This document discusses incorporating ankle injury prevention exercises into gymnastics training. It begins by introducing the author and physical therapist. It then provides details on developing a coach-PT relationship to facilitate active recovery programs for injured gymnasts. The document outlines various exercises that target muscle imbalances, weaknesses, and proprioception around the ankle to prevent injuries. These include exercises for the hips, calves, feet and toes. It emphasizes the importance of proper mechanics during jumps and landings. Finally, it provides suggestions for how to implement the injury prevention program into a gymnastics gym's regular training.

1. Incorporating Ankle Injury Prevention in the Gym Tony Retrosi Tony@atlanticgym.com Brandi Smith-Young, PT Perfect 10.0 Physical Therapy Perfect10PT@gmail.com

2. Tony Retrosi Owner/ head coach Atlantic Gymnastics Training Centers Director National Gymnastics Training Center summer camp Former Region 6 Elite Program Chairman USAG Educator (safety/ risk management and other stuff)

3. Brandi Smith-Young Competitive gymnast 2 time USAG Collegiate National Champions at TWU Bachelors in Kinesiology at TWU Masters in Physical Therapy at Tx St Fellowship trained in Orthopedic manual physical therapy Board certified orthopedic specialist in PT Specialize in treating gymnast

4. Coach & PT relationship Open lines of communication are important to achieve maximum recovery while maximizing time and training in the gym Speak with the PT about the reasons for modifications (tissue healing, impact, loading, immobilization, etc) Educate the PT on possible training tools or modification which meet the recovery criteria.

5. Treat each gymnast like aprize race car Fill it up with the best quality fuel. (and refuel frequently!) Make sure all the parts are running as close as possible to 100% efficiency Give it a rest some times Frequent tune ups

6. Active Recovery Allows the athlete to do as much training as possible, painfree, while still allowing for the injury to heal appropriately and efficiently. This is defined by the tissues involved, aggravating activities, and proper healing times. Modifications are arrived at by a close interaction with the coach and PT.

7. Benefits of Active Recovery Physical Benefits Continued overall fitness, strength, cardiovascular & anaerobic capacity Continued progress in strength & skill level on the non injured areas maintain body composition Mental benefits Proven benefit of maintaining team environment. Maintains structure for the athlete. Prevent/decrease development of mental blocks Return to competition sooner

8. Coach & PT relationship Together with your gymnastics and coaching knowledge and the PTs knowledge of healing time frames and biomechanics you can create a successful active recovery program. Use your relationship with the PT to improve training regimens and develop injury prevention programs.

9. Why is this important to the Coach Healthy athletes = more reps in the gym Healthy athletes = better competitor Healthy athletes = consistent workouts Healthy athletes = outside growth Healthy athletes = easier motivation in the gym Healthy athletes = practices more FUN

10. Why is this important to the club owners Healthy athletes = Less lost revenue Healthy athletes = make team more marketable Healthy athletes = Outside growth Healthy athletes = Bragging rights over other sports Healthy athletes = Less problem parents

11. What plays a role in ankle injuries Ankle Injury can be caused by and cause: Decreased joint motion (rolling and gliding) Decreased range of motion (flexibility) Decreased strength (hip, knee, ankle) Balance and propriocetion deficits

12. Anatomy of the ankle

19. Anatomy cont’d All these muscle provide stabilization for the ankle and foot. If these muscles are not functioning properly increased stress will eventually lead to injury.

20. Muscle imbalances Some muscles are strong While opposing muscles are weak Some muscles are stretched out While opposing muscles are too tight

21. Due to the stringent requirements placed on gymnast certain muscles tend to develop stronger than others Certain muscles get weak Other muscles develop tighter Some develop looser or stretched

22. Common muscle imbalances Poor hip, knee, and foot control Weak hip muscles Weak posterior tibialis Posterior tibialis doing too much and the gastroc not doing enough Weak Soleus muscle (the other toe pointer) Weak foot intrinsic muscles Tight calf muscles

23. Balance 3 systems make up balance: Visual System (eyes) Vestibular System (inner ear) Propriocetion system (receptors in joints)

24. Visual System Eyes give input into the system indicating the environment around us and movements we are making. I have found gymnast tend to be visually dominant. Any change in vision can affect balance.

25. Vestibular System The inner ear monitors the position of the head. Any inner ear infection or injury (ie cold, fluid in the ear, sinus infection or ear infection) can affect balance.

26. Proprioception System The receptors in our joints give sensory input from your lower extremities to give your brain feedback about the floor. Any joint injury can cause damage to these receptors and affect balance (does not have to be a major injury).

27. How it works in my gym PT comes in 3 x per week. (only because they are a parent of an athlete) 1 x per week is what we were doing before List of kids to see/ evaluate Consults with conditioning and rehab exercises by GROUP Consults with conditioning and rehab exercises for individuals

28. Triage Watches rehab exercises corrects positions and resistance Brings me coffee and the occasional Biscotti

29. Nuts and Bolts each event has specific exercises related to that event exercises are posted and changed about every 3-4 weeks ATTITUDE towards the exercises is as important as the exercises themselves explain WHY and the WHAT of each exercise

30. Stations

31. Demonstration Time

32. Foot Mechanics Single leg standing Single leg ¼ squat When taking off or landing it is imperative to have good mechanics.

33. Improper mechanics lead to repetitive abnormal stress Leads to inefficient performance Leads to injury

36. Proper jump/landing mechanics Straight back Hips square Hip inline with the knee Knee inline with the 2nd toe Hips slightly flexed Knees bent with the knee falling over the midfoot

37. Proper jump/squat mechanics

38. Loading mechanics

39. How to make an arch in the foot Pen-Penny Place penny under ball of the foot Place pen under mid arch Push down into the penny Lift off the pen The pen should drop to the floor Hold 10 sec x10 Try to balance on that foot

40. Sweepers (posterior tibialis) First do the pen-penny Then slide the toes toward the other foot keeping the arch. Sweep across. x15

41. Foot Mechanics & Balance Single leg standing (SLS) Mechanics Eyes open hard surface Eyes closed (-visual system) (test proprioception and vestibular) Eyes closed on soft surface (- visual –proprioception) (test vestibular) Eyes closed on soft surface head back (challenge vestibular system)

42. Eyes open on hard surface

43. Eyes closed on hard surface

44. Eyes closed on soft surface

45. Eyes closed head back on 8 incher

46. Proper foot mechanics can be achieved by Balancing muscle imbalances Hip, ankle, and foot strength and flexibility Improving balance or proprioception Training proper take-off and landing mechanics

47. Strengthen Hip muscles Clam ph I (fig 1) Sidelying, roll hip forward. Tighten abs, tighten buttock. Keep heels together and lift one knee up. Monitor hips, no motion. Hold 10 sec x5 Figure 1

48. Hip & knee control Squatting (card pickups near wall) Both legs Create arch Hinge from hips Bend straight down Knee inline with second toe

49. Hip & knee control Single leg ¼ squat (fig 2) Standing on one leg, hips level Use a pen, golf ball, or card Squat to set ball down with R hand Back to start position Squat and pick up ball with L hand Continue alternating which hand picks up the ball. Knee must stay over 2nd toe and no motion at the hips. Weight evenly through the foot DO NOT let the arch of foot collapse 2x20 (can follow with balance postures) Figure 2

50. Golfer Squat

51. These exercises can lead up to landing drills: Make sure the gymnast’s arch is not collapsing when landing May start with just a jump to a stick. Then jumping from the beam or vault to a stick.

52. When doing plyos and other conditioning the key is for the gymnast to control their foot and knee on push-off and landing. Do NOT allow the arch to collapse or be loose. Do NOT allow the knees to come together or inward.

53. Retrain calf muscles Heel raise with knee straight (fig 3) Progress from 2 ft to 1 Raise heel up. Heel must stay in line over the 2nd toe. DO NOT let the heel move inward. 2x15 Figure 3

54. Gastroc Standing

55. Partner Gastroc

56. Soleus Bent knee heel raise (seated) (Fig 4) Start seated, 1 leg crossed with arms rested on knee. Slow and controlled. Raise heel over 2nd toe. 2x15 Figure 4

57. Soleus Bent knee heel raise (standing) (fig 5) Progress to standing, start both feet at same time progress to 1 foot Use beam for balance. Slow and controlled. Raise heel over 2nd toe 2x15 Figure 5

58. Soleus standing

59. Partner Soleus

60. Ankle 4 way with bands Inversion Eversion Dorsiflexion (toe to shin) Plantarflexion (point toe)

61. Strengthen foot/toe muscles Towel curls (fig 6) Place a towel on a smooth surface (tile works well) Do in standing and 1 foot at a time. Curl the towel with your toes towards you until reach the end of the towel. Start again x 5 min May add 1-8 pounds on towel. Heel must stay on the ground. Do NOT let arch collapse. Figure 6

62. Balance Training progression SLS eyes open Balance postures SLS eyes closed Balance postures SLS on 8 incher or foam or gel eyes open SLS on 8 incher or foam or gel eyes closed SLS on 8 incher or foam or gel head back eyes closed SLS balance postures on beam

63. Balance training Balance Postures Maintain arch in foot. Hold 20 sec-1 min Tree (Fig 7) Front Scale (Fig 8) Figure 7 Figure 8

64. Balance Training Cont’d Balance Postures Back Scale (Fig 9) Bent knee back Scale(Fig 10) Sneaky Lunge (Fig 11) Figure 9 Figure 10 Figure 11

65. Balance Training

66. Balance Training

67. Band Balance training

68. Challenge balance Add 4 incher, 8 incher, BOSU ball (Fig 12) Progress from 2 feet stable surface (floor) 2 feet unstable surface Sting mat to 8 incher to BOSU ball 1 foot stable surface 1 foot unstable surface Put them on beams Stand 1 leg balancing Add ball tossing Figure 12

69. BOSU Balance

70. Beam ball toss In releve… in coupe…in pose…in square hip scale

71. Jump mechanics and Agility

72. Jump mechanics and Agility

73. Ladder drills

74. Ladder drills

75. Stretch calf muscles Calf stretch (fig 13) Against a wall or stationary object. Place foot stretching back with toes straight forward. Create an arch. Gently lean forward DO NOT let foot collapse. Hold 1 min Figure 13

76. Slant board stretch

77. How to incorporate in the Gym Station at Vault or Bars Station during routines at Floor or Beam Drills during vault or conditioning Jump drills as part of plyometeric training Stretch at the beginning or end of workout or when waiting for turns

78. THE BOTTOM LINE IT WORKS AND DOESN’T TAKE UP ANY MORE TIME THE KIDS ARE GOING TO TALK DURING WORKOUT. GIVE THEM SOMETHING TO DO WHILE THEY TALK

79. To a hammer- everything looks like a nail

80. Contact Information Atlantic Gymnastics www.atlanticgym.com tony@atlanticgym.com Follow Tony Retrosi at facebook, twitter, and google plus

81. Contact Information Perfect 10.0 Physical Therapy & Performance Training www.perfect10physicaltherapy.com perfect10pt@gmail.com 512-426-6593 Follow Perfect10PT on gymanstike, facebook, and twitter

82. All information from: The Manual Therapy Institute http://www.mtitx.com/ Shirley Sahrmann. Diagnosis and Treatment of Movement Impairment Syndrome.