Wrist Injury Prevention in the Gym Tony Retrosi

Tony@atlanticgym.com

Brandi Smith-Young, PTPerfect 10.0 Physical Therapy

www.perfect10physicaltherapy.comperfect10pt@gmail.com

Tony RetrosiOwner/ head coach Atlantic Gymnastics

Training CentersDirector National Gymnastics Training

Center summer campFormer Region 6 Elite Program ChairmanUSAG Educator (safety/ risk management

and other stuff)

Brandi Smith- YoungCompetitive gymnast2 time USAG Collegiate National Champions at

TWUBachelors in Kinesiology at TWUMasters in Physical Therapy at Tx StFellowship trained in Orthopedic manual

physical therapyBoard certified orthopedic specialist in PTSpecialize in treating gymnast

Coach & PT relationshipOpen 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 timesFrequent tune ups

Active RecoveryAllows 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 RecoveryPhysical 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 relationshipTogether 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 yourpatters relationship with the PT to improve training regimens, identify injury patterns or injury cycles which may be occurring, and develop injury prevention programs.

Why is this important to the Coach

Healthy athletes = more reps in the gymHealthy athletes = better competitorHealthy athletes = consistent workoutsHealthy athletes = outside growthHealthy athletes = easier motivation in the

gymHealthy athletes = practices more FUN

Why is this important to the club owners

Healthy athletes = Less lost revenueHealthy athletes = make team more

marketableHealthy athletes = Outside growthHealthy athletes = Bragging rights over

other sportsHealthy athletes = Less problem parents

What plays a role in wrist injuries

Wrist Injury can be caused by and be the cause of: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 strongWhile opposing muscles are weak

Some 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 tightSome develop loose or stretched

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 enough

Weak hand intrinsic musclesTight pec and lat muscles

Balance

3 systems make up balance:

Visual System (eyes)Vestibular System (inner ear)Propriocetion system (receptors in joints)

Visual SystemEyes 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 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.

Proprioception SystemThe 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)

How it works in my gymPT 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/ evaluateConsults with conditioning and rehab

exercises by GROUPConsults with conditioning and rehab

exercises for individuals

TriageWatches rehab exercises corrects positions

and resistance Brings me coffee and the occasional Biscotti

Nuts and Boltseach event has specific exercises related to

that eventexercises are posted and changed about

every 3-4 weeksATTITUDE towards the exercises is as

important as the exercises themselvesexplain WHY and the WHAT of each exercise

Demonstration Time

Resting position

Wrist MechanicsPush 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 performanceLeads to injury

Proper Loading mechanicsFingers facing fwdMaintain palmar

archesAntecubital fossa

(“Smiley face”) points inward (“kiss each other)

Elbows straight but not locked out

Shoulder blades cinched up to the rib cage (no winging)

Pre-Treatment Post- Treatment

Pre-Treatment Post- Treatment

Pre-Treatment Post- Treatment

Poor Shoulder blade control

Proper wrist mechanics can be achieved by

Balancing muscle imbalancesShoulder blade, shoulder, and wrist strength

and flexibilityImproving balance or proprioceptionTraining proper loading mechanics

Strengthen Shoulder Blade musclesCat Rocking (fig 1)

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 1

Ts ph I (middle trap)(fig 2)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 2

Y ph II (fig 3)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 5

Figure 3

Wall Slides(upper trap) (fig 4)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 4

Elbow StrengthBicep curls

Make sure to start with the palm facing the body.Rotate the wrist outCurl up slow and controlledDon’t lock the elbow

Elbow StrengthTriceps pushes

Make sure they keep the shoulder blade cinched to the rib cage with a straight back

Straighten the elbow keeping the “smiley face” toward the body

Don’t lock the elbow

Wrist strengthWrist Extension(fig

5)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 5

Basic Wrist strengthFlexion (curl) (Fig 6)

Supination (out) (Fig 7)

Pronation (in) (Fig 8)

Always keep wrist in neutral.

Slow and controlled.2x15

Figure 6

Figure 7

Figure 8

Wrist strength with band

Wrist Strength with RockersRadial/Ulnar Deviation Supination/Prontation

Wrist Rolls with weight on Wobble board

Strengthen finger musclesPillow pickups or foam pickups

Elbow at side and bent to 90 deg.Wrist in neutral.Pickup foam with straight

fingers. (fig 9)X 2-3 minPick up foam with finger tips

bent. (fig 10)

X2-3 min

Figure 9

Figure 10

Upper extremity controlPush ups (on the floor or tennis balls)

Create arch in wristElbows facing each otherBend straight downDon’t sag in shoulder bladesEven weight through wrist

Tennis ball or Rockers Butt-up Pushups

Balance Training progressionPushup position weight shifting on therapy

ballWeight shifting on ballBalance BoardBosu Ball

Rocker Handstand HoldsFloor/pommel/Pbar hand position

Bars hand position

Handstand wobble board

Handstand Rebound

Rocker Slides & Slide to Press up

Rockers Press ups floor hands

Rockers Press ups floor hands

Rockers Press ups Bar hands

These exercises can lead up to tumbling and vaulting:Make sure the gymnast’s hand is not collapsing

when loadedMake sure the gymnast is not locking the

elbows outMay start with just fixing the position in push

ups and then in handstandsProgress 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.

Stretch LatsRobots lat stretch

(fig 11)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 11

Stretch pec musclesPec stretch (fig 12)

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 12

Stretch Pronator musclesPronator stretch

(fig 17)Place hand palm up

on a wall at waist height.

Straighten the elbow.

Gently lean hip into the elbow, pushing toward the ceiling and wall.

Hold 30 sec- 1 minute

Figure 17

Stretch Wrist ExtensionPlace the wrist you are

stretching fingers facing straight forward.

Place the other hand on top resting over the bend in the wrist

Press the bottom hand flat with the top hand as you lean your body weight forward.

Be sure to keep the arch of the hand

How to incorporate in the GymStation at Vault or BarsStation during routines at Floor or BeamDrills during vault or conditioningDuring handstand holds or pushups or other

conditioning make the athletes aware of proper mechanics.

Stretch at the beginning or end of workout or when waiting for turns

THE BOTTOM LINEIT 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 InformationAtlantic Gymnastics

www.atlanticgym.comtony@atlanticgym.com

Follow Tony Retrosi at facebook, twitter, and google plus

Contact InformationPerfect 10.0 Physical Therapy & Performance Training

www.perfect10physicaltherapy.com

perfect10pt@gmail.com512-426-6593Follow Perfect10PT on gymanstike, facebook, and twitter

All information from:

The Manual Therapy Institutehttp://www.mtitx.com/

Shirley Sahrmann. Diagnosis and Treatment of

Movement Impairment Syndrome.