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Wrist Pain in the Gymnast

Gymnastics is an extremely intense sport both emotionally and physically. The physical demands of this sport unfortunately leave gymnasts susceptible to almost any injury under the sun. Wrist pain is very commonly experienced by gymnasts, males, and females alike. Distal Radial Epiphysitis, also called “Gymnast Wrist”,  specifically, is a common diagnosis that may explain this wrist pain amongst gymnasts due to the sport’s repetitive nature. 

Upper body injuries are more common in male and female gymnasts compared to other sports. The upper extremities are weight-bearing joints and absorb direct forces in all events of both men’s and women’s gymnastics. Acute injuries, such as a wrist fracture, often occur from a fall on an outstretched arm. However, injuries related to overuse and overtraining, such as Distal Radial Epiphysitis, are more common in gymnasts. 

The Diagnosis and How This Occurs:

– Distal Radial Epiphysitis, also known as “Gymnast Wrist”, is a growth plate injury to an adolescent gymnast with immature, growing bone structures
– The growth plate is prone to injury because the ligaments and joint capsule of the wrist are stronger than the cartilaginous growth plate 
– Repeated loading and wrist hyperextension cause the body’s forces to be directed to the radius bone which has not yet fused. This causes inflammation and widening of the growth plate. This often occurs with dorsal wrist impingement. 

Common Symptoms:

– Several weeks of unilateral or bilateral wrist pain 
– Usually occurs gradually, without history of acute trauma 
– Worsened pain with load bearing activities and when the wrist is extended 
– Pain relieved with rest 
– Range of motion normal or slightly limited due to pain
– Possible decrease in grip strength 
– Tender to palpation along the distal radius 
– Swelling may be present 

Differential Diagnoses:

– Dorsal Wrist Impingement 
– Scaphoid Stress Fracture 
– Carpal Ligament Sprains (Scapholunate and Lunotriquetral Ligament Injuries) 
– Triangular Fibrocartilage Complex Injuries 
– Ulnar Impaction
– De Quervain’s Tenosynovitis 
– Distal ulnar or radial stress fracture 

Pertinent Tests/Diagnostic Imaging:

– X-ray findings will typically appear normal
– In severe cases, a widening of the growth plate or ulnar variance may be visible
     – X-rays may be recommended 6-12 weeks post diagnosis or when symptoms subside to verify proper healing, but are usually not necessary if the initial X- rays appeared normal 
     – Routine X-rays may be recommended for about 6 months to one year post injury if the initial X-ray showed a lot of damage to the growth plate
– MRI is not usually necessary 

Risk Factors:

– Repetitive stress predisposes the wrist to acute injury, overuse injuries, and degenerative damage 
– Adolescent athlete with premature growth plates 
     – Adolescent gymnasts ages 10-14 are more likely to have wrist pain
– Recent growth spurt causing transient weakness at the growth plate

When to Seek Medical Attention: 

– Persistent pain that does not improve with rest over time 
– If this condition progresses it could lead to a fracture of the growth plate or ulnar variance 
– Ulnar Variance: if Gymnast Wrist becomes chronic and goes untreated, the growth plate may close prematurely resulting in cessation of radial growth too early, while the ulna continues to grow
     – Positive Ulnar Variance (the ulna appears longer): may result in altered wrist biomechanics, decreased wrist range of motion, and altered loading in weight bearing positions of the wrist 
     – Progressive damage to the ulnar side of the wrist may increase risk for chronic wrist pain and dysfunction

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Principles and Goals of Wrist Pain Treatment:

– Decrease the stress that is causing the pain
     – Stop weight bearing exercises for about 6 weeks or until symptoms subside 
– Wrist rehab to achieve symmetrical wrist range of motion and strength 
– Improve shoulder flexibility and thoracic spine mobility 
– Alternative training and conditioning aimed at improving upper body and core strength to decrease the stress on the wrist joint when returning to gymnastics 
– Stage 1: correct impairments in joint mobility, muscle length, and neuromuscular control in the spine, shoulder, and upper extremity joints
– Stage 2: continue manual techniques to correct impairments, progress exercises in neuromuscular control, introduce sport specific activities in limited weight bearing positions
– Stage 3: address impairments with manual techniques as needed, advance exercises in neuromuscular control, progress sport specific activities to full weight bearing positions  

Return to Sport:

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– Once there is a decrease in pain, and range of motion and strength have been restored, the gymnast can begin a gradual increase in training load
– It is important that there is careful attention to sport biomechanics and proper form/ technique to limit further damage or re-injury 
– Wrist braces may also be worn to limit excessive wrist hyperextension 

Exercises to try if you may have Wrist Pain in Gymnast:

Wrist specific exercises 
     – Hand arch and splay 

Hand arch and splay - Prep Performance Center in Chicago
     – 4-way wrist strengthening (flexion, extension, ulnar and radial deviation) 

Upper body exercises 
     – It is important to have stabilization in proximal joints such as the shoulders and spine in order to improve stability and decrease stress in the elbow, wrist, and hand 
     – Scapular retraction and Shoulder ER at 90-90 
     – Planks and Side Planks 

Exercises to treat wrist pain in the gymnast - Prep Performance Center in Cebu
Training modifications 
     – Supported handstands on a wall, block, or table to decrease weight through the wrists and hands 

PT Role in Preventing Wrist Pain:

Overuse injury prevention
     – Limit excessive loading of the wrist
     – Maintain wrist joint flexibility
     – Incorporate wrist strengthening into training
     – Emphasize proper technique to reduce unnecessary stress 
     – Strengthen core and upper extremity joints to reduce stress on the wrist joints 
     – Wrist braces may be used in skeletally immature gymnasts to decrease the load on the wrist joints and help prevent early closing of the growth plates 

 

References:
Benjamin HJ, Engel SC, Chudzik D. Wrist Pain in Gymnasts: A Review of Common Overuse Wrist Pathology in the Gymnastics Athlete. Current sports medicine reports. 2017;16(5):322-329.
Boucher B, Smith-Young B. Examination and physical therapy management of a young gymnast with bilateral wrist pain: A case report. Physical Therapy in Sport. 2017; 27:38-49.
DiFiori JP, Puffer JC, Aish B, Dorey F. Wrist Pain in Young Gymnasts: Frequency and Effects Upon Training Over 1 Year. Clinical Journal of Sport Medicine. 2002;12(6).
Hart E, Meehan WP, 3rd, Bae DS, d’Hemecourt P, Stracciolini A. The Young Injured Gymnast: A Literature Review and Discussion. Current sports medicine reports. 2018;17(11):366 375.
Poletto ED, Pollock AN. Radial Epiphysitis (aka Gymnast Wrist). 2012;28(5):484-485.
Trevithick B, Mellifont R, Sayers M. Wrist pain in gymnasts: Efficacy of a wrist brace to decrease wrist pain while performing gymnastics. Journal of Hand Therapy. 2019.
Written for PREP Performance Center by Gianna Scala, SPT

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Off Season Training Tips - Prep Performance Center in Chicago

Off Season Training Tips for Young Gymnasts (Levels 5 and under)

Unlike most other sports there is no real off-season in gymnastics. But it’s important to let your mind and your body take a break from the sport each year to prevent overtraining or burnout, especially as a young gymnast. So what should you do in your off time to make sure you are fresh and ready to go once you’re back in season? … PLAY! While it is important to maintain your fitness in order to be able to pick back up without missing a beat, fitness can be maintained in large part through play. 

Moderate to Vigorous Aerobic Activity during Off Season

This is a fancy term for activity that makes your heart race and makes you breathe hard. There are a lot of different ways to accomplish this: Running around playing tag or capture the flag with your friends, jumping on a trampoline or jumping rope, swimming, dancing, doing as many back walkovers as you can in a row… you name it! The important part, according to scientists at the CDC is that you spend at least 60 minutes being active! 

Strengthening on Off Season

Rather than doing any particular exercises during off season it is best to use your muscles while playing. See if you can outlast your friends in a pull up competition on the monkey bars or see who can jump the farthest on the ground. 

Stretching

You know the drill – hamstrings, quads, wrists, shoulders, splits – you do a LOT of stretching at practice. Anytime you spend flexing should help you to at least maintain all the flexibility you gained last season. But scientists have found that if you spend 10 minutes a day in each stretch you actually increase the flexibility of your tissues. So maybe challenge yourself to make this break the break when you get your center splits! 

Specific stretches: 

1. Back of the Wrists

– Description: Sit on the ground with the back of your hands flat against the ground in front of you. Make sure the back of your hands stay flat on the ground as you lean back until you feel a stretch on the outside of your arm below the elbow.

– Compensations: Make sure you are not allowing the back of your hands to lift off from the floor at all. Also make sure your fingertips are pointing straight towards your body and not inward or outward. 

– Purpose: In gymnastics, unlike in life, you weight bear through your hands often whether in a back walkover or back hip circle. Weight bearing through your hands requires a lot of mobility in the wrists. When taking some time off from the sport it is important to keep your wrists limber in order to avoid injury upon return. 

2. Bridges (Back and Shoulders) 

– Description: Perform a bridge push out through your feet such that your feel a stretch under your armpits. 

– Compensations: Make sure your fingertips are pointed straight back towards your feet and not rotating inward or outwards. 

– Purpose: To maintain flexibility of your back and shoulders 

3. Splits

– Description: Sit in your left, right, and middle splits for at least 30 seconds at a time. 

Compensations: Keep your pelvis neutral – check to make sure those bones on the front of your hips are pointed straight in front of you and not downwards toward the ground. Make sure your knee cap on your back leg is flat on the floor and the kneecap on your front leg is pointing straight up toward the ceiling and that neither are rotated out to the side. One leg is always “better than the other” but it is important to stretch equally to prevent structural imbalances that can predispose injury. 

– Purpose: To maintain flexibility of your legs.

Okay I know earlier I said that you could maintain your fitness through play and that’s definitely true for your aerobic fitness and strength, but stretching does need to be a bit more structured. But that doesn’t mean it can’t be fun. Maybe see if you can convince your parents to let you watch an episode of TV if you are stretching the whole time or have a slumber party with your friends from gymnastics and stretch together! 

 

Contact us today!

Are you ready to perform at your optimal level? Contact Doctor of Physical Therapy, Mary Kate Casey at our Chicago, IL clinic today! Through our movement analysis, we can assess jumping and landing mechanics and help you improve performance and reduce your risk of injury. Give PREP Performance Center a call at 773-609-1847 for more information on our movement analysis program!

 

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Exercises in gymnasts for shoulder and elbow strength

5 exercises to increase shoulder and elbow strength and stability in gymnasts 

Gymnasts spend a lot of time on their hands. Tumbling, swinging on the bars, vaulting, you name it; at some point a gymnast will be upside down supporting themselves on their hands. The repetitive high impact gymnasts place on their upper extremities can lead to overuse injuries of the shoulder, elbow, and wrist. Strengthening the muscles that support these structures in dynamic and functional ways, with proper form, can reduce the incidence of these injuries. Below are 5 exercises for gymnasts, with their progressions, that can help to strengthen and stabilize the shoulder and forearm muscles. These exercises can be incorporated into warm ups, different events, or conditioning programs. 

Also sharing here an article related to Gymnastics about the move and routine.

Exercises for Gymnasts #1: Bosu Ball Walk Outs 3X 10 repetitions, progress as necessary

How To:

Using an exercise ball

– The gymnast will roll out using their hands into a plank position, making sure the core is engaged and you are actively pushing their hands into the floor. Their back should be flat. Once in the plank position, they should be able to walk back to the starting position.

– Progress to arm and leg lifts

– Once they are able to roll out into a plank with proper form, they can progress to lifting one leg at a time from the exercise ball, maintaining plank position and form.

– Progress to lifting one arm at a time, maintaining form. 

– One full repetition will include roll out into plank, lift legs alternatively, lift arms alternatively, roll back to starting position 

Using floor bar

– This is a great and functional progression for the uneven bars. With hands on a floor bar, feet on exercise ball, alternatively lift legs, then arms, returning to plank position on bar. 

Exercises for Gymnasts #2: Wall handstands

How To: 

-With stomach facing the wall, gymnast can kick up or walk their feet up the wall into a handstand position. You will know the shoulders are engaged if the gymnast can perform a shoulder shrug. 

– Proper form is held at the top of the shoulder shrug, pushing down and away from the floor. Core is engaged, in proper form there will be a straight line from the toes to hands on the floor, you should not be able to see their ears. 

– Modify by starting with hands farther away from the wall, making sure they are still able to maintain a straight line from toes to hands. 

– Once they are able to maintain form with hands next to the wall, they can progress

Progression to lateral weight shifts: 

– Start this progression in a handstand, stomach facing the wall, and have them shift their weight from side to side, while maintaining straight form for exercises in gymnasts.

Progression to shoulder taps: 

– If they are able to perform weight shifts properly, progress to shoulder taps. 

– Shifting their weight completely onto one had to tap their opposite shoulder before returning to the handstand.  

– Watch to make sure they don’t relax their core or shoulders as they shift their weight. If their back starts to arch or their head starts to poke out and shoulders shrug, they need to correct before progressing. They can alternate for 10 repetitions. 

Progression to lateral walking: 

– The next step is lateral walking along the wall. Start with short distances, they have to walk down and back! Progress from 1M up to 5M as their strength and endurance increases. 

Advanced option:

– Handstand walking across the floor, forward and backward with good form 

Exercises for Gymnasts #3: Plank slides with weighted bag: 3 X 10 repetitions 

How To:

– Staring in plank position on the floor, using their grip bag as the weight, have them drag the bag to their opposite hand while maintaining plank position. 

– Make sure they don’t twist their body as they reach and pull the bag. This is great for tricep strength. 

Progression: 

– Have them progress by increasing the weight of the bag, balancing their legs on an exercise ball, or both. 

Exercises for Gymnasts #4: Concentric/eccentric biceps and triceps with theraband

How To:

– Seated in pike position, start with by holding the theraband in both hands. Sitting in a pike is a great way to work on posture and core strength with these exercises in gymnasts. 

– For triceps, start by holding the theraband up at chest level. Straighten out the right arm, pulling down towards their legs, and slowly releasing and bending elbow back to starting position. The slow and controlled motion of releasing the band is great at strengthening muscles! Repeat on the left side…

– For the biceps, start by holding the thread and in both hands down by their legs. Bend the right elbow up to the chest and slowly release down to starting position. Repeat on the left side…

Exercises #5: Kneeling row with overhead press with theraband: 3X 10 

Target Muscles: 

– Not only does this exercise work on UE strength, we are working on UE and trunk flexibility and core stability.

How To: 

– Loop a theraband around the supports of the beam or bars until you have one end of the theraband in each hand. 

– Kneeling on both knees, start by bringing arms up to chest level. 

– Complete a row, bending the elbows back and squeezing the shoulder blades together. Arms should be parallel to the floor. 

– Then rotate hands up, fingers pointing to the ceiling, and complete an overhead press, extending the elbows. 

– Reverse each move slowly until back to starting position. 

Progression: 

– You can progress this exercise to be completed in standing. 

Contact us today!

Are you ready to perform at your optimal level, now that we have ideas on exercises for gymnasts to help increase shoulder and elbow strength and stability? Contact Doctor of Physical Therapy, Mary Kate Casey at our Chicago, IL clinic today! Through our movement analysis, we can assess jumping and landing mechanics and help you improve performance and reduce your risk of injury. Give PREP Performance Center a call at 773-609-1847 for more information on our movement analysis program!

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Tips for Avoiding Injury as a Gymnast

Tips for Avoiding Injury as a Gymnast

Gymnast – It is no secret that gymnastics takes a toll on your body. You move, bend, flip, and control your body in ways that many people would never even consider. While gymnastics is a great way to exercise and perform, it also comes with some risk factors. Fortunately, sports physical therapy treatments can help you learn proper body techniques in order to perform at your optimum level and prevent the risk of sustaining an injury. To learn more about how you can benefit from these methods of treatment, contact PREP Performance Center today!

Common injuries sustained by gymnasts:

Before you can make an effort to avoid injuries, it is important to understand some of the most common injuries that gymnasts tend to experience. This will help you notice the signs quickly, in the chance that you end up with one. Some of the most common injuries sustained by gymnasts include:

Stress fractures. Stress fractures are tiny cracks in the bone that develop from excessive overuse of a body part. For example, a stress fracture may occur in the shoulder from repetitive tumbling or vault exercises, due to the repetitive strain of weight that is put on them.

Spondylolisthesis. Spondylolisthesis is a spinal disorder. It occurs when vertebrae in the base of the spine slip backward, forward, or over the vertebrae below it. As we mentioned earlier, a gymnast’s body moves differently than others. Repetitive tumbling can cause vertebrae to shift over time, which can result in spondylolisthesis.

Sinding-Larsen-Johansson Syndrome. Sinding-Larsen-Johansson Syndrome is another overuse injury. It occurs when the bone at the bottom of the patella (kneecap) becomes inflamed in the area where the tibia (shin bone) is connected by a tendon. A lot of stress is put on a gymnast’s knees, from the beam, to the vault, and especially the floor. Repeated stress from weight-bearing exercises can result in Sinding-Larsen-Johansson Syndrome over time.

Proper technique in Gymnast:

One of the best ways to decrease your risk of sustaining an injury is to practice proper technique. For a gymnast especially, this is important for both the upper and lower body. Some proper techniques to consider include:

1. Proper upper-body loading and landing mechanics during handspring, vault, and bars.

– Hands shoulder distance apart.

– Elbows straight.

– Pushing through hands to engage through shoulders for proximal stabilization.

 

The use of proper hand placement while loading allows for reduced load and stress at the elbow and wrist.

2. Proper lower-body loading and landing mechanics during handspring, vault, and bars in Gymnast.

– Neutral foot and knee alignment – toes and knee facing forward.

– Hips back – avoid letting the knees go over the toes.

– Single leg alignment.

– Toes and knees forward.

– Hips forward and equal.

Shock absorption while pushing the hips back allows for proper hip, knee, and foot placement, as well as reduced stress and load on the knee and ankle.

If you are a gymnast looking to improve your skill and avoid injury, contact our Chicago, IL physical therapy center today. We’ll help provide you with the techniques and methods necessary for you to reach your optimum physical capabilities and decrease your risk of pain or injury!

Contact PREP Performance Center for more information.

 

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