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October 2, 2006

A University of Michigan Health Minute update on important health issues.

Jocks and brains: New U-M program focuses on concussions and other brain/nerve problems in athletes

Migraines, sleep problems, nerve injuries are more common among competitive athletes, says co-director of Michigan NeuroSport clinic

ANN ARBOR, MI – As any athlete knows, playing sports isn’t just about physical strength. To really do well, your brain has to be in the game too. And to play at an advanced level, like high school, college or professional athletes do, you need to be sharp.

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But the brain, and the network of nerves that it controls, are delicate things. And in the crush of competition, or the stress of training, they can get damaged. Plus, any problem off the field that affects the brain and nerves can hurt an athlete’s performance on the field.

In fact, athletes are more prone than others to a lot of brain and nerve problems, says Jeffrey Kutcher, M.D., a University of Michigan neurologist. From concussions and migraines to sleep problems and nerve injuries caused by repetitive use, all of these have the potential to interfere with their ability to compete – or even to return to practice. And the medicines that athletes use to treat these ills need to be chosen wisely, to keep them from violating sports-league rules.

That’s why Kutcher and his colleague Jonathan Edwards, M.D., have launched a unique new program for competitive athletes that focuses on injuries and illnesses affecting the brain and nerves. Called Michigan NeuroSport, it helps athletes on a high school, college and professional level get fast diagnosis and treatment, without running afoul of performance-enhancing drug guidelines.

“Our clinic is dedicated to competitive athletes and the neurological concerns that they might develop from playing their sport, but also for the appropriate diagnosis and treatment of neurological conditions that they might have unrelated to their sport,” says Kutcher, an assistant professor in the U-M Department of Neurology.

Concussions are a big concern for athletes in many sports, Kutcher notes – and not just the major full-contact sports like football and hockey. Getting hit on the head with a ball, suffering a hard jolt from a collision, or hitting the ground hard are all ways that athletes’ brains can get injured. Even if they don’t get knocked unconscious, athletes whose brains get “bumped” in this way can suffer a concussion.

Athletes and coaches know that a concussion needs to be treated with painkillers and a few days’ break from competition and practice. But even after the initial brain impact heals, a concussion can leave long-lasting effects.

Athletes who have suffered more than one concussion are especially likely to suffer long-term problems with thinking, memory, depression and dizziness – an effect called post-concussive syndrome. And that can interfere with their performance on the playing field.

An athlete who suffers a concussion should check with a doctor for advice on when it’s safe to return to practice or competition, which depends on the severity of the concussion and the nature of the sport. “We’re always balancing between the desire for an athlete to get back into the game quickly, and the need to make sure that there’s no permanent damage intellectually,” says Kutcher.

Those who compete at an elite level need special attention, he adds. “With athletes who are very likely to be in a situation where they’re going to get another concussion, we have to be much more careful, do more rigorous testing, follow them more closely, because in the week or two after we see them in the clinic, they’re probably going to be back in a situation where it could happen again.”

Health minute ImageBut concussions aren’t the only thing that can happen to an athlete during play or practice, he says. Because athletes often make the same motions over and over, nerves in their wrists, hands, feet and other areas can begin to hurt from over-use. If they suffer a broken bone, the nerves nearby can become “entrapped,” or pinched, by the injury. Problems can persist even after the break heals.

Epilepsy and other conditions that cause seizures require special treatment in athletes. “Most athletes with seizures are able to compete without any impairment of their performance,” says Edwards, an associate professor of neurology. “The key is to choose treatments that don’t interfere with cognition, coordination or concentration.”

The stress of competition, and of intense physical activity, can make two other neurological problems worse: sleep disorders and migraine headaches.

Athletes are prone to insomnia, or the ability to get to sleep or stay asleep. They also are more likely to have a condition called sleep apnea, especially athletes in sports where large size is an advantage such as football or wrestling. People with sleep apnea experience brief interruptions in their breathing while they sleep, because their throat closes up temporarily. This causes the brain to “wake up” for a moment, which means that the person doesn’t get a good night’s sleep.

In athletes, Kutcher says, “Sleep apnea not only affects the ability of someone to sleep, but their ability to perform both intellectually and physically during the day.” He and his colleagues at NeuroSport often refer athletes to the U-M Sleep Center for an overnight test that can determine what kind of sleep problem they have and help determine what kind of treatment might help.

As for migraines, the combination of performance-related stress and the typical age range of elite athletes creates perfect conditions for major headaches. “Migraines are most common in the second and third decade of life,” during the peak ages for high school, college and professional athletes, explains Kutcher, “An athlete who’s training hard, not sleeping a lot, putting their body through a lot of stress, is at a higher risk for getting more frequent migraines.”

Medicines to treat sleep problems, migraines and pain have gotten better recently, and specialists like Kutcher and Edwards are experts at helping patients find the right treatment for them. But these medicines come with an added issue for athletes: the banned-drug list. College sports, many professional sports, and even some states’ high school athletic associations, ban the use of certain medicines that can unfairly enhance an athlete’s performance. The NeuroSport clinic pays special attention to this issue, so that their patients can rest assured that the medicine they’re taking to make them feel better won’t also lead to their disqualification from competition.

“Some of the treatments we use for migraines, narcolepsy or excessive daytime sleepiness are actually banned substances, and so we have to be very careful that we’re providing the athlete with the best care without encroaching on the rules they’re performing under,” says Kutcher. “There are also drugs that aren’t on a banned list but we suspect they might be added to the list soon, because there are new medications every year in neurology and a lot of them have a direct effect on intellectual performance.”

This attention to athletic rules, combined with customized treatment, makes NeuroSport a unique service, the doctors say. And that kind of specialization may help many athletes get back in the game faster.

“Competitive athletes have a short period of time before their season is over, and they need to be treated quickly,” says Kutcher. “They need to see results faster and that’s what we focus on.”

About Michigan NeuroSport
Athletes, and athletic trainers or referring physicians treating athletes with neurological concerns, may contact the NeuroSport clinic at 734 936-9055 or at Neuro-Sport@umich.edu.

NeuroSport’s physicians assist with any neurological concern affecting an athlete at the elite high school, college or professional level. These include concussion, post-concussive syndrome, peripheral nerve injury, migraine, seizure disorders such as epilepsy, insomnia and sleep apnea, multiple sclerosis, tremor and movement disorders, and balance disorders.

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Written by Kara Gavin

 

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