Incorporating Ankle Injury Prevention in the

Gym

Tony RetrosiTony@atlanticgym.com

Brandi Smith-Young, PTPerfect 10.0 Physical Therapy

Perfect10PT@gmail.com

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)

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

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.

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

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.

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

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.

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

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

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

Anatomy of the ankle

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.

Muscle imbalances

Some muscles are strongWhile opposing muscles are

weakSome muscles are stretched outWhile opposing muscles are too

tight

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

Certain muscles get weakOther muscles develop tighterSome develop looser or

stretched

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

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 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).

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

Triage Watches rehab exercises corrects

positions and resistance Brings me coffee and the occasional

Biscotti

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

Stations

Demonstration Time

Foot Mechanics

Single leg standing

Single leg ¼ squat

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

Improper mechanics lead to repetitive abnormal stress

Leads to inefficient performance Leads to injury

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

Proper jump/squat mechanics

Loading mechanics

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

Sweepers (posterior tibialis) First do the

pen-penny Then slide

the toes toward the other foot keeping the arch.

Sweep across.

x15

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)

Eyes open on hard surface

Eyes closed on hard surface

Eyes closed on soft surface

Eyes closed head back on 8 incher

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

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

Hip & knee control Squatting (card pickups near wall)

– Both legs– Create arch– Hinge from hips– Bend straight down– Knee inline with second toe

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

Golfer Squat

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.

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.

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

Gastroc Standing

Partner Gastroc

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

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

Soleus standing

Partner Soleus

Ankle 4 way with bands

Inversion Eversion

Dorsiflexion (toe to shin)Plantarflexion (point toe)

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

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

Balance training

Balance Postures Maintain arch in

foot. Hold 20 sec-1 min

– Tree (Fig 7)

– Front Scale (Fig 8)

Figure 7

Figure 8

Balance Training Cont’d Balance Postures

– Back Scale (Fig 9)– Bent knee back

Scale(Fig 10)– Sneaky Lunge (Fig

11)

Figure 9

Figure 10Figure 11

Balance Training

Balance Training

Band Balance training

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

BOSU Balance

Beam ball tossIn releve… in coupe…in pose…in square hip scale

Jump mechanics and Agility

Jump mechanics and Agility

Ladder drills

Ladder drills

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

Slant board stretch

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

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

To a hammer- everything looks like a nail

Contact Information

Atlantic Gymnastics

www.atlanticgym.com tony@atlanticgym.com

Follow Tony Retrosi at facebook, twitter, and google plus

Contact Information

Perfect 10.0 Physical Therapy & Performance Training

www.perfect10physicaltherapy.com

perfect10pt@gmail.com 512-426-6593Follow 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.