An interview with Dr. Brian Hainline, M.D., the U.S. Open chief medical officer and author ofBack Pain Understood.
How did you become the chief medical officer at the U.S. Open?
It started off in 1992 when we realized was there were a lot of physicians on site, but there wasn’t a coordinated medical policy and procedure. I was asked to come on to devise a master plan. This year will be my 16th year and it likely will be my last year. It’s been a great tradition for me. I’m on the board of directors on the USTA and this is my first year doing that. It’s hard to be a part-time staff person and also on the board of directors.
What’s it like to have the responsibility at an event as big as the Open?
On the staff and spectators’ side, we will see within the two-week period, sometimes up to 2,000 people. Then there are roving paramedics and two ambulances and a large staff. A lot of it is things like being out in the sun for a long time and getting headaches or blisters. We’ve seen heart attacks and strokes. Anytime you have that many people in one area over a two-week period of time, just statistically you can expect something to happen.
What about for the players?
On the players’ side, there’s always myself, who’s a neurologist and I specialize in the spine, then there’s an orthopedic surgeon, and an internist, so there’s always three of us on site from an hour before the first match starts to up to an hour after the last match ends. It’s a long haul, including during the qualifying tournament and the weekend before that.
What kinds of care do you provide players?
It’s moved from just putting Band-Aids on people and taking care of acute injuries to educating players about the importance of being responsible for their medical care in a preventative manner. The Open is the last Grand Slam, so a lot of the players are carrying with them some chronic ailments. At the Open, players can obtain a definitive diagnoses and management strategy. If someone has a sort of chronic shoulder problem, we’ll diagnose them and they’ll get their MRI and we’ll come up with a game plan. It’s very much about long-term care. If someone comes in and you give them two Advil and they go out and play again, they’re going to get injured and be back the next week. That’s not good medical care.
What have been some of the most stressful times at the Open?
One very stressful moment was in 1999 when [Pete] Sampras hurt his back the year he was earmarked to win his 13th Grand Slam. He just hit a simple backhand and developed severe lower-back pain. And—this is all public information—he had a herniated disk. This is really why I wrote the book, because it’s not about making a diagnosis, it’s looking at the person in their eyes and saying, “How did [this diagnosis] come to arrive in you and what’s the most comprehensive thing we can do for it?” For Pete, one could say he was carrying the weight of the world on his shoulders before that tournament. Did that stress lead to the disc herniation or was it bad luck? Everyone will have their own interpretation. If you look at the U.S. Open, you have to win seven matches, and they’re grueling matches. If we had tried to make him pain-free, and the disc had ruptured even further, that could have been the end of his career. He decided to pull out. That was very stressful because the whole world wants to know what’s going on. I had to go into hiding to avoid people.
Tell us about your book, Back Pain Understood.
It’s a mind-body approach, which is not the same as mind over matter. I don’t believe in that. There are very strong genetic programs in us. At every level of awareness there’s what your body is doing and what your emotions are doing. The book is trying to bring that into focus. A lot of our responses, our fear, our rage, our deep anxiety, these programs intertwine with chronic pain. Anger and fear and even love, take three very primal emotions, they have their expression in the body before we’re even aware of them. But on the other hand, our body will link to certain emotions. When you’ve hurt yourself and you’re in pain, sometimes that links to considerable fear and anxiety, and then they start playing off each other.
So can physical pain be caused by emotions?
What you don’t want to do is be judgmental about it. People will say, “Well, he’s saying it’s emotional, he’s saying it’s in my head.” And you can’t do that, you have to be willing not to be judgmental. We’re all called to be compassionate, and I think that’s what medicine is. You have to get to know the person.
When what should someone do when they’re in pain?
The first thing is to understand that pain is a way our body calls attention to itself. So don’t ignore it. If it’s a mild thing, you have to ask yourself, “How did I overdo it?” Sometimes we overdo it because we’re a weekend warrior, and sometimes we do it because we’re stressed at work and haven’t taken care of our body. Once things transform into chronic pain that’s persisted for a month or more, you really have to step back and have a specialist evaluate the situation. It’s usually a combination of things, not just physical but emotional. It comes down to medicine is about the human being, not just the label.
What kinds of treatments do you recommend in your book to take care of back pain?
A lot of physical therapists, you go in and there’re 10 people there and you all do the same ultrasound and exercises. But someone who really knows the spine, they understand the muscle balance and that’s critically important. It’s not just about ultrasound and doing pelvic tilts and situps. It’s where did your imbalance come from? A skilled physician and therapist can figure that out. And sometimes the balance won’t happen if you haven’t let go of your stress. If you’re at a desk 12 to 14 hours a day, you can’t expect physical therapy once a week and aspirin or ibuprofen to cure you. So it’s working with a therapist, sometimes medicine, and you try to understand the person and try to help them understand how they can take care of themselves.
What’s your response to people who say mind-body medicine is new-agey?
If you look at the scientific work on chronic pain, the very deep limbic pathways that mediate our deepest emotions, they’re intimately involved in chronic pain—you can’t separate them. And I’m not saying there’s a cause and effect here, because it’s a two-way street. We have to bring that science to medicine. And what makes it seem wishy-washy is that in our medical world we want to put everything under a microscope and make it physical, we want to say that there’s a drug for every malady, and so we take the human being out of the equation. But what I’m trying say is there’s a new science out there—it’s unequivocal that the mind and body interact at every level.
How can people find a good doctor for pain?
There is a relatively new medical profession called pain medicine. They usually work in a multidisciplinary group setting. We have an anesthesiologist, a neurologist, orthopedic surgeons, psychologists, massage therapists, physical therapists, acupuncturists. And you never know when someone has chronic pain what the right fit for them is. There are actually medical societies, the American Pain Society, the American Academy of Pain Medicine, that serve as references to help guide patients. Part of good medicine is making sure you’re doing as much as possible—patients need to be armed.