What ER Doctors Refuse to Have in Their Own Homes

Excerpt:

“We see a lot of serious trampoline injuries...upper-body fractures, broken femurs, neck injuries. That’s why most ER doctors I work with won’t buy trampolines for their kids. They’re all trouble. There’s no good kind. Unfortunately parents get a false sense of reassurance; when there’s a net around something, they think their kids will be safe.” — Ferdinando Mirarchi, MD, medical director of the Department of Emergency Medicine at University of Pittsburgh Medical Center

 Related:

are backyard trampolines safe?

 

Kate Foster on Good Morning America

GoFundMe for Cassie Whitcomb

A former UCLA Bruin, Cassandra Whitcomb recently had spinal fusion surgery:

As many of you probably know...I finally received the spinal fusion surgery I've been needing for a while on Monday. I was no where near prepared for the recovery that it entails. For the past 5 days I have found myself in a gloomy mood feeling as if the pain will never go away. But for some reason, I woke up today and I told myself it was gonna be different. I wrote out some goals on a white board to be accomplished by the end of the day. Such as, sitting up in a chair for 15 minutes or changing my bandages. Simple but something to strive for. I realized that this is a new chapter in my life. Many times new chapters are scary and bring something new and so we don't recognize the chance to grow and learn. Well I am taking a moment today to reflect on just how far I have come with this injury, what I have endured, and how much better my quality of life will be after recovery. Anything worth having is going to require some work to get there. So I'm getting to work

Cassandra's mom:

Cassie is a former International/National Team Gymnast (about 6 years!) and was on the National Tops Team for about 5-6 years prior to that! She spent most of her young life competing in Gymnastics  (since she was 4 1/2 years old!) Her passion was always to be the best she could be. Regardless of her pain, she just kept going. When she made the National Team, she worked through many injuries to help her team win gold medals in many countries (Belgium, Italy, France, United States, etc) You can find several videos on you tube: "Cassie Whitcomb"...

Random clip I filmed of her doing an exhibition routine a few years ago:

Go here if you are able to donate; and/or help spread the word to others who might contribute.

Sacred Cows Die Hard

I think this research has a lot of merit:

There is much more than just hip flexors and quads in relation to structures that limit motion for the back leg of splits. The hip joint has two types of stabilizers to support it, static and dynamic stabilizers. Static stabilizers are more passive things out of the athlete’s control like inherent boney congruency or shape, ligaments/capsular tissue, and the labrum. Dynamic stabilizers are muscular based structures like the hip flexors, hip rotators, and other glute/adductor muscles. These muscular dynamic components tie in heavily with neurological control and strength to maintain hip stability during motion.

Passive hip stabilizers like the iliofemoral ligament, ligamentous teres, labrum, and anterior hip capsule are very important structures in the front of the hip that assist in stability during high force skills in gymnastics. The iliofemoral ligament and extension of the anterior capsule have been noted in anatomical research to restrain external rotation and extension ranges of motion, like seen in extreme back leg split positions, and stabilize the hip against excessive movement out of the front of the joint.  The labrum is a fibrocartilage ring of tissue that deepens the socket, aids in joint stability, and helps disperse forces. Research suggests it too can be stressed with excessive movement of the femoral head out of the hip socket.

Read more from Dr. Dave Tilley. 


Old school habits will die hard, though; and when coaches are still getting results (or perceived results), will their methods evolve?  Or stick with what they know and with what's been done for ages?  I'd love to see research examination on rhythmic gymnasts. 

Another important point is that gymnasts in the video are clearly hyper mobile individuals who don’t have an issue with passive range of motion. I’d be willing to bet money on the fact that on xray they have morphological hip changes like hip dysplasia or femoroacetabular version that make passive flexibility easy. They also likely have connective tissue level differences that makes it possible for them to get into these positions, with naturally reduced static ligamentous and capsular capabilities. These naturally mobile gymnasts with reduced static stability depend on exceptional dynamic stability to keep their hips safe and to increase their gymnastics performance.
This is usually the case for most flexibility examples in videos or presentations, where gymnasts who have huge flexibility ranges naturally are chose to demonstrate the drills. I will tell you honestly not all gymnasts will have the same hip anatomy. The same drill that is easy for one gymnast demonstrating the drill with underlying hip dysplasia or differences in morpholocial boney alignment will completely destroy another gymnast’s hips who don’t have that naturally.

Ankle Weights

Dr. David Tilley:

To start, I’m aware this is a another controversial topic in gymnastics. I have spent quite a long time organizing my thoughts and how to present them in a positive, constructive article. As a younger coach I used to do a ton of ankle weight work, but have changed my approach quite a bit in the last few years. I hope to outline the reasons why I don’t use ankle weights based of the research and literature I’ve read, as well as the increase in hip related injuries I have treated gymnastics patients for lately. Then rather than only being a “negative Nancy”, I’ll offer alternative ideas as to what I do in practice for improving hip strength, power, and skill development.

Read his thoughts.

I've never really used ankle weights; and have consciously been turned away from them for the past few years, in part from reading discussions at the Chalk Bucket Forum and with the advocacy of therabands as an alternative.

Webinar with Dr. Dave Tilley & Dr. Joshua Eldridge

The Rice Bucket Challenge

The gym had finally gotten my request for a rice bucket, on my birthday, last month.  We only have it for team use, so as to minimize any likelihood of rice spillage.  It's a minute for each grain of rice found on the floor, that the last person who used the bucket has to go around and pick up trash in the gym.  So whoever is having rice time needs to be responsible for the previous person as well as for himself, by making sure any grain outside of the bucket goes back in, after he's done.

The first day, the young ones were obsessed with knowing all about it.  I told them to stay away, like it was Pandora's box.  After a few days, I still hadn't covered the rice bucket with the lvl 3s.  So come Monday after we got the bucket, throughout workout, every single one of the 3s at some point was gripping her wrist asking to do the bucket.  This is a group of girls who have never complained of any wrist pain, of course!

Anyway, I finally did go over it with them, and how to be responsible for the rice.  Since then, the novelty's worn off a bit, of course.  But the young ones are my eyes.  They've been policing and ratting out anyone who spills rice.  Especially when it's the boys.  Such tattle tales!

 List of exercises on the bucket:

1.  10 rice grabs (warm-up):  Grab and release rice on top
2. Grab & squeeze (20 sec):  Fingers wide, jam hands deep into bucket
3. Flexion & extension (20 sec):  Make fists, front to back wrist flexion & extension
4. Radioulnar deviation (20 sec):  Make fists, movement in radial & ulnar deviation
5. ABCs (20-30 sec):  Fingers together in fist or straight, trace abcs (Variety:  capital, lower case, cursive); or write poem or paragraph.
6. Circle in (20 sec):  Make fists, circle
7. Circle out (20 sec):  Make fists and circle
8. Grab & rotate (20 sec):  Make fists grabbing and releasing rice & supinate (rotate outward)
9. Grab & rotate (20 sec):  Make fists grabbing & releasing rice while pronating (rotate inward)
10. Rice grabs (20 sec):  Grab & release surface of the rice
11. Finger extensions (20 sec):  Pinch fingers together then extend out wide
12. Straight finger pinch (20 sec):  Keep fingers straight, open and pinch together on surface
13. Grab & squeeze (10 x 2 sec):  grab rice in hand above bucket and squeeze tightly then release
14. Fast grabs (20 sec):  On surface, grab rice and release as quickly as you can, like a sprint
15. Ruler resistance (20 sec):  Grab ruler in bucket, rotate wrists

I've been doing this list, myself; and by the 7th exercise in succession, my forearms feel ballooned out like I just ate a can of spinach (my dad apparently, when he was a little boy, thought spinach gave you Popeye forearms). 

I got at least half of the exercises from this video:

World's biggest rip?

Probably not.  But...

Que the gross-out factor:

Post by Greg Roe Trampoline GRT.

Improvising Wrist Supports

Lisfranc Joint Injury

Ban and a Hex on W Sitting

Kill it wherever you see it:

I had a patient recently ask me if it is okay for her thirteen-month-old daughter to be W-sitting during playtime. The short answer is: absolutely NOT! 
It is never ok to be sitting like this for a prolonged period of time, and should be stopped immediately whenever you see it. There are a few postural and developmental reasons for this, and I'll go into some detail on all of them:

• Hip Distortion

• Knee and Foot Distortion

• Poor Development of Core Muscles

• Lack of Cross-Body Coordination

Read on...

3 Reasons on Gradual Return to Gymnastics Following Injury

The Hybrid Perspective:

Research supports that a big possible risk factor to ongoing overuse injuries or re-injuries in gymnastics is a premature return to sport. From personal experience over my years in gymnastics, and as many readers may agree,  I think this is pretty accurate. I think many parents/coaches/gymnasts get concerned when this phase of the injury comes into play, especially if it was a more serious injury.  I wanted to offer my spin on this idea from a pain science, adaptation, and psychological point of view. Here are 3 concepts for people to think about.

Read the article

Measuring Dorsi-flexion

Overuse injuries in young athletes

Preview of a 60 Minutes segment that apparently aired on Showtime tonight, 10pm EST:

Toe Point Exercise without Overuse of Calf Muscle

Fortifying the Bones with Gymnastics Activity

Duh:

A new Canadian study shows that practicing gymnastics as a child can help strengthen bones, and in turn prevent osteoporosis years later. University of Saskatchewan researcher Marta Erlandson, a former gymnast herself, said her study revealed that even one hour a week of gymnastics can lead to health rewards. “Due to many factors, kids are much more sedentary and this puts them at increased risk of osteoporosis later in life,” she said. “They (children) had better bone parameters even after an hour or so a week of (gymnastics) participation."

More on the study here.

The Hybrid Wrist Guards

I was just thinking the same thing yesterday about wrist supports, as comparable to grips on bars. 

A number of good coaches seem to frown upon the (over)use of wrist guards, due to the belief that the wrists run the risk of becoming over-reliant upon them; and not be given enough adequate stress to strengthen and adapt to the forces placed upon them.

However, I've started coming around to the belief that some things in gymnastics- like yurchenko vaults, pommel horse, and excessive tumbling- places so much "unnaturally" excessive force (vaulting) or overusage (i.e., 100 circles in a row on horse) upon the wrists, that it's just inviting injury.

Like Retrosi and Geddert, why not protect the wrists before they become injured?  Not after.  So what if the gymnast is dependent upon wrist supports the rest of their competitive career?  Where else in life are they going to subject their wrists to the amount of force that they do during a yurchenko?  One bad angle, and those wrists are placed in great hyper-extension with a tremendous amount of force generated behind them.

Like vault landings on hard surfaces, coaches might take into consideration on limiting the amount of repetition.  Like saving wear and tear on the knees and ankles, we should be preserving our wrists as much as possible, for longevity in workouts.  Landings are done on softer surfaces to increase amount of repetition; why not the same for donning on wrist supports, after a certain number of reps?

Hybrid Perspective:

Wrist pain is one of the most common issues gymnasts and coaches deal with within the sport. The majority of the wrist problems that athletes complain about are wrist extension based (back of the hand moving upward), and are usually localized to the dorsal aspect (back of the palm/wrist) of the wrist joint. For this week, I wanted to offer some insight into the topic and offer advice on how to manage/prevent wrist pain with yourself or your athletes. 

~~

This is an important topic to understand because of its high frequency in gymnastics, and potential for progressive injury when not addressed properly. Due to a variety of unique aspects to the sport (which I will go into below) and the structure of the wrist joint, many athletes develop nagging pains in their wrist. The pain is most commonly experienced during weight-bearing skills like handstands, tumbling, vaulting, and many other skills. There is some biomechanical research models to suggest that forces up to 2.5x an athletes body weight can be loaded through the wrist during some gymanstics skills, and up to 5x during heavy tumbling/vaulting. This number most likely dramatically increases when shallow tumbling angles or uneven weight bearing occurs on some skills. Coaches and athletes must be aware of the fact that if left unaddressed, overuse may progress to a variety of problems like tendonitis, bone bruising, ligamentous damage, possible growth plate irritation, scar tissue build up, and possible stress fractures. A very large number of athletes simply “push through the pain” not knowing that they may be causing some big problems down the road. I will explain some basic anatomy concepts for understanding, outline some reasons why a gymnast may develop wrist pain, and offer some techniques athletes can utilize to possibly manage/combat their problems.

Read the rest.

One of my concerns as a coach is in avoiding doing things that can damage the growth plates of young athletes.

I knew I had written a bit of my thoughts on this topic before and found the following unpublished post (I thought I had published, but it remained in draft form).

~~~~~~~~~~~~~~~~~~

*Following drafted 6/9/2014, mistakenly unpublished*

Tiger Paws seem to be the most popular amongst gymnasts.  Less well-known and advertised seem to be the Ezy ProBrace.  Wade mentioned he favors those over Tiger Paws (Tiger paws prevent the wrists to go into hyperextension by acting as brace; the Ezy ProBrace elevates the palm but still allows freedom for hyperextension, to occur, and therefore the wrists still have an opportunity to strengthen by dealing with the stresses).

Back in the late 80s former Bruin gymnast and medical student Luc Teurlings brought in the prototypes for the Ezy ProBrace, which he designed.  Everyone on the team was given a pair to test out and offer feedback.  After all these years, I still have mine.

On the left:  Ezy ProBrace prototype.  Right:  My favorite wrist support acquired at USGTC in Irvine

A number of coaches discourage their gymnasts from using Tiger Paws, for fear of developing over-reliance and "brittle" wrists.

Coaches like John Geddert suggest wearing wrist supports during Yurchenko training as a prevention safeguard before wrists potentially incur injury.

I have been leaning toward not being overly concerned about gymnast reliance on wrist supports.  The risk of developing overuse injury in the sport of artistic gymnastics seems to be pretty high. 

Also blogging:

GymnasticsCoaching.com

Thoracic Mobility Stretch with Tennis Balls

Previous related post.

Lack of shoulder flexibility or thoracic immobility?

Spreading the Workload

Video description:

A few quick tips for teaching gymnasts to not use their lower spine as a primary mobility area, as it can load some spine structures dangerously. Goes over some background, a quick drill for encouraging movement at the hips/thoracic spine/shoulders, and how to transfer it to gymnastics skills.