Though Dr. Jeff Brown joined the staff of Saint Francis Hospital and Medical Center just a few months ago to become Director of Primary Care Sports Medicine at the Connecticut Sports Medicine Institute, he is very familiar with the institution. As a Conard High School student growing up in West Hartford, he had the opportunity to do research there with cardiologist Dr. Bernard Clark after securing a summer fellowship through the American Heart Association. “Dr. Clark created this amazingly fun, energetic environment to work in that really stimulated my interest in medicine,” Dr. Brown recalls. “He’s been a mentor ever since.”
Dr. Brown returned to Saint Francis Hospital and Medical Center for a fellowship in sports medicine after completing a family medicine residency at the University of Rochester. As a fellow, he worked weekly with orthopedist Dr. Michael Joyce, who became another important mentor to the young physician-in-training. “He gave outstanding patient-centered care and had incredible interactions with each patient he served,” recalls Dr. Brown. When Dr. Joyce reached out to Dr. Brown about returning to Saint Francis Hospital and Medical Center to head up the primary care side of the Connecticut Sports Medicine Institute, he jumped at the opportunity.
Many people think of sports medicine as an orthopedic surgical specialty; however, primary care sports medicine specialists focus mainly on a non-operative approach to treating sports injuries. “We try to maximize all the different options that would be available to a person before they would need surgery,” Dr. Brown explains.
He notes that not all his patients are elite athletes. Sports medicine specialists treat a wide range of sports and fitness enthusiasts. “Anyone who is active and has a condition limiting them from participating in their activity, whether it’s a Tuesday night basketball game or a weekly exercise class,” he says, “can be helped to regain their function and get back to their activity.“
A confluence of early influences
Dr. Brown grew up in West Hartford with parents who were educators. His father taught mathematics at Conard; his mom was an English teacher, a paraprofessional and, eventually, a minister. “I came from a house with a lot of educational influences,” he says. “And so much of what we do as sports medicine doctors is education, to help people both in the office and in the community.”
As an urban studies major at Brown University (where he met his wife, Hartford Hospital gynecologic oncologist Dr. Amy Brown), Dr. Brown focused primarily on public health. He completed the university’s eight-year combined undergraduate and medical school program, then completed his family medicine residency and chief residency at the University of Rochester, where he loved working as a sideline physician at football and soccer games during the sports medicine part of his training.
Dr. Brown’s current position represents a confluence of his early influences. Not only is he currently a team physician for both Central Connecticut State University and the University of Hartford, but he continues his parents’ teaching legacy – and continues to pursue his interest in public health – by giving community talks on topics such as sports-related concussions.
Concussions: Caring for the injured brain
Today, people are more aware of the dangers of traumatic brain injuries and much more compliant about waiting to return to play after sustaining such injuries. “The management of concussions has become much easier, because everyone understands this is a real issue,” says Dr. Brown. “It’s rare that I get anyone who questions ‘return-to-play’ guidelines, whereas in the past, I would get that from athletes, coaches, and parents.”
The Connecticut state legislature is currently considering a bill that mandates coaches and athletic trainers learn to recognize and handle signs of concussions. Symptoms, Dr. Brown says, include headache, dizziness, blurry vision, fogginess, or “just feeling out of it.” According to Dr. Brown, any athlete who has suffered a head impact, or falls in a way that causes whiplash, should be removed from the field for evaluation. “That person needs to be assessed by someone trained in concussion management,” he says.
Dr. Brown advises his concussed patients about what they can do to alleviate symptoms and helps them devise a return to play – as well as a “return to learn” – game plan. “You start with brain rest,” he says, “avoiding video games, loud noises, moving lights (like spotlights, or watching action movies on TV), computer work and continual texting.” But he points out that new research suggests light activity – like walking, biking or using an elliptical trainer – soon after injury helps the brain recover more quickly.
“Gone are the old days of having someone sit in a dark room for three or four days,” Dr. Brown says. “Light activity helps to retrain the brain to respond to the stimuli we are all exposed to – if you cocoon the brain [through inaction], you actually delay the resolution of the concussion symptoms.”
Once symptoms have abated, Dr. Brown conducts a series of tests evaluating balance, as well as visual and cognitive function. Returning to play too early – before the brain is completely healed and while hand/eye coordination and balance are subpar – puts young athletes at greater risk of repeat, and possibly more devastating, injury. “Concussions need to be managed correctly,” says Dr. Brown. “We only get one brain and we need to protect it.”
Early sports specialization: Not a healthy option
Another concern for young athletes, according to Dr. Brown, is early sports specialization. “There is a wake-up call going on in the sports medicine community that playing the same sport season after season, all year long, is not a healthy option,” he says. “It leads to a much higher rate of overuse injuries, stress fractures, and psychological burnout.”
Unfortunately, children feel pressure, once they reach a certain level in a sport, to play that sport every season in order to make it onto elite teams and into travel leagues. That’s a problem.
“If you play one sport all year long,” says Dr. Brown, “you use the same part of the body – and the same muscles – all year long.” Using your hamstrings and quads to run up and down a soccer field, he says, is different from how you might use those muscles to play ice hockey or volleyball. Exercising muscle groups in different ways is less taxing to the body. Cross training, he explains, and including both high impact and low impact activities, helps avoid injuries like stress fractures, tendonitis (acute inflammation of the tendon) and tendonosis (chronic tendon damage).
Shoulders and knees: Treating common sports injuries
Dr. Brown often addresses shoulder issues, particularly problems in the rotator cuff, a group of tendons that structurally support the shoulder and connect the arm bone to the shoulder socket. Often, he says, the tendons are frayed, or weakened from wear and tear. “We try to strengthen the muscles around the injured tendons, so the whole unit will function better with less pain and hopefully more strength.” Dr. Brown works with a physical therapist to develop a course of therapy.
Shoulder instability or laxity is also a common complaint in younger patients, he says. Lax ligaments in some people make their shoulders more likely to move partially out of the socket. Because the ligaments move more, the bones move more, so muscles have to work overtime to keep things in place. Strengthening the muscles around the rotator cuff – as well in the upper back and the core – helps young athletes minimize, and recover from, such injuries, he says.
Knee pain also brings many patients into Dr. Brown’s office. Patellofemoral pain syndrome, or pain around the kneecap, can be caused by a loose kneecap (patella), or one that has a lateral tilt that leads to friction. Some athletes develop overuse injuries in the patella tendon, which connects the bottom of the kneecap to the shin bone, or in the quadriceps tendon, which connects to the top of the knee, leading to tendonitis or tendonosis. Active people are also susceptible to meniscal tears (the meniscus is a cushioning of cartilage found between the surfaces of the knee joints).
While meniscal tears are often treated surgically, a recent study of middle-aged patients in the Journal of the American Medical Association found that exercise therapy is as effective as arthroscopic surgery at improving knee function. “Most, if not all, providers are on board for a conservative, non-surgical trial for almost all patients who have shoulder, knee and ankle problems,” says Dr. Brown. “If they don’t have severe swelling, or severe locking of the joint, a conservative trial makes sense.” This means home exercise, physical therapy, activity modification, bracing if needed, and icing to decrease inflammation and pain – an approach that is sufficient for at least 80 percent of patients, according to Dr. Brown. “We reserve surgical options for the 10 to 20 percent who might need it down the road, and for those with severe traumatic injuries or fractures,” he adds.
Treating and teaching
Dr. Brown’s job also entails helping young athletes manage their medical conditions. He weighs in on training regimens for kids with conditions like exercise-induced asthma or diabetes, and also decides when athletes with mononucleosis, or other infectious illness, need to abstain from play for the sake of their own – or their teammates’ – health. He notes that many athletes also develop equipment or uniform-related skin conditions, including rashes, abscesses and infections, which also fall under the primary sports medicine purview.
Though Dr. Brown grew up playing soccer, tennis and golf, and a lot of street and pond hockey, the sports medicine doctor’s own athletic endeavors are limited these days to playing soccer and T-ball with his two children, aged 6 and 8, in their Glastonbury backyard. When he isn’t treating athletes, Dr. Brown is teaching others to do so through UConn’s Primary Care Sports Medicine fellowship program at Saint Francis Hospital and Medical Center, where he received his training 14 years ago, and is now the assistant director.
“I enjoy teaching immensely,” says Dr. Brown. “We are all products of the teachers who shaped us along our way. I enjoy passing on the tips and strategies that I have learned from some outstanding teachers and mentors to the current fellows and residents.”
Lori Miller Kase is a freelance writer living in Simsbury.
Photographer Seshu Badrinath of Avon specializes in intimate, natural portraits of families and children; seshuphotography.com