Wrist Injuries In Gymnast
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Transcript of Wrist Injuries In Gymnast
Brandi Smith-Young, PTPerfect 10.0 Physical Therapy
Fellowship trained manual therapistBoard certified orthopedic specialist
www.perfect10physicaltherapy.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 [email protected]
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.