Archive for the ‘Uncategorized’ Category

“Stressing Out Over Stress Fractures”

Monday, July 21st, 2008

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…

“She’s Not a Construction Worker”

Sunday, June 8th, 2008

I work with a gymnast whose mother is in the medical field.  I have choreographed nearly every one of this beautiful gymnast’s routines.  She is in college now and this will be the second and final college floor routine that I help her create.  Her mom told me a story today that really sheds light on a situation.  We all need to think about what we’re asking gymnasts to do and consider what the long-term injury results will be.  I understand the coaches view, after coaching in the NCAA for 16 years, but I am a physical therapist.  The mom told me that her daughter had a spiral fracture in one of her fingers and the coach said to just tape it up.  The mom said, “She’s not a construction worker!”  I love this comeback to the coach.  More people need to speak up and more people need to educate themselves on healing times, etc.  Maybe even take the broken finger and flip some of these coaches off.

“Got Physical Therapy?!?!?!?”

The Book

Friday, May 2nd, 2008

It seems as though everyone wants to write a book.  Well, I already “wrote” one.  I wrote an entry everyday after gymnastics practice for five years!  My dad’s idea.  He said, “If you’re going to do this many hours a day, this many days a week, you better keep track of what you are doing.”  So I did.  This journal began when I was 12 and stopped at age 17.  There are at least 1500 mimiographed sheets (as my dad still called the process) – my hand-written daily log – complete with dates, times, #s of routines, moods, quotes, comments, feelings, reactions, weigh-ins, scores, and other interesting facts and figures.  My husband sees it as a book.  It’s ready.  It’s waiting.  It’s “good stuff.” In my spare time – between changing diapers (twin babies), dealing with temper tantrums (three year-old), trying to figure out the minds (four teenagers), acting like a single mom (when hubby is away with USAG stuff), dealing with elderly parents and in-laws, writing USECA, IG and Posture Lady articles, helping 46 gymnasts (more to come) find floor music for routines this summer –

I WILL PUBLISH THIS BOOK SOMEHOW SOMEWAY SOMEWHERE over the rainbow!  It’ll be worth the pot of gold.

Being In the Now

Thursday, April 10th, 2008

There’s a lot of talk about “being in the now”, and then there is living it.  I can honestly say that I have lived it since I was a very little girl.  I remember taking the time to actually look at other gymnasts’ painful problems (like a sore ankle or knee) and really concentrate on helping them with it at that moment.  It was like some sort of mini-healing session.  I couldn’t have been more than 10.

I remember being in the now at age 13 when I began coaching preschool gymnastics.  I remember really empathizing with a toddler when he was scared of some skill in the lesson.

Every Saturday morning of 8 semesters of college, I was in the now coaching tots and not zoning out about what I was going to do that night.

When I started an adaptive gymnastics class in 1985 (still going strong today at MIZZOU),  I learned how to be in the now from the greatest experts on earth – kids with special needs.  We should all learn lessons from these great human beings.

Coaching college gymnastics for 16 years made being in the now a reality.  Being on a cold bus in a midwestern blizzard, with 18 young woman PMS-ing at the same time, will do it to you.

 At times I have felt like choreography is just too much for me.  It’s emotional and physically exhausting and tedious as heck.  But when I stay in the now, it always means something.  It meant something when I choreographed for Christy Henrich before she died of anorexia.  It meant something when I choreographed just hours after news that my grandma died.  It meant something when I choreographed on the day I found out I didn’t get a head coaching job and I got the call in the middle of a floor routine.  It meant something when I choreographed on September 11th, 2001.  It meant something when I really wanted to give it up, but choreographed for three gymnasts in three different states, whose mothers had all just died that summer.

Being in the now.  It’s a good goal each day for anyone involved in the sport of gymnastics.  It seems to keep the ego in check.