Gymnastic Injuries - Physiohealth...8.Ankle Sprains 9.Recovery, Warm Up, Stretching Injury...
Transcript of Gymnastic Injuries - Physiohealth...8.Ankle Sprains 9.Recovery, Warm Up, Stretching Injury...
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Definition
Gymnastic
Injuries
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CONTENTS 1. Injury Statistics
2.When do the injuries occur?
3.Why do we get injuries
4.Landing
5.Balance
6.Growth Plate Injuries
7.Medial Tibial Stress Syndrome
8.Ankle Sprains
9.Recovery, Warm Up, Stretching
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Injury Statistics 18 month Australian study (artistic Gymnastics)
Kolt and Kirby 1999
3.3 injuries per 1000 hours (20hrs/week =~1000hrs)
ankle and foot 31%
knee 16.3
Lower Back 15.9%
elbow and forearm 12.4%
wrist and hand 9.8%
Growth Plate 12.3%
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When do Injuries Occur? Marshall et al 2007
16 year Review NCAA – College Age
6 x more likely to have Knee injury in competition
3 x more likely to have ankle injury in competition
70% injuries result from landing in floor exercises or
dismounts
2:1 Injury rate Competition/practice
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When do Injuries Occur?
APPARATUS INJURY % WHEN
Floor Ankle ligaments 25 Routine
Knee 21 Routine
Uneven Bars Knee 19 Dismount
Elbow Dislocation 7 Routine
Balance Beam Knee 15 Dismount
Ankle 15 Dismount
Vault Knee 22 Dismount
Ankle 16 Dismount
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Why do we get Injuries?
• Landing – 70%
• Overtraining – No. Hours
• Growth / immature skeleton
• Repetition of High Stress Movements – Growth Plates
• Landing Technique / Error
• Bone Fatigue – Stress Fracture
• Inadequate cross training/rest/recovery
• Stress
• Poor Concentration
• Diet ??
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Overtraining - Hours
• Not just Gymnastics
• Be careful of sports with similar demands ie. Basketball,
volleyball, athletics
• ? Modify training when school athletics/ hurdling etc to
decrease load
• Encourage more cross training eg. Swimming
• Sleep – School Balance
• Sleep – Linked to Stress Fracture
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Do Gymnasts land better than other athletes?
Seegmiller & McCaw 2003
• Compared Gymnasts with recreational
athletes
• Measured Vertical GRF at 30cm/60cm/90cm
• Gymnastics landed with heavier technique at
60 and 90 cms
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How to Land Correct Landing can cut ACL injury rate by 50%
Always land on 2 feet where possible
Avoid landing with a straight knee
Avoid going “Knock kneed”
Get stronger Hips, keep pelvis level
Practice step downs – avoiding knock knees
Practice jumps, hops, SPECIFIC landing technique
Practice Balance
Try to make it feel natural
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Landing – Frontal View
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Side on Landing Technique
• adequate hip, knee and ankle flexion help absorb GRF
• By using gluteals and quadriceps athletes can minimise
their GRF
• Landing with trunk flexion can reduce quads activity by
28%
• Females tend to underuse Gluts compared to males
• Females tend to land with knees “too straight”
• Increased load to knee – increased injury risk
• ACL injury
• INC PFJ loading
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Side On Landing
Which technique is better?
Which technique loads the quadriceps more?
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Core Strength
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Core Strength • Core strength does not mean strong Abs
Definition – the ability to dynamically stabilize and control your trunk on top of
your legs whilst changing body position
• Includes – abdominals
- pelvic floor and diaphragm
- gluteals
- Hip Flexors
- Back extensor muscles
• Better core strength =
- less likely to fall over
- better alignment
- helps prevent torsion of feet/ankle
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Core Strength
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Balance • Gymnastics needs trunk control and stability to help minimize demands
of foot and ankle
• Technique crucial
• Scientifically
- people with reduced proprioception and poor postural sway get injured
more often
- Balance training can prevent Ankle and Knee Injuries
- Previous history of injury = greater chance of injury reoccurring
- use balance as a training tool
-If injured do at home eg. Down ball, eyes closed, jumping, landing
-At training don’t waste time include it as part of your warm up
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Star Excursion
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Injuries • Growth Plates
• Medial Tibial Stress Syndrome (Shin Splints)
• Acute Ankle Sprains
• High Ankle Sprains
• Chronic Ankle Sprains
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Growth Plates • Common source of pain
• Can remain open until 30 years of age
• Prevalent between ages 10-16
• Foot
• Achilles
• Knee
• Hip
• Present as “Tendonitis” or BONE type pain
• Xrays reveal growth plate BUT that does not
always mean pain or pathology
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Sever’s Disease
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Osgood Sclatters
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Inselin Disease-Peroneal Brevis
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Jones/Dancer’s Fracture
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Kohler’s Disease
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Medial Epicondyle
Normal Widened growth plate
plus distal segment
fracture
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Sesamoiditis
• Sesamoids located
within flexor hallucis
brevis tendons
• Traction and
compression forces
• Look for Toe
gripping, clawing
• Poor stability of foot
or trunk
• AVOID
• Slow to heal
• Stress Fracture
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Medial Tibial Stress Syndrome
• Continuum
• Muscular
• Tendon
• Teno-periosteal
• Bone Stress
• Fracture
• Muscle attachment
• ? Bone bending
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Shin pain Can be avoided
Calf Endurance Important
Load Management – too many sports, too much training
Inadequate rest and recovery
Bone Fatigue
Shin Splints/Stress Fractures
Israeli Army
$Millions on shoes
$Millions on orthotics
Strength/stretching Programs
Nothing worked
SLEEP 8 hours Day
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Calf Strength
Calf raises
Good technique up onto “On Toe” – demi pointe
Good control
Good endurance – up to 40 reps
Important to reduce Shin pain
Helps reduce loading stress
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ANKLE ROM
• Reduced
dorsiflexion
• Important for shock
absorption when you
run or land
• Linked to knee,
ankle, back and hip
injuries
• Minimum 12 cm
• Ice bucket ex
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Ankle Sprains
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Not all ankle sprains are the
same • Can improve quickly
• Isolated ATFL ruptures
often don’t appear to be
severely injured
• Often results in “laxity”
• High recurrence
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Not all ankle sprains are the
same High Ankle Sprain - Syndesmosis
Medial Ankle Sprain
• Usually rotation
mechanism
• Higher force
• More difficult to WB
• Stricter immobilisation
• Longer Rehab
• Eversion mechanism
• Usually higher force
• Usually longer rehab
• Less recurrence
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Not all ankle sprains are the
same
• PLUS THE ASSOCIATED COLLATERAL DAMAGE
• BONE DAMAGE
• BONE FRACTURES - AVULSIONS
• TALAR DOME LESIONS
• OSTEOCHONDRAL DAMAGE
• IMPINGEMENTS
• ANTERO-LATERAL
• MEDIAL
• POSTERIOR – Cant
Jump/Hop/Vault
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Not all ankle sprains are the
same Posterior Impingement
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Not all ankle sprains are the
same Osteo-chondral Fracture
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Not all ankle sprains are the
same Osteo-chondral Fracture
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Not all ankle sprains are the
same Osteo-chondral Fracture plus loose body
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Recovery Start Immediately once injury identified
PRICER
Protect
Rest – relative rest where possible
Ice
Compression
Elevation
Referral
Sleep – important for bone
Rest
Don’t overtrain – basketball, other sports etc
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Rehabilitation
Ankle Sprain Initial Management crucial
Ice and compress until swelling goes
Ice Bucket regime to get mobility back
Balance
Opinion – Sprain = Torn Ligaments
Return to sport when ready full hop, jump, full lunge
Completed 2 training sessions
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Prevention Of Injuries Warm Up
Landing Technique
Stretching
Calf Strength and Endurance
Ankle DF Range
Overload
Monitor Hot Spots
Recovery
Rehabilitation
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Warm up
Crucial to warm muscle, improve flexibility
Helps “cue in” balance systems
Teachers – stress importance
Discipline esp with junior instructors
Make functional
Use Dynamic/Functional Movements
Incorporate balance
Static Stretching – Do at Home
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Stretching
Stretching Do away from formal training sessions
Can be important if you are a stiff jointed person
Not essential if you are naturally flexible
Regular stretching on non-training days may actually
increase strength of connective tissue