Gymnastics: Return to Sport Clinical Pearls Gina M. Pongetti, MPT, MA, CSCS, ART-Cert. Physical Therapist, Biomechanics Specialist USA ...

   Gymnastics: Return to Sport
   Clinical Pearls
   Gina M. Pongetti, MPT, MA,
    CSCS, ART-Cert.
   Physical Therapist,
    Biomechanics Specialist
   USA Gymnastics National
    Health Care
   Speaker, Author, President:
    www.MedGym.net
   Clinical Work: Accelerated
    Physical Therapy-
   Chicago, IL

   Former gymnast (see creds)
   Coach- MSU and Club- Swiss Turners- The Hamm
    Twins
   Choreographer
   Lecturer for USA Gymnastics
   USA Gymnastics HCRN
   Asst. Director of 2003 World Championships in
    Anaheim, CA- 75 countries, over 900 athletes
   Leading Writer/Research/Theory for 10 years for
    USAG Congress, education for Coaches, Judges,
    Gym owners, etc.
   Treated over 1200 gymnasts, 39 clubs

   Experience trumps Education- always
       Discipline of practice- PT, ATC, MT, MD, PA, etc.
   6 way chain of Communication:
       Coach, Parent, Athlete, Physical Therapist, Doctor,
        Program Director/Nat Team Coord (If appl.)
   Stability and mobility- balance of the two

   1) No one is ever out of the gym, except for
    illness, cancer, or 24 hours from injury. Period.
   2) Development of the relationship with the
    physician to avoid communication expectation
    set- ups or break downs
   3) Always condition the joint above and below
    immediately after injury.
   4) Aerobic Endurance/Anaerobic endurance-
    Being UE and LE specific
   5) Air Sense- importance of being inverted,
    flipping, rotating.

   6) Vertical Compression- Importance to bones,
    joints, and healing (ref Wolffs Law)
   7) Return in Steps: 2 Day Feel Rule
   8) LE specifics: “walk before run”
   9) Surfaces- which come first?
   10) Bracing- when to use?

   Why?
       Mental
       Hearing coaching corrections
       Conditioning
   MD’s think you need a “break”
       Deconditioning
       Atrophy
       Even in cast, decrease vibration, stretch, abs, spine,
        etc.

   Get to know the MD referral
   Make sure they know that you are directing medical
    care as an overall picture, if you are a former
    gymnast and have experience and respect
   Talk with them about your plan, and let them know
    specifics
       Many do not know options for being “in” the gym without
        being full out in practice
       Instruction heard” slowly return each day with more”
         “walk before run” theory

   Joints around for stability
       Ex: abs, ribs, hips for Spine pain
       Ex: for wrist pain- focus on shoulder strength,
        considering RTS- need for concentric and eccentric
        use of serratus, pecs, up trap, lats
   Joints around for mobility
       Ex: Wrist: need to consider shoulder flexibility,
        flexion, axillary opening (or lack of) and the effect on
        wrist positioning in inverted position on UPB, Beam
        hand placement, etc.

   Aerobic
       No more than 15 minutes for gymnast
   Anaerobic
       Can do long “time” in increments, with lengthy rest periods
        (1:4 WTR ration)
   UE Specific
       No UBE- completely not sport specific
       Hold and use weights in GH flex/ext position as ex.
   LE specific
       Can get aerobic benefit from doing combo major muscle
        work in LE Glut, Ham, Quad without plyo

   Inverted
       Get upside down, no matter what
         Static: inversion table
         Dynamic: spotting belt if UE injury
   Flipping
       If UE injury, standing back tucks (high level to low
        for ease)
   Rotated
       Turns for inner ear balancing, jump turns for
        accuracy, etc.

   Compression in spine
       Need to make sure inter-joint and disc pressures are
        loaded and unloaded
   Compression in joints
       3 reasons:
         1) fluid motion, viscosity, etc.
         2) co-contraction of stabilizing muscles (in knee can be
          up to 9!)
         3) compression with motion for disc/meniscus load/
          unload
   Compression to increase Wolffs law- lay more
    bone, density, calcium production, etc.
       NASA example.

   2 day rule
       Do check DOMS vs. pain vs. surrounding muscle pain
   Approach in progression of levels
       Ex: Level 10 starts being a “5” equivalent for 2-3 days,
        then 6, etc.
   Feed-forward mechanism
       Need to wait to take time to have coordination,
        anticipation, response, and motion awareness return
       This is where the physician release to just “ramp up
        slow” become problematic
         Reinjury due to lack of awareness, proprioception

   Considerations for progression
       Two foot then one foot
         Popa’s prior to switch leaps, whether concern is take off or
          landing
       Eccentric, concentric
         Work back tucks off beam for eccentric
         Need to work back tuck take off explosion as well- separate
       Height of landing and therefore absorption
       Air sense over foam prior to landing
       Floor routines with sprints to work aerobic before adding
        tumbling
       Beam sets over high beam but with parts (not low beam)-
        need to conquer RTS fear

   Which comes first?
       MD’s will state that they want soft landings
       Problems:
         Lack of proprioception
         Uneven for balance
         LE injuries and preparedness
   Ex of matting:
       Resi Pit
       8”
       Air Floor
       Tumble Track
       Trampoline
   Consider “landing” or impact surfaces for UE
       Sting can be placed over Vault table, or on RO entry UE
        placement

   Pros:
       Allows you to be daring with confidence in injured
        joint earlier
       Increases proprioception from
   Cons
       Decreases proprioception truly coming from joint
        itself, instead comes from a “false” sense of security
        from “Walls” that will not there to tell you M or L
        tension, for example
   Consensus: Great for training, never for more
    than 3 days of a trick!- Then, should do more
    drills and ramp ups versus high performance