Brandi Smith-Young, PTPerfect 10.0 Physical Therapy

Fellowship trained manual therapistBoard certified orthopedic specialist

www.perfect10physicaltherapy.com

perfect10pt@gmail.com

Introduction

Competitive gymnast

Two time USAG Collegiate National Champions at TWU

Bachelors in Kinesiology at TWU

Masters in Physical Therapy at Tx St

Practicing for 5 years

Fellowship trained in Orthopedic manual physical therapy

Board certified orthopedic specialist in PT

One of 300 therapist in the US with these certifications

My passion:Bring sport specific quality care to

gymnast

Decrease the number of injuries in gymnast

Improve performance, recovery time, decrease time lost in the gym, and improve return to sport status

Performance Enhancement

Common Complaints

Pain on the outside of the wrist

Pain on the inside of the wrist

Pain across the wrist

Pain into the hand

What plays a role in wrist injuries

Wrist 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

Anatomy of the Wrist

Front

Back

Anatomy cont’dAll these muscle provide stabilization

for the wrist.

If these muscles are not functioning properly increased stress will eventually lead to injury.

Muscle imbalances

Some muscles are strong

While opposing muscles are weak

Some muscles are stretched out

While opposing muscles are too tight

Due to the stringent requirements placed on gymnast certain muscles tend to develop stronger than others

Certain muscles get weak

Other muscles develop tight

Some develop loose or stretched

Common muscle imbalances Poor shoulder blade, arm, and wrist control

Weak shoulder blade and shoulder muscles

Extensor Carpi Radialus Brevis (ECRB) doing too much and the other wrist extensors not doing enough

Weak hand intrinsic muscles

Tight pec and lat muscles

Balance

3 systems make

up balance:

Visual System (eyes)

Vestibular System

(inner ear)

Propriocetion system

(receptors in joints)

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.

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.

Proprioception System The receptors in our joints give sensory input from

your upper 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)

Demonstration Time

Resting position

Wrist Mechanics

Push up position

Push up

When taking off or landing on the wrist it is imperative to have good mechanics.

Improper mechanics lead to repetitive abnormal stress

Leads to inefficient performance

Leads to injury

Pre-Treatment Post- Treatment

Demonstrate Muscle testing

Shoulder Blade

Wrist

Hand

Flexibility testing

Pecs

Lats

Proper wrist mechanics can be achieved by

Balancing muscle imbalances

Shoulder blade, shoulder, and wrist strength and flexibility

Improving balance or proprioception

Training proper loading mechanics

Strengthen Shoulder Blade muscles Cat Pushes(serratus) (fig 1)

On all fours

Set shd blades down and back

Push through the heel of the hands.

Rounding out like a cat

Make sure to push till you can push no more. Keep head in.

Hold 10 sec x10

Figure 1

Cat Rocking (fig 2) Start in the Cat Pushes

Once rounded, keep the upper back rounded by pushing through the heels of the hands as rock back toward heels

Keep rounded as return to the start position.

Repeat x15

Figure 2

Ts ph I (middle trap)(fig 3)

Lay face down with arms in a “goal post” position

Set 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 x5

Figure 3

T ph II Laying 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

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 x10

Figure 4

Y ph I (lower trap) (fig 5)

Lay face down hands on head

Set shd blades down & back.

Gently lift from the elbows enough to slide a piece of paper underneath

Make sure upper traps relaxed and shd blades stay down & back

Hold 10 sec x 5

Figure 5

Y ph II (fig 6)

Lay face down arms in a bent arm Y position

Set shd blades down & back.

Gently lift from thumbs enough to slide a piece of paper underneath

Make sure upper traps relaxed and shd blades stay down & back.

Hold 10 sec x 5Figure 6

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 5

Figure 7

Wall Slides(upper trap) (fig 8)

Standing 6” from wall, place elbows shd width apart on the wall.

Raise arms up as high as possible

Breath 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 x5

Figure 8

Upper extremity control Push ups

Create arch in wrist

Elbows facing each other

Bend straight down

Don’t sag in shoulder blades

Even weight through wrist

Balance Training progression Pushup position weight shifting

Wight shifting on ball

Balance Board

Bosu Ball

These exercises can lead up to tumbling and vaulting:

Make sure the gymnast’s hand is not collapsing when loaded

May start with just fixing the position in push ups and then in handstands.

Progress to tumbling, etc.

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.

Wrist strengthWrist Extension(fig 9)

Set wrist in neutral.

Actively lift wrist.

Push with the other hand to the end range.

Hold 10 sec x10

DO NOT let the wrist move inward.

May have to start with no weight. Progress to 1-3 lbs.

Figure 9

Basic Wrist strength Flexion (curl) (Fig 10)

Supination (out) (Fig 11)

Pronation (in) (Fig 12)

Always keep wrist in neutral.

Slow and controlled.

2x15

Figure 10

Figure 11

Figure 12

Strengthen finger muscles

Pillow pickups or foam pickups

Elbow at side and bent to 90 deg.

Wrist in neutral.

Pickup foam with straight fingers. (fig 13)

X 2-3 min

Pick up foam with finger tips bent. (fig 14)

X2-3 min

Figure 13

Figure 14

Stretch Lats Robots 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 times

Figure 15

Stretch pec muscles Pec stretch (fig 16)

Stretch as pictured or

Have 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 minute

Figure 16

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

All information from:

The Manual Therapy Institute

http://www.mtitx.com/

Shirley Sahrmann. Diagnosis and Treatment of Movement

Impairment Syndrome.