C Vitae

Back in his court

After suffering a tennis-related injury in college, back expert Brian Hainline prevents pain from sidelining the pros.

By Dawn Reiss

Illustration by Richard Thompson

When Pete Sampras, on the cusp of winning a record-setting 13th Grand Slam victory, was injured during practice with a simple backhand at the 1999 U.S. Open, he was forced to withdraw from the tournament. The cause: an acute herniated lumbar disc.

The decision to compete or withdraw fell heavily on Brian Hainline, MD’82, the U.S. Open chief medical officer from 1992 to 2007. It’s a moment Hainline calls one of the most stressful of his career. “Had Pete played and won, he would have broken the Grand Slam record,” says Hainline, a back-pain expert and chief of neurology and integrative-pain medicine at ProHealth Care Associates in Lake Success, New York. “But in a situation like that, the question becomes, do you try to allow the person to be pain-free to finish the tournament or advise them to sit back and rehabilitate?”

Ultimately, Hainline advised Sampras to withdraw. Had the “fresh herniation” torn more, he says, it could have “radically changed the biomechanics of Sampras’s back.” That risk, coupled with Hainline’s belief that Sampras probably wouldn’t be able to play seven matches in two weeks, helped cement the decision. And because he sat out the rest of tournament, “Pistol Pete” eventually recovered and went on to win two more Grand Slam singles titles, the 2000 Wimbledon and the 2002 U.S. Open, making him the all-time singles leader with 14 titles.

“You never treat an athlete as a superstar,” says 52-year-old Hainline, now a director-at-large on the U.S. Tennis Association board of directors. “An athlete is no better, no worse than any other patient. You have to make it clear you are taking into consideration how to help them in this tournament and more importantly how to help them for their career, their overall health and well being. There is an understanding that sometimes those two things are in conflict.”

It’s a personal struggle that Hainline knows well. A walk-on to Notre Dame University’s tennis team, he became the No. 1 singles and doubles player during his senior year in 1978. But while diving for a backhand volley during a late-season match, his back went out, ending his collegiate career. In 1990 he had a discectomy to remove a herniated disc fragment, and he began to examine proactive measures, including stress levels, proper biomechanics in day-to-day activities, and mental and emotional health, to prevent reinjury. In 1991 he joined Manhattan’s Hospital for Joint Diseases as director of clinical and sports neurology, later becoming vice chair of the neurology department and codirector of the pain center. There he conducted brain-tumor research, and he also studied complicated failed back-surgery cases and chronic-pain patients.

While talking to a medicine man during a 1997 family trip to Western Africa’s Ivory Coast, Hainline made a discovery. The medicine man “couldn’t comprehend chronic pain. He said, ‘That doesn’t exist in my society.’” So Hainline began to explore more deeply the effect that unconscious emotions can have on chronic pain, research that later became the basis of his book Back Pain Understood (Medicus Press, 2007). He developed a multidisciplinary approach—combining medicine, biomechanics, and “Westernized techniques” like surgery with alternative methods such as meditation, yoga, and mind-body connections.

Despite his own back problems, Hainline, who has worked at ProHealth Associates since 1997 and lives in Douglaston, New York, still plays tennis with his wife and three kids (aged 12, 21, and 25) at his town’s famed Douglaston Club, where former professionals like John McEnroe and Mary Carillo are regulars. “He’s a beautiful tennis player and a terrific athlete,” says Carillo, a sportscaster for HBO, CBS, ESPN, and NBC. “There’s a reason he was out at the U.S. Open. He knows a lot about tennis. Myself and a lot of other people out there have a deep level of trust and respect for Brian.”

Seven years after he told Sampras to withdraw, Hainline made a different call with Andre Agassi at the 2006 U.S. Open. This time the physician gave the tennis player epidural injections to cope with extreme back pain during the tournament, where he lost in the second round against Benjamin Becker. 

“It was clear to Andre that he was at the end of his career,” Hainline says. “At that point, you just try to help a person get through the match.” Even in those last-ditch situations, adds Hainline, also chair of the International Tennis Federation’s Sport Science and Medicine Commission, “you are still guided by what guides us in medicine, which is to do no harm and, more importantly, to do good.”

Hainline, who’d already been a consulting physician for the U.S. Open, officially joined the organization in 1992, the year after a player almost died of heat stroke. Brought on as chief medical officer and asked to overhaul the operation, he traveled around the world to see how other major sporting venues like Madison Square Garden and events including the Indianapolis 500, the French Open, and Wimbledon built their medical-care systems. Hainline then created a crisis-management team of 14 paramedics, including three permanent first-aid stations and a team of rovers who could respond to any medical situation within three minutes.

The team could handle the U.S. Open’s rapid crowd growth: attendance rose from more than 350,000 spectators in 1981 to 480,000-plus in 1991, and more than 700,000 in 2007, when physicians saw 2,000 patients a day for problems ranging from blisters and headaches to heart attacks. The physicians also attend to the rise in athletic injuries. Players now compete at a younger age, and equipment improvements—graphite and titanium racquets, synthetic strings—give the game more speed and harder swings, so they suffer more back and hip problems. After 9/11, meanwhile, Hainline came up with a plan in case of a terrorist attack. His improvements earned him the 2001 International Tennis Hall of Fame Tennis Education Merit Award and the 2004 Women’s Tennis Association Tour Irving Glick Award.

Hainline has been playing tennis since his childhood in Detroit. One of seven siblings, he fell in love with the sport at the city courts and at the nation’s oldest tennis camp, the Hoxie Tennis Camp in Hamtramck, Michigan. “It was the first time I spent time with people different than where I grew up,” says Hainline. In the 1960s Detroit was segregated, but the camp drew players from different racial, ethnic, and economic backgrounds. “Tennis became important in my life, by opening up opportunities for me and by shaping my culture views at a very early age.” So tennis, Hainline says, “allowed me to step out of those cultural divides and question the way I was growing up and some of the great institutions that were supposedly in charge of saving my life.”

Hainline, an associate professor of neurology at New York University’s School of Medicine for the past 13 years, continued mingling with different cultures at Chicago, where he lived at International House and met his wife, Pascale, a French native taking a year of economics at Chicago. While studying at the Pritzker School of Medicine, he says, he learned “to become a good clinician.” It’s an art, he believes, becoming lost with today’s “make, bake, and shake” variety of physicians who try to give patients a quick fix through surgery or medication without looking at underlying problems. In his book he challenges both patients and doctors to look at mind-body strategies and stress-relieving techniques such as yoga, myofascial release, acupuncture, and chiropractic care to help deal with chronic pain.

Back-injury patients, he says, should begin by asking what is out of balance in their bodies and lives. “And it’s not a straightforward answer,” Hainline says. “So each day ask yourself, ‘Am I taking care of myself? Am I under a lot of stress and I’m not addressing it? Am I pushing myself to the extreme?’”

Balancing traditional and alternative techniques is also important in treating pain, he says. “I don’t presuppose that chronic pain is mind over matter and all your back pain will go away. But it’s about understanding the complex relationship of the mind and body.”

Which is why, Hainline jokes, he stays involved in tennis: “It keeps me sane.”

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