“It’s Like a Death”

July 24th, 2008 by Kris Merlo Robinson, PT

When a gymnast has a life-changing injury…I would have to empathize with them when they say, “It’s like a death.”

I felt the same way when I blew my knee.  I had just been around real death.  My uncle (my mom’s only brother) was 33 when he died of leukemia and I was 15.  It was a hard time.  I helped my mom care for him.  Just a few months before, another uncle died (my mom’s brother-in-law) and he was only 40 something.  Then my great-grandma.  Then my dog.  All on the 24th day of various months (and I noticed that today is the 24th).   

I had a strong belief system, but all of these deaths happened within a year or so.  I know that there are stages of death that the remaining loved ones go through and I’m not sure that I went through them correctly.

So when I blew my knee a few years later, it was like a death to me.  No one explained it to me like this.  My parents had no way of knowing the extent of my ACL injury back then, no one told me to exercise a certain way or to eat a certain, different, way, so I gained weight and started my period.  My face ballooned up and I didn’t recognize my body.  My three teenage brothers made fun of my new fat body.  I really didn’t know many people at my highschool and the best gym in town was so far away, so I really can’t remember how much time I was spending at a gym.  It was basically a lonely time, I think.

But when I’ve tried to complain about my knee and how it was like a death, it’s hard for me to justify it.  I know what my uncle with cancer went through.  I know what my five cousins, whose father died, went through.  I witnessed a guy gymnast break his neck and I know, personally, a teenage girl who broke her neck.  As a physical therapist now, I can somehow empathize and understand just how awful it must be to be paralyzed.

So fast-forward to now.  I’m not a psychologist or psychiatrist, but just a former gymnast turned physical therapist, with a bum knee (and ankles, and neck, back, shoulder, wrists, fingers and toes). 

I guess I would have some advice for a gymnast.  ”Don’t feel bad if your injury feels like a death.  There are stages that you might have to go through.  Everyone probably has to go through them at their own rate.  You might think you are over it, but then it hits you and you’re not.  The sadness might last 26 years, like mine has.  It might never go away.  But you can move on - stronger, somehow.  More feeling somehow.  It sucks though.  But I think that you can be helpful to other people.  They will be able to sense it and see it in your eyes.  Move along, but know that it’s OK to mourn.  It’s OK to be sad.  Get help if it gets too bad.  Stay fit and avoid eating disorders.  Smile often and know that it’s all in the cards.”

My strength, in part, has come from meeting people along the journey.  Some people prior to the injury were helpful - because of the things that they said to me or the ways that they behaved.  So I thought of those strong people.  Some people were now in my life simply because I did get hurt.  They probably wouldn’t have been if I didn’t.  And a lot of people, who had far worse injuries or illnesses than I, became examples of strength and courage.

My friend, Max, comes to mind.  He was a great long distance runner in college, but then had a tragic summer between freshman and sophomore year (around 1985).  He was working a job, laying tar on the highways, or something like that.  Got hot.  Decided to dive off a bridge into a creek that looked about 15 feet deep.  Well, it was only a foot and a half deep.  (Thus, the education he now does about “FEET FIRST, FIRST TIME.”)  He broke C3,4,5,6 and is paralyzed (C5 quadraplegia).  What an inspirational guy.  Hard to complain to him about anything.  He went on to help me coach Adapted Gymnastics and he went on to become an attorney.  How could I complain to him?  He did give me one of the greatest quotes that I could hold onto.  When I wanted to complain about my knee injury and what a life changer it was and how it felt like a death, he told me to go ahead and feel that I had the right to complain.  He said, “Everybody Has Their Own Wheelchair.”  He gave me the courage to go ahead and complain about it.  That it was OK.  That that knee injury was my wheelchair and that I needed to just talk it out.  He lended an ear.  Thanks Max.  

I hope this blog entry helps somebody help someone.

Kris

Future author of “Everybody Has Their Own Wheelchair”   

“Stressing Out Over Stress Fractures”

July 21st, 2008 by Kris Merlo Robinson, PT

This is a good title.  Dr. Suzanne Hecht (UCLA>>>now University of Minnesota) and I wrote this article originally for USECA.  I may have used parts of it before in lectures or after in other articles/lectures; but, here it goes again:

GETTING STRESSED OUT ABOUT STRESS FRACTURES?

So what is a stress fracture?  Dr. Hecht writes -

A stress fracture is an overuse injury to the bone that occurs when the bone cannot keep up with the demand that is placed on it leading to microfractures (mini breaks in the bone) and swelling of the bone marrow.

Dr. Hecht continues by describing typical symptoms of a tibial stress fracture include the following: 

·        Pain develops gradually

·        Shin pain occurring during or after workouts

·        Pain improves with rest

·        A sudden increase in training time or intensity

·        The shin may be sore to touchX-rays are often negative early on in the course of a stress fracture. 

Remember…just because the x-rays are negative doesn’t mean your gymnast doesn’t have a stress fracture.  The physician may recommend further testing to confirm the suspected diagnosis or may suggest treatment options and repeat the x-rays in 2-4 weeks to see if the stress fracture can be seen.  A bone scan is a common test used to look for stress fractures if the x-rays are negative.  Other physicians might order a MRI scan.

Dr. Hecht emphasizes that stress fractures of the front portion of the tibia (anterior) are very concerning.  These fractures can show up as a dark black line on the x-rays and physicians commonly refer to this finding as “the dreaded black line”.  This stress fracture worries physicians since the bone in this area is on tension and doesn’t like to heal.  The anterior tibial stress fractures should be taken very seriously and treated with extensive rest of the leg or placement of a rod into the tibia to help facilitate healing.  Stress fractures of the inside, back portion of the tibia (posteromedial) heal better and can be treated more liberally.  

A note from “The Posture Lady” regarding

BIOMECHANICS OF THE LOWER BODY

Poor biomechanics of the lower extremities and pelvic area often lead to conditions such as tibial stress fractures.  Be sure to check for muscle imbalances.  Finally, emphasizing correct standing posture cannot go unnoticed and should be an important part of the training process.

Comments from “The Posture Lady” 07/21/2008:  I have seen preschool kids, as young as two or three years old, stand in severe knee hyperextension.  My 3 and 1/2 year old son stands with “loosey goosey” looking knees, in complete knee hyperextension, every day and I remind him EVERY DAY that he needs to stand with his knees “soft.”  I believe we need to go this far back and start educating parents and kids about correct standing posture.

There are many elite gymnasts that stand in knee hyperextension.  This can be seen especially when at the chalk box or awaiting a turn on vault or beam.  It’s a horrible stance.  This is not to say that the gymnast’s legs should not look straight and gorgeous once airborne, but just to say we are NOT meant to stand in knee hyperextension.  I will soon learn how to post a picture from my mentor (RIP) Florence Kendall, PT.  She gave me permission to use the very picture that best shows the problem and consequences of knee hyperextension.  From the book, “MUSCLES Testing and Function” 5th edition, page 84, ISBN 0-7817-4780-5  (I’m in the book too - pages 395,396,397, if you want to see some crazy-short hip flexors and ITBs as a former elite gymnast.  What a mess.)

Back to the problem with this picture.  A gymnast that stands in knee hyperextension risks the possiblity of ending up with a posterior (backward) bow in the tibia and fibula.  I wonder if this helps lead to stress fractures or bones that “just pop and crack.”  My gut says, yes.  It saddens me that an elite gymnast may get to this point from something that might be prevented with education as early as the preschool years.  Let’s work to help fix the issue.

The gymnast should stand with good posture at all times.  The femurs (thighbones) should be in neutral rotation with the patellae (kneecaps) facing straight ahead.  The feet should be in good alignment; turned out only 7 to 10 degrees and arches maintained. 

If a gymnast has difficulty holding the arches up, the following suggestions may help:

-Reinforce the idea of contracting the side buttock muscles to help align the legs and lift the arches.

-Strengthen the posterior Gluteus Medius muscle with the following exercises and suggestions…

KICKS (with good hip turn-out and tight abdominal muscles) / JUMPS (pay close attention to straddle jumps very early in the gymnast’s career and make sure that they turn the leg out from the hip) / SIDELYING HIP ROTATION / HEEL PUSHES / POSTERIOR TIBIALIS STRENGTH / CORRECT WALKING and CORRECT CHOREOGRAPHY

Correct landings during the development of the young gymnast will help that athlete in the future.  The gymnast should have correct ankle range of motion and correct hip turnout.(“Quick Tests” and Corrective Exercises such as knee/foot mechanics and hip turn-out exercise)

The pelvis should be in good alignment with normal back curvature – the low back should curve in only slightly.  The gymnast should have good lower abdominal muscle control during landings.  The hip flexors and quadriceps should not be overdeveloped and over-used.  The Hamstring and gluteal muscles should contract sufficiently during landings.(“Quick Tests” and Corrective Exercises such as hip flexor stretch – two- joint muscles)

AVOID PAINFUL TIBIAL STRESS FRACTURES BY REALIZING THAT THE BASICS OF GOOD POSTURE, MUSCLE BALANCE AND BIOMECHANICS ARE THE POINTS THAT NEED TO BE STRESSED!  

More details on specific exercises to come…

Why is it that..

July 19th, 2008 by Kris Merlo Robinson, PT

A few notes about me and why I feel how I feel right now about the Olympic Team Results.

I live in Orlando, Florida…enough said.

I work as a PT with National/International gymnasts…enough said.

I was a product of mid-to late- 1970’s high-level girl’s gymnastics and was overtrained and overstressed…enough said.

It’s hard to go to public school, have multiple siblings, worry that your sport is costing your parents too much, have to babysit for money, travel to meets alone (with just your coach)…this was me in the 70’s and sounds familiar to gymnasts today…enough said.

WHY IS IT THAT…

Why is it that there are still coaches who push the gymnasts to the edge of their mental and physical tanks, but with no rhyme or reason?

Why?

Why do we still have so many overuse syndromes in the sport of gymnastics?

Why?

Why do we ignore pain because we feel that we have to for the sport?

Why?

LACK OF EDUCATION

LACK OF EDUCATION

LACK OF EDUCATION

“Never Leave the Ending Until the End”

June 10th, 2008 by Kris Merlo Robinson, PT

Good choreography rule:  “Don’t Leave the Ending To the End”

If you choreograph a floor routine over several days (I work with the gymnast for 1.5 to 2 hours/day on two separate days) take this advice.  Anything more (like when I coached college and could do the routines whenever I wanted to) would be a luxury.  Start working on the ending the first day!  Plan the routine.  Plan the tumbling passes (almost every gymnast takes 6-point-something seconds to do a three to four flight pass).  Plan the spacing of the dance elements and plan for cool moves to cool music.  But think about the ending too!  “A good ending is 40% of the dance!”

Reference:  These two “rules” are 2 of the 11 items on Doris Humphrey’s checklist for choreography.  “The Art of Making Dances”  1959  ISBN 0-87127-158-3

“Got Choreography?!?!?!?”