43. Supporting Artistic Athletes with Selina Shah, MD

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00:00
Jennifer Milner
Welcome back to Bendibodies with the Hypermobility MD, where we explore the intersection of health and hypermobility, focusing on dancers and other athletic athletes. This is co host Jennifer Milner, here with the founder of the Bendy Bodies podcast, dr. Linda Bluestein. 

00:15
Dr. Linda Bluestein
Our goal is to bring you state of the art information to help you live your best life. Please remember to always consult with your own healthcare team before making any changes to your routine. 

00:25
Jennifer Milner
Our guest today is Dr. Selena Shaw, dance company physician for numerous ballet companies and team physician for us, figure skating, USA artistic swimming, and USA Weightlifting. Hello, and welcome to Bendy Bodies. 

00:52
Dr. Selena Shaw
Thank you. It's great to be here, and I really appreciate the honor of being here for you guys. 

00:57
Jennifer Milner
Well, before we get started, could you tell us a little bit about yourself and your background? 

01:03
Dr. Selena Shaw
Sure. So I am a sports medicine physician practicing here in Walnut Creek, California, which, for those of you that don't know, is part of the greater San Francisco Bay Area. And I'm in private practice. And the reason I went into sports medicine is really my own personal background in terms of athletic endeavors. So I actually started off as a competitive gymnast, artistic gymnast, and fell in love with rhythmic gymnastics when I saw it on the Olympics, actually for the first time. So I thought, okay, that's perfect, because I really didn't want to do all of the flips and all the scary stuff in terms of what I thought in terms of gymnastics. So I went into competitive rhythmic gymnastics. And then after that, I was in a little small town, so unfortunately, the program fell through. So I got into dance. And so I've been dancing ever since. 

01:57
Dr. Selena Shaw
Dance all the way through medical school. Residency, fellowship have never stopped, actually. So I still dance, which is really exciting. And I've done ballet and point and jazz and hip hop and modern, and was in a professional Bollywood company in La. As well as a professional salsa dance group through residency. So really fun. 

02:19
Jennifer Milner
That's great. And just a reminder to everybody as they're listening that there's no time that you have to stop dancing. Right. That it's something that you can keep doing throughout your life. I still love to take class. Dr. Bluestein still loves to move. It's great to keep doing what you love and not feel like there has to be more to the story than that. You can be a successful and amazing doctor and also still enjoy your salsa dancing. So as a dancer and an athlete yourself, you work extensively with elite performers, sort of across several different fields. So why would Hypermobility be helpful to some of these competitors? 

03:00
Dr. Selena Shaw
So if you look across all the aesthetic activities, such as professional ballet, professional modern, even ballroom, professional ballroom, professional competitive dance, and then you look at your aesthetic sports, like artistic gymnastics, rhythmic gymnastics, figure skating, artistic swimming, which was formally called synchronized swimming, to name a few. All of them require such beautiful extension. And for somebody that's hypermobile, that comes mostly naturally to them. And usually it's in the joints that we want them to be hypermobile in terms of an aesthetic perspective, from the audience view, the judge's view, the artistic director's view, whatever the case may be. And so the nice, beautiful long legs, the ability to split, the ability to have that back extension, beautiful arms in terms of the positioning and whatnot, those usually come naturally to somebody that's hypermobile. And those of you listening probably don't realize it sometimes, but some people have to work so hard for that compared to someone who's got it naturally. 

04:13
Dr. Linda Bluestein
Sure, that makes sense. We also know that hypermobility can be problematic for performing artists and athletes. What aspects of hypermobility make them more prone to injury? 

04:27
Dr. Selena Shaw
So I think the problem is kind of first understanding what does it mean? I mean, why is someone more flexible than somebody else and what is flexibility versus hypermobility type of thing. And that's really a spectrum. So if we kind of think back to a little bit of the basics. So hypermobility mostly has to do with how flexible your collagen is. And collagen is found throughout our body in so many different tissues. But in particular when it comes to our joints, it's the capsule that covers the joints plus our ligaments. If you remember, ligaments connect bone to bone and so they're part of our support structures for the joints. And then if you look at tendons as well, which remember tendons connect muscle to bone. So the tendons also have collagen. So if your collagen is looser, meaning it's more elastic and stretchy, then that's someone who is born that way and has that in terms of what that's what hypermobility is. 

05:29
Dr. Selena Shaw
And so remember, all of those same structures, the capsule, the ligaments, the tendons are also there to support your joints. So if they're looser and stretchier, then sometimes it's actually also harder to control those joints. And so that's where the difficulty arises in terms of needing to balance that. And strength becomes more of an issue for people that are hypermobile and actually harder to attain than someone who doesn't have that elasticity looseness that a hypermobile person has. And so that's where issues can arise in terms of possibly increasing a risk for injury and even difficulty in holding certain positions sometimes. Sure. 

06:12
Dr. Linda Bluestein
And I bet a lot of our listeners will be able to relate to at least we get these comments a lot. I have so much difficulty building strength. Other people seem to be able to put on muscle or be able to maintain proper joint alignment more easily than I can. Can you elaborate a little bit as to why that's the case for people that are hypermobile? What are some of the reasons why they might have more difficulty building strength? 

06:41
Dr. Selena Shaw
Right, so it comes back again to that same concept of the collagen being sort of looser and more elastic. And remember, you can't strengthen ligaments, you cannot strengthen the capsule. So those are the deep structures that are really close to the joint. And so then comes your layer of the muscle tendons. And you can strengthen muscle for the most part, but remember, that muscle is also built of that tissue that tends to be a little stretchier and elastic. So trying to get that strong compared to someone who doesn't have that looseness is difficult. And so that's really the issue is the inherent structure of somebody who has hypermobility. So it's not impossible. It's certainly possible and it really has to be done in the right way. And I think the first step is really having that awareness, hey, am I hypermobile or not? And understanding that first. 

07:38
Dr. Selena Shaw
And once you have that awareness, I think it's helpful because it's helpful to alert everybody that's around you in terms of your coaches, especially that are training you. And so then maybe giving a little extra in terms of strengthening the muscles that are closest to the joints, sort of the smaller muscles and working outwards to the bigger muscles. And there are many different avenues to do that. So a lot of times the coaches have these great conditioning programs that all athletes performing artists go through. And sometimes it's helpful to get some additional help to do that. So Pilates is a great way, for example, to do that. And I think too, a common misperception is that people that are hypermobile often will keep stretching a lot. And it's okay, of course, to stretch, to maintain what you have for what you need for your performance aspect, your competitive aspect and whatnot. 

08:32
Dr. Selena Shaw
But we don't also want to keep self perpetuating that problem because then it actually makes it harder to get that stability and strength that you also need to support that flexibility. 

08:43
Dr. Linda Bluestein
Yeah, I think that's one of the really tricky points because it probably depends on are you a very serious pre professional, are you more of a casual dancer? Are you a professional dancer or any of these athletes? So balancing that stretching versus strengthening and knowing how much to push into the stretching. We actually also just recently chatted with Jennifer about stretching and overstretching, which is obviously an important topic. So in terms of training for hypermobile performing artists, you mentioned some of the things that might be different, it might be even more important for them to work with someone like Jennifer who is a Pilates instructor. Are there any other training suggestions that you would give to hypermobile performing artists? And perhaps it would be different depending on the level that they're at and or their age. Right. Because that's going to obviously make a huge difference. 

09:44
Jennifer Milner
Sure. 

09:46
Dr. Selena Shaw
I think first is always having that conversation with your artistic director, coach and ballet instructor fits that coaches for all the different athletes. And most of the time, the coaches are aware they've been training you, so they know that you're more hypomobile. And a lot of times their strength training actually already incorporates some of that. But it doesn't hurt to have a conversation to say, hey, what do you think I should work on? And that's in athletics, all that strength and condition is often built in. When it comes to dance, it's not always actually. So I know some studios do have strength and conditioning classes or Pilates classes and that kind of thing, but not all studios have that avenue available to them. And so one thought is, okay, talking to your teachers, hey, do you know anyone locally that does strength and conditioning for dancers? 

10:46
Dr. Selena Shaw
And a lot of times it is someone who does Pilates. A lot of Pilates instructors, at least in our area, were former dancers in some capacity, for example. So that's really nice to be able to have that as a resource. Another thought would be a trainer. So there are trainers out there who understand performing artists and dance and different sort of aesthetic athletic endeavors, and so working with some of them. So a lot of times they're going to work with you on body weight type of strengthening, and not the heavy weightlifting that you think of when you think of weightlifting, because also all of these aesthetic sports performing artists don't want to bulk up. And that's often the fear that people will have. Well, I don't want to do any strengthening because I don't want to build up big, bulk muscles, especially for females, but for the most part, you're not going to. 

11:43
Dr. Selena Shaw
It actually takes quite a lot to build up big, bulky muscles, and people that are hypermobile struggle with that anyway, so the chances of that happening are extremely low, especially if done guided with body weight type of stuff. And you can get really nice, long, lean muscle that supports your joints that way. 

12:04
Jennifer Milner
One of the common threads I'm hearing from you throughout all of this is that idea of getting one one feedback. You talk a lot about going to your dance teacher, going to your coach and saying, hey, what do I need to work on? Or do you have suggestions or find a trainer or sort of getting that individual attention, which I think is so key. I personally don't love to teach group classes because it's so hard to deal with that hypermobile body and that hypomobile body and that person who has a scoliosis. It's so hard to deal with all of the different issues well. And I think that hypermobile people are one of the ones that kind of get lost in those group classes because they can make the pretty pictures, but they're probably using the wrong muscles and they're hanging on their tendons, and it's really easy to get lost. 

12:55
Jennifer Milner
So I appreciate that you're saying get that one one attention you want to get in front of someone who is going to say do this, not that, or do that, but do it this way or with this intention. I think that's a really great thing to take home from this conversation is that getting that individual feedback, which can be expensive, doesn't have to be every week though, right? But getting that individual feedback is going to help so much as you're trying to train as a hypermobile athlete. So thank you for that. When we look at injuries, I know we're talking about sort of a wide group of people again, because you train swimmers and gymnasts and weightlifters and dancers, but are there certain types of injuries that you see that are more common for hypermobile artists and athletes? 

13:42
Dr. Selena Shaw
I would say it's really sport specific. That's probably the best way to really put it because it depends on what that specific athletic endeavor, dance endeavor even musicians really are using. And so usually it's going to be that repetitive use issue and so that's where we're going to see problems. So for example, in artistic swimming, they're egg beatering, so their hips are constantly being rotated. So we'll see a lot of hip issues there and shoulder issues too, because of what they're doing in the water. Whereas in dance we'll see issues with ankles, especially your point dancers, knees, hips and dancers too, and even low back or the entire back, because it's interesting with hypermobility, with back, sometimes people are flexible in certain levels more than others. And so again, sort of without really often being aware of it when they're doing maneuvers that require back extension. 

14:48
Dr. Selena Shaw
Again, whether it's rhythmic gymnastics, artistic gymnastics, figure skating, dance, where a lot of that is required they don't realize they're overusing. Sometimes a certain part of their back and not really the whole back and certain part of their back then is stronger than others. And so that's where we start to see a lot of issues when it comes to back issues. So it really depends on the sport and activity. 

15:13
Dr. Linda Bluestein
Which brings me to a common theme that we keep having. Is it's never too soon to start working with somebody. Because if you wait until you're really having a problem, then the best time probably to start working on that was, I don't know, a year ago. Or depending on the person, it's a good idea to be proactive. Would you agree with that? Do you find that? 

15:41
Dr. Selena Shaw
I definitely would agree with that. I mean, I think that, like I was saying in other sports, a lot of times the strength and conditioning is already built into part of their training where I think it's really lacking in a lot of dance. Not all, but many. And so to me I feel like if that could be identified early on and a lot of times, like I said, a dancer doesn't even realize they're hypermobile. They don't realize how easy something's coming to them and they may not realize it until they sort of get older and sort of notice that maybe their friend struggles a little more with that than someone else. But even then it's hard to note because they're constantly stretching and flexibility is such a big part of the training. So I think if it's helpful, if teachers were sort of aware, it could kind of help point it out to dancers and that type of thing when it comes to dance class and the same thing with other sports. 

16:34
Dr. Selena Shaw
Then, if that's the case, to start suggesting at a younger age, to start working on some strengthening, starting with planks for the core, for example, and things like that at a young age. But as we all know, planks are difficult even for the well trained person. So to have someone that young do one correctly really requires supervision, I think, at that age, to do it in a class type of setting, as opposed to going home and starting to do planks incorrectly on their own type of thing. So I think at a young age it really requires supervised training. But yes, I agree, starting early, if it can be brought to the surface and people realize this person has some extra hypermobility, that would be the ideal setting. So I think that comes to some education and awareness and training and those are all things we try to work on in our different organizations in terms of education. 

17:28
Dr. Selena Shaw
And then once someone's a bit older that pre professional elite level, obviously they can work on conditioning and that type of stuff on their own. 

17:37
Dr. Linda Bluestein
And in terms of rhythmic know, we actually also recently spoke with Vita Bachmann, who is a former Ukrainian rhythmic gymnast and now a coach, and we also talked with Jen about overstretching. So it's great to also chat with you because the three of you all have a little bit different, you're seeing a little bit different piece of that picture. And I feel like rhythmic gymnasts, if you actually look in the literature for there's dance medicine, obviously there's, I feel like less studies than there's in sports medicine, but if you take the subset of rhythmic gymnasts, there's even less. And I feel like that's a group who's really pushing into their flexibility, their joint mobility, and at such a young age, right, in terms of how much knowledge they have of the risk and benefit of things. So do you have any specific training tips that you would since you did do rhythmic gymnastics and you have worked with a lot of rhythmic gymnasts and gymnasts in general, do you have any specific tips for a group like that, especially at a really young age? 

18:44
Dr. Selena Shaw
It's a tough one, so the sport requires it, right? So at some level, 180 degree split counts for zero points, they have to have that oversplit to actually get points. So some of it is inherent in the sport in terms of what's required, right? So how can we do that safely, I think is really the key, and I think that's where the strength work is helpful. So not only the stretching part of that, but needing to work on the strength to balance that and all those muscles that are also being stretched to that extreme end range. And then there's spectrums, right? I mean, there's the athlete who's doing rhythmic gymnastics just for fun and never has any aspiration, which is totally fine to go to the Olympics or join a company like Cirque du Soleil and whatnot, where that extreme flexibility is required versus someone who does have those aspirations. 

19:50
Dr. Selena Shaw
So also a decision, mindset wise, am I going to push my body to those extremes, or am I just happy enjoying this sport, and I'll do what I can and leave it at that? I think that's a decision that can be made, but usually it's the hypermobile person that ends up sort of selecting into that higher level, sort of Olympic level competitiveness, because it's very hard for someone who's not hypermobile to be able to really attain that flexibility. Not impossible, and of course, they work on it at a young age, but it is harder. But the balance of that is someone that does attain that actually is not inherently that flexible, usually has better chance of strengthening. So there is sort of that idea of, hey, okay, maybe I'm not hypermobile, but I'm going to work hard on that stretching. I'm going to have I have a little advantage on the strength work. 

20:47
Dr. Selena Shaw
And so hopefully the two balance each other out. 

20:51
Dr. Linda Bluestein
That's a good point. So you mentioned about overuse injuries, and that in an artistic swimmer, their overuse injuries are going to be more likely in their shoulders and their hips because of the types of movements that they're doing. I think a really common misconception that I would love to hear you talk about is tendinopathy. What is it? We know that it's more common in people that are hypermobile, whether they're an athlete or not, but I think there's a lot of confusion about I've had tendinitis for the past ten years. So in terms of what is tendinopathy, what are some of the options for treating it? What does it look like in the different groups? Could you talk about that a little bit? 

21:35
Dr. Selena Shaw
Sure. So let's talk about tendinopathy. So if you come back to my initial anatomy lesson, remember, tendons connect bone to muscle, right? And they're sort of a thick ropey structure. Tendinopathy is really just a big, broad term to mean a problem with the tendon. Okay? And tendons have some blood supply, depending on the tendon. So that's what's interesting, is different. Tendons in our body are very different. For example, the Achilles tendon is unique in that the blood supply is in this sheath that surrounds the tendon. And so it's a very different tendon compared to something like a tendon in your elbow. And so the way that these tendons then get injured actually can be a little bit different. So there's tendonitis. And if you go back to Latin, itis means inflammation. So to literally have a tendonitis means there has to be inflammation. If we really look at what the true definition of that term actually means. 

22:39
Dr. Selena Shaw
And unfortunately that term, I think, gets thrown around a lot very incorrectly, even among the medical community. And so I think, again, if everyone can just understand that itis means inflammation. So to really, truly have a tendonitis, you have to have inflammation. And inflammation really should be a short lived sort of a few week issue. So if a pain in a tendon is really going beyond that, I think there's some question as to whether it truly is a tendonitis or is there some other actual problem going on and it's not really that tendon but some other structure in that joint? Or is it that there's what we call tendinosis, which is actually degeneration of the tendon, which usually starts later, but we see it in older teenagers in 20s, but usually see it a little bit more in people that are a little bit older than that. 

23:39
Dr. Selena Shaw
But degeneration means a breakdown of that same collagen that were talking about and some other structures, but really it's more a breakdown of that collagen. And so that can be difficult to treat depending on how severe the pathology is, what is involved and that type of thing. 

23:58
Dr. Linda Bluestein
Right. And tendons in general don't have great blood flow, right? Or at least I know you mentioned the Achilles tendon specifically, so they can be really stubborn problems. And do you do some more advanced types of procedures if people have tendinosis and are really struggling to? 

24:18
Dr. Selena Shaw
Yeah, so let's get back to that. So that's what I was alluding to, is you have to have a decent blood supply to get inflammation. And so if tendons don't have a great blood supply, which we've talked about, then a lot of times they're not truly getting inflamed. It's more along this realm of tendinosis or some degeneration. And when you get those tendons that already have some damage to them in terms of degeneration, and then you injure them like a strain, which is either an overstretch or a partial tear or a complete tear, those are very difficult to heal because there's already some underlying damage and they lack that blood supply to really heal themselves. Well, again, not impossible. And there's some good research studies on a couple of tendons like the elbow and even the Achilles out of Australia showing that with enough time, pathology can reverse. 

25:08
Dr. Selena Shaw
That's what's great about the human body, especially the younger you are, and so that requires adequate, appropriate rest and then a buildup appropriately. But in terms of treating that so let's say someone comes in with pain they've had and we diagnose it as a tendinosis, for example. So the first step is to sort of figure out where they are in training and can we modify that training to not load that specific tendon? Because most of the time you don't have to be pulled out of something completely. We can just work around it and let someone still train in other areas that don't overuse that specific tendon. And then we like to get physical therapy involved to help with the right appropriate exercises, taking a stepwise approach of building upon exercises as the person's ideally getting better. And if they don't get better and they're sort of stuck, either they're just not improving or they're plateaued, or maybe they need to return a little faster. 

26:10
Dr. Selena Shaw
There are some great procedures out there with some research showing benefit, again, depending on the tendon. So there's platelet rich plasma, for example, that's commonly done really throughout the world. And you have to be really good about reading the actual research studies and understand the methods that were used to really interpret them appropriately. For example, there have been some research studies that have come out recently saying that platelet rich plasma doesn't work in certain avenues. But when you actually read the research study and the methods that were done, unfortunately they use what's called a low concentrate platelet rich plasma. So not really a good platelet rich plasma concentration. So you really can't say that didn't work because they didn't really use the appropriate amount of plateletrich plasma. So what platelet rich plasma is platelets have growth factors. And the idea is that, hey, can they help promote some pain and functional improvement? 

27:04
Dr. Selena Shaw
And they can in some research studies. We were hoping that we could reverse arthritis 20 years ago when we started using this, but we're not seeing that happening. But we are finding really good application in terms of treating people's pain and improving people's function and tendons. And so it involves drawing people's blood, spinning it down in a centrifuge, concentrating the platelets ideally to at least a five time concentration, and injecting that in to these damaged areas of tendons. And this should be done ideally using guidance. So ultrasound, for example, is something I have in my office and many physicians that do this procedure do. And so you're looking visually at the actual tendon and injecting the platelet concentrate into these tendons to help promote that pain and functional improvement. It does require a period of rest in physical therapy to help, and it can take a few months before seeing complete full results and sometimes less, sometimes longer, but has great results. 

28:05
Dr. Selena Shaw
Nothing in medicine is 100%, so nobody will ever tell you something works 100%. So does this work for everybody? No, but it does work for a lot of people. When done in the appropriate setting, it can have over 75% success rate if done appropriately. There's also something called ultrasound guided percutaneous tinotomy. Big mouthful of words, but there are a couple of different devices out there. So there's one blunt probe, it's the size of a needle that basically produces, like, this high volume, high frequency water jet, basically, that can go in and sort of break up some of the damaged tissue. And another one that uses high frequency ultrasound to go in and break up damaged tissue and remove some of that damaged tissue. And so it's a little bit like mimicking surgery but not really full on surgery. And again done visually by looking through at the tendon with an ultrasound. 

29:07
Dr. Selena Shaw
Again, these probes are the size of a needle so they're just inserted into the tendon after getting anesthetized locally of course, and cleaning up the tendons basically, or at least part of the tendon pathology. And again similar can be several weeks to a few months recovery, working closely with the physical therapist and some rest of that area. But another great option. So what's really nice is that we have these two options that are fantastic. We really try to avoid cortisone in tendons because we have seen several research studies on how cortisone can damage tendon tissue and for someone that's at a high level using their tendons all the time, we really want to avoid cortisone. Unless you've got some emergency need for some upcoming performance or the Olympics or whatnot, that you just have to have that relief because you can't work through it and need it. 

30:00
Dr. Selena Shaw
It can be reserved for those and I would definitely recommend trying to get those ultrasound guided as well if possible, to just make sure that the right tissue is being injected but really want to try to avoid the cortisone if you can. And the last resort, surgery. Most people luckily don't need surgery with these other options these days, but that's always in the toolbox if needed. 

30:24
Dr. Linda Bluestein
I'm so glad you raised the question about Cortisone, because I feel like especially when people have weak connective tissue to start with, I know that I have patients that are still being offered those as options. And the data doesn't show that, like a year later, two years later, that they're any better off than the people who got the more conservative approach. 

30:49
Jennifer Milner
I think that tendinopathies, at least in my practice and the people that I seems to be more prevalent in the hypermobile population. And so it's really great that you have laid out some really concrete things that they can kind of talk through with their own physicians as they are trying to solve their own issues with the tendinopathies. And we've talked about the importance of having one one care with a strength and conditioning coach. Making sure that the coach or the dance teacher or whoever is in charge understands that they have hypermobility, knowing that sooner is better than later if they do have an issue that comes up and then what they can sort of bring up to talk about if they are trying. To treat some of the issues like you just mentioned there, for the hypermobile artists and athletes who are moving into a new situation, though, we would love to hear a little advice from you. 

31:45
Jennifer Milner
I know that you've been the team physician for numerous sports companies sports, sorry. As well as a company physician for several ballet companies. You've treated performers from major Broadway shows from Cirque du Soleil, san Francisco Opera. So how would you advise a hypermobile athlete to get the specialized training or attention or maintenance that they need when they're working with a team physician? Someone that they're sort of stepping into a different arena with than who they originally worked with as a soloist? 

32:17
Dr. Selena Shaw
I think the biggest key throughout this, if you were to summarize, is communication, right? That's been sort of a theme message throughout this. And so the nice thing is, at those high levels, there is a lot of healthcare support staff. And so I think definitely if you're new to the company or the team physician or company physician is new, then having an opportunity to meet that team physician one one is great. And then ideally, that team physician is helping coordinate all aspects of care. So introducing you to the other ancillary services that are available, such as physical therapy, there may be an athletic trainer, there may be massage, there may be pilates, and ideally having that conversation with all of those different avenues that may be available depending on the company or athletic situation. And that way they're all available and setting up appointments with the different people and starting to let them assess and figure out where they find problem areas, where are the weaknesses, where are the strengths and what's needed to be done to basically balance out the body, no pun intended. 

33:41
Dr. Selena Shaw
So I think in terms of just being sort of proactive about that, I think is really great and taking advantage of that because at that level you're so lucky to have all of that available. Whereas everyone knows when you first start training, not all of that's available. So it's nice to have it and be able to use it and just have everybody in communication and working together to optimize your treatment, your care, your body, to try to basically minimize injury. 

34:16
Jennifer Milner
Well, and that's something that is hard for artists and athletes to learn, is to have that communication because a lot of times we have that relationship of our coach or our trainer or our teacher is someone in a position of authority over us. And it's hard to develop that habit of approaching them and trying to have that communication. It's a learned skill for artists and athletes, but I think especially for artists. So it's important to learn that you do have to be able to advocate for yourself. It's okay to go to a coach and say, hey, I have this specific issue. Just wanted to let you know they will appreciate that and they'll be able to, like you said, point them in the direction of the services that are probably already there, but they just may not know how to get into those services. So that's an important theme that we see a lot as well. 

35:08
Jennifer Milner
Have you seen any trends, because you have been looking at so many different fields as a physician, have you seen any trends in hypermobility in these different fields? Do you feel like people are leaning more towards Elevating and pushing into those extreme ranges of hypermobility or do you see people starting to pull back from it? Is it really sports specific? What are you seeing? 

35:31
Dr. Selena Shaw
I think it's hard to know without a true research study, but I would just say that I think it's a process of natural selection like it is for any athlete, right? So generally the ones that are going to make it to that elite level either have been able to either attain that flexibility or they just naturally are hypermobile and were able to strengthen to maintain that flexibility. Some of it's just the time and availability of the type of training that they've had in their area. Many athletes move all over the country and sometimes the world to try to find that because that's their passion and that's what they're driving for. So we'll see a lot of that too. But I think to make it natural selection seems to be the main that's fair. 

36:26
Jennifer Milner
Is there any research that you would love to see on hypermobility and the artistic athlete? Anything you're hoping will come out? 

36:34
Dr. Selena Shaw
Well, I think as Linda alluded to, you mean, really, there's not that much research out mean as it is in general for these sports. And then if you take the niche of mean, it's even less so really the field is wide open for anyone out there who wants to take it on and has the time. But I think it'd be interesting. There's just so many ideas that even came up during this conversation. So what if you take someone young who's found to be hypermobile and you start strengthening them compared to someone who doesn't have that opportunity to strengthen through their career? Are there less injuries in the one that strengthened versus the one that didn't, for example? That would be interesting to see. It'd be interesting to see if this natural selection really holds true, how many hypermobile can't make it because they can't strengthen versus how many were able to strengthen and make it, and was it resources available to them that made that difference or was it that they were able to strengthen? 

37:33
Dr. Selena Shaw
There's just so many variables with that and those that do start strengthening at some point, again, if you compare one that has Pilates and whatnot available to them versus someone who doesn't or doesn't have the time similar, are there really less injuries? We think there are seems like it from what we see. But is it true. You really don't know until you do that research study. And what is the healing time difference for someone that's hypermobile versus someone that's not? Generally, what we see is that hypermobile people, unfortunately, do take longer to heal, do take a slower approach with physical therapy. You can't throw everything at them in the way that you can someone that's not hypermobile. It's a very gradual approach. Is that true? Again, we see it, but would be great to see a research study. And is there a difference in there's a spectrum of hypermobility. 

38:29
Dr. Selena Shaw
So along that spectrum, from the extreme, extreme circus type acrobatic contortionist to someone who's just barely hypermobile, what's the difference there in terms of the ranges of injuries and their longevity as an athlete, maybe, and that type of thing? So the field is wide open. 

38:53
Jennifer Milner
Hint, hint to all the researchers out there that are listening. Right? 

38:56
Dr. Linda Bluestein
Exactly. 

38:57
Dr. Selena Shaw
Those of you that have time and resources like IRBs that can do this yes. 

39:01
Dr. Linda Bluestein
Right. Need some thesis for their PhD program. 

39:05
Dr. Selena Shaw
Right. 

39:07
Jennifer Milner
Well, is there anything that you wanted to make sure we covered that we have not yet brought up? 

39:13
Dr. Selena Shaw
I think this is a fantastic topic and I think, gosh, you could take this in so many areas. I think it'll be fun to see what feedback and questions you get because I think that would probably spark something. There may be people that want to talk more about treatment of tendinopathy. I mean, that's a whole series in and of itself, but yeah, no, I think this is a fantastic start. Thank you so much for this opportunity. 

39:37
Jennifer Milner
Well, thank you. And you're absolutely right. Each episode sparks more questions that our listeners send to us, and then we find someone to talk about those questions and that sparks more questions. So it's an excuse for us to go down our own rabbit holes, I think, right? 

39:56
Dr. Linda Bluestein
Pretty much. No, that's exactly how we get the ideas for our episodes, is based on questions that we get and conversations like this where we say, oh, boy, we better learn more about some specific topic. So we really appreciate you sharing your knowledge with us. 

40:17
Jennifer Milner
Yes, thank you. Absolutely. And so where can people find you? How can they find you? Read more about you, get in touch with you. 

40:25
Dr. Selena Shaw
Sure. So I do have a website is probably the easiest way in this age of the Internet, so it's Selenashawmd.com, so Selinashahmd.com and I'm located in Walnut Creek, California. And as you can see, my specialty niches are taking care of dancers, performing artists, your aesthetic, athletes, but love to see everyone of all ages and abilities. So it's great. 

40:56
Jennifer Milner
Excellent. Well, and we will have your contact information that you just mentioned in the show notes so people can click on that link as well to find you easily. Well, you have been listening to Bendy bodies with the hypermobility MD. Today we have been speaking with Dr. Selena Shaw, dance company physician for a multitude of ballet companies, and team physician for US figure skating, USA Artistic Swimming, and USA Weightlifting. Dr. Shaw, thank you so much for sharing your expertise with us today. We really enjoyed having you. 

41:25
Dr. Selena Shaw
Thank you. 

41:27
Dr. Linda Bluestein
Thank you so much. 

41:29
Jennifer Milner
Thank you. And we'll say goodbye to our listeners. Bye. 

41:33
Dr. Linda Bluestein
Bye. 

41:33
Dr. Selena Shaw
Bye. 

41:35
Dr. Linda Bluestein
Thank you for joining us for this episode of Bendy Bodies with the Hypermobility MD, where we explore the intersection of health and hypermobility for dancers and other aesthetic athletes. If you found this information valuable, please share it with a colleague or friend and leave us a review on your favorite podcast player. Remember to subscribe so you won't miss future episodes. If you want to follow us on Instagram, it's at bendy underscore Bodies, and our website is WW bendibodies.org if you want to follow Bendy Bodies founder and co host Dr. Bluestein on Instagram, it's at hypermobilitymd all one word, and her website is www.hypermobilitymd.com. If you want to follow cohost Jennifer Milner on Instagram, it's at jenniferperiodmilner Milner and her website is WW dot. Jennifermilner.com, thank you for helping us spread the word about hypermobility and associated conditions. We want to hear from you. 

42:39
Dr. Linda Bluestein
Please email us at info@bendybodies.org to share feedback. 

42:44
Dr. Linda Bluestein
The thoughts and opinions expressed on this. 

42:46
Dr. Linda Bluestein
Podcast are solely of the cohost and their guests. They do not necessarily represent the views and opinions of any organization. The thoughts and opinions do not constitute medical advice and should not be used in any legal capacity whatsoever. This information is not intended to diagnose, treat, cure, or prevent any disease, as this information is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment, please refer to your local qualified health practitioner for all medical concerns. We'll catch you next time on the Bendy Bodies podcast.