Podcast is produced by
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01:44:39
Philavong
01:44:41
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01:44:44
Until next time, thanks for listening and
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