Concussion, Recovery, and the Athlete Mind with Dr. Anthony Alessi

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
The treatment of concussion has changed.
It changes all the time.
I had someone come to me in a situationwhere I was giving a deposition on a case
and the lawyer said, well, you know,doctor, we have it here that in 2015, this
is what you said.
Listen, this business changes every day.

(00:20):
What I said in 2015 certainly doesn'tapply to what I know today.
I mean, this is science.
I mean, but lawyers think that once it's
Once you've said it or they have a recordof it on a blog or on this podcast that
it's suddenly set in a tablet somewhere.
So anyhow, it's going to change.
And I think that's hard for a lot ofphysicians unless this is something you do

(00:43):
want.
That's Dr.
Anthony Alessi, board certifiedneurologist specializing in sports
neurology, speaking about how fast thestate of the science continues to advance
when it comes to understanding andtreating concussion in athletes.
And he would know.
He's the neurological consultant for theNew York Yankees and the Connecticut State
Boxing Commission.

(01:03):
He's been working with elite athletesacross a broad range of sports for more
than three decades.
He's seen a thing or two, not only aboutthe advances in research, but also in
terms of applying those advances inresearch within the more complex context
of treating athletes as the uniqueindividuals they are, holistically taking
into account their personal stories andcircumstances when creating a plan for

(01:26):
treatment.
You're listening to the Be a Good Wheelpodcast, the show where we explore what it
means to be a good wheel by digging intoscientific research and personal stories
about human potential and performance.
I'm your host, Amber Pierce.

(01:47):
Our guest today is Dr.
Anthony Alessi, a board certifiedneurologist specializing in neurology,
neuromuscular diseases, EMG, and sportsneurology.
Dr.
Alessi is a Clinical Professor ofNeurology and Orthopedic Surgery at the
University of Connecticut and is thedirector of the UConn NeuroSport Program,
a comprehensive interdisciplinary programfor athletes who suffer from neurologic

(02:09):
injuries and persistent neurologicconditions.
He has served as a consultant to manyprofessional and collegiate sports
organizations, including
the UConn Huskies, New York Yankees, NFLPlayers Association, WNBA, U .S.
Ski Team, Professional Bull Riders, U .S.
Coast Guard Academy, Connecticut BoxingCommission, and more.

(02:30):
He was named Ringside Physician of theYear in 2009 by the American Association
of Professional Ringside Physicians forhis efforts in making boxing safer.
When I experienced the worst concussionsymptoms of my career, I went to UConn
Health to get checked out and could notbelieve my luck when Dr.
Alessi walked in the office.
Here was a neurologist who not only knewthe physiology inside and out, but who

(02:54):
also understood the mind of an athlete.
I'll never forget how scared I was walkinginto that appointment and how empowered
and hopeful I felt walking out afterspeaking with him.
Dr.
Alessi's unique combination of medicaltraining, clinical practice, and work with
athletes across multiple sports makes himuniquely qualified to speak about the
state of the science.

(03:14):
as well as the more nuanced considerationsof treating individual human beings like
me, who suddenly find themselves dealingwith frightening symptoms in a confusing
landscape of conflicting information aboutconcussion and brain injury.
With decades of experience helpingathletes navigate some of the most
vulnerable and challenging moments oftheir lives, Dr.
Alessi is deeply sensitive to the uniqueneeds and stories of each patient and to

(03:38):
the complexities of applying theory andresearch in real life.
Our conversation covers a lot of groundand because this is such an important
topic, we've linked a summary of keypoints in the show notes.
Of course, I should make clear that thispodcast is for informational purposes only
and is not intended to replaceprofessional medical advice.

(03:59):
My conversation with Dr.
Alessi includes questions submitted by ournewsletter subscribers.
If you want to get advance notice andsubmit questions for our podcast guests,
go to beagoodwheel .com to sign up for ournewsletter.
I'm so pleased to welcome to the showtoday Dr.
Anthony Alessi.
Thank you so much for joining us today,Dr.
Alessi.
Thanks for having me.

(04:19):
We are going to try to cover a lot today.
I sent Dr.
Alessi a very ambitious list of interviewquestions.
We had some really insightful questionsfrom listeners who wrote in, so we're
going to try to get to all of those.
And the way I want to start to kind oftalk about your background, Dr.
Alessi, and then from there folks, we'llget into...

(04:40):
more of an overview of brain injury.
We'll get into some practical guidance interms of diagnosis, treatment, prognosis,
prevention.
And hopefully we'll be able to talk alittle bit more, dig in a little bit more
on the research of brain injury.
And yeah, we'll see how much we can get totoday.
But Dr.
Alessi, I want to start by asking you outof curiosity, why neurology?

(05:05):
It's very interesting.
you brought up actually some old memoriesof how I got started in sports, which was
really as an athletic trainer.
And I don't advertise myself as anathletic trainer because back then I was
in high school and becoming an athletictrainer was a correspondence course.

(05:25):
But I found that I was playing football inhigh school and got injured and I just
started becoming involved in
the injury aspect in working with ourschool athletic trainer who needed an
assistant.
And I suddenly realized that I had morepotential in the medical field than
playing football.

(05:46):
So that's how I got involved in sports.
But, you know, after going to medicalschool, I really didn't have much contact
with it.
I chose neurology or neurology chose me.
I actually, you know, you go through thesethings in
school, are you going to do this, that,and the other.
I thought I was going to do ophthalmologyand came back to New York and I was doing

(06:09):
my internship in New Rochelle, New York.
And one day a nurse said to me, she said,you know, why don't you ever go to think
of going into neurology?
She said, you do so well with thesepatients in our ICU who have had stroke
and these other problems.
And I always loved neurology and I neverreally thought of myself as a neurologist.
And I called around to places where

(06:31):
I might be able to apply.
And at the University of Michigan, theyjust happened to have an empty slot.
Somebody canceled.
And they said, well, if you could be herein six weeks.
And I said, yeah, I could be there.
And sure enough, I went from a smallcommunity hospital in New Rochelle, New
York to the University of Michigan, whereI did my residency and fellowship and

(06:54):
eventually spent some time teaching.
So it was a great place to be.
So neurology kind of found me.
And actually,
I still stay in touch with that nurse.
I spoke to her a couple of weeks ago.
She's retired now.
But just an offhand comment to somebody,kind of praising them.
I mean, even at an older age, sometimesyou can give somebody that little bit of

(07:17):
encouragement that changes their wholeperspective and their whole view of
themselves and obviously change my lifeand my family's life because now I have
two daughters who are neurologists.
So I guess there's something to be takenfrom that.

(07:39):
yeah.
I think it's easy to wonder about how muchof a difference a person can make as one
individual in the world.
And it's so nice to hear examples likethat, where a really simple observation
with sincere intent can be a bigdifference.
wasn't just an impact on your trajectory,but everybody that you've treated.

(08:04):
And we'll get to more of that later.
But yeah, yeah.
Remember, folks, you have a lot ofpotential to make impact for people in
ways that you might not even realize.
I am curious.
So in the introduction, we talked abouthow you've been involved with a lot of
really major athletics organizations.
one of them, of course, I think whenpeople think concussion, they

(08:26):
automatically think about football.
And you have been involved with the NFLPlayers Association.
How did you end up involved with the NFLPlayers Association?
You know, this has been this realevolution of a career that I didn't intend
to have.
In 1995, the New York Yankees moved theirAA affiliate to Norwich, Connecticut,

(08:49):
where I was in practice.
And
started working with the team.
They would call me for things, whateverneeded to get done, and developed a
relationship just working with them.
And they invited me to come to springtraining and said, you know, we've never
worked with a neurologist.
Now, you have to understand, 1995, weweren't talking about concussion much.

(09:10):
A matter of fact, throughout my career inmedical school and in residency at the
University of Michigan, I never heard theword concussion more than five times.
It's such a vague diagnosis.
We never use that term.
You know, it's not something you just naildown.
And now, let's face it, we're doing apodcast on concussion.

(09:34):
You can't open a magazine.
You can't watch a sporting about whatsomebody talking about a head injury or a
concussion protocol.
So the word concussion itself is such avague term.
But yet the Yankees said, you know, we'venever worked with a neurologist.
And
we started working together back then.
Shortly after that, as I said, I was inNorwich, Connecticut, and we were close to

(09:59):
the Foxwoods Casino and Mohegan SunCasino, and they hosted a lot of fights
like other casinos.
So they asked me to come down and go to afight.
Now, this was pretty weird because I'm aneurologist, and I'm going to watch two
people beat each other up.
But I went to the first one and thecommissioner said, well, what do you

(10:21):
think?
And I said, well, I said, I don't reallymind helping you, but do I get to end the
fight?
And he said, yeah, that's your job.
He says, you think the fight's over, youjust get up and end it.
I said, then I'm your guy, as long asyou're OK with it.
So suddenly, I was in a situation where Iwas watching and watching brain injury.

(10:46):
I say it's almost like having a lab.
I mean, let's face it, these are cruelsports.
I mean, if we put two animals in there,they'd be taking me off to jail.
But if you put two poor people in therewho need a check to beat each other up and
neurologically impair each other, that's asport.
So it's pretty weird from that standpoint.

(11:09):
So I saw myself and continue to see myselfas an advocate for the fight.
the person in there.
Because in boxing, just think about it.
I mean, in boxing, the object of the sportis to neurologically impair your opponent.
There's no other sport like it.

(11:29):
In hockey, football, you still have toscore points.
But not in boxing.
You win by impairing neurologically youropponent.
So I found that that would be a greatchallenge to try and make
boxing safer.
And I've worked with and continue to workwith excellent people who understand that.

(11:53):
So a lot of what we do in boxing iseliminate fights ahead of time based on
their pre -fight examination.
So we will bag them before they get in,especially if we think it's a mismatch.
It depends on what you're doing.
Now, even in MMA, you can get a hold onsomebody and still win the fight.

(12:14):
without neurologically impairing them.
So, boxing was a particular challenge.
And the reason I bring that up is becausein 2011, DeMaurice Smith, who was then the
executive director for the NFLPA, reachedout to me and said, we're getting ready
for our collective bargaining agreement,and I'd like you to come on board and work

(12:36):
with us.
Now, I'd never worked in professionalfootball.
I did work at the University ofConnecticut at the time on their sideline.
said, well, why me?
I mean, I have no contact with this.
And he said, because in 2009, you wouldname the ringside physician of the year.
And he said, we don't want our sport tobecome boxing.

(13:01):
Again, think about it.
He didn't want his sport to become a sportwhere mothers don't want their kids to
play.
And in 2011, that collective bargainingagreement
So much of it was based on safety.
Right away when you hear collectivebargaining, it's about the money.
He didn't make it about the money.
Also, think back then.

(13:22):
The NFL back then was still working on thepremise that concussion is not an issue in
the sport of football.
They would tell me that to my face inmeetings, which were not very pleasant.
But so we went in 2011 to where we aretoday.
in promoting safety.
And the NFL Players Association continuesto drive that position.

(13:47):
So it's kind of a long answer to yourquestion, but it's interesting how
everything started linking together,especially with respect to the NFLPA and
the insight of a brilliant man likeDeMaurice Smith.
That's so, I mean, what foresight, right,to be able to see that coming and to

(14:07):
address it as early as he did.
I love that you've taken this on to workwith athletes in so many different sports.
You've worked with professional bullriders.
You've worked with Coast Guard Academy.
You've worked with WNBA.
What do you love about working withathletes in particular?
Yeah.
What I love is the fact that I knowthey're going to do what they have to do

(14:31):
to get better.
You know, there's this athlete mind, Icall it.
And it pertains to any illness.
I've had patients with Lou Gehrig'sdisease.
It's going to be terminal.
And athletes take a different position.
And no matter how bad it is, a braintumor, Lou Gehrig's disease, they get back

(14:56):
to the point of, OK, yeah, all right.
Well, how do I get better?
They're not taking this thing that this isterminal, this is over.
Never.
they just want to get back to the gym asquick as they can and start working it
out.
And that's what I love because they'regoing to listen to me.
First of all, they know how to takeinformation and guidance and digest it.

(15:19):
Whereas other patients kind of, and theseare, many of these are former athletes,
they're not even professional athletes,but having that athletic background makes
them think, yeah, okay, I know what you'retelling me, but all right, what's the
for getting better.
I need a plan and I'm going to follow it.

(15:39):
And they do.
And I think it adds to their longevity.
It's that attitude.
And yeah, that's what gets me going.
Those are the people you want to workwith.
Is that also something that makes itchallenging to work with athletes?
Good point.
Well, let me explain why.

(16:00):
Okay.
I'm laughing, but let me explain why.
There are two types of athletes.
There are employed athletes, right?
So when I work with baseball players,football players, they go on the IL,
right?
They're injured, they go on an IL, they'restill getting a paycheck.

(16:21):
Then there are self -employed athletes,right?
So combat sports athletes, the bullriders, cyclists, I'm sure again, you're
self -employed.
You're paying your own way.
You go down.
Nobody's paying your house bills.
Right.
So, you know, you have some sponsorships.

(16:42):
So here's the rule.
Employed athletes lie to me about half thetime when they're ready to go back.
Self -employed athletes lie all the time.
OK.
Because it's no play, no pay.
Right.
I mean, so I really have to figure out,you know, who

(17:03):
who's running some jive by me here so theycan get back on the bike, right?
So you have to take that all intoconsideration, and especially with boxing.
I mean, it's so funny.
I go back to boxing because it's thatextreme example, right?
I'm sitting there witnessing brain injury.

(17:24):
And I've learned a lot because I'velearned that the human brain is a very
resilient organ if you treat it right.
So if they get hurt, as long as they restit for a period of time, the brain will
repair itself.
It's when they keep going back and startsparring a few days later, things like

(17:45):
that.
So in those situations, you learn an awfullot about the athlete.
But also, again, we said boxing, these areathletes who come from
When you look at the history of boxing,it's always people in the lowest
socioeconomic level, right, who have to dothat.

(18:05):
I mean, nobody, I mean, we look at thesehigher level athletes, but that's few and
far between.
There are combat sports events going oneverywhere in the United States every day.
And many are people who are down on theirluck, may have just gotten out of prison,
and are trying to make a few hundred bucksby going in a ring and getting beaten up.

(18:27):
So.
Again, that's where you have to be reallycareful with a sport and advocate for the
fighter.
Yeah.
Yeah.
I think the advocation for the athlete isso big, and that's one of the things that
I really appreciate that comes through inall of the research I've done, all the
interviews, and of course, our worktogether.
I want to expand on that for just a minutebecause I think there are definitely the

(18:50):
financial incentives, but also from apsychological perspective.
You don't get to a high level of sportwithout loving the sport and really having
committed yourself to it for a really longtime.
So there's financial risk, but there'salso a really deep psychological risk,
right?
To loss of identity and this idea thatyou've put all of this time and effort

(19:13):
into pursuing maybe your life's dream andit's become your life's work.
And the idea that you might need to taketime out from that or you might not be
able to...
know, enter the renex race, or you mighthave to sit out the season.
Those are not things that really anyathlete wants to hear at any level.
Absolutely.
So, you know, that's where the rehab piececomes in, I think.

(19:37):
Let's get into that.
Let's talk about a high -level overview ofbrain injury.
I think most of our audience, they'veheard of concussion, they've heard of TBI,
traumatic brain injury, but let's kind ofestablish some definitions for the
purpose of discussion.
So is there a difference betweenconcussion and a traumatic brain injury,

(19:58):
and if so what is that difference?
And I know you mentioned in your questionsyou sent me you know, I'm sure you want to
give some disclaimer about treating injuryand stuff.
Obviously, I'm not going to treatanybody's specific injury over a podcast.
But I think today, as we move throughthis, I hope to give every listener

(20:20):
actionable information.
information that will help them eitherwith respect to their current brain health
or recovery from a brain injury.
I think that's our goal from thatstandpoint, and it can be done.
So, I really want to make that point.
As a matter of fact, by the time we'redone with the questions you asked, I think

(20:44):
most of your listeners, they will knowmore than most physicians about a
concussion.
But we'll see.
That's wonderful and also scary.
Well, let's go right off the bat.
You asked about concussion and TBI.
So when you look at traumatic braininjury, we're looking at a range of
injury.
So the most severe traumatic brain injuryis obviously a penetrating trauma, a

(21:10):
gunshot, a shrapnel wound to the brain.
That's the most severe.
The most mild in that range is aconcussion.
that's why some people refer to it as amild traumatic brain injury.
What makes it hard to diagnose this, as Isaid, it's vague.
It's a functional disturbance.

(21:31):
So, it's not a disturbance where you'regoing to see something on a CT scan or an
MRI or some outward sign.
It's a functional disturbance.
And to understand that, we need to take astep back again and look at the brain.
What makes up the brain?
the brain is basically a network of wires.

(21:52):
When I give a slide presentation, I showkind of like the traffic pattern, right?
You see where it's green, it's red.
Once you upset that network, everythingturns red because things are not talking,
things are clogged up.
That's a concussion.
And the question becomes, can you get itback to working to where it was?

(22:15):
And if so, how?
And that's, I think, the important part ofwhat we're discussing today.
So when we think of a discussion, adefinition of concussion, it is a
syndrome, a group of symptoms that aretransient.
So it's transient neurologic syndrome as aresult of a biomechanical force applied to

(22:41):
the brain.
Now, that injury could be direct, such asgetting hit on the head.
or it can actually be indirect, such as awhiplash type of injury or something of
that nature where the brain rattles withinthe skull.
So again, that's the best workingdefinition.

(23:03):
Now, we used to say it was immediate andtransient, and it doesn't have to be
immediate.
Usually, at the most, it would take atleast 48 hours, okay?
Often it's immediate.
But sometimes you can see some delayedsymptoms of a concussion or a traumatic
brain injury.

(23:23):
So we take that into consideration withthe definition itself.
The difference with athletes is that whensomeone hits their head in a car accident
or falls down the stairs, you don't assumethat they're going to fall down the stairs
or get in another car accident.
But when I see a cyclist, and I saw amountain biker the other day.

(23:44):
I'm pretty much assuming he or she isgoing down again somewhere along the way.
So that's what makes the difference intreating athletes is you have to have this
implicit understanding that, okay, thishappened now.
It may have happened in the past, but it'sgoing to happen again if they're going to
continue their sport.

(24:04):
So that's what really distinguishes thetreatment and definition of concussion
when you get to an athlete as opposed to
someone tripping and falling in a store orsomething of that nature.
That makes sense.
One of the questions our listeners posedwas, can you sustain a TBI without hitting
your head?
And before you dive in to answer that, letme just share, I remember when I came to

(24:27):
see you and one of the things I said toyou was like, I wasn't sure if it was
concussion because I didn't hit my head.
And you said, you don't have to hit yourhead.
And I kind of, I don't mean to answer thequestion for you, but I just remember in
that moment, I experienced
this whole montage of my career and all ofthese hard falls that I'd had and realized

(24:49):
that I had been racing my bike for over 10years with a very inaccurate assumption
that I had to hit my head to get a TBI.
So, with that, I'll let you answer thequestion.
Yeah.
So, we see that quite a bit.
Also, you know, so we see that movement.
You have to understand.

(25:10):
So, when we think of
biomechanics of it, right?
So there's these linear vectors going backand forth, and there's a rotational
vector.
And that's why in boxing or even infootball, the most punishing blow is an
uppercut, because you can impart not onlya linear, but a rotational vector, right?

(25:32):
So just think about that, because youdon't need to have a blow to the head,
especially in cycling, right?
To have -
an impact where the bike suddenly stops,right, and you don't, all right, and
there's this rotational and linear vectorapplied to the brain at high speed.

(25:53):
So with that, you don't, you clearly donot.
Now another thing we often see is anassociation with similar symptoms to
concussion, but they're coming from a neckinjury, and you don't want to miss the
neck injury.
So we call that
cervicogenic disease.
Okay.
So a headache and dizziness, right?

(26:16):
So headache, dizziness, vomiting, youknow, the whole thing, but can be coming
from the neck.
But you don't want to make that assumptionearly on.
Acutely, you want to get it worked up asif it's a concussion, but often we need to
focus on the neck in terms of our rehab.
That's interesting.

(26:36):
Yeah.
So if you focus too narrowly onconcussion, you might miss
neck injury that could, you know, causeongoing issues?
Absolutely.
And we see that very often.
We see that often in baseball, oddlyenough, because baseball is the hardest
sport to come back to after a head injury.
And you could imagine why, andspecifically hitting a baseball, because

(26:59):
you have to have such good eye -handcoordination.
You have to pick up the spin of the ballas it's coming and know when to react.
And
it's in such a short period of time, justthink if that network is not working in
its best situation, you're going to be introuble.
So often baseball players are the biggestchallenge and specifically hitting a

(27:23):
baseball to getting back to their fullparticipation.
That's so interesting.
So one of our listener questions before wemove on from this, they ask, what's the
difference between an innocuous bump onthe head and a concussion?
Great question.
Because we've almost created a concussionparanoia out there, okay?

(27:45):
So everybody thinks we've all hit ourheads in the attic, right?
You got up too quick.
You were under a table doing something.
There's a big difference between hittingyour head and having a concussion.
Don't forget, as we said, the definitionof concussion is a syndrome, right?
So it's a group of symptoms.
Could be a loss of consciousness, butdoesn't have to be, right?

(28:07):
You could have nausea, dizziness,persistent headache.
But the thing I look for the most, andthis is where we're getting into, I'm
going to make your listeners the smartestpeople in the sports bar, okay, right now.
Because here I am at ringside, right?

(28:29):
And I'm watching a fight, and thensuddenly I get up and end the fight.
before the fighter has gone down beforethey're bleeding.
Naturally, that's when everybody booze,but I'll tell you what I'm looking for.
I'm looking at their feet.
I'm looking at their feet because if theydevelop unsteady gait, that means their

(28:53):
feet are uncoordinated.
So if you're watching a fight in a sportsbar with your friends and you see a
fighter go down and gets up and he's
he or she are just not feeling theirbalance.
They are so -called flat -footed.
That fight's going to end pretty quicklyand not well, because if they can't
coordinate their feet, they also can'tcoordinate their hands.

(29:16):
And now I potentially have a defenselessfighter.
So I'm looking at their feet.
The same holds true for other athletes.
So when I'm on the sideline watching agame, I'm looking for three things.
And I think, again, your listeners shouldbear this in mind.
Even if you're a parent at a soccer gameor so, we all should be observers, whether

(29:43):
it's your team, the other team, whateverit is.
The three things to look for are, is ittaking the athlete longer to get up from
the ground than they should?
Did they need help getting up?
And after getting up, going back to thehuddle or playing, is their gait unsteady?

(30:03):
If you see those three things, it's timeto tell the coach to at least bring them
to the sideline and ask a couple ofquestions to see what's going on.
You could see the same thing when someonegets the wind knocked out of them.
You could see it in other circumstances.
But again, the possibility of that personhaving a concussion is relevant.

(30:26):
The other problem with this is understandwhen someone's been hit in the head,
they're not the best informant, right?
You've got an impaired informant.
So you're trying to get information fromsomeone who may have had some amnesia for
the event.
So that's what makes it pretty challengingfrom that standpoint.

(30:46):
But those three things are key if you'rewatching an event and especially if it's a
children's event.
where you may not have EMS, you don't haveathletic trainers.
You know, as parents and grandparents, weall need to participate in the process.
I love that.
Yeah.
So a couple of follow -up questions foryou on that.

(31:07):
One is, so with cycling, for example,there's kind of two scenarios that come up
in cycling.
One is during a competitive event, and oneis during training.
Training is a little bit, and there'sdifferent constraints for each scenario.
So in a competitive event, you actually do
probably have more third party observers.
So you have, you know, team directors inthe cars following the race who might

(31:29):
either witness the fall or witness theaftermath of the fall.
You have mechanics, you have other staff,you have other riders who can observe the
athlete who may have fallen.
But what's interesting about the gait isthat once the athlete gets back on the
bike, their feet are clipped into thepedals.
And so you're not necessarily going to seea disruption in gait as they're pedaling

(31:49):
if they do get back on the bike.
Is that something like as a third partyobserver in a race scenario, would you be
looking specifically for, okay, I need tobe really focused on watching this athlete
get up from the ground?
What would you suggest in that situation?
That's an interesting situation.
So it's interesting because when you bringup cycling, we know that the first reflex

(32:12):
when a cyclist goes down is what?
Get back on the bike.
As fast as you can.
Get back on the bike.
Also, are they making good judgments?
Are they performing the way they should?

(32:32):
So in this case, again, you're notwatching their feet, but by the same
token, are they hesitant to get back onthe bike?
Meaning, are they scrambling to look forparts?
Are they just not following the transitionsequence that we would expect?
right?
Because right away they're looking around,they got the bike, they're getting ready

(32:54):
to clip in.
Is there that moment of pause wherethey're not sure of where they are or what
they're doing?
So I would look for that acutely in acyclist.
That would be the best way to look atthat.
That makes sense.
The other thing that's complicated about arace scenario, and I'm speaking
specifically about road cycling, that'swhere my - I gathered that.

(33:17):
My experience is -
this can hold true for some mountain bikeraces too, but they don't stop the race,
right?
So if there's a crash, the expectation isthat the race keeps going.
So if somebody hits the deck, it's up tothem to make the decision to get back on
the bike and get back in the race.
And the longer they take to make thatdecision, the more, the higher the chances
that they're not going to, you know, beable to reconnect with the race and, and

(33:40):
participate.
So the athlete, you know, they are
100%, I got to get back on the bike asfast as I can, that adds an element of
complication.
Like there's no, you know, we don't get togo to the corner of the ring.
There's no bench where we can sub somebodyin.
How risky is it to keep going if you havesustained a concussion versus stopping in

(34:05):
that scenario?
Or is there a way to generalize that even?
Interesting.
It's an interesting question because
Well, let's get to the physiology becauseI think that will explain it a little bit
better.
When we think of a concussion, it's acellular change that we've been able to

(34:25):
demonstrate.
So what happens is there's a breach in anerve cell wall in your brain, like many
of them.
The nerve cell is kept in balance bycalcium being outside the cell and
potassium being inside the cell.
When you breach that wall, calcium rushesin and causes swelling and damage to the

(34:52):
cell.
So to use an analogy, if you had a leak inyour basement, there was a crack in the
wall, right?
Water's rushing in.
So what you have to do now is pump thatwater out as fast as you can.
It's the same thing the cell is doing.
It has these little pumps in the membrane.

(35:13):
that require energy in the form of ATP todrive them and get the calcium out.
What really happens is it's an energydeficit.
So when you have this concussion and allthis going on, your brain demands more
oxygen, more circulation at a point whereit's getting less.

(35:35):
So what you're dealing with in the brainis an energy deficit between the need for
energy
and your body's ability to produce thatenergy.
So what will happen in the most extremecase is you lose consciousness.
Your brain is saying, I can't keep up.

(35:56):
We're shutting down and rebooting thisthing.
So that's what's happening.
Now, when we talk about people who havethe second impact syndrome or things that
get worse, if you can imagine that youhave this crack,
you're trying to repair it and you go backand you don't take yourself out of the

(36:17):
game and you get hit again.
Now you've got another crack, right?
So you've overwhelmed these cells withswelling that can cause so much brain
swelling and eventually end in death.
Now to get back to your analogy, let'sthink about it.
So you've had this head injury and you'regetting back on the bike.

(36:38):
So now your body is trying to repair
something has to give.
So what will happen is your neurologicsymptoms will worsen, whether they be

(36:58):
headache, nausea, in coordination, any ofthe things I talked about.
And especially confusion, okay, becauseyour brain can't work properly.
And
can't work too well either.
So you're really at this energy...
So it becomes readily apparent that ifthat's the case where you've had a

(37:22):
concussion and you're going to try andkeep going, you're not going to be very
successful.
Can't be.
So hopefully the athlete listening to thispodcast will understand that because now
you've amplified the damage.
So where you might have been able to shutit down and come back the next day for the

(37:43):
next stage, right, you may be down for aweek now.
So you really have to understand the brainand some of that basic physiology.
And it's something athletes can understandbecause they understand oxygen, right?
Everybody's measuring their VO2 max,right?

(38:03):
Everybody's got a ring or a watch.
Everybody's, they're into those numbers.
Well, those numbers don't lie when itcomes to the brain either.
So yeah.
Yeah.
I think your point about taking being outfor, you know, the rest of the day or a
day or a week versus, you know,compounding that into weeks, months is a

(38:24):
really point, a point well taken.
And I can, you know, I'm thinking back onmy career, how many times I hit the deck
really hard.
And my, my thinking in the moment was, youknow, which I,
The concussion that I sustained when Icame in to see you, I'll never forget, I
hit the deck really hard.
But my first thought was, well, I didn't.

(38:44):
And that was a gravel race, right?
Exactly.
That was a gravel race.
No, because you're, listen, you have,Amber, you have the rare distinction of
being the only gravel racer I've ever seenin my career.
It's true.
That's funny.
So yeah, I hit the ground and I rememberthinking, okay, I didn't hit my head and I
did this kind of quick head to toeassessment and thought,

(39:05):
If I can get on my bike, I should.
And my follow -up thought was, if there'ssomething really wrong, I'll deal with it
at the finish line.
Not thinking that the time between megetting back on the bike and the finish
line could be that most important timewindow of either exacerbating an issue or

(39:27):
giving me the opportunity to heal andrehabilitate faster.
So, this is, to any athletes listening, Ithink, learn from my mistakes.
It's the same mistake of many.
And it's part of that athlete mentalitythat we talked about.
yeah.
I mean, I think, honestly, I think I musthave been in shock.

(39:49):
And in that race, the reason I stoppedwasn't because of cognitive impairment.
It was because I had hit my knee in thefall and my knee started swelling.
And I thought, well, in my, and again,this just goes to show the -
my lack of understanding in the moment, Isaw the knee swelling and I thought, well,
it's not worth it to me to finish thisrace and have a lifelong knee injury, so

(40:09):
I'm going to stop.
But it never occurred to me to think, it'snot worth it to me to finish this race and
have a lifelong or season long braininjury, so I'm going to stop.
And that just speaks to the visibility ofit, right?
Yeah.
Sure.
The inexperience and just general socialawareness and cultural awareness within
sport, I think, makes a big difference.

(40:31):
So this is one of the questions that cameup a lot, which was, how can I even tell
if I have a concussion?
So let's set the racing aside for amoment.
A lot of people ride for fun, or even as acompetitor, I spent most of my time on
training rides, not necessarily in races,where I may be riding alone.
I don't have a team doctor following me,and maybe I hit the deck, and it's likely

(40:57):
if I do have a concussion that I'mimpaired,
is there a way that somebody could likeself -assess in the field, so to speak?
That's a tough one because you're alreadyimpaired, right?
So, you know, you'll know.
I mean, when your head starts pounding,you'll know something's wrong.

(41:18):
If you can't remember the circumstancesfor which you went down, which retrograde
amnesia is not uncommon, you're going tosuddenly start to realize this while
you're on the ride.
or you're going to note that you're makingstupid mistakes, things that should be
automatic, like shifting, right?

(41:40):
I mean, for a racer, shifting isautomatic, right?
You know when you have to shift.
And if you find yourself in the wrong gearor just things aren't working that
smoothly after you've had a fall, it'stime to reassess.
But again, it's hard to self -assess

(42:01):
after you've been impaired.
That's what makes it difficult.
But I think that as you get back on thebike and you're riding and you're saying,
something's not right here, it's time toshut it down.
Yeah.
And so at that point, let's say whetheryou're in a race or you're in a training
ride and you've decided something's up andyou need to shut this down, what are the

(42:26):
steps for seeking treatment?
Who should you be speaking to and how doyou follow up on that?
So there's a succession of things.
So first of all, the question becomes, doyou need emergency care in terms of the
level of injury?
Do you need a CT scan?

(42:46):
Did you hit your head directly?
So the initial assessment is, do I need toget to an emergency room?
Do I need to get that urgent care?
If you've been cycling at high speed andyou hit your head, you better get to the
emergency room.
Right.
And I almost hate to say this, but
they say, well, the radiation, theradiation is minimal.
And I have a very low threshold in thecase of an acute injury to get a CT scan,
because it gives you so much information.
And you remember we talked about thisrange of illness, right?
So, you know, you're going to have to goto the doctor, you're going to have to go
to the doctor, you're going to have to goto the doctor, you're going to have to go
to the doctor, you're going to have to goto the doctor,

(43:30):
you know, when you're down here atconcussion at the lower end, getting a CT
scan isn't that big a deal.
But what you don't want to miss is theother end and the so -called subdural
hemorrhage or hematoma or epiduralhematoma.
Now, the epidural hematoma is everyperson's nightmare, every physician, every

(43:53):
athletic trainer's nightmare.
And to use the analogy of NatashaRichardson.
that you've heard her story, and I've hada similar story in the last few months
where I was called actually by a law firmof all people.
And it was a situation where a young manhit his head in a soccer match.

(44:19):
I think it was a head to knee collision.
They were in another state, and theathletic trainer assessed them.
They didn't put him back in, but
dad was going to drive him home ratherthan have him go to a hospital or
something of that nature.
And on the way home, he started to declinerapidly.

(44:39):
And father had enough sense to get himright to an emergency room and he had an
epidural hemorrhage.
He would have died, really.
And the fact that he's still alivecompeting is fairly miraculous.
In the Natasha Richardson case was, youknow, she had been skiing, hit her head in
Canada and
went down, saw the EMS people.
They wanted her to go to the emergencyroom to get a scan.

(45:00):
She refused.
The ambulance actually came to themountain and she still said, no, I'm
feeling fine.
Goes back to her condominium and dies.
So there's this clear period whereeverything's back to normal, but there's
this hemorrhage coming from an artery inthe brain that eventually often leads to

(45:23):
someone's total demise.
So again, I have a low threshold forgetting a CT scan in those situations.
Now, outside of the emergency care, youknow, seeing your primary care physician
is fine, but it's, you know, you have tounderstand also, somewhere around 90 % of

(45:44):
all concussions get better in two weeks,right?
That's the beauty of it.
That's really encouraging.
here's what it is.
Everybody's got a concussion clinic.
I mean, we got everybody treatingconcussions.
And I'll probably get some, I'll getcalls, but I mean, there are dentists who
have concussion clinics, chiropracticconcussion clinics, psychologists have

(46:04):
concussion clinics.
I mean, you don't have to be a Phi BetaKappa to take care of something that gets
better in two weeks, okay?
So, there is that period of time.
The real issue comes in is when it's notgetting better.
What I tell people who have not gone tothe emergency room,
is what we like to do is observe somebodyfor a period of hours, four hours or

(46:27):
whatever, or if they go home, make surethey're being observed because if they're
not getting better or getting worse, it'stime to get to the emergency room.
But in the long run, seeing a neurologistwho has expertise in seeing sports
injuries makes a big difference because ofthe way we approach the brain.

(46:51):
from that standpoint.
But again, primary care sports, people doa great job of it.
They see a lot of concussion.
You want to see a doctor who sees a lot ofconcussion and athletes, as opposed to
just seeing concussion in the legal arena,for lack of a better term.
Yeah.

(47:11):
So one of our listener questions that'srelevant to this is, why is it that most
doctors are not trained in the area ofconcussion?
So I'm curious about that, because I dothink that
does seem to be a lag between kind of thelatest research and clinical application.
And if somebody is seeking care, you know,not emergent care, but through maybe a GP

(47:33):
or somebody, why is it that most doctorsaren't trained in this area?
And then a follow -up question to that ishow can people advocate for themselves to
get to see somebody who would have thisbackground and this perspective?
Well, myself and my daughter Stephanie arealways available in terms of
we know where there are these pockets ofpeople who do it better than other people.

(47:58):
It's hard because it's a complicated, it'snot that simple.
Even though I said it gets better in twoweeks, the ones that don't get better are
difficult to manage.
So the question becomes, I think we'vemade great strides with physicians
recognizing a concussion.
And if anything, the pendulum has swung inthe other direction.

(48:20):
in terms of recognition of concussion.
But by the same token, I'd rather it gothat way.
I'd rather people have a low threshold forit, and then we clear it up.
Because we haven't even talked about thefeatures that make it worse.
Like, for example, if someone has migraineheadaches, guess what's going to happen if
you hit your head?
Probably going to get a migraine.

(48:42):
So is this, are we treating migraine now,or are we treating a concussion?
People who have depression.
brought up the idea of someone who mayhave some baseline depression now is taken
away from the one thing they love, theirsport.
What do you think is going to happen?
They start feeling more isolated.

(49:02):
That's why I like to have my athletes,even after they have had a concussion,
still working out with their team.
Whether they're riding the bike on thesideline, they have to be part of the
action.
You don't want to just leave them isolatedin a room or doing something else.
because they're going to fall into adepression.

(49:22):
The mental health aspects of it are awhole other thing, probably a whole other
podcast, but certainly something that youneed to take into consideration.
And the treatment of concussion, itchanges all the time.
I had someone come to me in a situationwhere I was giving a deposition on a case

(49:44):
and
the lawyer said, well, you know, doctor,we have it here that in 2015, this is what
you said.
Listen, this business changes every day.
What I said in 2015 certainly doesn'tapply to what I know today.
I mean, this is science.
I mean, but lawyers think that once you'vesaid it or they have a record of it on a

(50:05):
blog or on this podcast that it's suddenlyset in a tablet somewhere.
So anyhow.
it's going to change.
And I think that's hard for a lot ofphysicians unless this is something you do
a lot.
Yeah.
Yeah, that makes sense.
And that speaks to the importance ofseeing a specialist who has this
experience and who is on top of that.
So what are some things that you wouldlook for if somebody came in to see you

(50:28):
with having had either, you know, directblow to the head or a hard fall?
What are some of the things that you wouldbe looking for in terms of diagnosis?
Well, a couple of things.
First of all, one of the key things inneurology is
to just sit and listen to the patient.
Just listen to them because typicallythey're going to paint a picture.
Now, the visit takes a long time.

(50:50):
I mean, you've got to be willing to sitthere for an hour because you've got to
get out of them exactly what has happenedand what they're describing.
You also need to go back into their pasthistory to have a good understanding of
that person.
Don't forget, I've never seen this personbefore.
I'm not their primary care doctor.
I don't know what else is going on in lifeand what their other problems have been,

(51:14):
what their genetics are, right?
So a lot of times getting a concussionwill provoke the first migraine they've
ever had in someone who has a strongfamily history of migraine headaches.
So again, you know, I often say if you'veseen one concussion, you've seen one
concussion and that's truly the case.

(51:35):
And that's why I
I resent these protocols, right?
We've got protocols.
And maybe resent is a strong word, butunderstand a protocol is designed for
research, right?
So that everybody involved in a researchproject does everything the same way.
That's what a protocol is.

(51:58):
So what we've done is we've createdprotocols for people who are not fully
trained as physicians or
or even as medical personnel to say, okay,you hit your head, this is what you do to
get better, right?
Stay away from screens, no noise, you goto sleep, you need to sleep this man.

(52:19):
Doesn't work.
Every person is different.
So, we have to recognize that right fromthe beginning.
Now, having a protocol even to get someoneback to their activity is different
because it's different based on theirsport.
So we've tried to simplify things andmaybe messing it up because a lot of times

(52:44):
I'll see an athlete who's on this protocoland they're out for two weeks and I'm
like, you can go back today.
This has got nothing to do with hittingyour head.
You know, you've got a migraine headache,here's the medication, go back and play.
Or it's something totally different.
So I think people are surprised that whenthey come to see me, and I noticed this

(53:05):
was
with the professional bull riders, right?
They, when we started seeing them, I thinkthere was this feeling that, no, no, no,
send him to see the neurologist, he'sgoing to end my career.
So they would fly them here to theUniversity of Connecticut.
And the first two folks we saw, we saw onefellow who, really, he thought his

(53:29):
headaches were from hitting his head alot.
They were actually migraine headaches.
And we treated his migraine.
And the other fellow had ADHD, never knewit.
He was always the slowest kid in the backof the classroom and he couldn't focus.
So we treated both of those athletes andthey rose to being among the top 10 in the

(53:50):
world in their sport.
So suddenly we started getting thefeedback that, hey, you ought to go see
these folks because I got better, right?
So there's a brain health factor.
and again, misinformation.
So there are a lot lot different aspectsto seeing patients with this type of

(54:11):
problem from that standpoint.
We'll hear more from Dr.
Alessi after this quick break.
We want to make this podcast financiallysustainable and need your help to keep a
good thing going.
Sign up for a Be a Good Wheel membershipon Ko -Fi and get access to extended guest
interviews, bonus episodes and Be a GoodWheel here.
gear.
Monthly membership start as low as threedollars per month.

(54:33):
Go to ko -fi .com slash be a good wheel tojoin other members who are supporting the
show.
That's K O dash F I dot com slash be agood wheel.
And now back to our conversation withsports neurologist, Dr.
Anthony Alessi.
I love your quote that if you've seen oneconcussion, you've seen one concussion.

(54:57):
And I think that what people are trying toachieve with the protocols is, you know,
in that crucial moment, like what do wedo?
And I know know cycling, the UCI, theUnion Cycliste Internationale our
International Federation uses the SCAT5protocol.
But this is not something that you can doroadside until you've decided that the

(55:18):
athlete is coming out of competitionbecause it just takes too long.
And I think, you know, at this point,organizations feel like they have to have
a protocol or
they're not fulfilling their duty of carefor their athletes.
So what would you recommend for coaches ortrainers or staff members who want to

(55:41):
fulfill duty of care for their athletes?
What is the better option?
Is it to recommend that they see aspecialist?
Because to your point, the protocol isgeneralized.
And what you're saying with one, if you'veseen one concussion, you've seen one
concussion is each case is different.
and very specific to the individual.
So how do we balance those two?

(56:02):
So of the protocols that are out there, ofthe testing that's out there for non
-physicians, the SCAT-5 and SCAT-6 are thebest.
The problem we get into is when we startadministering the SCAT in the face of
acute injury, because don't forget, you'reasking somebody to remember five things

(56:23):
forward, numbers in reverse.
They're going to do things that theyreally can't do.
If you think it's a concussion, so thathelps you if you're not sure it's a
concussion.
So then when we look at it, we look atconcussion, we have possible, probable,
and definite.
When you've got a definite concussion, whydo you need the test?

(56:45):
You're going to shut them down, right?
If it's possible, you're going to assessother things to see if it is.
And again, that's where a physician comesin to help you to say, yeah,
you're good to go.
I mean, that's what I do on the sidelineis I help determine if an athlete can go
back into a football game or other event.

(57:06):
And the probable is where it helps you.
But doing it acutely doesn't help a greatdeal.
The thing we have a problem with are thesetests that are designed to say, okay, you
got a green light or red light orwhatever.
I mean, we had the impact test.

(57:27):
I think people still require the impacttest, but the impact test looks at a very
narrow psychological presentation in termsof cognitive ability rather than the
entire patient.
I'm often called upon to assess an athletewho has not passed the impact test but is
ready to go back, right, physically,mentally.

(57:49):
And what's happened is they're so nervousabout taking the impact test that they
take too long to answer the questions.
So, I have to kind of overrule that partof it, and I can do that.
So, that's where it becomes kind of an artin terms of seeing the patient and trying

(58:09):
to treat them.
And there are a lot of different tests tojust base it on psychological tests.
I see that all the time.
So, they administer a variety ofpsychological tests and determine the
athlete's not ready to go back.
But what did the psychological test lookat before?
Okay.
Did you have a baseline?
Often that's not the case.

(58:30):
So you have to work off of, there's no onetest that tells you the best.
It's really medical judgment for a medicalpractitioner, not just a neurologist, but
a medical practitioner who has experiencein working with patients like this.
Yeah.
Let's say a coach assesses an athlete.

(58:50):
They've determined to take him out of thesport, you know, at least temporarily to
seek treatment.
One of the things I hear a lot is, rest,stay off screens, sit in a dark room,
especially in the first 48 hours.
How does that advice track with yourexperience?
Totally wrong.
And I'll tell you why.
And believe me, that lawyer may havequoted me correctly in 2015, but here's

(59:15):
what we have learned.
When we think of the human body, the humanbody loves homeostasis.
If the human body could wake up the sametime every day, go to sleep the same time
every day, eat the same thing every day,your cells are happy, happy campers.
But we know that's not practical.

(59:35):
We all have to deal with things.
And when you're a cyclist or any otherprofessional, you have to deal with
travel.
You have to deal with workout schedules.
But just think about it.
Your body loves homeostasis.
We've taken this athlete who's performingat this level every day, and they hit

(59:57):
their head, and we bring them down tozero.
Zero.
Lock them in a room.
It's dark.
No stimulation.
What does that do to homeostasis?
Right?
Screws it up pretty good.
So the studies that have been done byThomas and other researchers have shown
that the quicker you get an athlete back

(01:00:19):
to some level of aerobic activity.
So instead of dropping them down, justbring them down to where they can tolerate
the activity, they will return to theirsport in half the amount of time as
someone who went to zero.
It's very interesting.
So what do we mean by that?

(01:00:40):
And what we mean is tolerated exercise.
So if they can get on the stationary bikethe day after an injury without
You don't have to get your heart rate upover 100.
We just want you moving, okay?

(01:01:02):
And we'll work from there.
So I like to get athletes back into someaerobic fitness activity within 48 hours
of a head injury, even if they're havingsymptoms.
So it doesn't mean you got to shut downuntil all your symptoms go away.
No.
you go back to the activity tolerated.
Same thing with screens.

(01:01:23):
Some people can't stand looking at ascreen after a concussion.
Others say, not so bad.
I can tolerate this.
I can watch TV.
Some people just can't take bright lights,so they wear sunglasses, okay?
But so everybody is different in what theycan tolerate.
So again, that's where a protocol doesn'tfit.

(01:01:43):
You need to understand the athlete, butspecifically for athletes,
we can't have their level of activitycrashing like that.
That's going to work against us in thelong run in getting them back.
That's so interesting because that seemscounterintuitive when you're thinking
about what we talked about earlier whenyou have that cellular damage happening in

(01:02:04):
the brain that's requiring this hugeamount of energy to address.
You're trying to fix a leak in thebasement.
It's taking a big amount of energy.
Why is it important to go back to somelevel of activity rather than rest
completely?
given that energy demand that's happening?
Well, because the energy demand, thatanalogy is in the acute phase, right?

(01:02:25):
So there's an acute, subacute chronic,right?
When you're talking a day later, you'reinto the subacute phase.
That's been repaired.
If you didn't repair that crack by then,you're in big trouble, right?
So that has been repaired.
That's in the acute phase of injury, whichis typically in the first minutes to hours

(01:02:46):
after injury.
Now you have to deal with the subacutephase and the chronic phase of recovery.
So even if you take that narrow window oftwo weeks, right, you've got that period
to work with to get back.
So somebody who it takes two weeks versusone week, that aerobic exercise could make

(01:03:06):
the difference.
That's really interesting.
Does it make a difference in terms of likeblood flow, lymphatic drainage, in terms
of the healing and the recovery process?
Absolutely.
Absolutely.
That's where the level of activity comes,right?
Because your body is an athlete.
You're used to a certain amount.
You're used to blood pumping, right?
So to start shutting that down and thenthink, okay, my headache's gone.

(01:03:31):
I'm ready to get back on the bike.
You're like, what happened here?
Yeah.
I remember one of the things that you saidwhen we worked together was that
concussions can cause a whole suite ofdifferent types of symptoms.

(01:03:53):
I don't know if we want to call themsymptoms or, you know, functional
limitations that arise as the result of aTBI.
Because it seems like there's been a lotof progress on that front as well.
Yeah, great question.
Well, first of all, you have to narrowthings down to where the biggest symptom
is.
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.
So, you know, you're going to have tonarrow it down to where the biggest
symptom is.
incorporate a neuropsychologist.
I have an excellent neuropsychologist whoworks with athletes and could give me an
objective measure of is our problem hererelated to hitting your head or is it
related to some other factor that hasbecome worsened, like a certain level of
anxiety that may have now become amplifiedafter this traumatic injury, in which case

(01:04:42):
we want to treat the anxiety, right,because we want to get that under control
or we're never getting back to our sport.
So that would be the cognitive aspect ofit.
Some people, their predominant issue isheadache.
How is the headache behaving?
Is it more of a headache coming from theback of the hand radiating forward like
occipital neuralgia, in which case you cando some nerve blocks that would work

(01:05:08):
wonderfully for that type of headache?
Somebody with
migraine, right?
So now you have to get more aggressive intreating their migraine.
You also want to look at, as we said, yourneck.
The vestibular symptoms are often verydifficult, right?
And that's where that sudden dizziness, ifyou're turning to the side.
Imagine having vestibular symptoms andtrying to ride a bike, right?

(01:05:31):
It's not going to work.
I don't have to imagine.
I remember.
So we have to, right.
So we have to work with a
physical therapist who's specificallytrained in vestibular rehabilitation to
reprogram that connection of moving yourhead and your brain knowing it.

(01:05:52):
So again, it becomes very specialized towhat your symptoms are.
And if you're already having symptoms andalready on medication, maybe altering
those medications and working within thescope of that.
Yeah.
I remember
I think I just told you, I just feel off.
And I was actually embarrassed to sharethat because it felt like such a, I felt

(01:06:16):
like as an athlete, yeah, I should havethe self -awareness and the body awareness
to give you a much more specific and lessvague suite of symptoms to describe how I
was feeling.
And that was as specific as I could get.
And I think a lot of that did have to dowith that vestibular and proprioceptive
system because I literally just...

(01:06:37):
wasn't exactly sure where I was in space.
It wasn't that I couldn't walk andfunction, but I just felt off.
And it was a really odd, big, nuancedsensation that really only became clear
with more time.
It's interesting.
So many people come to me and say, I thinkI'm crazy, but, and they present symptoms

(01:06:58):
that make total sense to a neurologist.
So I want to encourage people not to beintimidated to share.
I'm a little off, okay?
Well, let's expound upon that.
Or, you know, I feel tingling, like theysay, I feel like something's crawling on
my arm.
Well, that's called a paresthesia.
That's a distortion of sensation.

(01:07:19):
That makes a lot of sense to aneurologist.
Whereas, you know, you start at two o'clock in the morning, you think, wow,
man, I am really way out.
So, you know, you need to share thosesymptoms with your neurologist when you're
doing that.
Yeah, I think it's funny that
In my head, it just seemed like such aweird thing to say.
And to you, it was like, that's actually areally helpful diagnostic.

(01:07:43):
So have you observed or are you aware ofdifferences in either the experience,
diagnosis, or treatment for concussionbetween men and women according to age?
Are there any kind of general trends orpatterns along kind of demographic lines
that have emerged?
Yeah.

(01:08:05):
In general, it takes longer for childrento get better.
And that's why we're so cautious withchildren, because their brains are not
fully developed, really until you're inyour early teens.
That's why playing tackle football for achild under the age of 14 doesn't make any
sense.
It just does not make sense.

(01:08:26):
Some parents think that this youthfootball, tackle football, is
the beginning of an NFL career.
And typically it's the end of an NFLcareer because they'll have injuries that
will prevent them to getting to a higherlevel.
Whereas now I'm so happy to see so manypeople playing flag football.

(01:08:48):
And even they wear helmets for flagfootball.
My grandson started playing, I couldn'tbelieve it.
It's like a headband with a cushion on theback because they're going to fall back.
But Archie Manning never had his sons playyouth football.
Tom Brady didn't play youth football.
They played other sports and built thoseskills.

(01:09:09):
So I would encourage parents to stay awayfrom that.
It takes children longer to get better forthe reasons that their brains have not
fully matured and could have greaterimplication in the long run.

(01:09:32):
to get better.
Again, not sure.
But people with ADHD, depression,migraine, headaches, again, these other
ongoing symptoms will also take longer toget better.
Yeah, that was really interesting.
In my case, you ordered the neuropsychevaluation.
I went in, we were looking for, you know,

(01:09:53):
any cognitive impairment as a result ofthe concussion and come to find out that I
had undiagnosed ADHD, which was incrediblyhelpful and life -changing for me.
And I think that one of the things that wefound in that was, as you had mentioned,
that I knew that I had previouslystruggled with anxiety and it definitely
amplified with this injury.

(01:10:14):
And that was something that I was able towork with my therapist on and super
helpful.
And I'm so happy that that's somethingthat you brought up because I think
is such an important component, not onlyof the treatment and the prognosis, but
just mental health is a really key factorin basic wellbeing, but also performance

(01:10:35):
for athletes.
Yeah.
Absolutely.
Absolutely.
Yeah.
And I'm curious about the age.
So I would have thought that it would takekids less time to recover.
Is there a U -curve with that?
Is it just in terms of the -
development into early adulthood?
And then do you kind of have like aplateau in terms of prognosis?

(01:10:59):
Does prognosis, does it take longer toheal as you get like in advanced age?
I'm laughing because there is a curve.
It takes longer.
And then when you hit 40, it starts takinglonger again.
OK, so so there's this cycle of life wherewe end up as children again.

(01:11:19):
So, yeah, as you get older, it also takeslonger.
So, recovery is best when you're in thatwindow, I think, more than anything.
That's basic physiology.
So.
So, what are some, aside from age, whatare some factors that affect prognosis or
might either shorten or lengthen the timethat it takes for somebody to feel normal

(01:11:44):
again or to return to play?
I think their underlying health.
there are always those other factors interms of it.
So I think good general health, and that'sagain why I like eating habits, because
what are the basic things again?

(01:12:05):
Well, are you getting enough sleep?
Are you eating a good diet?
And are you hydrating?
This isn't rocket science, all right?
I mean, it really isn't.
we got to get back to that homeostasiswhere you're meeting your body's demands.
And so that's why, you know, people tryingto sell you the next great powder or

(01:12:29):
treatment or device can sometimes befrustrating overall.
Because - yeah.
You just need to get to the basics andtreat your brain right.
Overall health is important for prognosis.
Age can affect it.
Why is it, you know, this actually isanother question that comes from one of
the listeners, so I'll just read itverbatim.

(01:12:50):
Why do some athletes say recovery lastsmonths and months, and others a week or
two?
What are some of the things that kind offeed into or influence these wildly
varying recovery times that we see?
So I think it's based on what you'reworking with to begin with in terms of are

(01:13:10):
there these other factors?
As I said,
can imagine someone who is now goingthrough a period of depression after their
head injury, you've got to get them out ofthat phase.
So that could take a while.
Just looking at it from a psychologicalstandpoint, someone who is having these
neurologic symptoms, but as a result of aneck injury until you wrapped your arms

(01:13:33):
around that.
Some people, their vestibular symptomslast a long time and the vestibular
therapy takes a while.
So
really depends on the degree of injury interms of how long it will take to recover.
So there's no way to predict.
Yeah, that's good to know.
So one of the things I was curious aboutis my understanding, and I could be wrong

(01:13:55):
here, so please, this is a question foryou.
My understanding is that in the peripheralnervous system, neurons can regenerate,
but in the central nervous system, brainand spinal cord, damaged neurons don't
regenerate.
Is that still what the science is tellingus?
Absolutely not.

(01:14:15):
Interesting.
Do tell.
I'll use the analogy of stroke.
Right?
You used to think if someone had a stroke,right, they clotted off a blood vessel
going through the brain, a piece of thebrain dies, and they would lose all
function.

(01:14:39):
That has changed a lot.
Funny story, and I almost hate to admitthis, but I've learned the most about
stroke from my mother -in -law who's nowdeceased.
God love her.
When I first finished medical school, Iknew everything, right?
Everybody does when you first finish.
And my wife's uncle had a stroke and hecouldn't move one side of his body.

(01:15:03):
My mother -in -law was a nurse, old schoolnurse, old school.
wore the hat, starched whites.
She would go to that rehab facility everyday and make him squeeze a ball.
And I'm telling my fiancee at the time, Idon't know what she's doing.
I mean, the guy's got dead brain.

(01:15:24):
I mean, nothing's coming back, right?
Fast forward 40 years, right?
And we understand now that
Certainly there is an area of that, if youthink of a bullseye, there's probably some
dead brain there.
But there's this other ring called thepenumbra.
And this penumbra are cells that caneither live or die.

(01:15:49):
And the way they live is by getting themto exercise.
Interesting.
Because that uncle made a full recovery.
This guy went from not moving anything togoing back to
actually work.
I mean, he was retired.
He was back on his boat, lived absolutely,you would not know he had a stroke.
Wow.
Right.

(01:16:09):
So that's why when people have a stroke,we want them rehabbing again within 24
hours.
We want them trying to walk.
We want them trying to squeeze.
Some people actually take the person'sgood arm and disable it.
Right?
They disable it.
They put it in a sling.

(01:16:30):
and just force them to use that paralyzedarm, no matter how hard it is to move, to
get that penumbra back.
So again, my mother -in -law was right,but for non -physiologic reasons, it just
took us a while to catch up to her.
And that's the beauty of neurology, isthat how much we're learning.

(01:16:50):
So stroke, the treatment of stroke hasjust changed dramatically by the same
token after you've had a head injury or
even a concussion.
Do you have dead brain?
Probably not.
Now, even if you've had a hemorrhage,again, there's still this penumbra around

(01:17:12):
it that can recover.
So, you've got to get on that.
So, it's totally changed.
When you look at other tissues, I mean,I'm thinking about bone growth remodeling,
skin remodeling.
Sure.
in many other tissues, the remodelingprocess is stress to the remodeling is

(01:17:32):
actually really beneficial for thatremodeling process because especially with
bone, it's going to grow stronger understress.
And I didn't realize that it was similar.
I mean, I'm assuming that this - Same withthe brain.
Yeah, I'm drawing an analogy.
Thank you.
You're absolutely right.
I think that's a perfect analogy, Amber.
I mean, yeah, that happens in the brain.

(01:17:53):
is.
And what happens also is in addition tothat penumbra, remember if we go back to
the analogy of this network and traffic,right?
What happens when you're stuck in traffic?
You find another road to go around it.
The brain does the same thing.
So we used to think the old phrenology,right?

(01:18:13):
You know, your speech center is here andonce you've affected that, you've lost
this, okay?
Not necessarily because your brain can nowremodel
and start using nerves from other areas,other nerve cells to recover some of that
speech.
May not be perfect, but it'll recover.
So again, that network idea globally ofhow the brain works is perfect for this.

(01:18:41):
And I want to frame this with the caveatthat this process still requires a lot of
energy.
So this isn't a situation where you'regoing to go out and
train full gas and hammer and all of that,that's not what we're talking about by
exercise or stress, allowing yourself tobring that level of training stress down

(01:19:02):
so that you can divert that energy tohealing, but maintain some low level of
light, low intensity aerobic exercise.
Am I characterizing that correctly?
Absolutely.
So even if we take the analogy of
hitting a baseball again after aconcussion, right?

(01:19:22):
You don't just go in there and starthitting fastballs, right?
So, you have them hitting off a tee,right?
So, to gradually get that skill backagain, again, that remodeling.
You know, we've gone from a concussioncourse to an entire residency in neurology
right now.
So, we're on a roll.
Everything you want to know aboutneurology from Alessi in two hours.

(01:19:47):
It's going to be so, so helpful becausethere are so many just, you know, even
like I've mentioned, you know,misconceptions and assumptions that are,
you know, either were true five, 10 yearsago and are no longer.
So it's awesome.
So before we move on, one of the things Iwant to just highlight is we talked about

(01:20:09):
exercise, screen time, to tolerance.
And that's a very subjective term.
And when it comes to athletes, especiallycyclists, I'll say, I think you could make
a strong argument that the sport ofcycling really comes down to training
yourself to tolerate more discomfort thanthe competitor next to you.

(01:20:33):
So this is something that cyclists arereally, really good at is tolerating
discomfort.
So when you tell a cyclist to, or anathlete, and sure, this is true for many
sports.
When you tell an athlete that they canexercise to tolerance or they can use
screens to tolerance, what would you sayto them to ensure that they are

(01:20:59):
safeguarding and not overriding somesignals of discomfort that they should
maybe listen to?
One of the hardest things most humanbeings have is listening to their body.
And we say that a lot, right?
We say that
with mindfulness training, we say thatpsychological training, but we certainly

(01:21:19):
need to do that with physical training.
So when I think of cyclists, rowers, okay,competitive rowers, okay.
Great example.
Right, so they, these are athletes whotrain themselves to endure pain.
Marathoners, same deal.
So you have to listen to your body.

(01:21:42):
think most athletes know what I mean bythat.
You know that when your performance isn'twhere it should be, there after an injury,
it's time to dial it back because it's notgoing to get better.
It's not a no pain, no gain situation.
We know it's no pain, no gain becausethat's what you do when you're training.

(01:22:06):
But after an injury, you have to reallylisten
and look at your training, right?
Look at your data, right?
You're looking at your watch, you'relooking at all the different things you
do.
And if those numbers are just not there,then it's time to dial it back and wait.
It'll get better.
Just wait.
Yeah.

(01:22:26):
And it seems like the sooner you can makethat decision, the shorter, potentially
the shorter your recovery time could be.
The same with everything.
Same with a knee injury.
I mean, we're not, this is not.
high level psycho dynamics here.
That's the way it is.
It's not rocket science.

(01:22:49):
So one of the questions that we got, itconnects back to, I'm fascinated that
there is the possibility for neuronalregeneration in the brain.
That's not something that I was aware of.
And this question comes to us from one ofour listeners.
And the question is, what is the biggestchange in the scientific community's
understanding of concussions in the last10 years?
And how was this discovered?

(01:23:10):
I think probably in the last 10 years, asI mentioned, the work by Dr.
Thomas and several other doctors aboutgetting people back to aerobic activity is
probably the biggest change.
I think the other change is the fact thatwe have recognized that when examining

(01:23:30):
someone, it was a good point, when you'reexamining someone doing what we call
visual ocular motor screening.
So we know that of those networks wetalked about, probably the most
complicated is coordinating vision andmotion because it takes so many

(01:23:51):
connections in the brain, not just in theeyes, occipital lobe, brainstem,
cerebellum.
You've got so many connections.
So with vestibular oculi...

(01:24:14):
I think that part of the examination haschanged the evaluation of concussion a
great deal.
Because you will bring, if someone ishaving some subtle symptoms, you start
stressing them, moving their head likethat, and they're holding on to something.
So you know what you've got.
So again, you're going to have to becareful about that.
And you're going to have to be carefulabout that.
And I think that's a very important point.
And that part of the examination, I think,has changed it, I would say, in the last

(01:24:37):
five years.
So, we're learning quite a bit from as westart to do different tests and look at
different situations.
What are some of the constraints in termsof conducting research in this area?
Because I imagine it's not exactly ethicalto recruit human subjects and induce

(01:24:58):
concussion or TBI.
So, it must be really difficult, Iimagine.
conduct research that is relevant to humansystems or human systems in vivo.
What are some of those constraints andlike what are maybe some of the types of
studies or experimental designs that giveus the best information?
Well, my daughter Stephanie's involved ina project now she started actually looking

(01:25:22):
at high school football players beforethey play football in high school doing
baseline examinations.
And now
following them throughout their career.
So if they get a concussion, reevaluatingthem, comparing it to their previous exam,
and seeing how their exam progresses, howlong it takes them to recover.

(01:25:45):
So I think clinical studies such as thatare helpful.
Whenever you can do a controlled study,you know, and this comes into when people
are looking at new treatments, variousdevices,
and things such as that, again, you wantto make sure you're doing controlled and

(01:26:05):
blinded, if possible, studies where you'recomparing apples and apples to see if that
device or that intervention changesthings.
And in some respects, things have changed.
I'll use the example of people are hearingabout the Guardian Cap, right?
The Guardian Cap was a football device,right?
It looks like a pillow put over the headand athletes say, this looks silly and

(01:26:29):
you know, at first, it was one of thosethings where I didn't have enough
information to recommend it or notrecommend it to a team.
Teams were using them.
You can't use them in a game.
So the National Football League PlayersAssociation got together and what they did
was they looked at athletes using this andcompared it to athletes not using it.

(01:26:54):
So they had whole teams and came up with
the finding that it did reduce concussionin certain players.
So, in the sport of football, we havedecided that everybody looks the same,
everybody has the same injury.
When you look at football, it's a lot ofdifferent skills, right?

(01:27:15):
So, we all saw the two injury where he hadmultiple concussions, the quarterback
fell, hit the back of his head.
So what we finally figured out is you needto design different helmets for different
positions because they're going to havedifferent injuries.
So the Guardian cap works very well forlinemen.
Does it necessarily work very well forsafeties and speed or skilled athletes?

(01:27:41):
Because it adds extra weight to the helmeton the neck.
So we were seeing athletes come up withneck strain.
We saw some of that at the Coast GuardAcademy.
So again,
athletes who have to run quickly or catcha ball now have this extra strain on their
neck.
Which brings us to the point, if peoplewant to try to resist concussion and avoid

(01:28:04):
concussion, the best thing you can do isbuild up your neck, right, to avoid that
extra motion.
So from that standpoint, so again, so withthe Guardian Cap, it's something I
couldn't recommend or not recommend, butnow I feel like we have enough information
to say, yeah, if you're a lineman inpractice, it's worth using.
from that standpoint.

(01:28:24):
So the data kind of changed things as weapproach things.
People always ask me about supplements.
Is there a supplement?
And you brought up the creatine.
But what we do know is magnesium andvitamin B2 after a concussion, for some
reason, if headache is the predominantsymptom, that will often help.

(01:28:47):
So a lot of the commercial things peopleare selling these days are basically
magnesium and vitamin B2.
So I do use that in athletes.
Again, we have found that to be effectivein looking at studies.
That's so interesting.
So a lot of our audience are veryproactive.

(01:29:07):
They're keen to understand the latesteither because they're coaches or they're
parents.
They're highly educated.
They're not shy about going to PubMed, forexample, and looking up studies.
Sure.
Where are some good sources for people tokeep tabs on what are the latest advances,
what are the latest changes in ourunderstanding of the state of the science?

(01:29:29):
That's a good question.
I think, you know, it's hard, but I thinkin the neurologic literature we're seeing
more and more of it, in the sportsliterature.
But, you know, these studies are ongoing.
The biggest study is going on was, again,funded by the National Football League
Players Association, the Harvard studythat has been an ongoing.
study that looks at a lot of differentaspects of football injuries.

(01:29:52):
So I don't have a single source for you onthat.
I think you'll see things coming up evenin the popular literature.
But again, it's worth asking someone whois a trusted resource, an athletic
trainer.
Again, they're keeping up with it as partof their continuing education.

(01:30:12):
So if you hear something, go to a trustedsource and say, hey, I read this
does it make sense before you startengaging in it?
Or spending a lot of money.
Let me also explain, there are a lot ofpeople making a lot of money on things
because it's a cash payout and you may notget the results that are being promised.

(01:30:34):
That's a really good point.
So in terms of this discrepancy betweenclinical application and the latest
science, so I learned some
new things today, which I'm reallyencouraged by.
And I'm sure that some people listeningwho maybe heard the old go in a cave and

(01:30:55):
don't do anything advice, you know, aresurprised to learn that some light
exercise can be really beneficial.
When an athlete or a coach or a parent isspeaking with a provider or kind of in
this situation, how would you recommendthat they advocate for some of these newer

(01:31:16):
interventions or treatments if theprovider or the medical care team seems to
be recommending something else, or maybeit's a coach recommending something else.
How would you recommend that people kindof advocate for themselves in those terms?
You know, coaches coach.
They don't treat patients.

(01:31:36):
And I think that coaches need to knowtheir limitations as well.
And one of my frustrations is sometimeswhen coaches
I don't know if all coaches understandthat that level of influence can adversely

(01:32:03):
affect an athlete as much as help them.
Only because I've dealt with thesesituations where, you know, coach wants
what's best for their athlete and theyheard something from somebody else, and
they're like, well, I'm going to go withthat.
And I think that's a good thing.
And I think that's a good thing.
you need this or maybe you need that.
And there's already been a plan set outfor that athlete's recovery with their

(01:32:26):
physician.
And now we've thrown another variable intoit that ends up setting us back.
Does that make sense?
It really does.
Yeah.
I think coaches, before going to anathlete with that suggestion, run it by
their doc.
run it by the team doctor and just say, Iheard this, do you think I should bring it

(01:32:51):
up?
I mean, I like coaches to be part of therecovery team.
I don't like to say, hey, you know, stayin your lane.
I want you to be part of the team, but Idon't want you going off and telling my
patients something that may hurt us in thelong run.
Recovery is a team aspect.

(01:33:11):
You need a physical fit for a high levelathlete.
need your coach on board, you need yourphysical therapist on board, and you
certainly need a physician on board witheverybody having a say in what's best for
that athlete if you're going to get themback.
That makes a lot of sense.
So it sounds like the best advice for acoach would be to work closely with the

(01:33:34):
care team and make sure that they'recommunicating constantly with the care
team and running any medical related orrecovery related suggestions by the care
team before the athlete.
just to avoid unintentionally maybeintroducing an idea that could be
counterproductive.
Yep, exactly.
That's great advice.

(01:33:55):
And for parents or staff membersadvocating, is it similar there just
having a conversation with the physicianand the physical therapist and just being
a part of that conversation?
Sure.
Absolutely.
Absolutely.
know, and because there are people outthere trying to promise these, you know,

(01:34:17):
quick fixes, you know, and typicallythey're cash pay.
You know, there's a reason why, you know,not everybody's doing it.
Just don't believe somebody's got thissecret sauce because it could really mess
things up and hurt in the long run.

(01:34:37):
We see that all the time.
It's so tempting because
It would be so reassuring to have thatsilver bullet answer, that secret sauce
that's going to make everything okay.
So it is hard not to want to buy intothose claims and those promises, but you
guys are hearing it from an expert here.

(01:34:58):
It's not the way to go.
I hear a new one every day.
I'm sure you do.
What do you hope our listeners willremember from this conversation today?
I hope that they'll remember that
concussion is real.
It could be presenting in a lot ofdifferent ways and that it's not something

(01:35:20):
that is hopeless, that you will get backto your usual level of activity.
And if not, part of being an athlete isknowing that there's another direction to
go in and you could also be successful.
One of the things I guess that in my workwith professional bull riders,

(01:35:42):
like most athletes, and I think maybe moreextreme with that because I've learned a
lot about Western sports athletes, and wehave now advocated for treating them as
athletes.
I don't think they were treated asathletes.
They were treated as kind of an attractionof some type, okay, and rodeo, and

(01:36:03):
gradually now they're starting to seethat, wait, you could make real money and
compete, but
What I try to explain to them is if yourcareer ends, and it's a short -lived
career, an old bull rider's 30 in their30s, is that all is not lost when your

(01:36:23):
career ends, whether it be for medicalreasons or age -related, because as an
athlete, and especially a self -employedathlete, you've learned how to run a
business.
You are a business.
That's so true.
It is true, especially in cycling.
you've run a business and you havedeveloped skills that are easily

(01:36:47):
transferable, either staying self-employed or going to work for someone
else.
And I want athletes to understand that andnot feel hopeless when they've had a head
injury and they're having symptoms and ifthey can't fully recover to their previous
level.
So I certainly want this to be

(01:37:09):
a hopeful discussion.
And I'm hoping we've given people someidea of what the state of the art is in
neurology and sports neurology.
And as always, I'm available to you oryour listeners.
If I can be of help, you can put them intouch with me.

(01:37:32):
And I'm happy to assist in either making areferral or
being able to give them some helpfuladvice.
that's incredibly kind.
So Dr.
Alessi has a radio show.
We'll put links to that in your website.
And anybody who does have follow -upquestions for Dr.
Alessi you can email me, amber at Be aGood Wheel .com.
If you have questions about referrals, Ican pass those along to Dr.

(01:37:55):
Alessi.
I really feel hopeful after thisconversation.
I'm so encouraged by that plasticity ofthe brain, its ability to heal.
I'm so encouraged by the progress.
that's being made in this area, in thisfield.
And I'll never forget when I came to seeyou, I felt so confused and scared and

(01:38:16):
vulnerable.
And at one point in our session, you askedme, do you still want to race?
And it was a loaded question for mebecause that year I had already planned to
retire from competitive sports.
You know, I planned to and hope to ride mybike for the rest of my life, but not as a
competitive athlete.
But the concussion really like,
a spanner in the works.
I wasn't expecting that and I wasn't sureif I wanted to continue racing or not

(01:38:39):
after that.
But I remember what you said to me wasthere are so many different types of
concussions, but there are also as manyways of treating them.
And what we'll do is we'll make sure thatwhatever you decide to do is your
decision.
And it was the most profoundly hopeful andencouraging thing anyone could have said
to me in that moment.

(01:39:00):
So
since you're here I just want to thank youfor that.
It was genuinely a life-changing momentfor me.
And thank you for sharing all of thisincredible insight and wisdom with all of
our listeners.
Amber it's my pleasure.
And it's great to see the evolution ofthat over the course of the past six
years.
I'm always gratified when athletes getback to me or come to me.

(01:39:27):
And sometimes they're now they're comingwith their children.
Okay, who have had concussions, so.
Which is probably telling me somethingelse, but anyhow.
With that, thank you.
Thanks for having me.
Thank you, Dr.
Alessi.

(01:39:48):
Dr.
Alessi has a pretty packed schedule, andI'm thrilled we were able to have such an
in -depth conversation on this topic.
I raced bikes professionally from 2016until 2018.
In that time, I hit the pavement hardenough to break bones on five different
occasions.
Among other crashes, forceful enough tobreak equipment or leave me with
substantial road crash.

(01:40:10):
In all of that time, the closest I came tobeing properly assessed for a concussion
was to be asked if I'd hit my head.
In many cases,
No one even posed that question.
Honestly, I'm very lucky.
Not everyone gets through a career thatlong without sustaining worse or more
permanent damage.
But I wish I had known more aboutconcussion from the start.

(01:40:30):
At the very least, I would have beenempowered to ask better questions and
advocate for the appropriate assessmentsand care.
Of course, our understanding of the brainand brain injuries has come a very long
way over that span of time.
Dr.
Alessi pointed out how quickly both thescience and clinical practice can change.
and how important it is to seek care fromprofessionals who treat a lot of

(01:40:50):
concussions and work with a lot ofathletes.
If you just thought to yourself, well, I'mnot really an athlete.
Let me remind you of what Dr.
Alessi said about homeostasis.
The body loves this state of stablephysiological conditions.
If you ride on a regular basis, thatregular aerobic activity is part of your

(01:41:12):
body's baseline for normalcy.
In other words, it's part of thosephysiological conditions that make up your
body's experience of homeostasis.
And that's a really important part ofdetermining the best plan of treatment for
you.
And another reason is worth seeking out aphysician who understands that dimension
of treating concussion.
Two takeaways really stood out for me.

(01:41:34):
The first is how important it is to workwith a qualified professional to get
assessed and create an individualizedtreatment plan as soon as possible if you
know or suspect you've had a concussion.
Doing so can enable you to heal and getback to normal much faster.
For some athletes, this can make thedifference between missing a couple of
days or weeks compared to being out for awhole season or worse.

(01:41:58):
This also means you have a qualifiedprofessional guiding your plan for
rehabilitation and return to your sport,which can make all the difference if you
need someone to advocate for you with ateam coach, director, or manager.
Not everyone has the same understanding ofconcussion.
and having a well -informed expert to backyou up can make a real difference.
The second thing that really stood out tome is this.

(01:42:19):
As important as it is to avoidunderestimating a potential concussion,
it's equally important to avoid becomingoverly fearful about concussion.
A concussion is a treatable injury.
And our understanding of and ability totreat concussion has never been better.
Thankfully, this will continue to be trueas the medical field continues to advance.

(01:42:40):
No one rides bikes with the intention offalling down, just like no one gets in
their car anticipating an accident.
Things happen.
But that doesn't keep you from driving tothe grocery store.
The benefits of riding bicycles andengaging in sport far outweigh the risks
of injury or accident.
And as Dr.
Lessey pointed out, most concussionsresolve within two weeks.

(01:43:02):
Consider the lifelong benefits of riding.
Riding improves almost every aspect ofwell -being, physical, social, cognitive,
emotional.
These not only span years, but have beenshown to persist into old age.
Yes, it's important to take concussionsseriously, and as much as I don't ever
want to get injured, I'll gladly acceptthe risk of a skinned knee or a couple

(01:43:23):
weeks to rehab a concussion when it meansI get to experience the transformative
impact on quality of life that comes withriding bikes.
Plus, empowered with what we've learnedfrom Dr.
Alessi today, we can feel confident thatin the case of a concussion,
Getting care from a qualified professionalin a timely manner gives you the best
probability for a quick and completerecovery.

(01:43:47):
Dr.
Alessi has generously offered to answerfollow -up questions and to offer
suggestions for how to find specialistswhere you are.
You can email your questions for Dr.
Alessi to me, amber at beagoodwheel .com.
You can find this and more information,including key points and references from
our conversation in the show notes forthis episode.

(01:44:10):
Thank you for joining us for today'sepisode.
This is an abridged version of the fullinterview.
To get full length and extended versionsof each episode, sign up for a membership
on Ko -Fi.
Memberships start as low as $3 a month.
Check out all the perks atko-fi.com/beagoodwheel.
That's ko-fi.com/beagoodwheel to sign up.

(01:44:35):
The Be A Good Wheel Podcast is produced byour wizard behind the curtain, Maxine
Philavong
If you loved today's episode, don't forgetto rate us 5 stars.
Until next time, thanks for listening andthanks for being a Good Wheel.

All Episodes

Episode Transcript

Popular Podcasts

1. Stuff You Missed in History Class

2. Dateline NBC

3. Crime Junkie

.css-15opob5{left:0;position:absolute;top:0.8rem;} All Episodes

.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Concussion, Recovery, and the Athlete Mind with Dr. Anthony Alessi