Sports Medicine

Dr. Alessi and the Concussion (R)evolution

by Peter Nelson

an artsy illustration of a brain overlooking a landscape brain


“You wanna fight? You damn stupid fool,” says Jackie Gleason’s character, trainer Maish Rennick, to Louis “Mountain” Rivera (played by Anthony Quinn) in the 1962 film “Requiem for a Heavyweight.”

“Don’t you understand? The odds are, all you’ll wind up is a mumbling idiot — a stuttering jerk. Why don’t you go home?”

Dr. Anthony Alessi, UConn Health associate clinical professor of neurology and orthopedics and director of the UConn NeuroSport Program, has been giving fighters similar messages, albeit more tactfully phrased, for the last 21 years as the consulting neurologist during boxing matches at Mohegan Sun. He has gone on to study head trauma in other sports, how to measure recovery, how to gauge when an athlete is ready to return to play, and how to prevent head injuries. But he got his start as a “fight doctor.”

After working as an athletic trainer at Mount St. Michael Academy in the Bronx, Alessi eventually opened a neurology practice in Norwich, Connecticut. He started working with the Yankees’ Double-A team, and noticed during his hospital shifts that he was looking at many baseline, prefight brainwave EEGs for boxers on the cards at Mohegan Sun casino.

“The Connecticut boxing commissioner invited me to come down to watch a fight,” Alessi says. “After the fight, he said, ‘How would you like to work with us?’ I said, ‘Do I get to end the fight?’”
“He said, ‘We want you to.’ I’ve been ending fights since 1996.”

There’s no such thing as a minor concussion. And as I tell students, if you’ve seen one concussion, you’ve seen one concussion. They’re all different.

Alessi admits it’s odd for a neurologist to work in a sport where the entire goal is to induce maximum cognitive impairment in your opponent — but that’s exactly what makes his presence imperative.

“In mixed martial arts, you have the ability to tap out,” Alessi says. “In boxing, they can’t quit. But you’d be surprised how many times you go into the corner and the fighter doesn’t want to come back out. That’s the first question I ask them, and if they say no, I end the fight. He’ll still get paid, and I’ve saved his life.”

The American Academy of Neurology has backed off from its edict in the 1980s that boxing should be banned, instead calling for measures including more regulations and formal neurologic examinations for fighters. Alessi says more and more neurologists have gotten involved in the sport, screening individuals to determine whether they should fight.

Besides protecting individual athletes, Alessi has used boxing as a lens through which to view the larger picture surrounding head trauma.

“As the public awareness about long-term brain damage from concussions developed, I realized it was like I had my own lab,” he says.

More to Learn

The world has known for a long time about the dangers of head trauma, the syndrome codified in 1928 when New Jersey forensic pathologist Dr. Harrison Stanford Martland published a paper in The Journal of the American Medical Association on fighters and coined the term “punch drunk.”

Today, it seems that new findings on head injury are in the news daily. Since 2001, more than 60,000 scientific papers on chronic traumatic encephalopathy (CTE) and brain trauma have been published, raising awareness at both the public and professional levels, leading to protocols where athletes are pulled from games at the first sign of concussion. Trainers are taught to perform a SCAT5 (Sport Concussion Assessment Tool, 5th edition), elaborating on the questions the old cigar-chomping cornermen used to ask fighters between rounds: “What’s your name? What day is it? Do you know where you are?”

The SCAT5 is used because the greatest and most immediate danger to concussion sufferers is second-impact syndrome, a fatal edema caused by a second head trauma sustained before the brain has had time to repair torn tissues, ruptured blood vessels, or damage at the cellular level from an earlier injury. Other organs have room to expand if they swell. The brain, encased in a hard shell, does not.

“There’s no such thing as a minor concussion,” says Alessi, who teaches at the UConn School of Medicine. “And as I tell students, if you’ve seen one concussion, you’ve seen one concussion. They’re all different. In most cases, a single concussion should not cause permanent damage, but a second concussion, soon after the first, does not have to be very strong for its effects to be permanently disabling or deadly.”


Throughout his career, neurologist Dr. Anthony Alessi has served as a consultant for professional boxers and football and baseball players, as well as UConn student-athletes.

Throughout his career, neurologist Dr. Anthony Alessi has served as a consultant for professional boxers and football and baseball players, as well as UConn student-athletes. Over the decades, he has witnessed a sea change in the way people talk about, prevent, and treat head injuries in contact sports. Peter Morenus


The problem with studying concussions is that you can’t line up a variety of test subjects of various ages and sizes, take baseline measurements, and then hit them in the head with a 13-pound bowling ball moving 20 mph — the equivalent, experts estimate, to taking a punch from a pro boxer. You can’t then compare those results to the results from hitting them with 6-pound bowling balls moving 40 mph, or to what the results would be if you hit them once an hour, or once a day for a month, or in the side of the head instead of the front.

“Ninety percent of the time, after a concussion, you wait 10 days and the athlete is going to be okay. But we still don’t know what the long-term effects might be. We know how the cells repair themselves, but we don’t know what kind of debris might be left behind once the cells heal,” Alessi says.

Playing Smarter

In July, Boston University released the results of a study of the brains of 202 deceased football players, 111 of whom had played in the NFL. All but one of the NFL players’ brains were found to have CTE.

Alessi is, of course, aware of the current discussion of CTE in relation to professional sports, but he attends from a scientist’s detached distance.

“There’s an association with football, but it doesn’t mean there’s causation. It’s an important difference. There’s a lot of selection bias.”

Those who donate their brains, Alessi says, may be looking for a biological explanation for their depression, for example.

Alessi is more concerned that attention is being paid in the wrong places.

“It’s a pyramid,” he says. “There are only 1,800 professional football players. In college football, there are 54,000. In high school football, about a million. In youth football, you have over 3 million children. Another 3 million children play youth soccer, and a half million play youth hockey. So you have 6.5 million young athletes playing high-velocity collision sports, all with brains that are still developing.”

Children lack both the myelin sheathing that protects older brains and the developed neck musculature that helps older athletes avoid injury. In addition to working with UConn student-athletes and teams, Alessi advises youth sports programs and is concerned for the younger athletes.

“They’re smaller and they don’t move as fast, so the force of impact is less, but they’re more vulnerable,” Alessi says. “We used to think if you let kids play full-contact sports, it will toughen them up — not true. The more contact you have, the greater the risk.

“There’s also inadequate medical attention at those levels,” he says. “We’re not paying attention to where our resources should be placed the most.”

The Korey Stringer Institute (KSI), a national sports safety research and advocacy organization based at UConn, recently urged state high school athletic associations to implement life-saving measures after KSI conducted the first comprehensive state-by-state assessment of high school sports safety polices. Each state received a score based on the extent to which it met best- practice guidelines addressing the four leading causes of sudden death among secondary school athletes, which include head injuries.

Requiring the presence of certified athletic trainers at every secondary school athletic event and training coaches on concussion symptoms are among the bare-minimum guidelines, which are endorsed by leading sports medicine organizations in the United States.

Still, progress has been made.

Banning checking and headers in youth hockey and soccer and reducing full-contact practices to once a week for professional and college football have been linked to reduced injuries, Alessi says. But many youth football teams still have full-contact practice five days a week.

No one wants collision sports to go away, Alessi says, but instead of striving to play harder, he believes we can strive to play smarter.

“You have to ask, what’s to be gained from high-velocity impact at a young age? The fastest-growing youth sport in America today is flag football. Archie Manning [former pro-football quarterback and father of Peyton and Eli Manning] didn’t let his sons play youth football. Tom Brady never played youth football. A lot of really good professional athletes in the NFL knew that they could build skill without getting hit,” Alessi says.

“I think there’s a lot to be gained by us changing the rules. We’ve made a lot of headway with all neurologic injuries in sports. Legislation isn’t required to deploy common sense.”

Thanks to the work of Alessi and people like him, athletes know the risks before they step on the field or in the ring. While there’s always more research to be done, at the very least, we’ve replaced the comical cartoon image of the cross-eyed concussion victim — with the lump rising from his noggin and stars and birds circling his head — with reliable information. The kind of information an athlete in a collision sport needs to make informed decisions and to play safely, avoiding injuries when possible and returning to play only when it’s safe to do so.

“If you gotta say anything to him,” Maish Rennick says of “Mountain” Rivera at the end of the movie, “tell him you pity him. Tell him you feel so sorry for him you could cry. But don’t con him.”

All-Star Athletes to Weekend Warriors: How UConn Health Sports Medicine Keeps Patients Off the Sidelines

By Lauren Woods

Crop of woman's legs in running shoes on a pain splattered lime-green background.


Anthony Giansanti, 27, of Montville, Conn. has been playing baseball practically since he could walk. It’s in his blood. Giansanti’s grandfather and his nine brothers started their own league in Hartford in the 1950s. Giansanti first picked up a bat at age 4, and began playing competitively at 9.

“It’s always been a dream of mine to play professionally,” says Giansanti, who joined the Chicago Cubs organization shortly after graduating from Siena College in Loudonville, N.Y.

But Giansanti, who has played on a variety of Cubs-affiliated minor league teams around the country and is now playing for the Bridgeport Bluefish in the independent Atlantic League, almost didn’t achieve his dream. During his freshman year at Siena, he was running to first base during a game against Tulane when he experienced what he says felt like a gunshot in his upper right leg.

The hamstring injury put Giansanti on the sidelines for two months. He did special pool exercises, underwent ultrasound and muscle-stimulation therapy, and rested every day. But no matter what he did, the injury continued to resurface throughout college and his early professional career, benching him for two to three weeks each time it flared up.

There’s nothing better than seeing a patient walk into my office smiling, saying they were able to do something in physical therapy for the first time in years.

In 2015, Giansanti was running to third for the Triple-A Iowa Cubs when he felt the same warm, intense cramp as he had his freshman year at Siena. Again, he was out for two months.

On the recommendation of other athletes, Giansanti visited UConn Health’s Dr. Cory Edgar, who sees patients at UConn Health Storrs Center and is an orthopaedic team physician for UConn Athletics. Edgar and Dr. Matthew Hall, another Huskies team physician, diagnosed him with a hole in his hamstring, and suggested an advanced, injectable treatment called platelet-rich plasma (PRP), followed by physical therapy and rehabilitation.

For four months, Giansanti practiced eccentric strength training and stretching. He received two PRP injections, six weeks apart.

“I now have absolutely no issues with my hamstring,” says Giansanti. “I am faster and stronger than ever before.”


Bridgeport Bluefish outfielder Anthony Giansanti, 27

Bridgeport Bluefish outfielder Anthony Giansanti, 27, is back in the game after UConn Health sports medicine experts treated his recurring hamstring injury. Courtesy of Bridgeport Bluefish


Treating Athletes and Average Folks

The UConn Health team of nine sports medicine doctors who are trusted with keeping professional athletes like Giansanti, as well as more than 700 UConn Huskies student-athletes, in the game are the same ones who see 26,000 everyday people each year. And they bring the same cutting-edge strategies to the table to prevent and treat injuries for both types of patients.

“UConn’s sports medicine experts apply what keeps their top-performance athlete patients healthy and translate that knowledge to help guide the care of their everyday recreational athlete patients, and the weekend warriors, to keep them moving and doing what they want to do as they age,” says Dr. Robert Arciero, chief of the Division of Sports Medicine at UConn Health, a UConn Athletics team physician, and past president of the American Orthopaedic Society for Sports Medicine.

The cooperation between UConn Health and UConn Athletics benefits both groups — and their patients.

“UConn Health sports medicine experts are phenomenal and an integral part of our UConn Athletics team, as we rely heavily on their expertise to care for our UConn student-athletes,” says UConn’s Head Team Physician, Dr. Deena Casiero, the new director of sports medicine at UConn and an attending physician at UConn Health who completed a fellowship with UConn’s sports medicine team.

In addition to treating thousands of past and present UConn Huskies, UConn’s doctors have lent their expertise to such organizations as USA Hockey, the Hartford Whalers, the U.S. Open Tennis Championships, and the New York Islanders as team docs. What’s more, they are also all professors in the UConn School of Medicine’s Department of Orthopaedic Surgery, and all perform research that is leading the charge in preventing and treating sports injuries.

While proper rehabilitation, rest, and physical therapy form the bedrock of quality sports medicine and can fix many common injuries, such as stress fractures or shoulder dislocations, UConn’s research is taking treatment a step further.

“Our mission is to provide all aspects of musculoskeletal medicine for patient care, while advancing basic science and research, teaching and training doctors, and educating researchers around the world,” says Dr. Augustus D. Mazzocca, chair of the Department of Orthopaedic Surgery, director of the UConn Musculoskeletal Institute, and an orthopaedic team physician.

Much of the work centers on using a patient’s own tissues, including PRP or stem cells, to help heal injuries. One particularly ambitious undertaking is the HEAL (Hartford Engineering A Limb) Project, a global initiative led by UConn Health’s Dr. Cato T. Laurencin that aims to regenerate a human knee within seven years and an entire human limb by 2030.

Edgar, who treated Anthony Giansanti with PRP injections, studies how stem cell injections aid healing in tendon, bone, and rotator cuff injuries, as well as meniscus transplants.

“Our use of a patient’s own stem cells can expedite tissue healing, reduce the risk of repeat surgery, and speed a patient’s return to daily life,” Edgar says.

And ensuring patients can get back to doing what they love — be it dancing in the kitchen with their spouses or playing on the court in front of thousands — is the primary goal.

Giving Patients New Hope

Mazzocca is using stem cells to treat a particularly tricky type of injury. Athletes and average Joes alike struggle with stubborn rotator cuff injuries, which can occur while playing sports or from overuse, but sometimes happen for unknown reasons. In addition to being common, torn rotator cuff tendons — which hold the shoulder in place and allow for its movement — don’t always heal, leaving patients unable to lift or move their arms, and doctors don’t always know why.

Mazzocca and his team are working on both physical therapy and biological methods to change that.

“The patient with a bad outcome is the patient that drives us,” he says.

Part of Mazzocca’s team is conducting tests on cadavers to find out how much strain it takes for a newly repaired rotator cuff tendon to fail. The goal is to determine how much strength patients are likely to have post-surgery, giving doctors an idea of when they can tell patients to start rehab work. Another group is testing different physical therapy regimens to see which ones help patients recover fastest and most completely.

Despite the best efforts of surgeons and physical therapists, about 15 percent of rotator cuff patients just don’t heal — and the team suspects a biological reason. For those patients, Mazzocca says he is trying to “use the body’s own natural resources to precisely target and directly repair injured tissue.”

To do so, Mazzocca harvests the patient’s own stem cells during surgery, then spins them down in a centrifuge to concentrate them and inject them back into the repair site to advance healing. These adult stem cells, harvested from bone marrow within the patient’s humeral bone, have the potential to turn into bone, tendon, or cartilage.

“Someone who hasn’t used his or her arm in 10 to 15 years and you’re able to return that function to them — that’s the big thrill,” Mazzocca says.

That’s also the goal of the sports medicine team as a whole.

“There’s nothing better than seeing a patient walk into my office smiling, saying ‘Doc, look what I can do now,’ or saying they were able to do something in physical therapy for the first time in years,” says Edgar.