Growth Spurt Injury — Keeping Your Junior's Body Healthy with Dr. Erin Boynton

Summary

Dr. Erin Boynton — orthopedic surgeon, medical director of the Rogers Cup WTA event for 16-17 years — presents a three-step injury prevention protocol (“Three Rs”) and argues that 70-75% of surgical candidates can avoid surgery through proper exercise and stretching. Her daughter Hannah played Division III tennis at Williams College and won two national championships.

Guest Background

Orthopedic surgeon based in Toronto. Medical director for the Rogers Cup (WTA Canadian Open) for 16-17 years — giving her direct, sustained access to the injury patterns of elite professional tennis players. Daughter Hannah played D3 tennis at Williams College (NESCAC) and won two national championships. This parent-plus-professional dual perspective shapes her practical orientation.

Key Findings

The Three Rs Protocol

Her injury prevention framework:

1. Release — foam rolling and soft tissue work to address fascial restrictions and muscle tightness
2. Rebalance — restore range of motion and correct muscle imbalances (particularly posterior shoulder capsule tightness)
3. Reactivate — fire the correct muscles in the correct sequence through targeted activation exercises

This sequence must be performed in order. Attempting to reactivate muscles that are still restricted or imbalanced produces compensation patterns.

70-75% Surgery Avoidance Rate

Her most clinically significant finding: 70-75% of patients who presented as surgical candidates improved sufficiently through the Three Rs protocol — exercise, stretching, and soft tissue work — to avoid surgery. This reframes the surgery decision as non-default for a significant majority of tennis injury cases.

Rotator Cuff Imbalance from Posterior Capsule Tightness

The primary shoulder injury mechanism in tennis players: posterior capsule tightness creates rotator cuff imbalance. The overhead serving motion, repeated thousands of times, tightens the posterior capsule and shifts the humeral head position, creating impingement patterns. This is a correctable condition through release work — it does not require surgery in most cases.

Glute/Hamstring Reciprocal Inhibition

Hip and knee injury risk increases when glutes are underactivated (inhibited), causing hamstrings to over-compensate. This is a common pattern in athletes who sit for extended periods (school) and then train intensively. The reactivation phase of the Three Rs specifically addresses glute activation as a knee/hip protection mechanism.

15-Minute Pre-Practice Release Protocol

Her practical prescription: 15 minutes of foam rolling and targeted release work before every practice session. This is not optional — it is the minimum investment to maintain tissue quality under high-volume training loads. She argues that programs that skip warmup to maximize hitting time are trading short-term efficiency for long-term injury rate.

Dynamic Warmup Over Static Stretching

She is explicit: static stretching before activity reduces force production and does not prevent injury. Dynamic warmup (movement-based preparation at escalating intensity) is the evidence-based standard. She references the same principle echoed by Todd Whittom in a separate episode (no static stretching before pro training sessions).

Daughter at D3 Williams: Level Is Elite

Incidentally, she notes that Williams College D3 tennis won two national championships with her daughter on the team — aligning with the broader ParentingAces narrative that D3 is a legitimate, high-level competitive environment.

Actionable Advice

• Implement the Three Rs (Release → Rebalance → Reactivate) as a mandatory pre-practice protocol, minimum 15 minutes.
• Address posterior capsule tightness proactively in overhead athletes — do not wait for shoulder symptoms.
• Activate glutes before lower-body training — inhibited glutes shift load to hamstrings and increase knee/hip injury risk.
• Replace static stretching with dynamic warmup in all training environments.
• Before agreeing to surgery, exhaust the exercise/stretching protocol — 70-75% of surgical candidates can avoid the procedure.

INTENNSE Relevance

INTENNSE’s human performance infrastructure should integrate Dr. Boynton’s Three Rs framework at the team level. Standardized pre-practice release protocols across all INTENNSE teams would reduce injury rates and extend player careers. Her surgery avoidance data is relevant for the league’s player health narrative — INTENNSE as an environment that takes athlete longevity seriously, not just performance.

Notable Quotes

“Seventy to seventy-five percent of the patients we see as surgical candidates don’t need surgery — they need the right exercise protocol.”

“The warmup is not optional. You’re either investing 15 minutes now or you’re investing surgery later.”