Incorporating ankle injury prevention in the gym
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Incorporating Ankle Injury Prevention in the
Gym
Tony [email protected]
Brandi Smith-Young, PTPerfect 10.0 Physical Therapy
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Tony Retrosi
Owner/ head coach Atlantic Gymnastics Training Centers
Director National Gymnastics Training Center summer camp
Former Region 6 Elite Program Chairman
USAG Educator (safety/ risk management and other stuff)
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Brandi Smith-Young
Competitive gymnast 2 time USAG Collegiate National
Champions at TWU Bachelors in Kinesiology at TWU Masters in Physical Therapy at Tx St Fellowship trained in Orthopedic
manual physical therapy Board certified orthopedic specialist in
PT Specialize in treating gymnast
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Coach & PT relationship Open lines of communication are
important to achieve maximum recovery while maximizing time and training in the gym
Speak with the PT about the reasons for modifications (tissue healing, impact, loading, immobilization, etc)
Educate the PT on possible training tools or modification which meet the recovery criteria.
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Treat each gymnast like aprize race car
Fill it up with the best quality fuel. (and refuel frequently!)
Make sure all the parts are running as close as possible to 100% efficiency
Give it a rest some times Frequent tune ups
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Active Recovery Allows the athlete to do as much
training as possible, painfree, while still allowing for the injury to heal appropriately and efficiently.
This is defined by the tissues involved, aggravating activities, and proper healing times.
Modifications are arrived at by a close interaction with the coach and PT.
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Benefits of Active Recovery Physical Benefits
– Continued overall fitness, strength, cardiovascular & anaerobic capacity
– Continued progress in strength & skill level on the non injured areas
– maintain body composition Mental benefits
– Proven benefit of maintaining team environment. Maintains structure for the athlete.
– Prevent/decrease development of mental blocks
Return to competition sooner
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Coach & PT relationship Together with your gymnastics and
coaching knowledge and the PTs knowledge of healing time frames and biomechanics you can create a successful active recovery program.
Use your relationship with the PT to improve training regimens and develop injury prevention programs.
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Why is this important to the Coach
Healthy athletes = more reps in the gym
Healthy athletes = better competitor Healthy athletes = consistent
workouts Healthy athletes = outside growth Healthy athletes = easier motivation
in the gym Healthy athletes = practices more
FUN
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Why is this important to the club owners
Healthy athletes = Less lost revenue Healthy athletes = make team more
marketable Healthy athletes = Outside growth Healthy athletes = Bragging rights
over other sports Healthy athletes = Less problem
parents
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What plays a role in ankle injuries
Ankle Injury can be caused by and cause:– Decreased joint motion (rolling and
gliding) – Decreased range of motion (flexibility)– Decreased strength (hip, knee, ankle)– Balance and propriocetion deficits
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Anatomy of the ankle
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Anatomy cont’d
All these muscle provide stabilization for the ankle and foot.
If these muscles are not functioning properly increased stress will eventually lead to injury.
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Muscle imbalances
Some muscles are strongWhile opposing muscles are
weakSome muscles are stretched outWhile opposing muscles are too
tight
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Due to the stringent requirements placed on gymnast certain muscles tend to develop stronger than others
Certain muscles get weakOther muscles develop tighterSome develop looser or
stretched
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Common muscle imbalances
Poor hip, knee, and foot control Weak hip muscles Weak posterior tibialis Posterior tibialis doing too much and
the gastroc not doing enough Weak Soleus muscle (the other toe
pointer) Weak foot intrinsic muscles Tight calf muscles
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Balance
3 systems make up balance:
– Visual System (eyes)– Vestibular System (inner ear)– Propriocetion system (receptors in joints)
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Visual System
Eyes give input into the system indicating the environment around us and movements we are making.
I have found gymnast tend to be visually dominant.
Any change in vision can affect balance.
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Vestibular System
The inner ear monitors the position of the head.
Any inner ear infection or injury (ie cold, fluid in the ear, sinus infection or ear infection) can affect balance.
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Proprioception System
The receptors in our joints give sensory input from your lower extremities to give your brain feedback about the floor.
Any joint injury can cause damage to these receptors and affect balance (does not have to be a major injury).
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How it works in my gym
PT comes in 3 x per week. (only because they are a parent of an athlete) 1 x per week is what we were doing before
List of kids to see/ evaluate Consults with conditioning and rehab
exercises by GROUP Consults with conditioning and rehab
exercises for individuals
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Triage Watches rehab exercises corrects
positions and resistance Brings me coffee and the occasional
Biscotti
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Nuts and Bolts
each event has specific exercises related to that event
exercises are posted and changed about every 3-4 weeks
ATTITUDE towards the exercises is as important as the exercises themselves
explain WHY and the WHAT of each exercise
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Stations
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Demonstration Time
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Foot Mechanics
Single leg standing
Single leg ¼ squat
When taking off or landing it is imperative to have good mechanics.
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Improper mechanics lead to repetitive abnormal stress
Leads to inefficient performance Leads to injury
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Proper jump/landing mechanics
Straight back Hips square Hip inline with the
knee Knee inline with
the 2nd toe Hips slightly flexed Knees bent with
the knee falling over the midfoot
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Proper jump/squat mechanics
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Loading mechanics
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How to make an arch in the foot Pen-Penny
– Place penny under ball of the foot
– Place pen under mid arch
– Push down into the penny
– Lift off the pen– The pen should
drop to the floor– Hold 10 sec x10– Try to balance
on that foot
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Sweepers (posterior tibialis) First do the
pen-penny Then slide
the toes toward the other foot keeping the arch.
Sweep across.
x15
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Foot Mechanics & Balance
Single leg standing (SLS)– Mechanics– Eyes open hard surface – Eyes closed
(-visual system) (test proprioception and vestibular)
– Eyes closed on soft surface (- visual –proprioception) (test vestibular)
– Eyes closed on soft surface head back (challenge vestibular system)
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Eyes open on hard surface
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Eyes closed on hard surface
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Eyes closed on soft surface
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Eyes closed head back on 8 incher
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Proper foot mechanics can be achieved by
Balancing muscle imbalances– Hip, ankle, and foot strength and
flexibility Improving balance or proprioception Training proper take-off and landing
mechanics
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Strengthen Hip muscles Clam ph I (fig 1)
– Sidelying, roll hip forward.
– Tighten abs, tighten buttock.
– Keep heels together and lift one knee up.
– Monitor hips, no motion.
– Hold 10 sec x5
Figure 1
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Hip & knee control Squatting (card pickups near wall)
– Both legs– Create arch– Hinge from hips– Bend straight down– Knee inline with second toe
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Hip & knee control Single leg ¼ squat (fig 2)
– Standing on one leg, hips level– Use a pen, golf ball, or card – Squat to set ball down with R
hand– Back to start position– Squat and pick up ball with L
hand– Continue alternating which hand
picks up the ball.– Knee must stay over 2nd toe and
no motion at the hips.– Weight evenly through the foot– DO NOT let the arch of foot
collapse– 2x20 (can follow with balance
postures)
Figure 2
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Golfer Squat
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These exercises can lead up to landing drills:– Make sure the gymnast’s arch is not
collapsing when landing– May start with just a jump to a stick.– Then jumping from the beam or vault to
a stick.
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When doing plyos and other conditioning the key is for the gymnast to control their foot and knee on push-off and landing.
Do NOT allow the arch to collapse or be loose.
Do NOT allow the knees to come together or inward.
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Retrain calf muscles
Heel raise with knee straight (fig 3)– Progress from 2 ft to
1– Raise heel up.– Heel must stay in line
over the 2nd toe.– DO NOT let the heel
move inward.– 2x15
Figure 3
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Gastroc Standing
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Partner Gastroc
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Soleus
Bent knee heel raise (seated) (Fig 4)
– Start seated, 1 leg crossed with arms rested on knee.
– Slow and controlled.– Raise heel over 2nd toe.– 2x15
Figure 4
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Soleus
Bent knee heel raise (standing) (fig 5)
– Progress to standing, start both feet at same time progress to 1 foot
– Use beam for balance.– Slow and controlled.– Raise heel over 2nd toe– 2x15
Figure 5
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Soleus standing
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Partner Soleus
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Ankle 4 way with bands
Inversion Eversion
Dorsiflexion (toe to shin)Plantarflexion (point toe)
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Strengthen foot/toe muscles
Towel curls (fig 6)– Place a towel on a smooth surface (tile
works well) Do in standing and 1 foot at a time.
– Curl the towel with your toes towards you until reach the end of the towel.
– Start again x 5 min– May add 1-8 pounds on towel.– Heel must stay on the ground.– Do NOT let arch collapse. Figure 6
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Balance Training progression
SLS eyes open– Balance postures
SLS eyes closed– Balance postures
SLS on 8 incher or foam or gel eyes open
SLS on 8 incher or foam or gel eyes closed
SLS on 8 incher or foam or gel head back eyes closed
SLS balance postures on beam
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Balance training
Balance Postures Maintain arch in
foot. Hold 20 sec-1 min
– Tree (Fig 7)
– Front Scale (Fig 8)
Figure 7
Figure 8
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Balance Training Cont’d Balance Postures
– Back Scale (Fig 9)– Bent knee back
Scale(Fig 10)– Sneaky Lunge (Fig
11)
Figure 9
Figure 10Figure 11
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Balance Training
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Balance Training
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Band Balance training
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Challenge balance– Add 4 incher, 8 incher, BOSU ball (Fig
12)– Progress from
2 feet stable surface (floor) 2 feet unstable surface
– Sting mat to 8 incher to BOSU ball 1 foot stable surface 1 foot unstable surface Put them on beams
– Stand 1 leg balancing– Add ball tossing Figure 12
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BOSU Balance
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Beam ball tossIn releve… in coupe…in pose…in square hip scale
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Jump mechanics and Agility
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Jump mechanics and Agility
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Ladder drills
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Ladder drills
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Stretch calf muscles
Calf stretch (fig 13)– Against a wall or
stationary object.– Place foot
stretching back with toes straight forward.
– Create an arch.– Gently lean forward– DO NOT let foot
collapse.– Hold 1 min
Figure 13
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Slant board stretch
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How to incorporate in the Gym
Station at Vault or Bars Station during routines at Floor or
Beam Drills during vault or conditioning Jump drills as part of plyometeric
training Stretch at the beginning or end of
workout or when waiting for turns
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THE BOTTOM LINE
IT WORKS AND DOESN’T TAKE UP ANY MORE TIME
THE KIDS ARE GOING TO TALK DURING WORKOUT. GIVE THEM SOMETHING TO DO WHILE THEY TALK
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To a hammer- everything looks like a nail
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Contact Information
Atlantic Gymnastics
www.atlanticgym.com [email protected]
Follow Tony Retrosi at facebook, twitter, and google plus
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Contact Information
Perfect 10.0 Physical Therapy & Performance Training
www.perfect10physicaltherapy.com
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All information from:
– The Manual Therapy Institute– http://www.mtitx.com/
– Shirley Sahrmann. Diagnosis and Treatment of
Movement Impairment Syndrome.