Brian Hainline - Academia.edu (original) (raw)

Papers by Brian Hainline

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2014

Background: Since 1982, the National Collegiate Athletic Association has used the Injury Surveill... more Background: Since 1982, the National Collegiate Athletic Association has used the Injury Surveillance System (ISS) to collect injury and athlete-exposure data from a representative sample of collegiate institutions and sports. At the start of the 2004-2005 academic year, a Web-based ISS replaced the paper-based platform previously used for reporting injuries and exposures. Objective: To describe the methods of the Web-based National Collegiate Athletic Association ISS for data collection as implemented from the 2004-2005 to 2013-2014 academic years. Description: The Web-based ISS monitored National Collegiate Athletic Association-sanctioned practices and competitions, the number of participating student-athletes, and time-loss injuries during the preseason, regular season, and postseason in 25 collegiate sports. Starting in the 2009-2010 academic year, non-time-loss injuries were also tracked. Efforts were made to better integrate ISS data collection into the workflow of collegiate athletic trainers. Data for the 2004-2005 to 2013-2014 academic years are available to researchers through a standardized application process available at the Datalys Center Web site. Conclusions: As of February 2014, more than 1 dozen data sets have been provided to researchers. The Datalys Center encourages applications for access to the data.

Oxford University Press eBooks, Dec 1, 2019

Retirement from sport is a big decision for any athlete. Currently there are no evidence- or cons... more Retirement from sport is a big decision for any athlete. Currently there are no evidence- or consensus-based guidelines for retirement from sport following multiple concussions. This gap is compounded by the lack of objective biomarkers to guide such decision-making. Current recommendations for retirement center around worrisome neurological findings on exam or brain imaging, prolonged recovery following concussion, low threshold for developing concussion, and shortened time intervals between concussions. Retirement from sport following one (or multiple) concussions should be based on multiple factors, including evidence of neurologic impairment, prolonged recovery, lower threshold for developing concussion, and personal/family concerns.

Journal of Athletic Training, Mar 1, 2017

Journal of Clinical Sport Psychology, Dec 1, 2019

This study sought to determine whether completion of the National Collegiate Athletic Association... more This study sought to determine whether completion of the National Collegiate Athletic Association’s “Supporting Student-Athlete Mental Wellness” online module for coaches increased mental health literacy, reduced stigma, and increased intentions to: 1) communicate proactively with team members about the importance of mental health care seeking, and 2) respond appropriately to support an athlete believed to be struggling with a mental health issue. College head coaches completed pre-test surveys (n = 969) and immediate post-test surveys (n = 347, completion rate = 36%). Module completion was associated with increased mental health literacy, decreased stigma about help seeking and increased intentions to engage in culture setting communication. These findings suggest that the online module is a good start for coach education about mental health; however, additional modifications may be warranted to the extent coach referral to sports medicine staff or provision of emotional support to student-athletes struggling with mental health concerns are considered desired behaviors.

Clinical Journal of Sport Medicine, 2013

Objective: To examine the incidence of illness and highlight gender differences in tennis players... more Objective: To examine the incidence of illness and highlight gender differences in tennis players competing in a major professional tennis tournament over a 16-year period between 1994 and 2009.

Journal of Neuro-ophthalmology, Mar 1, 1996

Journal of Athletic Training, Aug 1, 2019

The Second Safety in College Football Summit resulted in interassociation consensus recommendatio... more The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and nontraumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.

British Journal of Sports Medicine, May 16, 2019

Objectives To present an overview of the existing epidemiological evidence regarding the occurren... more Objectives To present an overview of the existing epidemiological evidence regarding the occurrence of mental health symptoms and disorders among current and former elite athletes. Design Systematic review and meta-analysis. Data sources Five electronic databases were searched from inception to November 2018: PubMed (MEDLINE), SportDiscus via EBSCO, PSycINFO via ProQuest, Scopus and Cochrane. Eligibility criteria for selecting studies We included original quantitative studies that were written in English, were conducted exclusively among current or former elite athletes, and presented incidence or prevalence rates of symptoms of mental disorders. Results Twenty-two relevant original studies about mental health symptoms and disorders among current elite athletes were included: they presented data especially on symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 2895 to 5555 current elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression. Fifteen relevant original studies about mental health symptoms and disorders among former elite athletes were included: they similarly presented data especially about symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 1579 to 1686 former elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 16% for distress to 26% for anxiety/depression. Conclusions Our meta-analyses showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/ depression for current elite athletes, and from 16% for distress to 26% for anxiety/depression for former elite athletes.

British Journal of Sports Medicine, May 2, 2023

Objectives To characterise psychological distress during the COVID-19 pandemic among collegiate a... more Objectives To characterise psychological distress during the COVID-19 pandemic among collegiate athletes and assess whether racial and ethnic differences in psychological distress are attenuated when accounting for inequitable exposure to structural and social determinants of health. Methods Participants were collegiate athletes on teams competing in the National Collegiate Athletic Association (n=24 246). An electronic questionnaire was distributed by email, open for completion 6 October to 2 November 2020. Multivariable linear regression models were used to assess the cross-sectional associations between meeting basic needs, death or hospitalisation due to COVID-19 of a close contact, race and ethnicity, and psychological distress. Results Athletes racialised as Black had higher levels of psychological distress than their white peers (B=0.36, 95% CI 0.08 to 0.64). Psychological distress was higher among athletes who had more difficulties meeting basic needs, and who had a close contact die or be hospitalised with COVID-19. After adjusting for these structural and social factors, Black athletes experienced less psychological distress than white peers (B=−0.27, 95% CI −0.54 to −0.01). Conclusions The present findings provide further evidence of how inequitable structural and social exposures are associated with racial and ethnic differences in mental health outcomes. Sports organisations should ensure the mental health services available for their athletes are appropriate for meeting the needs of individuals experiencing complex and traumatic stressors. Sports organisations should also consider whether there are opportunities to screen for social needs (eg, related to food or housing insecurity), and to connect athletes with resources to help meet those needs.

Clinical Journal of Sport Medicine, Jun 8, 2020

Oxford University Press eBooks, Dec 1, 2019

Vestibular dysfunction is common following concussion, and the development of severe dizziness is... more Vestibular dysfunction is common following concussion, and the development of severe dizziness is a predictor of prolonged post-concussion recovery. Vestibular dysfunction is also a clinical domain of concussion that benefits from domain-specific rehabilitation. Unfortunately, post-concussion patients with complaints of dizziness, or worsening vestibular symptoms with exercise, are too often advised to rest, and prolonged rest can worsen vestibular dysfunction. If vestibular dysfunction does manifest in an individual with concussion and is not addressed, it can lead to persistent post-concussive symptoms that may be misunderstood as a more severe brain injury or prolonged recovery from concussion.

Neurology, Nov 19, 2018

Sports neurology is a relatively new specialty in neurology. Interested trainees may find it diff... more Sports neurology is a relatively new specialty in neurology. Interested trainees may find it difficult to learn about issues in sports neurology both in medical school and residency. This review highlights what the current state is in medical school and residency training and how an interested trainee or neurologist could pursue a career in this area.

Health Education & Behavior, Sep 30, 2019

Concussions are an anticipated part of sports that involve routine contact or collision and can a... more Concussions are an anticipated part of sports that involve routine contact or collision and can also occur in noncollision sports as a result of accidental contact with another athlete, equipment, or playing surface (Zuckerman et al., 2015). Concussion education for coaches is being increasingly recommended (

Journal of Athletic Training, Oct 1, 2019

Stroke, Jul 1, 1988

Duplex scanning of the carotid bifurcation has emerged as an accurate noninvasive means of predic... more Duplex scanning of the carotid bifurcation has emerged as an accurate noninvasive means of predicting and quantifying carotid arterial stenoses. Compared with the more widely reported measurements of spectral broadening and peak frequency ratios, measurements of diastolic velocity ratios have theoretical advantages in predicting carotid artery stenosis. The use of diastolic velocity ratios between the internal and common carotid arteries was prospectively studied in 30 consecutive patients to determine its accuracy in predicting significant stenosis of the internal carotid artery when compared with angiography. A total of 55 carotid bifurcations were studied, and the use of diastolic velocity ratios correctly predicted high-grade stenosis (>75% diameter reduction) in 52 cases (95%). We conclude that diastolic velocity ratios may be used to accurately detect significant internal carotid artery stenosis. {Stroke 1988;19:910-912

Continuum, Dec 1, 2014

Purpose of Review: The purpose of this review is to discuss peripheral nerve injuries in sport an... more Purpose of Review: The purpose of this review is to discuss peripheral nerve injuries in sport and to discuss such injuries within the context of their mechanisms of action. Recent Findings: This review is based on the author's personal experience combined with analysis of pertinent articles and reviews. Peripheral nerve injuries are uncommon in sport, but represent a potentially serious cause of morbidity to the athlete. Although making a diagnosis of the involved peripheral nerve is not necessarily difficult for the practicing neurologist, it is critical to always place peripheral nerve injury in sport within the context of sports medicine. Nerve injuries do not occur in isolation, but rather are intertwined with the conditioning of the athlete, the biomechanics of the sport, and the use of protective equipment. Summary: In assessing peripheral nerve injuries in sport, it is not enough to simply make a diagnosis of the involved nerve; the physician must also assess whether the nerve became injured through a process of direct acute compression or stretching, repetitive compression and stretching over time, or another mechanism such as ischemia or laceration. Diagnosing sports-related peripheral nerve injuries within the context of their mechanism of action better allows for the possibility of functional rehabilitation.

Journal of Athletic Training, Apr 1, 2016

Clinical Journal of Sport Medicine, Sep 1, 2018

Objective: For elite athletes to train and compete at peak performance levels, it is necessary to... more Objective: For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge. Data sources: Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified. Main Results: Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life. Conclusions: The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance.

Psychiatric Clinics of North America, Sep 1, 2005

The following descriptions of pain by patients who suffer with chronic pain syndromes suggest the... more The following descriptions of pain by patients who suffer with chronic pain syndromes suggest the complexity of the conscious experience of chronic pain: ''I feel as if someone has pulled the skin off of my left leg, and is then constantly rubbing salt into my leg.'' ''I feel as if my leg is on fire. My skin feels burnt, and it is as if someone is taking claws and tearing into my skin twenty-four hours a day.'' ''I feel as if someone has taken a hot poker knife and is jabbing it deep in my right eye. If I could pull my eye out, only to remove this sensation, I would gladly do so.''

Neurology, Nov 1, 1992

Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compress... more Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compression. Eight had known cancer, the ninth an epidural abscess. Lower-extremity dysmetria, gait ataxia, or both, were the only neurologic signs in five patients. An incorrect initial diagnosis led to delay in treatment and subsequent neurologic deterioration in six patients. Failure to recognize isolated, painless ataxia as the initial manifestation of spinal cord compression and appropriately treat the disorder can result in irreversible spinal cord deterioration.

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2014

Background: Since 1982, the National Collegiate Athletic Association has used the Injury Surveill... more Background: Since 1982, the National Collegiate Athletic Association has used the Injury Surveillance System (ISS) to collect injury and athlete-exposure data from a representative sample of collegiate institutions and sports. At the start of the 2004-2005 academic year, a Web-based ISS replaced the paper-based platform previously used for reporting injuries and exposures. Objective: To describe the methods of the Web-based National Collegiate Athletic Association ISS for data collection as implemented from the 2004-2005 to 2013-2014 academic years. Description: The Web-based ISS monitored National Collegiate Athletic Association-sanctioned practices and competitions, the number of participating student-athletes, and time-loss injuries during the preseason, regular season, and postseason in 25 collegiate sports. Starting in the 2009-2010 academic year, non-time-loss injuries were also tracked. Efforts were made to better integrate ISS data collection into the workflow of collegiate athletic trainers. Data for the 2004-2005 to 2013-2014 academic years are available to researchers through a standardized application process available at the Datalys Center Web site. Conclusions: As of February 2014, more than 1 dozen data sets have been provided to researchers. The Datalys Center encourages applications for access to the data.

Oxford University Press eBooks, Dec 1, 2019

Retirement from sport is a big decision for any athlete. Currently there are no evidence- or cons... more Retirement from sport is a big decision for any athlete. Currently there are no evidence- or consensus-based guidelines for retirement from sport following multiple concussions. This gap is compounded by the lack of objective biomarkers to guide such decision-making. Current recommendations for retirement center around worrisome neurological findings on exam or brain imaging, prolonged recovery following concussion, low threshold for developing concussion, and shortened time intervals between concussions. Retirement from sport following one (or multiple) concussions should be based on multiple factors, including evidence of neurologic impairment, prolonged recovery, lower threshold for developing concussion, and personal/family concerns.

Journal of Athletic Training, Mar 1, 2017

Journal of Clinical Sport Psychology, Dec 1, 2019

This study sought to determine whether completion of the National Collegiate Athletic Association... more This study sought to determine whether completion of the National Collegiate Athletic Association’s “Supporting Student-Athlete Mental Wellness” online module for coaches increased mental health literacy, reduced stigma, and increased intentions to: 1) communicate proactively with team members about the importance of mental health care seeking, and 2) respond appropriately to support an athlete believed to be struggling with a mental health issue. College head coaches completed pre-test surveys (n = 969) and immediate post-test surveys (n = 347, completion rate = 36%). Module completion was associated with increased mental health literacy, decreased stigma about help seeking and increased intentions to engage in culture setting communication. These findings suggest that the online module is a good start for coach education about mental health; however, additional modifications may be warranted to the extent coach referral to sports medicine staff or provision of emotional support to student-athletes struggling with mental health concerns are considered desired behaviors.

Clinical Journal of Sport Medicine, 2013

Objective: To examine the incidence of illness and highlight gender differences in tennis players... more Objective: To examine the incidence of illness and highlight gender differences in tennis players competing in a major professional tennis tournament over a 16-year period between 1994 and 2009.

Journal of Neuro-ophthalmology, Mar 1, 1996

Journal of Athletic Training, Aug 1, 2019

The Second Safety in College Football Summit resulted in interassociation consensus recommendatio... more The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and nontraumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.

British Journal of Sports Medicine, May 16, 2019

Objectives To present an overview of the existing epidemiological evidence regarding the occurren... more Objectives To present an overview of the existing epidemiological evidence regarding the occurrence of mental health symptoms and disorders among current and former elite athletes. Design Systematic review and meta-analysis. Data sources Five electronic databases were searched from inception to November 2018: PubMed (MEDLINE), SportDiscus via EBSCO, PSycINFO via ProQuest, Scopus and Cochrane. Eligibility criteria for selecting studies We included original quantitative studies that were written in English, were conducted exclusively among current or former elite athletes, and presented incidence or prevalence rates of symptoms of mental disorders. Results Twenty-two relevant original studies about mental health symptoms and disorders among current elite athletes were included: they presented data especially on symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 2895 to 5555 current elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression. Fifteen relevant original studies about mental health symptoms and disorders among former elite athletes were included: they similarly presented data especially about symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 1579 to 1686 former elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 16% for distress to 26% for anxiety/depression. Conclusions Our meta-analyses showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/ depression for current elite athletes, and from 16% for distress to 26% for anxiety/depression for former elite athletes.

British Journal of Sports Medicine, May 2, 2023

Objectives To characterise psychological distress during the COVID-19 pandemic among collegiate a... more Objectives To characterise psychological distress during the COVID-19 pandemic among collegiate athletes and assess whether racial and ethnic differences in psychological distress are attenuated when accounting for inequitable exposure to structural and social determinants of health. Methods Participants were collegiate athletes on teams competing in the National Collegiate Athletic Association (n=24 246). An electronic questionnaire was distributed by email, open for completion 6 October to 2 November 2020. Multivariable linear regression models were used to assess the cross-sectional associations between meeting basic needs, death or hospitalisation due to COVID-19 of a close contact, race and ethnicity, and psychological distress. Results Athletes racialised as Black had higher levels of psychological distress than their white peers (B=0.36, 95% CI 0.08 to 0.64). Psychological distress was higher among athletes who had more difficulties meeting basic needs, and who had a close contact die or be hospitalised with COVID-19. After adjusting for these structural and social factors, Black athletes experienced less psychological distress than white peers (B=−0.27, 95% CI −0.54 to −0.01). Conclusions The present findings provide further evidence of how inequitable structural and social exposures are associated with racial and ethnic differences in mental health outcomes. Sports organisations should ensure the mental health services available for their athletes are appropriate for meeting the needs of individuals experiencing complex and traumatic stressors. Sports organisations should also consider whether there are opportunities to screen for social needs (eg, related to food or housing insecurity), and to connect athletes with resources to help meet those needs.

Clinical Journal of Sport Medicine, Jun 8, 2020

Oxford University Press eBooks, Dec 1, 2019

Vestibular dysfunction is common following concussion, and the development of severe dizziness is... more Vestibular dysfunction is common following concussion, and the development of severe dizziness is a predictor of prolonged post-concussion recovery. Vestibular dysfunction is also a clinical domain of concussion that benefits from domain-specific rehabilitation. Unfortunately, post-concussion patients with complaints of dizziness, or worsening vestibular symptoms with exercise, are too often advised to rest, and prolonged rest can worsen vestibular dysfunction. If vestibular dysfunction does manifest in an individual with concussion and is not addressed, it can lead to persistent post-concussive symptoms that may be misunderstood as a more severe brain injury or prolonged recovery from concussion.

Neurology, Nov 19, 2018

Sports neurology is a relatively new specialty in neurology. Interested trainees may find it diff... more Sports neurology is a relatively new specialty in neurology. Interested trainees may find it difficult to learn about issues in sports neurology both in medical school and residency. This review highlights what the current state is in medical school and residency training and how an interested trainee or neurologist could pursue a career in this area.

Health Education & Behavior, Sep 30, 2019

Concussions are an anticipated part of sports that involve routine contact or collision and can a... more Concussions are an anticipated part of sports that involve routine contact or collision and can also occur in noncollision sports as a result of accidental contact with another athlete, equipment, or playing surface (Zuckerman et al., 2015). Concussion education for coaches is being increasingly recommended (

Journal of Athletic Training, Oct 1, 2019

Stroke, Jul 1, 1988

Duplex scanning of the carotid bifurcation has emerged as an accurate noninvasive means of predic... more Duplex scanning of the carotid bifurcation has emerged as an accurate noninvasive means of predicting and quantifying carotid arterial stenoses. Compared with the more widely reported measurements of spectral broadening and peak frequency ratios, measurements of diastolic velocity ratios have theoretical advantages in predicting carotid artery stenosis. The use of diastolic velocity ratios between the internal and common carotid arteries was prospectively studied in 30 consecutive patients to determine its accuracy in predicting significant stenosis of the internal carotid artery when compared with angiography. A total of 55 carotid bifurcations were studied, and the use of diastolic velocity ratios correctly predicted high-grade stenosis (>75% diameter reduction) in 52 cases (95%). We conclude that diastolic velocity ratios may be used to accurately detect significant internal carotid artery stenosis. {Stroke 1988;19:910-912

Continuum, Dec 1, 2014

Purpose of Review: The purpose of this review is to discuss peripheral nerve injuries in sport an... more Purpose of Review: The purpose of this review is to discuss peripheral nerve injuries in sport and to discuss such injuries within the context of their mechanisms of action. Recent Findings: This review is based on the author's personal experience combined with analysis of pertinent articles and reviews. Peripheral nerve injuries are uncommon in sport, but represent a potentially serious cause of morbidity to the athlete. Although making a diagnosis of the involved peripheral nerve is not necessarily difficult for the practicing neurologist, it is critical to always place peripheral nerve injury in sport within the context of sports medicine. Nerve injuries do not occur in isolation, but rather are intertwined with the conditioning of the athlete, the biomechanics of the sport, and the use of protective equipment. Summary: In assessing peripheral nerve injuries in sport, it is not enough to simply make a diagnosis of the involved nerve; the physician must also assess whether the nerve became injured through a process of direct acute compression or stretching, repetitive compression and stretching over time, or another mechanism such as ischemia or laceration. Diagnosing sports-related peripheral nerve injuries within the context of their mechanism of action better allows for the possibility of functional rehabilitation.

Journal of Athletic Training, Apr 1, 2016

Clinical Journal of Sport Medicine, Sep 1, 2018

Objective: For elite athletes to train and compete at peak performance levels, it is necessary to... more Objective: For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge. Data sources: Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified. Main Results: Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life. Conclusions: The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance.

Psychiatric Clinics of North America, Sep 1, 2005

The following descriptions of pain by patients who suffer with chronic pain syndromes suggest the... more The following descriptions of pain by patients who suffer with chronic pain syndromes suggest the complexity of the conscious experience of chronic pain: ''I feel as if someone has pulled the skin off of my left leg, and is then constantly rubbing salt into my leg.'' ''I feel as if my leg is on fire. My skin feels burnt, and it is as if someone is taking claws and tearing into my skin twenty-four hours a day.'' ''I feel as if someone has taken a hot poker knife and is jabbing it deep in my right eye. If I could pull my eye out, only to remove this sensation, I would gladly do so.''

Neurology, Nov 1, 1992

Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compress... more Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compression. Eight had known cancer, the ninth an epidural abscess. Lower-extremity dysmetria, gait ataxia, or both, were the only neurologic signs in five patients. An incorrect initial diagnosis led to delay in treatment and subsequent neurologic deterioration in six patients. Failure to recognize isolated, painless ataxia as the initial manifestation of spinal cord compression and appropriately treat the disorder can result in irreversible spinal cord deterioration.