Post on 01-Jun-2015
description
Ankle Injuries in gymnastics
Brandi Smith-Young, PTPerfect 10.0 Physical Therapy
www.perfect10physicaltherapy.comperfect10pt@gmail.com
Fellowship trained manual therapistBoard certified orthopedic specialist
Introduction
Competitive gymnastTwo time USAG Collegiate
National Champions at TWUBachelors in Kinesiology at TWUMasters 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:To bring sport specific quality
care to gymnastDecrease the number of injuries
in gymnast Improve recovery time, decrease
time lost in the gym, and improve return to sport status
Enhance performance
Common Complaints
Pain on the outside of the ankle Pain on the inside back of the ankle Pain in the midfoot; many times
outside Pain in inside of shin Pain in outside of shin Pain in the Achilles
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).
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
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 backon 8 incher
Demonstrate
Muscle testing – Hip– Ankle– Foot
Flexibility testing– Gastroc– Soleus
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
Clam ph II (fig 2)– Begin with clam ph
I.– Then lift from the
knee straight up with heels a few inches apart.
– Hold 10 sec x5 Clam ph 2.5
– Same as ph III– Against a wall– Hip rolled forward,
heel touching wall.– Hold 10 sec x5
Figure 2
Clam ph III (fig 3)– Roll hip forward.– Tighten abs, tighten
buttock.– Turn top foot out,– Raise leg.– Hold 10’ x5– No motion at the
hips. Keep rolled forward.
Figure 3
Hip & knee control
Squatting (card pickups near wall)– Both legs– Create arch– Hinge from hips– Bend straight down– Knee over second toe
Hip & knee control Single leg ¼ squat (fig 4)
– 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 4
These exercises can lead up to landing drills:– Make sure the gymnast’s foot 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 on push-off and landing.
Do NOT allow the foot to collapse or be loose.
Retrain calf muscles
Heel raise with knee straight (fig 5)– 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 5
Soleus
Bent knee heel raise (seated) (Fig 6)
– Start seated, 1 leg crossed with arms rested on knee.
– Slow and controlled.– Raise heel over 2nd toe.– 2x15
Figure 6
Soleus
Bent knee heel raise (standing) (fig 7)
– 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 7
Strengthen foot/toe muscles
Towel curls (fig 8)– 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 8
Balance Training progression
SLS eyes open– Balance postures
SLS eyes closed– Balance postures
SLS on 8 incher eyes open SLS on 8 incher eyes closed SLS on 8 incher head back eyes
closed SLS balance postures on beam
Balance training
Balance Postures Maintain arch in
foot. Hold 20 sec-1 min
– Tree (Fig 9)
– Front Scale (Fig 10)
Figure 9
Figure 10
Balance Training Cont’d Balance Postures
– Back Scale (Fig 11)– Bent knee back
Scale(Fig 12)– Sneaky Lunge (Fig
13)
Figure 11
Figure 12Figure 13
Challenge balance– Add 4 incher, 8 incher, BOSU ball (Fig
14)– 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 14
Beam ball toss
Stretch calf muscles
Calf stretch (fig 15)– 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 15
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.