Injury Occurrence in Gymnastics

 
 
Injury Occurrence in Gymnastics
Injury Occurrence in
                                                Gymnastics
     Gymnastics Injury               In a Recent Study Conducted by the SAFE
                                     KIDS Campaign, Nearly 23,500 Children
  Prevention and Treatment           Ages 5-14 Were Treated in Hospital
     Bryce Compton, MS, LAT, ATC     Emergency Rooms for Gymnastics Related
                                     Injuries.
        Certified Athletic Trainer
                                     Among Girls’ Sports, Gymnastics has One of
                                     the Highest Injury Rates, Increasing With the
                                     Level of Competition.




       Causes of Injuries
      in Child Gymnastics                   Gymnastics Injuries
Handsprings/Flips – 42.3%.
Cartwheels – 30.7%.
Handstands – 8.9%.
Dismounts/Landings – 5.8%.
Somersaults – 4.9%.
Backbends/Walkovers – 3.5%.
Splits – 2.1%.
Headstands – 1.7%.
                                         Traumatic                Overuse




       Traumatic Injuries                   Inflammatory Signs
Sudden Onset of                                               Redness.
Injury.                                                       Heat.
Mechanism of Injury                                           Pain.
is Usually Known.                                             Swelling.
Usually a Clear                                               Loss of Function.
Indication of an
Inflammatory
Process.




                                                                                     1
Injury Occurrence in Gymnastics
Common Traumatic
      Injuries in Gymnastics   Grade 1 Concussions
Head Injuries.                            Symptoms:
Hand and Wrist                            – Transient Confusion.
Injuries.                                 – No Loss of
Low Back Injuries.                          Consciousness.
Leg Injuries.                             – No Headaches.
                                          – No Neurological
Knee Injuries.
                                            Symptoms.
Ankle and Foot Injuries.                  – Symptoms Resolve
                                            in Less Than 15
                                            Minutes.




       Grade 1 Concussions     Grade 2 Concussions
Management:                               Symptoms:
                                          – Transient Confusion.
– Remove from
                                          – No Loss of
  Contest.                                  Consciousness.
– Examine                                 – Mild Headache.
  Immediately and at                      – Amnesia.
  5-Minute Intervals.                     – Light-
                                            Light-Headed.
                                          – Unable to Concentrate or
– May Return if Post-
                Post-                       Focus.
  Concussive                              – Symptoms do Not
  Symptoms Resolve                          Resolve in Less Than 15
  Within 15 Minutes.                        Minutes.




       Grade 2 Concussions     Grade 3 Concussions
Management:                               Symptoms:
– Remove From                             – Any Loss of
  Contest and Disallow                      Consciousness.
  Return for That Day.                         Brief (Seconds).
– Examine Frequently                           Prolonged (Minutes).
  for Signs of Intra-
               Intra-                     – Severe Neurological
  Cranial Pathology.                        Symptoms.
– Physician                               – Beware of Second
  Management.                               Impact Syndrome.




                                                                       2
Injury Occurrence in Gymnastics
Head Injury Take
       Grade 3 Concussions                                          Home Instructions
Management:                                  Head Injury Take Home Instructions                                            Observe for 24-
                                                                                                                                       24-48
– Transport to the            Head injuries are among the most feared of all sporting injuries. The vast majority of
                              head injuries are minor; however, the potential for serious injury is always present. The
                                                                                                                           Hours.
  Nearest Emergency           following recommendations can help prevent a seemingly minor injury from becoming a
                              life threatening injury.



  by Ambulance if
                              If any of the following symptoms are present 24-48 hours after a head injury, the athlete
                              should be taken immediately to your family physician or to an emergency room:                Symptoms to Be
                                        •   Severe headaches (deep throbbing)


  Unconscious or if
                                        •
                                        •
                                        •
                                        •
                                            Dizziness or loss of coordination
                                            Temporary loss of memory/mental confusion/disorientation
                                            Ringing of the ears (tinnitus)
                                            Blurred or double vision (diplopia)
                                                                                                                           Observed.
                                        •

  Worrisome Signs are
                                            Unequal pupil size
                                        •   No pupil reaction to light
                                        •
                                        •
                                        •
                                            Nausea and/or vomiting
                                            Slurred speech
                                                                                                                           Management:
  Detected.                             •
                                        •
                                        •
                                            Convulsions or tremors
                                            Excessive sleepiness or grogginess
                                            Clear fluid from the nose and/or ears




– Use Backboard and
                                        •
                                        •
                                        •
                                            Decreased pulse rate
                                            Gradual increase in blood pressure
                                            Numbness or paralysis (partial or complete)
                                            Difficulty being aroused
                                                                                                                           – Head Injury Take
  Send to Emergency
                              Management Instructions:

                                        •   Check breathing rate, heart rate, skin color and other symptoms every two
                                                                                                                             Home Instructions.
                                            hours
                                        •   Awaken the athlete every two hours to check their condition

  Room.                                 •
                                        •
                                            Allow the athlete to consume only clear liquids for eight hours
                                            Do not allow the athlete to take any medications in the initial 24 hours
                                            following the injury unless directed by a physician. Certain medications
                                            may thin the blood that could increase the severity of the injury. They may
                                            also mask the symptoms of a serious head injury
                                        •   If there is a question at any time concerning the well-being of the athlete,
                                            seek medical attention immediately




    Hand and Wrist Injuries                    Hand and Wrist Injuries
Types:                                                                                                                     Mechanism:
                                                                                                                           Contact.
– Sprains.
                                                                                                                           – Getting Hit Directly on
– Fractures.                                                                                                                 the Hand and Wrist.
– Dislocations.                                                                                                            – Falling and Landing with
                                                                                                                             the Hand and Wrist in a
– Tendon Injuries.                                                                                                           Awkward Position.
– Dorsal Wrist                                                                                                             – Improper Form During a
                                                                                                                             Cartwheels, Handstands,
  Impingement.                                                                                                               or Flips.




    Hand and Wrist Injuries                    Hand and Wrist Injuries
Signs and Symptoms:                                                                                                        Treatment:
– Mild to Sharp Pain.                                                                                                      Non-
                                                                                                                           Non-Surgical.
– Mild to Moderate                                                                                                         –   Brace or Cast.
  Swelling.                                                                                                                –   Rest.
– Discoloration and                                                                                                        –   Control Inflammation.
  Bruising.
                                                                                                                           –   Modalities.
– Inability to Move the
  Hand, Wrist, and/or                                                                                                      –   Rehabilitation.
  Fingers Properly,                                                                                                        Surgical.
  Depending on Severity.                                                                                                   – Depending on Severity.
– Point Tender Over the                                                                                                    – Depending on Bone
  Injured Area.                                                                                                              Displacement with
                                                                                                                             Fractures.




                                                                                                                                                        3
Injury Occurrence in Gymnastics
Hand and Wrist Injuries                        Dorsal Wrist Impingement
                                           One of the Most Common Injuries to a
                                           Gymnast’
                                           Gymnast’s Wrist.
                                           Occurs When the Dorsal (Back) Edge of the
                                           Radius Impinges on (Strikes) the Wrist Bones.




Dorsal Wrist Impingement                       Dorsal Wrist Impingement
                                           Mechanism:
                                           – Repetitive Combination
                                             of Hyperextension and
                                             Axial Loading on the
                                             Wrist.
                                           – Walkovers.
                                           – Handsprings.
                                           – Cartwheels.
                                           – Flips.
                                           – Handstands.




Dorsal Wrist Impingement                       Dorsal Wrist Impingement
             Signs and Symptoms:           Treatment:
              – Pain and Tenderness on     Non-
                                           Non-Surgical:
                the Dorsal (Back) Aspect   –   Rest.
                of the Wrist.              –   Splint or Brace.
              – Pain Usually Subsides by   –   Control Inflammation.
                the End of the Routine.    –   Manual Therapy.
                                           –   Modalities.
                                           –   Rehabilitation.
                                           Surgical:
                                           – If Conservative
                                             Treatment is Not
                                             Successful.




                                                                                           4
Injury Occurrence in Gymnastics
Lumbar Strain                                      Lumbar Strain
        Muscles in the Lower Back     Mechanism:
        Gradually Tighten Over        – A Sudden Movement or
        Time Due to Overuse and         Twisting May Cause a
        Improper Posture.               Strain.
        A Sudden Movement or          – Repetitive Flips and
        Twist May Cause the             Cartwheels With Added
        Muscle Fibers to be             Stress on the Spine.
        Stretched or Torn.
                                      – Improper Technique.
        Causes Muscles to Go Into a
        Spasm, and Lack of Oxygen
        Causes Weakness.




Lumbar Strain                                      Lumbar Strain
        Predisposing Factors:         Classification:
        –   Muscle Tightness.
        –   Muscle Imbalance.
                                      – Grade I.
        –   Poor Conditioning.        – Grade II.
        –   Muscle Fatigue.           – Grade III.
        –   Improper Warm-
                      Warm-Up
            Prior to Participation.




Lumbar Strain                                      Lumbar Strain
        Grade I:                      Grade II:
        – Stretching or Minor         – Muscle is Partially Torn
          Tearing Within the            But Still in Tact.
          Muscle.                     – Probably Cannot Walk
                                        Properly.
        – Mild Discomfort.
                                      – May Get Occasional
        – Tightness in the Back.        Sudden Twinges of Pain
        – May be Able to Walk           During Activity.
          Properly.                   – May Notice Swelling.
        – Probably Won’
                    Won’t Have        – Pressing the Area Causes
          Much Swelling.                Pain.
                                      – Can Limit Activity.




                                                                   5
Injury Occurrence in Gymnastics
Lumbar Strain                                          Lumbar Strain
            Grade III:                      Treatment:
             – Muscle is Completely Torn.   Non-
                                            Non-Surgical:
             – Unable to Walk Properly.     –   Rest.
             – Severe Pain.                 –   Back Brace.
             – Severe Swelling and          –   Control Inflammation.
               Discoloration Immediately.   –   Manual Therapy.
             – Static Contraction will be   –   Modalities.
               Painful and Might Produce
               a Bulge in the Muscle.       –   Rehabilitation.
             – Expect to be Out of          Surgical:
               Competition for 3 to 12      – Surgeon May Decide to
               Weeks.                         Operate with Grade III
                                              Strain.




    Lumbar Strain                                            Leg Injuries
            Prevention:                     Hamstring Strains.
             – Proper Warm-
                      Warm-Up.              Quadriceps Strains.
             – Proper Stretching            Calf Strains.
               Techniques.
             – Proper Strength Building
               Techniques.
             – Proper Condition Both
               Before and During the
               Season.




Hamstring, Quadriceps,                             Hamstring, Quadriceps,
   and Calf Strain                                    and Calf Strain
            Mechanism:                      Predisposing Factors:
             – Pushing Off or Slowing       – Doing Too Much, Too Soon and Pushing Beyond
               Down While Running.
                                              Your Limits.
             – Landing Incorrectly.
                                            – Poor Flexibility.
                                            – Poor Muscle Strength.
                                            – Muscle Imbalance.
                                            – Muscle Fatigue that Leads to Exertion.
                                            – Improper Warm-
                                                       Warm-Up.
                                            – Leg Length Discrepancy.




                                                                                            6
Injury Occurrence in Gymnastics
Hamstring, Quadriceps,                         Hamstring, Quadriceps,
   and Calf Strain                                and Calf Strain
            Classification:               Grade I:
             – Grade I.                   – Stretching or Minor
                                            Tearing Within the
             – Grade II.                    Muscle.
             – Grade III.                 – Stiffness, Soreness, and
                                            Tightness in the Muscle.
                                          – Little Noticeable
                                            Swelling.
                                          – Normal Walking Gait
                                            and Range of Motion
                                            with Some Discomfort.




Hamstring, Quadriceps,                         Hamstring, Quadriceps,
   and Calf Strain                                and Calf Strain
            Grade II:                     Grade III:
             – Muscle is Partially Torn   – Muscle is Completely
               But Still in Tact.           Torn.
             – Limp May be Present.       – May Hear an Audible
             – Muscle Pain, Sharp           “Pop”
                                             Pop” or “Snap”
                                                       Snap”.
               Twinges, and Tightness     – Pain During Rest Which
               in the Muscle.               Becomes Severe With
             – Noticeable Swelling and      Rest.
               Bruising.                  – Difficulty Walking
             – Painful to the Touch.        Without Assistance.
             – Limited Range of           – Noticeable Swelling and
               Motion and Pain When         Bruising.
               Contracting Muscle.




Hamstring, Quadriceps,                         Hamstring, Quadriceps,
   and Calf Strain                                and Calf Strain
            Treatment:
            Non-
            Non-Surgical:
             – Rest.
             – Back Brace.
             – Control Inflammation.
             – Manual Therapy.
             – Modalities.
             – Rehabilitation.
            Surgical:
             – Surgeon May Decide to
               Operate with Grade III
               Strain.




                                                                        7
Injury Occurrence in Gymnastics
Knee Injuries                                           Knee Injuries
Represents Approximately 60% of                    Ligament Injuries.
Gymnastics Disorders.                              – Anterior Cruciate.
                                                   – Tibial (Medial)
Peak Vertical Ground Reaction Forces of              Collateral.
8-14 Times the Athlete’
               Athlete’s Body Weight               Meniscal Injuries.
Occurs in High Skill Tumbling Activities.
                                                   Patellar Dislocation.
                                                   Patellar Subluxation.




                                                              Anterior Cruciate
 Anterior Cruciate Ligament                                   Ligament Injury
                      Anatomy:                     Mechanism:
                      – Connection Between         Contact.
                        Anterior Tibia and         – Getting Hit in the Back
                        Posterior Femur.             of the Knee While on
                      Function:                      Full Body Weight.
                      – Prevents Rotational        Non-
                                                   Non-Contact.
                        Movements About the        – More Common.
                        Knee.
                                                   – Usually Caused by a
                      – Prevents Anterior            Deceleration, Improper
                        Translation of the Tibia     Landing, or Pivoting
                        on the Femur.                Motion.




        Anterior Cruciate                                     Anterior Cruciate
        Ligament Injury                                       Ligament Injury
                      Signs and Symptoms:          Clinical Evaluation.
                      – “Pop”
                         Pop” or “Snap”
                                   Snap”.          – Manual Muscle
                      – Immediate Swelling and       Testing.
                        Pain.
                      – Unable to Continue
                                                   – Range of Motion
                        Participation.               Testing.
                      – Requires Evaluation by a   – Special Tests.
                        Physician.                 – Functional Testing.
                      – Possible Surgery.
                      – Treatment.




                                                                                  8
Injury Occurrence in Gymnastics
Anterior Cruciate
             Ligament Injury         ACL Injuries in Females
 MRI Evaluation.                 Incidence:
                                 – Rate of Non-
                                           Non-Contact ACL Injuries
                                   in Females Athletes is 2 to 1
                                   Compared to Male Athletes.




                                             Anterior Cruciate
       ACL Injuries in Females               Ligament Injury
Prevention:                                                   Treatment:
Intrinsic Factors:
                                                              Non-
                                                              Non-Surgical.
 – Alignment.
                                                              – Rest.
       Increased Q-
                  Q-Angle.
 – Joint Laxity.                                              – Control Inflammation.
 – Hormonal Effects.                                          – Rehabilitation.
Extrinsic Factors:                                            Surgical.
 – Muscle Strength.                                           – ACL Reconstruction.
       Strengthen Hamstrings.
 – Conditioning.
 – Technique.




             Anterior Cruciate
             Ligament Injury       Medial Collateral Ligament
Post-
Post-Surgical                    Anatomy:
Rehabilitation.                  – Made Up of 2 Bands.
 – Strengthen Knee               – Deep Band – Connected
   Stabilizing Muscles.            to the Medial Meniscus.
 – Correct Muscular              – Superficial Band.
   Imbalances.                   Function:
 – Functional Activity.
                                 – Prevents Medial
Bracing.                           Translation of the Knee.
Return to Activity.              – Prevents the Medial
 – 4-6 Months Post-
              Post-Surgery.        (Inner) Aspect of the
                                   Knee Joint from
                                   Widening from Stress.




                                                                                        9
Injury Occurrence in Gymnastics
Medial Collateral   Medial Collateral
             Ligament Injury     Ligament Injury
 Mechanism:                                Classification:
 – Getting Hit on the
   Lateral (Outside) Aspect                – Grade I Sprain.
   of the Knee With the                    – Grade II Sprain.
   Knee Slightly Bent.
 – Landing Incorrectly With
                                           – Grade III Sprain.
   the Knee Buckling
   Inward.
 – Deep Band is More
   Prone to Injury First,
   Which May Lead to
   Medial Meniscal
   Damage Also.




             Medial Collateral   Medial Collateral
             Ligament Injury     Ligament Injury
Grade I Sprain:                            Grade II Sprain:
– Stretching of the                         – Greater Than 10% of the
  Ligament Fibers with Less                   Ligament Fibers are
  Than 10% Being Torn.                        Torn.
– Mild Tenderness on the                    – Significant Tenderness
  Inside of the Knee Over                     on the Inside of the Knee
  the Ligament.                               on the Medial Ligament.
– Usually No Swelling.                      – Some Swelling Seen
– When the Knee is Bent to                    Over the Ligament.
  30 Degrees and Force is                   – When the Knee is
  Applied to the Outside of                   Stressed as for Grade 1
  the Knee, Pain is Felt But                  Symptoms, There is Pain
  There is No Joint Laxity.                   and Moderate Laxity in
                                              the Joint, Although
                                              There is a Definite End
                                              Point.




             Medial Collateral   Medial Collateral
             Ligament Injury     Ligament Injury
 Grade III Sprain:                         Clinical Evaluation.
 – This is a Complete Tear
   of the Ligament.                        – Manual Muscle
 – Pain can Vary and is                      Testing.
   Sometimes Not as Bad
   as That of a Grade 2                    – Range of Motion
   Sprain.                                   Testing.
 – When Stressing the Knee
   There is Significant Joint              – Special Tests.
   Laxity.
                                           – Functional Testing.
 – The Athlete May
   Complain of Having a
   Very Wobbly or
   Unstable Knee.




                                                                          10
Medial Collateral                            Medial Collateral
           Ligament Injury                              Ligament Injury
Possible Referral for an MRI Evaluation.   Treatment:
                                           Non-
                                           Non-Surgical.
                                           –   Rest.
                                           –   Control Inflammation.
                                           –   Manual Therapy.
                                           –   Modalities.
                                           –   Brace.
                                           –   Rehabilitation.
                                           Surgical.
                                           – Very Rare.
                                           – Only for Severe
                                             Instability.




           Medial Collateral
           Ligament Injury                     Medial and Lateral Menisci
                                                                        Anatomy:
Return to Activity:                                                     – Small “C” Shaped Piece
– Grade I: 1 - 2 Weeks.                                                   of Cartilage Between the
                                                                          Femur and Tibia.
– Grade II: 2 - 4 Weeks.                                                – One on the Medial
                                                                          Aspect and One on the
– Grade III: 4 - 6 Weeks.                                                 Lateral Aspect of the
                                                                          Knee.
                                                                        Function:
                                                                        – Primarily Acts as a
                                                                          Cushion Between the
                                                                          Two Bones.




          Medial and Lateral                           Medial and Lateral
          Meniscal Injuries                            Meniscal Injuries
Mechanism:                                 Classification:
– Pieces of Cartilage Tear                 Radial Tear.
  and are Injured Usually                  – Inside and Lateral Tear.
  if an Athlete Quickly                    Flap Tear.
  Twists and Rotates the
                                           – Piece of the Torn
  Upper Leg While the                        Cartilage Flips Upward.
  Foot is Firmly Planted.
                                           Peripheral Tear.
– Gradual Degeneration.
                                           – Around the Outer Edge.
                                           Longitudinal Tear.
                                           – Middle and Longitudinal
                                             Tear.




                                                                                                     11
Medial and Lateral                                     Medial and Lateral
         Meniscal Injuries                                      Meniscal Injuries
                           Signs and Symptoms:          Clinical Evaluation.
                           – Usually an Audible
                             “Pop”
                              Pop” or “Snap”
                                        Snap”.          – Manual Muscle
                           – Mild to Severe Pain          Testing.
                             Depending on the Extent
                             of the Tear.               – Range of Motion
                           – Swelling is Common,          Testing.
                             But May Also Develop
                             After Several Hours.       – Special Tests.
                           – Knee May Lock or Feel      – Functional Testing.
                             Weak.
                           – Unable to Continue
                             Participation.
                           – Requires Evaluation by a
                             Physician.




         Medial and Lateral                                     Medial and Lateral
         Meniscal Injuries                                      Meniscal Injuries
Possible Referral for an MRI Evaluation to See                                  Treatment:
the Extent of the Tear.                                                         Non-
                                                                                Non-Surgical.
                                                                                – For Very Minor Tears
                                                                                  with Little to No
                                                                                  Symptoms Present.
                                                                                – Rest.
                                                                                – Control Inflammation.
                                                                                – Manual Therapy.
                                                                                – Modalities.
                                                                                – Brace.
                                                                                – Rehabilitation.




         Medial and Lateral
         Meniscal Injuries                                      Patellar Dislocation
Surgical.                                                                       Patella is a Protective
Partial Meniscectomy.                                                           Bone That Lies in Front
                                                                                of the Knee Joint.
– Much More Common.
                                                                                The Patella is Attached
Repaired with Sutures.                                                          to the Quadriceps
– Occur Less Than 10% of                                                        Tendon and Acts to
  the Time.                                                                     Increase the Leverage
                                                                                From This Muscle
                                                                                Group When
                                                                                Straightening the Knee.




                                                                                                          12
Patellar Dislocation               Patellar Dislocation
The Patella Normally                                        Mechanism:
Lies Within the                                             – Getting Hit on the
Patellofemoral Groove,                                        Lateral (Outside) Aspect
and is Designed to Only                                       of the Knee.
Move Vertically Within                                      – A Sudden Twisting
This Groove.                                                  Action of the Knee.
A Dislocation is When
the Patella Moves or is
Moved Outside of This
Groove Onto the Lateral
Femoral Condyle.




         Patellar Dislocation               Patellar Dislocation
Predisposing Factors:                                       Signs and Symptoms:
– Insufficient Vastus                                       – Swelling in the Knee
  Medialis Obliquus                                           Joint.
  Strength.                                                 – Pain Around the Patella.
– Muscle Imbalance                                          – Impaired Mobility in the
  Between the Medial and                                      Knee.
  Lateral Quadriceps                                        – Obvious Displacement
  Muscles and IT Band.                                        of the Knee Joint.
– Excessive Foot
  Pronation.
– Increased Q-
             Q-Angle.
     Found in Women.




         Patellar Dislocation               Patellar Dislocation
Possible Referral for           Treatment:
an MRI Evaluation               Non-
                                Non-Surgical.
                                –   Rest.
to See the Extent of
                                –   Brace or Knee Taping.
the Injury.                     –   Control Inflammation.
                                –   Manual Therapy.
                                –   Modalities.
                                –   Rehabilitation.
                                       VMO Strengthening.
                                Surgical.
                                – Loose Fragments of
                                  Bone or Other Major
                                  Structural Damage.




                                                                                         13
Patellar Dislocation                              Patellar Subluxation
                                         A Temporary, Partial
                                         Dislocation of the
                                         Patella From its Normal
                                         Position Inside the
                                         Patellofemoral Groove.
                                         Occurs With Poor
                                         Tracking of the Patella
                                         Inside the
                                         Patellofemoral Groove.




Patellar Subluxation                              Patellar Subluxation
            Mechanism:                   Predisposing Factors:
            – Usually Occurs During      – Muscle Imbalance
              Forced Knee Extension,       Between the Medial
              With the Patella Moving      (VMO) and Lateral
                                           Quadriceps Muscles and
              Out of the Groove to the     IT Band.
              Lateral Aspect of the
                                         – Patella Atla.
              Knee.
                                         – Excessive Foot
                                           Pronation.
                                         – Increased Q-
                                                      Q-Angle.
                                              Found in Women.




Patellar Subluxation                              Patellar Subluxation
            Signs and Symptoms:          Treatment:
            – Feel the Patella Moving    Non-
                                         Non-Surgical.
              Out of Position.           –   Rest.
            – May Have Pain and          –   Brace or Knee Taping.
              Swelling Behind the        –   Control Inflammation.
              Patella.                   –   Manual Therapy.
            – May Have Pain or           –   Modalities.
              Discomfort When            –   Rehabilitation.
              Bending and                       VMO Strengthening.
              Straightening the Knee.
                                         Surgical.
                                         – If Conservative Treatment Does Not Fix Subluxation.




                                                                                                 14
Patellar Subluxation   Ankle and Foot Injuries
                                              Types:
                                              – Sprains.
                                              – Fractures.




                Ankle Sprains        Ankle Sprains
Most Common is an                             Signs and Symptoms:
Inversion or Inward                           – Mild Aching to Sudden
Stress.                                         Pain.
Least Common is an                            – Swelling.
Eversion or Outward                           – Discoloration.
Stress.                                       – Inability to Move the
                                                Ankle Properly.
Can be Traumatic or a
                                              – Pain in the Ankle Even
Chronic, Reoccurring                            When You are Not
Injury.                                         Putting Weight on It.




                Ankle Sprains        Ankle Sprains
Treatment:
Non-
Non-Surgical.
–   Rest.
–   Control Inflammation.
–   Manual Therapy.
–   Modalities.
–   Rehabilitation.
Surgical.
– In Recurrent Situations.




                                                                         15
Ankle and Foot Fractures            Ankle and Foot Fractures
Mechanism:                                           Signs and Symptoms:
Contact.                                              – Mild to Sharp Pain.
                                                      – Mild to Moderate
 – Getting Stepped on the                               Swelling.
   Ankle or Foot.
                                                      – Discoloration and
 – Jumping or Landing                                   Bruising.
   Improperly.                                        – Inability to Move the
 – Sudden Twisting or                                   Ankle, Foot, and/or Toes
   Pivoting Where the                                   Properly, Depending on
   Ankle Gives Out.                                     Severity.
                                                      – Point Tender Over the
                                                        Injured Area.




    Ankle and Foot Fractures            Ankle and Foot Fractures
Treatment:
Non-
Non-Surgical.
 – Brace or Cast.
 – 4-6 Weeks of
   Immobilization.
 – Control Inflammation.
 – Modalities.
 – Rehabilitation.
Surgical.
 – Depending on Severity.
 – Depending on Bone
   Displacement with
   Fractures.




When to Seek Medical Attention       When to Seek Medical Attention
   for a Traumatic Injury               for a Traumatic Injury
Swelling About a                                     Obvious Deformity.
Joint.                                               Inability to Walk or
Inability to Move a                                  Bear Weight on a
Joint.                                               Joint.
Decreased Joint
Motion.
                               ACL




                                                                                   16
Return to Competition
Treatment of Traumatic Injuries                     Following a Traumatic Injury
 Treat the                                          Pain Free.
 Inflammatory                                       Normal Range of
 Process:                                           Motion.
  – Rest.                                           Normal Strength.
  – Ice.                                            Able to Run.
  – Compression.                                    Able to Jump and Pivot.
  – Elevation.
                                                    Able to Perform Sport
 Seek Medical Help if                               Specific Activities.
 Necessary.




           Characteristics of                                Causes of Overuse
           Overuse Injuries                                Injuries in Gymnastics
                          Gradual Insidious         Strength Imbalances.
                          Onset.                    – Strength Deficits.
                          No History of Trauma.
                                                    Flexibility Deficits.
                          Typically No Indication
                          of a Major                Training Errors.
                          Inflammatory Process.
                          Usually the Result of
                          Repetitive Activity.




           Progression of
         Overuse Symptoms                               Common Overuse Injuries
 Pain After Sporting Activities.                    Distal Radial Stress
                                                    Fracture.
 Pain with Sporting Activities but with No          SLAP Lesion.
 Decrease in Performance.                           Low Back Injuries.
                                                    Patellar Tendinitis
 Pain During Sporting Activities with               (“Jumper’
                                                      Jumper’s Knee”
                                                                Knee”).
 Decreased Performance.                             Patellofemoral Pain
                                                    Syndrome.
 Unable to Perform Sporting Activities.             Plica Syndrome.
 Pain During Everyday Activities.                   Stress Fractures.
                                                    Achilles Tendinitis.




                                                                                    17
Distal Radial Stress Fracture                          Distal Radial Stress Fracture
                            Caused by Repetitive       X-Ray Plays an Important Role in the Diagnosis of
                            High Impact Forces that    This Injury.
                            Cause Compression on
                            the Wrist.                 This Injury Can Affect the Growth Plate in the Wrist.
                            – Repetitive Microtrauma   This Can Cause the Radius and Ulna to Grow to
                              Due to Axial Loading     Different Lengths.
                              and Extension of the
                              Wrist.                   Therefore it is Important to Have the Injury Evaluated
                            – Double Backward          When the Pain is First Felt.
                              Somersault.              Postponing a Visit to the Physician Can Lead to
                            This Can Lead to Small     Serious Complications.
                            Fractures in the Radius.




 Distal Radial Stress Fracture                          Distal Radial Stress Fracture
Signs and Symptoms:                                                                 Treatment:
– Pain and Tenderness are                                                           Non-
                                                                                    Non-Surgical:
  Often Felt Around the                                                              –   REST!!!
  Entire Circumference of
  the Radius Just Above                                                              –   Brace or Splint.
  the Wrist.                                                                         –   Control Inflammation.
– Pain is Experienced at                                                             –   Rehabilitation.
  the Onset of                                                                      Surgical:
  Participation and                                                                  – Not Necessary, However
  Progresses as Activity                                                               Severity and Failure to
  Continues.                                                                           Seek Immediate Help
                                                                                       May Lead to Surgery.




                SLAP Tear                                               SLAP Tear
                            Superior Labrum from       Mechanism:
                            Anterior to Posterior      – Fall Onto an
                            Tear.                        Outstretched Hand.
                            Biceps Tendon Pulls        – Common in Gymnasts
                            Off a Piece of the           Who Participate in the
                            Labrum.                      Rings.
                            This Section of the
                            Labrum is Susceptible
                            to Injury Because It has
                            a Poor Vascular Supply.




                                                                                                                 18
SLAP Tear                                                SLAP Tear
                     Signs and Symptoms:           Clinical Evaluation.
                     – Catching Sensation and
                       Pain with Overhead          – Manual Muscle
                       Shoulder Movements.           Testing.
                     – Pain is Deep in the
                       Shoulder Joint, or in the   – Range of Motion
                       Posterior Shoulder.           Testing.
                     – May Also have Pain and
                       Aching in the Front of      – Special Tests.
                       the Shoulder if Biceps
                       Tendinitis is Present.      – Functional Testing.




             SLAP Tear                                                SLAP Tear
                     Treatment:                    Surgical Procedures:
                     Non-
                     Non-Surgical.                 – Debridement of a SLAP Tear.
                     –   Usually Successful.
                                                         Torn Piece of Labrum is Shaved Away and Labrum
                     –   Rest.                           Surface is Smoothed Down.
                     –   Control Inflammation.
                     –   Injections.
                                                   – SLAP Repair.
                     –   Modalities.                     Using Sutures to Resecure the Torn Labrum Down to
                     –   Rehabilitation.                 the Shoulder Socket.

                     Surgical.                     – Biceps Tenodesis.
                     – If Conservative Therapy           Removing the Biceps Tendon from the Labrum, and
                       Fails.                            Reattaching it to a Different Location in the Shoulder.
                     – If Biceps Tendon is Torn.




        Low Back Injuries                                          Spondylolysis
Spondylolysis.                                     The Most Common Cause
                                                   of Low Back Pain in
Spondylolisthesis.                                 Adolescents.
                                                   Condition Where There is a
                                                   Stress Fracture in One or
                                                   Both Sides of the Lamina
                                                   (Pars Interarticularis) in a
                                                   Lumbar Vertebra.
                                                   Most Common at the
                                                   4th – 5th Lumbar.
                                                   5th Lumbar – 1st Sacrum.




                                                                                                                   19
Spondylolysis                                            Spondylolysis
          Mechanism:                     Signs and Symptoms:
           – Caused by Repetitive         – May Have Low Back
             Extension of the Back          Pain.
             (Bending Backwards).         – May Have Spasms of the
           – Causes Weakness of the         Lumbar Muscles or
             Lamina (Bony Ring) of          Hamstrings.
             the Vertebra, Eventually     – May Have Pain All the
             Leading to a Break.            Time, or Only From
           – May Also Result From a         Time to Time.
             Back Injury.                 – May Not Have Any
                Less Common.                Symptoms at All.




 Spondylolysis                                        Spondylolisthesis
          Treatment:                     Back Injury Involving
          Non-
          Non-Surgical:                  Forward Slipping of One
           – Rest.                       Vertebra Over Another.
           – May Continue                – Usually at the 5th Lumbar
             Participation if Pain
                                           Over 1st Sacrum.
             Free.
           – Avoid Stress on the         Most Common in
             Back.                       Children Between the
           – Possible Back Brace.        Ages of 9 and 14.
           – Manual Therapy.
           – Rehabilitation.
                Hamstring Flexibility.
                Core Strengthening.




Spondylolisthesis                                     Spondylolisthesis
          Often Seen in                  Mechanism:
          Conjunction with a              – Most Commonly Occurs
          Stress Fracture.                  in Sports That Have a
           – Spondylolysis.                 Lot of Strain on the
                                            Back.
          Stress Fracture Weakens
                                          – Repetitive Stress, Strain,
          the Bone and Causes               and Hyperextension of
          Shifting of the Vertebra          the Back.
          With Repeated Stress.




                                                                          20
Spondylolisthesis                                  Spondylolisthesis
          Classification:             Grade I:
           – Grade I.                  – 25% Forward
                                         Movement.
           – Grade II.                 – There May be No
           – Grade III.                  Symptoms at All and the
           – Grade IV.                   Patient May be Totally
                                         Unaware They Have a
                                         Defect in the Spine.




Spondylolisthesis                                  Spondylolisthesis
          Grade II:                   Grade III:
           – Greater Than 25%          – Greater Than 50%
             Forward Movement.           Forward Movement.
           – Lower Back Pain Which     – Same Symptoms as
             May or May Not Radiate
             Into the Legs.              Grade II.
           – Pain is Made Worse
             With Extension
             Activities.
           – May Have a Palpable
             Dip Where the Vertebra
             Has Slipped Forward.




Spondylolisthesis                                  Spondylolisthesis
          Grade IV:                   Treatment:
           – Greater Than 75%         Non-
                                      Non-Surgical:
             Forward Movement.         – Rest.
           – Same Symptoms as          – Avoid Stress on the Back.
             Grade II and III, But     – Back Brace.
             More Severe.
                                       – Manual Therapy.
                                       – Rehabilitation.
                                             Hamstring Flexibility.
                                             Core Strengthening.
                                      Surgical:
                                       – If Slip is Severe, May
                                         Have to Fuse Vertebra.




                                                                       21
Patellar Tendinitis                                   Patellar Tendinitis
                Inflammation and Irritation   Classification:
                of the Patellar Tendon.       Grade I.
                Overuse Injury that is        – Pain Only After Training.
                Usually Caused by Sports
                that Involve Jumping
                                              Grade II.
                Activities and Changing       – Pain Before and After Training, But Eases Up Once
                                                Warmed-
                                                Warmed-Up.
                Directions.
                With Repeated Strain,         Grade III.
                Micro-
                Micro-Tears and Collagen      – Pain During Training Which Limits Performance.
                Degeneration Occur in the     Grade IV.
                Tendon.                       – Pain During Everyday Activities.




     Patellar Tendinitis                                   Patellar Tendinitis
                Signs and Symptoms:           Treatment:
                 – Pain Directly Over the     – Rest.
                   Tendon.                    – Anti-
                                                Anti-Inflammatory
                 – Point Tender Over the        Medication.
                   Tendon.
                                              – Stretching.
                 – Pain with Activities,
                   Especially with Jumping    – Cross Friction
                   and Kneeling.                Massage.
                 – Less Common, Swelling      – Ice Treatments.
                   Around the Tendon.         – Cho-
                                                Cho-Pat Straps and
                                                Brace.




Patellofemoral Pain Syndrome                  Patellofemoral Pain Syndrome
                General Term Used to          Predisposing Factors:
                Describe Anterior Knee
                Pain.                         – Overloading the Knee.
                Comes on Gradually, With           Sports with Repeated
                Symptoms Increasing Over           Weight Bearing.
                Time.                              Repetitive Landing
                Occurs When the Patella            and Jumping.
                Does Not Track in a Correct
                Fashion When Bending and      – Feet Pronation.
                Straightening the Knee.       – Weak Quadriceps.
                Can Lead to Damage of the     – Chronic Tight Muscles.
                Surrounding Tissues.          – Previous Knee
                Most Common in                  Dislocation.
                Adolescent Girls.
                                              – Increased Q-
                                                          Q-Angle.
                                                   Found in Women.




                                                                                                    22
Patellofemoral Pain Syndrome                                 Patellofemoral Pain Syndrome
                           Signs and Symptoms:               Treatment:
                           – Aching Pain Around the Knee.    –   Rest.
                           – Tenderness Along the Medial
                             Border of the Patella.          –   Knee Brace or Support.
                           – Swelling After Activity.        –   Control Inflammation.
                           – Pain is Worse When Walking      –   Manual Therapy.
                             Up and Down Stairs.
                                                             –   Rehabilitation.
                           – Possible Clicking or Cracking
                             in the Knee.                    –   Orthotics if Pronated
                           – Discomfort When Sitting for         Feet are Present.
                             Long Periods of Time.
                           – Quadriceps Atrophy in Long
                             Term Cases.




Patellofemoral Pain Syndrome                                               Plica Syndrome
                                                                                          Result of a Remnant
                                                                                          Fetal Tissue in the
                                                                                          Knee.
                                                                                          These Plica Usually
                                                                                          Diminish in Size During
                                                                                          the Second Trimester of
                                                                                          Fetal Development.
                                                                                          In Adults, They Exist as
                                                                                          Sleeves of Tissue Called
                                                                                          Plica or Synovial Folds.




            Plica Syndrome                                                 Plica Syndrome
The Medial Plica is the                                                                   Signs and Symptoms:
Synovial Tissue Most                                                                      – “Snapping”
                                                                                             Snapping” and
Prone to Injury.                                                                            “Popping”
                                                                                             Popping” Sounds as the
When the Knee Bends,                                                                        Knee Bends.
the Plica is Exposed to                                                                   – Anterior Knee Pain with
Direct Injury, or Can be                                                                    Prolonged Knee Flexion.
an Overuse Injury.                                                                             Such as When Sitting
When the Plica                                                                                 for Long Periods of
Becomes Irritated and                                                                          Time or When
Inflamed, the Condition                                                                        Running Long
is Called                                                                                      Distances.
“Plica Syndrome”
       Syndrome”.




                                                                                                                      23
Plica Syndrome                                             Stress Fractures
Treatment:                                                   One of the Most Common
                                                             Injuries in Sports.
Non-
Non-Surgical:                                                Overuse Injury.
–   Rest.                                                    Occurs When Muscles
–   Control Inflammation.                                    Become Fatigued and are
                                                             Unable to Absorb Shock.
–   Manual Therapy.
                                                             Eventually, the Fatigued
–   Rehabilitation.                                          Muscle Transfers the
–   Possible Cortisone                                       Overload of Stress to the
    Injection.                                               Bone Causing a Tiny Crack
                                                             Called a Stress Fracture.
Surgical:                                                    Diagnosed with X-X-Ray or
– If Conservative                                            Bone Scan.
  Treatment Fails to
  Alleviate Symptoms.
– Removal of the Plica.




              Stress Fractures                                           Stress Fractures
                              Signs and Symptoms:           Treatment:
                               – Pain with Activity and     Non-
                                                            Non-Surgical:
                                 When Putting Direct        – Rest – 6 to 8 Weeks.
                                 Pressure Over the          – Cast, Brace, or Shoe
                                 Fracture Site.               Inserts if Necessary.
                               – Pain Subsides with Rest.   – Pain Medication.
                               – Swelling, Bruising, and    – Avoiding Activities that
                                 Discoloration May Also       Cause Pain or Discomfort.
                                 Occur.                     Surgical:
                                                            – If Fracture Does Not Heal
                                                              Properly.




              Stress Fractures                                          Achilles Tendinitis
Prevention:                                                                               Inflammation, Irritation,
– Set Incremental Goals.                                                                  and Swelling of the
      Increase Gradually.                                                                 Achilles Tendon.
– Cross Training.                                                                         Symptoms:
– Maintain a Healthy Diet.                                                                – Pain in the Heel When
– Use Proper Equipment.                                                                     Walking or Running.
      Proper Shoes.                                                                       – Achilles Tendon is Point
– If Pain or Swelling Occurs, Discontinue Activity.                                         Tender.
– Recognize Symptoms Early, and Treat Appropriately.                                      – Tendon May be Swollen
                                                                                            and Warm.




                                                                                                                       24
Growth Injuries
        Achilles Tendinitis                                   in Young Athletes
Treatment:                                        Growth Plate
– Rest.                                           Considerations.
– Anti-
  Anti-Inflammatory                               Injuries:
  Medication.                                     – “Osgood-
                                                     Osgood-Schlatter’
                                                              Schlatter’s
– Ice.                                              Disease.”
                                                    Disease.”
– Cross Friction                                  – “Sever’
                                                     Sever’s Disease.”
                                                             Disease.”
  Massage.                                          Calcaneal
– Rehabilitation.                                   Apophysitis.




         Growth Injuries
        in Young Athletes                            Osgood-Schlatter’s Disease
                      Osgood-                     Occurs Due to a Period of
                      Osgood-Schlatter’
                               Schlatter’s        Rapid Growth, Combined
                      Disease.                    with High Levels of
                                                  Sporting Activity.
                                                  Results in the Patellar
                                                  Tendon Pulling on the
                                                  Tibial Tuberosity Causing
                      Sever’
                      Sever’s Disease             Inflammation of the Bone.
                                                  Calcium Forms on the
                      Calcaneal                   Tibial Tuberosity Causing a
                      Apophysitis.                Bony Growth.




  Osgood-Schlatter’s Disease                         Osgood-Schlatter’s Disease
                      Symptoms:                   Treatment:
                      – Pain at the Tibial        – Rest.
                        Tuberosity.
                      – Swollen or Inflamed
                                                  – Ice.
                        Bump on the Tibial        – Stretching.
                        Tuberosity.               – Knee Brace.
                      – Tenderness and Pain are
                        Worse During and After
                        Activity.
                      – Pain When Contracting
                        the Quadriceps.




                                                                                  25
Sever’s Disease                                     Sever’s Disease
        Calcaneal Apophysitis                               Calcaneal Apophysitis
                         Most Common Cause of       Symptoms:
                         Heel Pain in Growing        – Pain or Tenderness in the
                         Athletes.                     Heel.
                         Due to Overuse and          – Discomfort Upon
                                                       Awakening, or When
                         Repetitive Microtrauma        Squeezing the Heel.
                         of Growth Plates of the
                                                     – Limping.
                         Calcaneus in the Heel.
                                                     – More Severe Pain After
                         Most Common in                Walking or Exercise, and
                         Children 9 – 15 Years         Difficulty Walking.
                         Old.                        – Pain During Running
                                                       and Sporting Activities.




           Sever’s Disease                          When to Seek Medical Attention
        Calcaneal Apophysitis                          for an Overuse Injury
                         Treatment:                 If Symptoms are Present
                         – Rest.                    with Everyday Activities.
                         – Ice.                     If Symptoms are Severe
                         – Compression.             Enough to Cause an Altered
                         – Elevation.               Gait.
                         – Elevate the Heel.        If the Symptoms Diminish
                         – Stretch the Hamstring    After a Week of Activity
                           and Calf Muscles 2 – 3   Modification but Return
                           Times a Day.             Soon After the Athlete
                         – Foot Orthotics.          Resumes His or Her Sport.
                         – Medication.




                                                            Preventing Overuse
Treatment of Overuse Injuries                              Injuries in Gymnastics
Relative Rest.                                                                     Utilize Proper
Treat the Inflammatory                                                             Training Techniques.
Process.
                                                                                   Improve Strength.
–   Rest.
                                                                                   – Correct Muscular
–   Ice.
                                                                                     Imbalances.
–   Compression.
–   Elevation.                                                                     Improve Flexibility.
Correct the Underlying
Cause of the Injury!




                                                                                                          26
Proper Training Techniques                                      Rules of Strengthening
Begin Slowly.                                             Light Resistance.
Progress Gradually.                                       High Repetition.
The #1 Cause of Injury
                                                          Emphasis on Endurance and Balance.
is Doing Too Much,
Too Soon.
The Tissues of the Body
can Adapt if Change is
Gradual.
                                                         * Refer to Strengthening Exercise Hand Outs.




     Strengthening Exercises                                    Strengthening Exercises
                          Weight Training Should Not
                          be Performed Until the
                          Athlete is 14 or Older.
                          Emphasis in Gymnastics
                          Should be on the Shoulder
                          Girdle, Trunk, Core, and the
                          Stabilizers of the Knee and
                          Ankle.
                          See Gymnastics
                          Strengthening Hand Outs.




     When is it Safe for Kids                                       Benefits of Strength
   to Perform Strengthening?                                        Training For Kids
Free Weights and                                          Increase Your Child's Muscle Strength and Endurance.
Machines – Not Until                                      Help Protect Your Child's Muscles and Joints From Injury.
14 or Older.                                              Improve Your Child's Performance in Nearly Any Sport.
Strength Training Using                                   Strengthen Your Child’
                                                                          Child’s Bones.
Own Body Weight or                                        Help Promote Healthy Blood Pressure and Cholesterol Levels.
Resistance Tubing.                                        Boost Your Child's Metabolism.
Emphasize Proper                                          Help Your Child Maintain a Healthy Weight.
Technique and Safety.                                     Improve Your Child's Self-
                                                                                Self-Esteem.
Make Exercises Sport
Specific.




                                                                                                                        27
Flexibility                                    Stretching Guidelines
Ability to Move a Body Part Through                     Precede Stretching Program
                                                        with a General Warm-
                                                                       Warm-Up.
Normal Motion Against Minimal                           Perform Static Stretching
Resistance.                                             Holding Each Stretch for
                                                        15-
                                                        15-20 Seconds.
A Stretching Program is Important in                    Perform Each Stretch 3-3-5
Injury Prevention.                                      Times.
                                                        Do Not Bounce.
                                                        See Gymnastics Stretching
                                                        Hand Out.




      Gymnastics Warm-Up                                         Stretching Exercises
The Purpose of a Proper Warm-
                          Warm-Up is to Prepare for
the Sport by Raising the Body Temperature,
Optimizing Performance, and Preventing Injury.
Warm-
Warm-up Activities Consist of General Running
Activities and Stretching Exercises.
As the Participant’
       Participant’s Skill Requirements Increase, the
Time Allotted for Warm-
                   Warm-Up Activities Increases and
the Exercises are More Specific.




        Stretching Exercises                                             Thank You




                                                                                        28
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