The document discusses wrist injuries in gymnasts, emphasizing the importance of sport-specific physical therapy and injury prevention. It outlines common complaints, anatomical factors, and specific exercises to improve strength, balance, and mechanics in the wrist and shoulder areas. Additionally, it provides detailed treatment techniques and muscle-improving exercises geared towards enhancing gymnast performance and reducing injury risk.

1. Wrist Injuries in GymnastBrandi Smith-Young, PTPerfect 10.0 Physical TherapyFellowship trained manual therapistBoard certified orthopedic specialistwww.perfect10physicaltherapy.comperfect10pt@gmail.com

2. IntroductionCompetitive gymnastTwo time USAG Collegiate National Champions at TWUBachelors in Kinesiology at TWUMasters in Physical Therapy at Tx St

3. Practicing for 5 yearsFellowship trained in Orthopedic manual physical therapyBoard certified orthopedic specialist in PTOne of 300 therapist in the US with these certifications

4. My passion:Bring sport specific quality care to gymnastDecrease the number of injuries in gymnastImprove performance, recovery time, decrease time lost in the gym, and improve return to sport statusPerformance Enhancement

5. Common ComplaintsPain on the outside of the wristPain on the inside of the wristPain across the wristPain into the hand

6. What plays a role in wrist injuriesWrist Injury can be caused by and cause:Decreased joint motion (rolling and gliding) Decreased range of motion (flexibility)Decreased strength (shd blade, shd, arm, wrist, hand )Balance and propriocetion deficits

7. Anatomy of the Wrist

8. BackFront

15. Anatomy cont’dAll these muscle provide stabilization for the wrist.If these muscles are not functioning properly increased stress will eventually lead to injury.

16. Muscle imbalancesSome muscles are strongWhile opposing muscles are weakSome muscles are stretched outWhile opposing muscles are too tight

17. Due to the stringent requirements placed on gymnast certain muscles tend to develop stronger than othersCertain muscles get weakOther muscles develop tightSome develop loose or stretched

18. Common muscle imbalancesPoor shoulder blade, arm, and wrist controlWeak shoulder blade and shoulder musclesExtensor Carpi Radialus Brevis (ECRB) doing too much and the other wrist extensors not doing enoughWeak hand intrinsic musclesTight pec and lat muscles

19. Balance3 systems make up balance:Visual System (eyes)Vestibular System (inner ear)Propriocetion system (receptors in joints)

20. Visual SystemEyes give input into the system indicating the environment around us and movements we are makingI have found gymnast tend to be visually dominantAny change in vision can affect balance.

21. Vestibular SystemThe inner ear monitors the position of the headAny inner ear infection or injury (ie cold, fluid in the ear, sinus infection or ear infection) can affect balance.

22. Proprioception SystemThe receptors in our joints give sensory input from your upper extremities to give your brain feedback about the floorAny joint injury can cause damage to these receptors and affect balance (does not have to be a major injury)

23. Demonstration Time

24. Resting position

25. Wrist MechanicsPush up positionPush upWhen taking off or landing on the wrist it is imperative to have good mechanics.

26. Improper mechanics lead to repetitive abnormal stressLeads to inefficient performanceLeads to injury

27. Post- TreatmentPre-Treatment

29. Demonstrate Muscle testing Shoulder BladeWristHandFlexibility testingPecsLats

30. Proper wrist mechanics can be achieved byBalancing muscle imbalancesShoulder blade, shoulder, and wrist strength and flexibilityImproving balance or proprioceptionTraining proper loading mechanics

31. Strengthen Shoulder Blade musclesCat Pushes(serratus) (fig 1)On all foursSet shd blades down and back Push through the heel of the hands.Rounding out like a catMake sure to push till you can push no more. Keep head in.Hold 10 sec x10Figure 1

32. Cat Rocking (fig 2)Start in the Cat PushesOnce rounded, keep the upper back rounded by pushing through the heels of the hands as rock back toward heelsKeep rounded as return to the start position.Repeat x15Figure 2

33. Ts ph I (middle trap)(fig 3)Lay face down with arms in a “goal post” positionSet shoulder blades down and back. Keep there.Gently, lifting from the thumbs just high enough to slide a piece of paper under the arms.Make sure to relax the upper trap and only engage the middle trap.Hold 10 sec x5Figure 3

34. T ph IILaying face down with elbows slightly bent in a T position.Set shd blades down and back.Keep down & back as raise arms slightly off the floor 1-3”Make sure upper trap is relaxed.Hold 10 sec x5

35. T ph III (fig 4)Lay face down in a T position with elbows straigth.Set shd blades down and back.Gently lift from the thumbs 1-3 inches off the floor.Make sure upper traps relaxed.Make sure not arching, engage abs.Hold 10 sec x10Figure 4

36. Y ph I (lower trap) (fig 5)Lay face down hands on headSet shd blades down & back.Gently lift from the elbows enough to slide a piece of paper underneathMake sure upper traps relaxed and shd blades stay down & backHold 10 sec x 5Figure 5

37. Y ph II(fig 6)Lay face down arms in a bent arm Y positionSet shd blades down & back.Gently lift from thumbs enough to slide a piece of paper underneathMake sure upper traps relaxed and shd blades stay down & back.Hold 10 sec x 5Figure 6

38. Y Ph III (fig 3)Lay face down arms in a Y position.Set shd blades down & back.Gently lift from the thumbs 1-3 inches from the floor.Make sure upper traps relaxed & shd blades stay down & back.Make sure not arching.Hold 10 sec x 5Figure 7

39. Wall Slides(upper trap) (fig 8)Standing 6” from wall, place elbows shd width apart on the wall.Raise arms up as high as possibleBreath in as shrug everything up toward the ceiling.Shd blades toward ears.Hold as breath out, keeping the ribs expanded and the shd shrugged.Hold 10 sec x5Figure 8

40. Upper extremity controlPush upsCreate arch in wristElbows facing each otherBend straight downDon’t sag in shoulder bladesEven weight through wrist

41. Balance Training progressionPushup position weight shiftingWight shifting on ballBalance BoardBosu Ball

42. These exercises can lead up to tumbling and vaulting:Make sure the gymnast’s hand is not collapsing when loadedMay start with just fixing the position in push ups and then in handstands.Progress to tumbling, etc.

43. When doing pushups and other conditioning the key is for the gymnast to control their shoulder, elbow, and wrist .Do NOT allow the arch of the hand to collapse or the elbows to roll out and hyperextend.

44. Wrist strengthWrist Extension(fig 9)Set wrist in neutral.Actively lift wrist.Push with the other hand to the end range.Hold 10 sec x10DO NOT let the wrist move inward.May have to start with no weight. Progress to 1-3 lbs.Figure 9

45. Basic Wrist strengthFlexion (curl) (Fig 10)Supination (out) (Fig 11)Pronation (in) (Fig 12)Always keep wrist in neutral.Slow and controlled.2x15Figure 10Figure 11Figure 12

46. Strengthen finger musclesPillow pickups or foam pickupsElbow at side and bent to 90 deg.Wrist in neutral.Pickup foam with straight fingers. (fig 13)X 2-3 minPick up foam with finger tips bent. (fig 14)X2-3 minFigure 13Figure 14

47. Stretch LatsRobots lat stretch (fig 15)Lie with knees bent.Pull ribs toward hips with abs.Elbows close together.Keep ribs down and elbows in as reach toward the floor.Hold 10 sec repeat 5 timesFigure 15

48. Stretch pec musclesPec stretch (fig 16)Stretch as pictured orHave a partner sitting at gymnast’s head.Place heel of the hand on the front of both shoulders.Gently lean into the partner, pushing toward the floor.Hold 1 minuteFigure 16

49. Contact InformationPerfect 10.0 Physical Therapy & Performance Trainingwww.perfect10physicaltherapy.comperfect10pt@gmail.com512-426-6593Follow Perfect10PT on gymanstike, facebook, and twitter

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