Sports Neurology and Pain Medicine
Dr. Williams is a board-certified clinical neurologist with very specialized
areas of subspecialty:
Sports Neurology and
Pain Medicine. While these may seem to be unique, unfamiliar, and/or unrelated areas
of medicine, they are really quite complimentary. And he believes the
overlapping themes make him a more effective physician and hopefully makes
you – a healthier and happier patient.
Sports Neurology is a new, exciting, and evolving area of subspecialty
in Neurology. Most people are at least aware of how sports and the brain
are related from the topic of
Concussion, which has dominated the headlines of both health and sports media for
several years. Along with other Sports Medicine specialists, Neurologists
are at the forefront of evaluating and managing Concussion. But Sports
Neurology is about much more than concussion. Sports Neurology is devoted
to a wide range of issues including:
1. Sports Related Neurological Injuries
Whether on the sideline, in the emergency department, or the Kerlan-Jobe
Center for Sports Neurology, my practice involves the evaluation and treatment
of the entire nervous system. Issues may arise in any of these areas from
- Brain (Concussion/TBI)
- Spine and Spinal Cord
- Brachial Plexus
- Peripheral Nerves
- Sports-Related Neurological Emergencies
2. Consultation Regarding Safe Participation in Sports and Athletics by
Patients with Neurological Conditions
Dr. Williams is frequently consulted by patients, trainers, coaches, agents,
and other stakeholders for expert opinion regarding safe participation
or return to play. The questions include:
- Is it safe to play certain sports if you have a history of seizure or epilepsy?
- If you’ve been diagnosed with a cyst in your brain, should you avoid
certain activities? Does a history of neuromuscular disease mean you should
avoid certain sports?
How long must one wait after a
Traumatic Brain Injury or stroke before returning to sport. When is It safe?
- How many concussions is too many and when should an individual consider
retirement from sport or changing what they do?
3. Neurological Contributors to Performance
Neurological function is perhaps the most critical aspect of
Performance. These functions can be tested and trained for improvement. In fact, at
every level of participation (youth, high school, collegiate, adult/elite,
and recreational) it turns out that individuals who have natural abilities
and individuals who are training and optimizing the following skills –
excel. They excel athletically,
academically, and professionally in their careers. These skills also translate to healthier
functional aging and productive performance across the lifespan. Whether
the goal is avoiding/reducing risk of injury, returning to peak condition
after injury, or optimizing overall performance and capacity, my practice
involves assessment, training, and surveillance to maximize:
- Neuromuscular Tone and Tensegrity
- Speed of Mental Processing
- Reaction Time
- Autonomic Quieting
4. Neurological Benefits of Competitive Sport and Exercise
Many people start participation in sport and
exercise because of their innate competitive nature. Others workout for the physical
fitness and health-related benefits. But consider this:
brain loves exercise! No matter how we look at it, this is continuously proven and reinforced.
Exercise changes the brain for the better. When considering the effects
of competitive sport and exercise:
Neurological function is better for people
with and without neurological disease and diagnosis.
- Neurological function is improved for the young, middle aged and elderly.
- Individuals suffering from chronic neurological conditions like Parkinson’s
Disease, Stroke, and Cognitive Impairment demonstrate improved function.
- There are significant benefits for those with psychological and psychiatric
disorders like depression, and anxiety.
- In many cases, exercise equals or exceeds the benefits of prescription
medications alone. It almost certainly augments pharmacotherapy for individuals
- Neurological health across the lifespan is optimized with committed, consistent
participation in aerobic and resistance-based exercise.
Pain Medicine is a fascinating medical subspecialty practiced by Neurologists,
Anesthesiologists, Physiatrists, Psychologists, and Internists, as well
as Primary Care physicians. People seek care to manage pain more than
any other symptom and they visit physicians, therapists, trainers, acupuncturists,
chiropractors, healers, and other healthcare professionals to find relief.
But as a Neurologist, Dr. Williams understands and hopes to reveal to
his patients that
All Pain Is In The Brain. My approach to pain medicine is neurologically based. It is based on
Pain Science. And it is effective.
Treating pain can be much trickier than one might imagine. Even the definition
of pain is complex. The
International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described in terms
of such damage". Most people think of pain as a
sensation, when in reality it is an
experience. The difference is critical to achieving comprehension and successful
PAIN IS NOT: An unpleasant
sensation (a physical feeling or perception resulting from something that happens
to or comes into contact with the body)
PAIN IS: An unpleasant
experience (a physical and mental state one goes through or lives through; a state
that involves practical observation of facts or events
as apprehended/understood). Therefore, what you understand affects your experience-and, therefore
affects your pain.
Most people think of pain as being located in the area that hurts when
injured. But in reality, what is experienced as pain is the sum total
of information interpreted by the brain and based on two simultaneously
active Neurological Pathways:
- Ascending Pathway (from the periphery up to the brain)
- Descending Pathway (from the brain down to the spinal cord)
Dr. Williams’ Neurological approach to pain medicine involves techniques
that address the entire nervous system, and focus on both the ascending
and descending pathways sequenced as follows:
Collecting data through expert subjective examination (history taking from
the patient) and objective examination (physical examination, review of
- Patient education/discussion regarding probable and possible pain generators
(causing and contributing to the pain)
- Development of goals and timeline
Multidisciplinary intervention as indicated (which may include combinations of
education, movement-based therapies and exercise, medications, interventional procedures,
biobehavioral therapies, and
- Reassessment, continuation, or adjustment and escalation as indicated
Approaches to managing acute, persistent, and chronic pain continue to
evolve over time. Pain Science in conjunction with new technology is increasingly
effective. Also, new approaches to long-standing and even ancient techniques
are being used to optimize pain management. The most state-of-the-art
Pain Science demonstrates the critical role of education, insight, movement,
and the brain in treating pain. In Dr. Williams’ opinion and based
on his experience, these things are more important than sole reliance
on any particular medication, injection, or surgery.
Overlap and Synergy
There are overlapping themes present in the approach to my two areas of
- Sports Neurology: Your brain makes you better. Neurological approaches
to performance and benefits of exercise on neurological function contribute
to Peak Performance athletically, academically, and professionally –
across the lifespan.
- Pain Medicine: All pain is in the brain. Understanding neurological pathways,
expectation, insight, and how the brain processes electrical signals provides
comprehensive approaches to Pain Medicine using sound, state-of-the-art
- Sports Neurology: Teaching athletes (and others) how we can assess and
train vision, balance, proprioception, focus, concentration, reaction
time and more Neurological functions and skills to optimize performance
is a game changer.
- Pain Medicine: Teaching patients with pain key aspects of Pain Science
is a critical aspect of management. Education as intervention is far more
effective than blindly prescribing a medication, intervention, or surgery.
Dr. Williams focuses on making education a key part of any treatment program.
- Sports Neurology: The brain and nervous system have the ability to change.
Connections between neurons and neural pathways can strengthen with the
right intervention, resulting in significant improvements in skills and
performance. That’s why training the brain improves vision, balance,
reaction time, accuracy, speed of mental processing, focus, concentration
and overall performance.
- Pain Medicine: Changes in how the nervous system processes signals can
explain why patients experience severe chronic and neuropathic pain. Understanding
this Neuroplasticity helps patients gain insight into their pain experience
and informs targets for intervention.
Sports Neurology: Applying stimulation to the brain using
transcranial magnetic stimulation, transcranial direct current stimulation, and other techniques is an exciting
new area of research and intervention being used to treat Neurological
injury, recover and rehabilitate after surgery, and optimize performance.
Cryoablation (targeted/focused cold therapy), Radiofrequency/Pulsed-Radiofrequency
Denervation, Spinal Cord and DRG Stimulation, Peripheral Nerve Stimulation,
and Transcranial Magnetic Stimulation are the newest, most exciting, and
promising interventional techniques for managing pain. Dr. Williams employs
these techniques in athletes and non-athletes. They are particularly attractive
because they can reduce or eliminate the need for dangerous opioid medications
and other prescription medications involving the risk of intolerable or
clinically significant side effects.
- Sports Neurology: Dr. Williams works with athletic trainers, physical therapists,
movement specialists, orthopedic surgeons, primary care sports medicine
specialists, physiatrists, sports psychologists, other neurological subspecialists,
performance specialists, strength and conditioning coaches, imaging specialists,
technicians, and other professionals on a daily basis as part of a multidisciplinary
team. This kind of collegial multidisciplinary atmosphere provides for
cross pollination of ideas and approaches that result in a synergistic
benefit to clients and patients.
- Pain Medicine: Dr. Williams works with athletic trainers, physical therapists,
movement specialists, orthopedic surgeons, pain psychologists, other neurological
subspecialists, anesthesiologists, imaging specialists, technicians, and
other professionals on a daily basis as part of a multidisciplinary team.
This kind of collegial multidisciplinary atmosphere provides for cross
pollination of ideas and approaches that result in a synergistic benefit
to clients and patients.
These common themes are critical because they work synergistically as areas
of interest and expertise. Dr. Williams believes he is a better Sports
Neurologist because of his experience and expertise in Pain Medicine.
And he is a better Pain Medicine Specialist because of his background
and expertise in Sports Neurology.