Click here to view the video with Dr. Erin Boynton, Orthopedic Surgeon, and Fred Robinson of Body Helix. Video Transcription is below.
Dr. Erin Boynton: Hi.
Fred Robinson: Hey, everyone, I’m Fred Robinson here with team Body Helix, and I have with me today, I’m excited to bring to you, Dr. Erin Boynton. She’s a—nice wave—an orthopedic surgeon. She has over 25 years of experience treating some of the world’s best athletes. She’s worked with the Toronto Blue Jays, the WTA. And recently, a kind of superstar—she’s going to blush now—she just won a bronze ball at the National Clay Courts in Houston. And we’ve had some questions come in from our friends, and Dr. B is going to answer some of the questions today. So, thank you for joining us.
Dr. Erin Boynton: Well, thanks a lot for having me, Fred. It’s really fun to be here. And we’ve got quite a few questions. So, the first one is from Georgia, and she has a couple of questions. One is, thoughts on cortisone shots for shoulder, elbow repetitive use injuries. I think that cortisone can play a role, but one of the most important things is to actually understand why you have the pain in the first place.
So, whenever I’m examining somebody for an elbow problem—say you have tendonitis in your elbow—I want to understand why that part of your body’s being overloaded. So, you have a tendon which attaches the muscle to bone. And within the tendon, there are little fibers of collagen. They’re like threads. And what can happen is, if you have too much mechanical load of the tendon, then the threads can pop—little microinjuries. Now, the amazing thing about our body is we can repair them if you take the pressure off that part of your body.
So, first of all, I would look at the range of motion of your elbow to make sure that the muscles are flexible, particularly your wrist flexibility. But what’s almost more important is what’s going on in your shoulder. I find that the scapula or shoulder blade is often in the wrong position which puts extra pressure on your elbow. So, it doesn’t really matter what you do to the elbow, until you change what you’re doing with your posture around your shoulder and neck, you can’t fix the elbow problem.
So, my first line of offense whenever I’m trying to treat a tendinitis problem is to understand how you go at it the first place, so it’s going to be fixing the imbalances of the muscles, and then making sure that you’ve got good posture. If you’ve done all of that and you’re still having pain, then I think that cortisone can play a role, especially in the elbow. One of the things that happens when you put the cortisone in the area is that it decreases inflammation. Now, it won’t necessarily promote healing, but the decrease in the inflammation can relax the tissue so that it takes some of the stress off of the tendon.
And one of the side effects of the elbow injection is actually rupturing the tendon, and in a way, that’s not such a bad thing because what you’re doing is lengthening it so it takes the pressure off of it. So, whenever I think about risks and benefits, it’s not such a terrible thing. But cortisone in the shoulder, you don’t want to rupture your shoulder tendon. That is a pretty serious thing, and so I’m pretty limited in the number of cortisone injections I would give around the shoulder.
Fred Robinson: And I think part of her question is, do I go through a cortisone, do I go to rehab, do I stop and let it rest, or a combination of those?
Dr. Erin Boynton: So, I think the key is to keep moving because when you do keep moving, you give direction to the body in how to heal. So, that tendon, when little fibers rupture, it stimulates a healing response. And if you don’t do anything, then the new healing tissue that’s laid down in the tendon goes out willy-nilly, if you don’t move. But if you move gently, then that gives a signal to the cells of how to lay down the collagen, and they’ll make the strongest repair. So, you want to move enough that you stimulate the healing response, but not so much that you break the healing tissue. And how do you know if you’re doing that? If it hurts, you’re doing too much.
Fred Robinson: Very good. We have some other questions. We have a number of questions coming in. Let’s see, we have another question from Brian. Can you see that question?
Dr. Erin Boynton: Yes, so Brian has been diagnosed by his orthopedic surgeon as a high-grade articular tendon tear, and I’m assuming this is in his shoulder, and these have been confirmed by X-ray and MRI. His question is: is a high-grade articular tendon tear able to be rehabilitated, or is surgery the only way?
Absolutely, a high-grade articular tear can be rehabilitated, but a little bit is going to depend upon how much stress you put on the tendon. And again, it’s, why do you have the stress going on this part of your shoulder? And I find that most people that have this kind of a problem, and particularly if they’re overhead athletes, they have a tight posterior capsule. And maybe he can go to my website and check out how to do the sleeper stretch because I think that this is an important balancing stretch to do around the shoulder. If you don’t have balance around the shoulder, which is a bowl and a saucer, what happens is that when you go to lift your arm up, and you have an imbalance at the back where, if it’s tight, the tendon gets pushed up against the bone and then it wears out.
So, the primary problem is really not the tendon tear, but the tightness at the back of the shoulder, which you treat with the sleeper stretch. And then you have to do exercises to change the position of the shoulder blade and the neck. Again, it’s treating the imbalances.
I had patients who, I had such a long waiting list for surgery—about two years for surgery—I would treat them with exercises: doing the sleeper stretch, strengthening the rotator cuff muscles, and they’d get better. And I could see at times the tendon would even heal. But if you’re going out and you’re overloading the tendon, and you put a lot of demand on it with a sport like tennis, depending on how high-grade the tendon tear is, you may have to have surgery if the tendon tear is so big that the structure can’t handle the load you’re applying.
Fred Robinson: All right, let me go to a few more questions. I think maybe…do you want to feel the one on Baker’s cyst?
Dr. Erin Boynton: I’d actually like to talk about the shoulder sleeve because maybe this can actually help with the last question.
Fred Robinson: Okay, yeah.
Dr. Erin Boynton: So…
Fred Robinson: Barbara Glass, thank you for your question. And Dr. Erin is going to talk about that right now—the shoulder.
Dr. Erin Boynton: So, the shoulder sleeve, what it does is it applies compression to the muscles around the shoulder, but because of the elasticity within the garment, I think it actually helps your muscles to function. So, there’s a couple of things that happen. One is that when you just touch the skin around a muscle, you kind of tap around the skin, you waken the muscle up, and that’s very important in the shoulder. So, the sleeve helps waken up the muscles around your shoulder.
And then the second thing is, because of the elasticity, I think it actually helps to initiate the motion so that the tendon and muscle, if it’s a little bit weak, it gets a little kick start and then it can contract.
Fred Robinson: Is that through the proprioception?
Dr. Erin Boynton: Well, I think that’s a combination of the proprioception and the elasticity in the actual garment.
Fred Robinson: Okay.
Dr. Erin Boynton: So, then it keeps you warm, which is good. My experience with the Body Helix sleeves is that they don’t slip. And I should let you talk about that because you’re the expert in that.
Fred Robinson: Yeah, the question with the shoulder is, during the summer, it will not slip with our products. They’re designed to stay in place. They are sweat-lock activated, so if you have any movement, put water on your hands, rub it on your elbow, pull the sleeve up—or on the shoulder, or on the thigh—and it will lock to your skin immediately, which is essential for tennis players, or whatever sport you’re playing.
Dr. Erin Boynton: And I’ve found personally that you just kind of forget that the sleeve is there. So, I think that it’s an excellent product for that. Anderson, her question: what can I do to prevent the Baker’s cyst behind my knee from swelling up and altering my gait? So far, the most effective preventative measure is a full-knee Helix, but I don’t wear it all the time. Well, (A) I’d say, why not? [Laughs] Again, this comes down to: why do you have a Baker’s cyst? Very often, a Baker’s cyst—which, for those of you who may not know, it’s a swelling at the back of the knee, and often times, it’s a symptom of degeneration within the knee. So, a kind of arthritic wear and tear process. Sometimes, there is a meniscal tear associated with it.
So, again, I like to treat the cause, and the cyst is sort of the symptom of the primary problem, which is overloading your knee. So, I think it’s important that you make sure that you have good flexibility of your hip, ankle, and thigh muscles, and that you make sure that you activate the VMO, that’s part of your quadricep muscle, to make sure that your kneecap is tracking properly and taking the pressure off of the joint.
So, I think the combination of…I like foam rolling to loosen up the tissue, activating the VMO, and then using the Body Helix when you’re out and doing your activities is a great combination to treat arthritis in the knee which often leads to a Baker’s cyst.
Fred Robinson: And one thing we talked about earlier, I recently had a tear in an Achilles, and we were talking about the importance of working the foot and the flexibility of the foot, and then also, above it, going into the calf, and how that reduces the stress that I was putting on my Achilles. Which, I found interesting.
Dr. Erin Boynton: Yeah.
Fred Robinson: Because when you hurt an Achilles, as a tennis player, my instinct is to go straight to the injury and try to treat the injury, and what you’re saying is, look at above and below.
Dr. Erin Boynton: And often, you can treat above and below. Again, you’re trying to take the stress… If you’ve got a rope that’s too tight, and maybe you’re even rubbing that rope on a sharp surface and the rope is fraying, if you can take the tension off the rope from above and below, then it allows the area of your body to heal that has too much tension.
Fred Robinson: Very good. I think we have some more questions coming in. Let’s see, I wanted to ask you about the question: how I can deal with a slight tear in my pec for my backhand follow-through extension.
Dr. Erin Boynton: Hi there, Sara Jane Stone.
Fred Robinson: Sara Stone.
Dr. Erin Boynton: Thank you for joining us.
Fred Robinson: Another tennis superstar.
Dr. Erin Boynton: There you go.
Fred Robinson: Hi, Sara.
Dr. Erin Boynton: Okay, so first of all, you need to make sure that your pec is stretched. And I think that Sara’s… I’ve got to ask her if she does any of the relaxing and rebalancing exercises that I ever teach her.
Fred Robinson: I don’t see a comment there.
Dr. Erin Boynton: [Laughs]
Fred Robinson: [Laughs] But I’m sure she does
Dr. Erin Boynton: So, the first thing is, you’ve got to take the stress off of your pec by having it loose and flexible. As tennis players, we tend to get very, very tight and rounded, so the pec gets short so that when you then want to extend, you’re pulling on a muscle that’s too tight and it tears. So, the key is to actually strengthen the muscles in the back of your shoulder blades, and to stretch your pecs. And you can do a combination of…I like using a little trigger point ball that I’ll place not on the area that’s…
Fred Robinson: Is that the one with the little spines on it? Or a smooth, round ball?
Dr. Erin Boynton: You can use either.
Fred Robinson: Okay.
Dr. Erin Boynton: I personally like the smooth one. I find the spine… I don’t really want to create too much pain
Fred Robinson: I use it on my back, so that’s why… Yeah.
Dr. Erin Boynton: But they’re excellent for releasing the muscle. So, I would put the ball to fix my pec, and you can either lean against the wall, or you could get a foam block and press it against the wall, and then you move your arm to stretch in to the position that you would like you’re going to hit the backhand. And then, that way, you can mobilize the pec around the area that’s torn without pulling on the actual tear. So, that way, it allows it to get better faster, because sometimes, when you have a tear and you’ve got scar tissue there, you’re going to re-tear all the time right at the junction of the fibrous scar tissue and then healthy muscle. So, if you take the pressure off of that by stretching it with the foam roller, or the ball, it allows the area to completely heal.
Fred Robinson: Very good. So, I have a question that I noticed on the tour…on the WTA tour, I see more and more of the ladies injuring their hamstring, and as the tennis superstar that you are, I wondered, do you have a theory or do you have thoughts on why so many of the ladies are pulling hamstrings? I mean, we see all of the players are doing it, and they’re wrapped up in some kind of an Ace bandage.
Dr. Erin Boynton: Well, I think one of the interesting things with tight hamstrings… Usually, a muscle that is tight is the one that will get pulled. Like your Achilles, you have a tight gastroc. And I think it all stems into the gluts shutting down. And I think we sit too much. Even though we’re really active and do a lot of sports, what happens is that when we sit, the muscles at the front of our hips, called the hip flexors, they get short. And then what happens then is they send a signal to the gluts to shut off.
Fred Robinson: Really?
Dr. Erin Boynton: Because if you want… Say, I want to bend my hand up to my mouth, my bicep needs to turn on, and the tricep has to turn off. If the tricep doesn’t turn off, I can’t get my hand to my mouth. It’s the same thing when we sit, the hip flexor gets short and tight, and it shuts off the glut. And then, unless you actively try and turn it on, it stays asleep. So, then they go out and they’re playing, and they’re using their hamstring then in a way that they shouldn’t be. So, when they’re getting down low and they’re pushing off and exploding to the ball, the hamstring, and particularly the upper portion—which really only covers a small part of the hip—is doing double-duty, and it gets so tight that you can never stretch it until you activate the glut.
So, I think that it’s…activating the glut is one thing. And I don’t know, but I think maybe proper recovery is another thing. Not overtraining. I think that there’s so much physicality to the game now, and that the girls have to make sure they’re getting enough food to repair, and rest.
But, on that note, you look at the girls on the tour—and I’ve worked with a lot of them- and they like to tape the thigh. And I think a message that the athletes need to understand is that when you tape the thigh, and you try and unload a part of the muscle, that tape will only be effective for about five minutes. And this is one of the things that I love about your product, is the elasticity. I’d really like to see the girls try the thigh sleeve instead of the tape.
Fred Robinson: So, would we. I think they’d be much better served.
Dr. Erin Boynton: It’d make a huge difference for them.
Fred Robinson: We just have to figure out how to make that happen.
Dr. Erin Boynton: [Laughs]
Fred Robinson: [Laughs] And I have one other question about the muscles, when you’re into a match and you’re playing a three-and-a-half-hour singles match in the heat, the muscle has a… And I’m just speaking from my own experience and feeling, but the question I have is, does the pliability in the muscle change from the beginning of the match to the end of the match? In other words, are you more likely to pull that muscle at the end of it, and is part of that your hydration.
Dr. Erin Boynton: Absolutely.
Fred Robinson: What’s happening there? How does that happen?
Dr. Erin Boynton: So long as you’ve warmed up properly…assuming that you’ve warmed up well, and you’re well-hydrated to begin with…
Fred Robinson: And you’re underway
Dr. Erin Boynton: …and you’re on your way, I think that as the match progresses, dehydration is a definite risk factor for muscle tendon injuries. It does a lot of things to you. Neurologically, and then with the muscle and its reactivity, and its ability to adjust to how you’re loading it is significantly affected.
Fred Robinson: And as you approach that window where you are getting closer to a point of, maybe, cramping, that has to have a big impact on the muscle, too, right?
Dr. Erin Boynton: Absolutely.
Fred Robinson: You know what I’m saying? You’re 10 minutes or 15 minutes away from cramping, what are the chances that you can pull a muscle at that point?
Dr. Erin Boynton: Well, I don’t know what’s going to get you first, pulling the muscle or cramping [Laughs]. Neither one of them are fun. I think that sometimes it’s really hard to stay ahead of your hydration, but you’ve got to your best. And then I think that the compression-wear helps with that, preventing the cramping
Fred Robinson: And then wearing it afterwards for recovery to help displace lactic acid, too. One of the benefits of… After I’ve played a hard match, for example, I wear the full thighs, and I’ll wear them for an hour or two. After I finish playing, I’ll keep them on, and the benefits to that, you see as…
Dr. Erin Boynton: I think it’s excellent. The studies and the literature show that the compression-wear can improve the blood flow to the muscle. And if you have improved blood flow, then you can get the nutrients back into the muscle, and you can get the metabolites, from the work, out of the muscle more effectively. So, compression wear is one tool that can be used.
Fred Robinson: Okay.
Dr. Erin Boynton: The quad tape is mental tape on tour [Laughs]. Okay, so that’s a good… So, Sara, I think she’s saying—and I’ve noticed this with a lot of professional athletes—they have a routine. They have a way…
Fred Robinson: It becomes a ritual.
Dr. Erin Boynton: It becomes a ritual. And it’s worked for them. Their mind is relaxed. They feel good about it. So, I think that we have to slowly introduce the product, or the concept and let the girls gain confidence in it. It’s hard to get people to change their routine.
Fred Robinson: Yeah, to make changes.
Dr. Erin Boynton: That’s what we’re here to do.
Fred Robinson: Yeah.
Dr. Erin Boynton: Cindy: Hi, Dr. B, I’m curious about your take on homeopathic remedies for injuries.
I love them. I’ve actually taken a lot of homeopathic courses. I went to Germany. I worked with a guy,, and he…wow, he was amazing. And I think I’m more of a homeopath by nature. When you look at: what is a homeopath trying to do? The homeopath is trying to help the body do what it’s trying to do itself. So, if you’ve got your car and you’re spinning your wheel, and you’re stuck in the mud, the homeopath just wants to give you that little nudge so that you can get out of the mud. Whereas, some traditional medicine, what they want to do is stop the process. So, in treating inflammation, they want to stop the inflammation, and yet the inflammation is there for a purpose of trying to heal some part of your body.
Fred Robinson: And you want to determine what the cause of the inflammation was, and then work on that.
Dr. Erin Boynton: And work on that.
Fred Robinson: Okay.
Dr. Erin Boynton: So, there’s a whole bunch of different homeopathic remedies that you can use for treating inflammation, or fibrosis, and one of my favorites is TraumaCare. It used to be called Traumeel, but it’s now TraumaCare, and it’s got a whole host of natural remedies that are put together, which help to decrease inflammation and decrease scarring.
Fred Robinson: Excellent.
Dr. Erin Boynton: All right, Robert. Robert Garrett. Hi, Robert.
Fred Robinson: Hi, Robert.
Dr. Erin Boynton: Many baseball players use the thrower’s ten exercises to strengthen their shoulder and elbow to prevent injury. Do you recommend a book for tennis players that is comprehensive, including exercises and…? I was getting…
You know, I don’t have a specific book yet. Yet. But that is something that we can work on. I think it’s very much towards my philosophy of you have to have a foundation of movement, which is relaxed, balanced tissues, and you have to be using the correct muscles. Then you build endurance in those muscles and the muscle-firing patterns, then you build strength, then you do power and speed.
And very often, what happens is that people will go and get treated, they’ll get a massage, they feel great, but then they don’t change how they move. And then they go back and they try to do the activity at the top of the pyramid, which is power and speed, and their pyramid just flips upside down because they don’t have any endurance, and they fail.
So, Robert, I think having a series of tennis exercises to get our athletes back is something that we should work on and get out there.
Fred Robinson: So, I will tell you that I spent a couple of hours on the court with Dr. Erin B. this morning, and we talked about…which was interesting…we had some interesting conversations on biomechanics and movement. And I’m going to ask you, at some point in the future, if you will come back and we can share some of the movements that we talked about on the court.
Dr. Erin Boynton: I’d love to. I think Fred’s got some really neat insights, and I’d love to be the guinea pig to show you how they work [Laughs].
Fred Robinson: Well, I think it’s important, and I think it’ll tie into injuries and movement. And also, we talked about power into shots, how to generate the power. And, yeah, it’ll be fun. So, I think we want to thank everybody. I want to thank Dr. Erin B. for coming to visit with our team today. And I want to thank all the team for texting and sending in all the questions, we appreciate them, and we will continue to collect those. And, certainly, with you I will bring her back in and we will do some more on injury, and we’ll get involved in some of the other sports, too. So, thank you for coming and being with us today. And thank you.
Dr. Erin Boynton: Thank you.
Fred Robinson: Okay. Bye, everybody.