Competition After Rehab

Competition after Rehab
Brandi Smith-Young, PT
Perfect 10.0 Physical Therapy
Perfect10PT@gmail.com
www.perfect10physicaltherapy.com

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 last 6 years

 Injuries are inevitable
 It’s not a matter of when
or how, it’s a matter of
how do we manage
them
 Even with the best injury
prevention there are still
variables out of our
control
– Growth spurts, wrong
place at the wrong time,
clumsy athletes, genetics
Photo from: trouw.nl
Photo from: getleotards com

Controllable Factors
 Equipment in the wrong place
 Cracks in mats
 Class kids running across the runway
 Athletes doing skills when they are not ready
– use drills and progressions
– don’t rely on spotting as injury prevention
 Nutrition
 Lack of Sleep or fatigue
 Stress (use Meditation)
 #1 OVERTRAINING

Overuse Injuries
 30-50% of youth sports injuries are
overuse
 As the rise in sports participation occurs so
has there been a dramatic increase in
injuries.
 We are seeing young athletes with adult
injuries (we cannot train immature skeletal
systems as we train a mature adult).

 Most gymnastics injuries occur on the
floor and most occur during practice
 The higher the level the greater the risk

How to prevent Over Training
– Macrocycle training (per Dr. Bill Sands)
– Give athletes recovery time
– Maximize training time (quality not quantity)
– Allow for a transition period post season
– Do periods of general fitness which look
nothing like gymnastics.
– Cross training, including lower impact
activities (trapeze, arial silks or hoop, swim,
diving, bike, eliptical)

 The first season post injury the athlete is
at highest risk for re-injury
 With the risk directly correlated to the
severity or chronicity of the injury (ie ACL
repair vs 1st ankle sprain vs chronic ankle
sprains)

10
Nutrition
Optimal
Performing
Athlete
Mental
Health
Physical
Health

 Get Sports Psychology on board early
 Even minor injuries can use a Sports Psych
to keep them moving forward
 Keep short and long term goals fresh on
their mind
 Keep their brains engaged and on track

 Loose mental monkeys can come
out to play and pull the athlete off
the rehab track
 Or derail a championship train!
 Having mental chorography,
mental sets, and mental
assignments as part of workout
will keep the mental monkeys
away and the train on track!
Doc Ali
www.headgames.ws
ali@docaliarnold.com
FREE two weeks of
webcamp: www.headgameswebcamp.
com/2weeks

 Key to tissue healing
 Key to injury prevention
 Key to optimal muscle performance
 Get a nutritionist involved…
 it’s not just are they eating enough calories,
fat, protein, carbs…it’s also the quality of
food, the timing of food in relationship to
training regimen and training days.
(competition nutrition should look different
than summer training nutrition)

Physical Phases of Rehab
Pain phase:
Goal: Resolve pain & any inflammation present
Mobility phase:
Goal: Normalize ROM
Stability phase:
Goal: Normalize strength
Proprioception phase:
Goal: Normalize balance and proprioception
Sport Specific Training Phase:
Goal: higher level speed, agility, and sport specific skills
14

 Unfortunately many Physical Therapist
don’t address this with gymnast.
 It is key to break down shapes and parts
of skills to address biomechanical errors,
technical errors, or faulty movement
patterns that in most cases created or set
the athlete up for injury.
 This where the coach can help work with
the PT or medical provider.

Injuries: Understanding what your
athletes are going through physically
 They key is tissue healing
 Each phase of rehab is determined by the healing
properties of the tissue involved
– Healing timeframes:
 Muscle: 4-8 weeks (minor sprain 100% strength) (Partial tear
80% strength)
 Bone: 6 weeks (100% strength) [immobilize to allow growth]
 Ligament: 8-9 weeks (100% strength) [40-60% 1 RM 100-200
reps per set]
 Tendon: 11-12 weeks for micro tears & 15-18 months for partial
tear/repair (80% strength) [40-60% 1 RM 100-200 reps per set]
 Cartilage/growth plate: 6-12 weeks depending on extent of
damage (80% strength)[20% 1 RM 1000s reps slow speed
comp/decomp]
 Progression can only occur as quickly as the tissue
heals. 16

“To push or not to push, that is
the question.”
• With every injury there is a “re-injury
5b
window”
• The time where the athlete is out
of pain but not back to full
strength, proprioception, and sport
specific motor skills/coordination
• Varies from injury to injury

18
• It is imperative to have open communication with the
PT/doctor to determine this window of time.
• There should be a graded progression guided by the
PT/doctor. (you can push within these parameters)
• Once the PT/doctor releases the athlete to full sport, you may
begin the push keeping in mind their mindset and proper skill
progression to prevent re-injury
• Recommend getting medical release in writing (risk
management issue)

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.

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

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.

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.

Treat each gymnast like a
prize 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

Use of Assistive Devices
 There may be a period of
using assistive devices to
improve proprioception or
decrease pain to allow for
increase activity.
 Tennis shoes to help support
a collapsing arch post ankle sprain
or give a lift to decrease stress on
Achilles during healing of Sever’s,
or improve knee control with
Osgood Schlatter
Photo by: Steven Lane, The Columbian

 Knee sleeve in the presence of knee pain
or ligament disruption.
– Research has shown that a knee sleeve or no
brace offers equivocal proprioception as ACL
custom brace depending on the sport looked
at (football vs soccer)
– Many orthopedics still issue the hard ACL
brace for a shorter period of time them
progress to the sleeve and then nothing
 Ankle brace post grade 2 or 3 ankle sprain
– Increase proprioception

 Bracing for longer periods in the presence
of structural hypermobility or instability
may be necessary.
www.bauerfeindusa.com

 BRACING ALONE WILL NOT PREVENT
AN INJURY!!!!
 Bracing is only utilized for increased
proprioception to the joints, muscles and
tendons and to help with pain (which
improves muscle firing patterns)
 RULE: if you are wearing a brace
you are doing PT for that body
part!!!!

 Many times we use tennis shoes, bracing,
or taping for practice only due to all the
repetitions and the fatigue factor in
practice.
 In this case have the athlete do their
workout with the bracing and then do 1
competition set without the bracing so
they can still feel confident outside the
bracing (AS LONG AS THERE IS NO PAIN).

PT EXERCISE TIME
 Carve out time for your athletes to do PT
exercise.
 This is easy at first when they’re not doing
everything.
 Ideas for when they do more: before and
after practice or add a PT station or a few
at each rotation.
 Have athlete make a PT folder which goes
from event to event

Progression Back
 Repetitions Progression:
– (ex: 50% numbers if painfree
2 workouts in a row then
progress to 60-70% numbers,
if painfree 2 workouts then 80-
90%, and if painfree 2
workouts then 100% numbers)
 Impact progression:
– Low impact to High impact
– Use low impact equipment
– Progress lower impact events
first, save highest impact for
final phase

Example post
grade 1-2 simple ankle sprain
 Achieve >10 degrees dorsiflexion,
strength >3+/5, fair+ to good balance,
able to run and jump no pain.
+ still in PT.
 wear tennis shoes while beginning
tumbling and vault (maybe beam,
depending on ankle control)
 May wear a brace first 1-2 wks
 EVERYTHING MUST BE PAINFREE

 Vault: 1st wk drills 50% numbers progress
to 50% vault use trampoline board 2-3rd
wk
 Bars: Full, dismount with shoes or landing
in the pit (progress to landing on firm
mat)
 Beam: 50-60% numbers leaps and jumps,
flight, dismount into pit.
 Floor: 50% numbers tumbling
passes/leaps/jumps tumbl trak with shoes,
floor basics

 Progress numbers on floor and vault with
shoes as there is no pain 2 workouts in a
row.
 DO NOT PROGRESS VAULT and FLOOR in
the same workout.

 Achieve 15-20 degrees dorsiflexion,
strength 4/5, good to good+ balance, able
to run and jump with good foot, knee
control
+ still in PT.
 Begin weaning from shoes or any bracing
 May start by first 5 tumbling passes or
vaults no shoes and then finish the last 5
with shoes.
 Gradually workout of the shoes
 EVERYTHING MUST BE PAINFREE

 Vault: Progress 50%, 60-70, 70-80, 80-90,
100% numbers every 2 workouts without
shoes (may have to do first part of
workout no shoes and shoes as begin to
fatigue)
 Bars: Full; dismount on to firm mat no
shoes or bracing.
 Beam: Progress to 60-70, 70-80, 80-100%
numbers every 2 workouts starting leaps,
jumps, then flight series. Dismount on to
firm mat no shoes or bracing.

 Floor: Progress 50%, 60-70, 70-80, 80-90,
100% numbers without shoes (may have
to do first part of workout no shoes and
shoes as begin to fatigue)
– if do 50% on the floor complete the rest of
the assignment on the tumbl track.

Skill Selection
 Choose appropriate skills at the
appropriate time in tissue healing time
frame.
 Take into account how they injured
themselves (likely that movement is
aggravating and will be one of the last to
add in)
 Respect what forces are put on the tissue
in different skills

Example Skill Selections
 If hyper extended the knee; stay away
from front landings or blind landings until
completely healed (do 1/1 instead of 1 ½)
 If lateral ankle sprain stay in straight
plane movements…no twisting while
healing
 torn/sprain MCL in knee, stay in fwd
backward planes… no twisting or sideways
movements until healed. (fine to do a
double back but no doublefulls)(fine
switch leap no switch sides)

 ACL repair: stay away from double
arabians, or 1 and ½ twist punch front.
Stick with double lays, double tucks, front
fulls, double fulls (avoid blind landings,
avoid landing twisting) first 1-2 years
depending on type of graft
 SI joint back pain (early on avoid switch
leaps and splits, running and step out
things) If chronic do flic lay two foot
landing instead of step out.

 Return to competition status and skills
depends on:
– Written Medical release (ie tissue healing)
– Athletes Fitness level
– Athletes confidence
– Development of any fears

10 Keys to Return to competition
 Continue ALL Physical Therapy exercises
– If pain arises make sure being consistent with
therapy exercises with proper form.
– If so check form
– If not, get back on the program.
– If pain not improving within 3-5 days of doing
exercise, go back to PT or MD.
– If pain worsening immediately go back to PT
or MD
 Address any minor issues quickly with PT
or MD

 Respect tissue healing
 Assistive Devices: utilize based on tissue
healing, wean slowly keeping in mind
fatigue factor.
 Skill Selection
 Quality vs quantity
 Athlete listen to their body. Coach listens
to the athlete.

 Nutrition
 Sport Psych
 Rest (sleep) and recovery time

Contact Information
 Perfect 10.0 Physical Therapy
& Performance Training
www.perfect10physicaltherapy.com
 perfect10pt@gmail.com
 512-426-6593
Follow Perfect10PT on gymanstike, facebook, and twitter

 All information from:
 The Manual Therapy Institute
 www.themanualtherapyinstitute.com
 Shirley Sahrmann.
 Diagnosis and Treatment of
Movement Impairment
Syndrome.

Competition After Rehab

More Related Content

What's hot

Viewers also liked

Similar to Competition After Rehab

More from Brandi Smith-Young

Recently uploaded

In this document

Competition After Rehab