Wrist Injuries In Gymnast


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Gymnastics Association of Texas 2010 conference: Presentation geared toward gymnastic coaches on common causes of wrist injuries in gymnast. Biomechanics of loading the wrist. Training exercises to prevent and decrease wrist injuries in gymnast.

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Wrist Injuries In Gymnast

  1. 1. Wrist Injuries in Gymnast<br />Brandi Smith-Young, PT<br />Perfect 10.0 Physical Therapy<br />Fellowship trained manual therapist<br />Board certified orthopedic specialist<br />www.perfect10physicaltherapy.com<br />perfect10pt@gmail.com<br />
  2. 2. Introduction<br />Competitive gymnast<br />Two time USAG Collegiate National Champions at TWU<br />Bachelors in Kinesiology at TWU<br />Masters in Physical Therapy at Tx St<br />
  3. 3. Practicing for 5 years<br />Fellowship trained in Orthopedic manual physical therapy<br />Board certified orthopedic specialist in PT<br />One of 300 therapist in the US with these certifications<br />
  4. 4. My passion:<br />Bring sport specific quality care to gymnast<br />Decrease the number of injuries in gymnast<br />Improve performance, recovery time, decrease time lost in the gym, and improve return to sport status<br />Performance Enhancement<br />
  5. 5. Common Complaints<br />Pain on the outside of the wrist<br />Pain on the inside of the wrist<br />Pain across the wrist<br />Pain into the hand<br />
  6. 6. What plays a role in wrist injuries<br />Wrist Injury can be caused by and cause:<br />Decreased joint motion (rolling and gliding) <br />Decreased range of motion (flexibility)<br />Decreased strength (shd blade, shd, arm, wrist, hand )<br />Balance and propriocetion deficits<br />
  7. 7. Anatomy of the Wrist<br />
  8. 8. Back<br />Front<br />
  9. 9.
  10. 10.
  11. 11.
  12. 12.
  13. 13.
  14. 14.
  15. 15. Anatomy cont’d<br />All these muscle provide stabilization for the wrist.<br />If these muscles are not functioning properly increased stress will eventually lead to injury.<br />
  16. 16. Muscle imbalances<br />Some muscles are strong<br />While opposing muscles are weak<br />Some muscles are stretched out<br />While opposing muscles are too tight<br />
  17. 17. Due to the stringent requirements placed on gymnast certain muscles tend to develop stronger than others<br />Certain muscles get weak<br />Other muscles develop tight<br />Some develop loose or stretched<br />
  18. 18. Common muscle imbalances<br />Poor shoulder blade, arm, and wrist control<br />Weak shoulder blade and shoulder muscles<br />Extensor Carpi Radialus Brevis (ECRB) doing too much and the other wrist extensors not doing enough<br />Weak hand intrinsic muscles<br />Tight pec and lat muscles<br />
  19. 19. Balance<br />3 systems make <br /> up balance:<br />Visual System (eyes)<br />Vestibular System <br /> (inner ear)<br />Propriocetion system <br /> (receptors in joints)<br />
  20. 20. Visual System<br />Eyes give input into the system indicating the environment around us and movements we are making<br />I have found gymnast tend to be visually dominant<br />Any change in vision can<br /> affect balance.<br />
  21. 21. Vestibular System<br />The inner ear monitors the position of the head<br />Any inner ear infection or injury (ie cold, fluid in the ear, sinus infection or ear infection) can affect balance.<br />
  22. 22. Proprioception System<br />The receptors in our joints give sensory input from your upper extremities to give your brain feedback about the floor<br />Any joint injury can cause <br /> damage to these receptors<br /> and affect balance (does <br /> not have to be a major<br /> injury)<br />
  23. 23. Demonstration Time<br />
  24. 24. Resting position<br />
  25. 25. Wrist Mechanics<br />Push up position<br />Push up<br />When taking off or landing on the wrist it is imperative to have good mechanics.<br />
  26. 26. Improper mechanics lead to repetitive abnormal stress<br />Leads to inefficient performance<br />Leads to injury<br />
  27. 27. Post- Treatment<br />Pre-Treatment<br />
  28. 28.
  29. 29. Demonstrate <br />Muscle testing <br />Shoulder Blade<br />Wrist<br />Hand<br />Flexibility testing<br />Pecs<br />Lats<br />
  30. 30. Proper wrist mechanics can be achieved by<br />Balancing muscle imbalances<br />Shoulder blade, shoulder, and wrist strength and flexibility<br />Improving balance or proprioception<br />Training proper loading mechanics <br />
  31. 31. Strengthen Shoulder Blade muscles<br />Cat Pushes(serratus) (fig 1)<br />On all fours<br />Set shd blades down and back<br /> Push through the heel of the hands.<br />Rounding out like a cat<br />Make sure to push till you can push no more. Keep head in.<br />Hold 10 sec x10<br />Figure 1<br />
  32. 32. Cat Rocking (fig 2)<br />Start in the Cat Pushes<br />Once rounded, keep the upper back rounded by pushing through the heels of the hands as rock back toward heels<br />Keep rounded as return to the start position.<br />Repeat x15<br />Figure 2<br />
  33. 33. Ts ph I (middle trap)(fig 3)<br />Lay face down with arms in a “goal post” position<br />Set shoulder blades down and back. Keep there.<br />Gently, lifting from the thumbs just high enough to slide a piece of paper under the arms.<br />Make sure to relax the upper trap and only engage the middle trap.<br />Hold 10 sec x5<br />Figure 3<br />
  34. 34. T ph II<br />Laying face down with elbows slightly bent in a T position.<br />Set shd blades down and back.<br />Keep down & back as raise arms slightly off the floor 1-3”<br />Make sure upper trap is relaxed.<br />Hold 10 sec x5<br />
  35. 35. T ph III (fig 4)<br />Lay face down in a T position with elbows straigth.<br />Set shd blades down and back.<br />Gently lift from the thumbs 1-3 inches off the floor.<br />Make sure upper traps relaxed.<br />Make sure not arching, engage abs.<br />Hold 10 sec x10<br />Figure 4<br />
  36. 36. Y ph I (lower trap) (fig 5)<br />Lay face down hands on head<br />Set shd blades down & back.<br />Gently lift from the elbows enough to slide a piece of paper underneath<br />Make sure upper traps relaxed and shd blades stay down & back<br />Hold 10 sec x 5<br />Figure 5<br />
  37. 37. Y ph II(fig 6)<br />Lay face down arms in a bent arm Y position<br />Set shd blades down & back.<br />Gently lift from thumbs enough to slide a piece of paper underneath<br />Make sure upper traps relaxed and shd blades stay down & back.<br />Hold 10 sec x 5<br />Figure 6<br />
  38. 38. Y Ph III (fig 3)<br />Lay face down arms in a Y position.<br />Set shd blades down & back.<br />Gently lift from the thumbs 1-3 inches from the floor.<br />Make sure upper traps relaxed & shd blades stay down & back.<br />Make sure not arching.<br />Hold 10 sec x 5<br />Figure 7<br />
  39. 39. Wall Slides(upper trap) (fig 8)<br />Standing 6” from wall, place elbows shd width apart on the wall.<br />Raise arms up as high as possible<br />Breath in as shrug everything up toward the ceiling.<br />Shd blades toward ears.<br />Hold as breath out, keeping the ribs expanded and the shd shrugged.<br />Hold 10 sec x5<br />Figure 8<br />
  40. 40. Upper extremity control<br />Push ups<br />Create arch in wrist<br />Elbows facing each other<br />Bend straight down<br />Don’t sag in shoulder blades<br />Even weight through wrist<br />
  41. 41. Balance Training progression<br />Pushup position weight shifting<br />Wight shifting on ball<br />Balance Board<br />Bosu Ball<br />
  42. 42. These exercises can lead up to tumbling and vaulting:<br />Make sure the gymnast’s hand is not collapsing when loaded<br />May start with just fixing the position in push ups and then in handstands.<br />Progress to tumbling, etc.<br />
  43. 43. When doing pushups and other conditioning the key is for the gymnast to control their shoulder, elbow, and wrist .<br />Do NOT allow the arch of the hand to collapse or the elbows to roll out and hyperextend.<br />
  44. 44. Wrist strength<br />Wrist Extension(fig 9)<br />Set wrist in neutral.<br />Actively lift wrist.<br />Push with the other hand to the end range.<br />Hold 10 sec x10<br />DO NOT let the wrist move inward.<br />May have to start with no weight. Progress to 1-3 lbs.<br />Figure 9<br />
  45. 45. Basic Wrist strength<br />Flexion (curl) (Fig 10)<br />Supination (out) (Fig 11)<br />Pronation (in) (Fig 12)<br />Always keep wrist in neutral.<br />Slow and controlled.<br />2x15<br />Figure 10<br />Figure 11<br />Figure 12<br />
  46. 46. Strengthen finger muscles<br />Pillow pickups or foam pickups<br />Elbow at side and bent to 90 deg.<br />Wrist in neutral.<br />Pickup foam with straight fingers. (fig 13)<br />X 2-3 min<br />Pick up foam with finger tips bent. (fig 14)<br />X2-3 min<br />Figure 13<br />Figure 14<br />
  47. 47. Stretch Lats<br />Robots lat stretch (fig 15)<br />Lie with knees bent.<br />Pull ribs toward hips with abs.<br />Elbows close together.<br />Keep ribs down and elbows in as reach toward the floor.<br />Hold 10 sec repeat 5 times<br />Figure 15<br />
  48. 48. Stretch pec muscles<br />Pec stretch (fig 16)<br />Stretch as pictured or<br />Have a partner sitting at gymnast’s head.<br />Place heel of the hand on the front of both shoulders.<br />Gently lean into the partner, pushing toward the floor.<br />Hold 1 minute<br />Figure 16<br />
  49. 49. Contact Information<br />Perfect 10.0 Physical Therapy <br /> & Performance Training<br />www.perfect10physicaltherapy.com<br />perfect10pt@gmail.com<br />512-426-6593<br />Follow Perfect10PT on gymanstike, facebook, and twitter <br />
  50. 50. All information from:<br />The Manual Therapy Institute<br />http://www.mtitx.com/<br />Shirley Sahrmann.<br />Diagnosis and Treatment of Movement Impairment Syndrome.<br />