1. Brandi Smith-Young, PTPerfect 10.0 Physical Therapywww.perfect10physicaltherapy.comperfect10pt@gmail.com

2. 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 physicaltherapy Board certified orthopedic specialist in PT Specialize in treating gymnast last 7 years USA Gymnastics National Congress Speaker 4 years Gymnastics Association of Texas Speaker 7 years USA Gymnastics National Health Care Referral Network 3. Anatomy of the Wrist 4. FrontBack 5. What muscles make up thecore Diaphragm Pelvic Floor Transverse Abdominus Internal Obliques External Obliques Paraspinals and MultifidusGraphic from Lee 2001 www.discoverphysio.ca 6. Graphic from gophoto.us 7. Anatomy contdAll these muscle provide stabilizationfor the wrist.If these muscles are not functioningproperly increased stress willeventually lead to injury. 8. Muscle imbalancesSome muscles are strongWhile opposing muscles are weakSome muscles are stretched outWhile opposing muscles are too tight 9. Due to the stringent requirementsplaced on gymnast certain musclestend to develop stronger than othersCertain muscles get weakOther muscles develop tightSome develop loose or stretched 10. Common muscle imbalances Poor shoulder blade, arm, and wrist control Weak shoulder blade and shoulder muscles Extensor Carpi Radialus Brevis (ECRB) doing toomuch and the other wrist extensors not doing enough Weak hand intrinsic muscles Tight pec and lat muscles 11. Balance 3 systems makeup balance: Visual System (eyes) Vestibular System(inner ear) Propriocetion system(receptors in joints) 12. Visual System Eyes give input into the system indicating theenvironment around us and movements we aremaking I have found gymnast tend to be visually dominant Any change in vision canaffect balance. 13. Vestibular System The inner ear monitors the position of the head Any inner ear infection or injury (ie cold, fluid inthe ear, sinus infection or ear infection) can affectbalance. 14. Proprioception System The receptors in our joints give sensory input fromyour upper extremities to give your brain feedbackabout the floor Any joint injury can causedamage to these receptorsand affect balance (doesnot have to be a majorinjury) 15. Demonstration Time 16. Resting position 17. Wrist Mechanics Push up position Push up When taking off orlanding on the wrist itis imperative to havegood mechanics. 18. Improper mechanics lead to repetitive abnormal stress Leads to inefficient performance Leads to injury 19. Proper Loading mechanics Fingers facing fwd Maintain palmar arches Antecubital fossa(Smiley face) pointsinward (kiss each other) Elbows straight but notlocked out Shoulder blades cinchedup to the rib cage (nowinging) 20. Pre-Treatment Post- Treatment 21. Pre-Treatment Post- Treatment 22. Pre-Treatment Post- Treatment 23. Pre Treatment 24. Post Treatment 25. Poor Shoulder blade control 26. Proper wrist mechanics can be achieved by Balancing muscle imbalances Shoulder blade, shoulder, and wrist strength andflexibility Improving balance or proprioception Training proper loading mechanics 27. Finger extensor stretch with lift Place thumb over end of arm bones and 2ndfinger under the 1st row of carpal bones (findthe bump) Lift the 2nd finger holding up the carpalbones. Keep the carpal bones up as flex the fingers. Keep the fingers flexed as curl the wristdown. Only go as far as you can keeping the fingersflexed and carpal bones up. ADD ELBOW BEND AND STRAIGHT X10 Repeat x20 Do frequently 2-5 times a day 28. Finger Flexor Stretch With lift Lift the first carpal row Place palm and all fingers flat on awall. Fingers up toward the ceiling Press everything flat to the wall Hold 30 sec. Lower arm down so hand is loweron the wall. Repeat 30 sec, ADD ELBOW BEND ANDSTRAIGHT X10 Go as low as can keep everythingflat. 3-5x/day Every day 29. Strengthen Shoulder Blade muscles Cat Rocking (fig 1) Start in the Cat Pushes Once rounded, keep theupper back rounded bypushing through theheels of the hands asrock back toward heels Keep rounded as returnto the start position. Repeat x15 Figure 1 30. Ts ph I (middle trap)(fig 2) Lay face down with arms ina goal post position Set shoulder blades downand back. Keep there. Gently, lifting from thethumbs just high enoughto slide a piece of paperunder the arms. Make sure to relax theupper trap and only engagethe middle trap. Hold 10 sec x5Figure 2 31. Y ph II (fig 3) Lay face down arms in abent arm Y position Set shd blades down &back. Gently lift from thumbsenough to slide a piece ofpaper underneath Make sure upper trapsrelaxed and shd bladesstay down & back. Hold 10 sec x 5Figure 3 32. Wall Slides(upper trap) (fig 4) Standing 6 from wall, place elbowsshd width apart on the wall. Raise arms up as high as possible Breath in as shrug everything uptoward the ceiling. Shd blades toward ears. Hold as breath out, keeping the ribsexpanded and the shd shrugged. Hold 10 sec x5Figure 4 33. Elbow Strength Bicep curls Make sure to start with the palm facingthe body. Rotate the wrist out Curl up slow and controlled Dont lock the elbow 34. Elbow Strength Triceps pushes Make sure they keep the shoulder blade cinched to therib cage with a straight back Straighten the elbow keeping the smiley face towardthe body Dont lock the elbow 35. Hand Splay Place thumb over the distal radius (end ofarm bones) and 2nd finger under the 1strow of carpal bones (find the bump/pokypart) Lift the 2nd finger holding up the carpalbones. Begin with hand in a fist, and in a slowcontrolled motion open the fist andfingers. Do not allow the wrist bones to drop, keepin place. Stop at the point the wrist bones begin todrop. X20 EVERY WORKOUT 36. Wrist strengthWrist Extension(fig 5) Set wrist in neutral. Actively lift wrist. Push with the otherhand to the end range. Hold 10 sec x10 DO NOT let the wristmove inward. May have to start withno weight. Progress to 1-3 lbs **Add lift. 37. Basic Wrist strength Flexion (curl) (Fig 6) Supination (out) (Fig 7) Pronation (in) (Fig 8) Always keep wrist in neutral. Slow and controlled. 2x15Figure 6Figure 7Figure 8 38. Wrist Strength with RockersRadial/Ulnar Deviation Supination/Prontation 39. Strengthen finger muscles Pillow pickups or foam pickups Elbow at side and bent to 90 deg. Wrist in neutral. Pickup foam with straight fingers. (fig 9) X 2-3 min Pick up foam with finger tips bent. (fig 10) X2-3 minFigure 9Figure 10 40. Pushup Position Hold Start on your knees Place hands straight forwardShoulder width apart Smiley faces kissing RELAX THE HANDS THINK OF LENGTH FROMTHE HEAD TO THE TAILBONE. BREATH INTO YOUR FISHGILLS/UMBRELLA Do Not allow the shoulderblades to sag.push outthrough the shoulder blades.DO NOT round in your upperback Hold 10 sec Repeat x10 41. Butt UP Pushup Holds Fingers straight forward. Smiley faces kissing Create an arch in your hands (Press throughthe thumb side and lift on the pink y side. Breath into the umbrella and out and lift lowerabs. Do Not allow the shoulder blades tosag.push out through the shoulder blades.DO NOT round in your upper back Hold 10 sec Repeat x10 **BLOW BEFORE YOU GO 42. Pushup Position with weight shift Start on your knees Place hands straight forwardShoulder width apart Smiley faces kissing Create an arch in your hands Do Not allow the shoulderblades to sag.push outthrough the shoulder blades.DO NOT round in your upperback Stay on your knees as pressthrough the shoulder blade andyou weight shift R and L = 1 Repeat x10 2 sets Every Day in Gym 43. Handstand weightshift 44. Upper extremity control Push ups (on the floor ortennis balls) Create arch in wrist Elbows facing eachother Bend straight down Dont sag in shoulderblades Even weight throughwrist 45. Tennis ball or Rockers Butt-up Pushups 46. Balance Training progression Pushup position weight shifting on therapy ball Weight shifting on ball Balance Board Bosu Ball 47. Rocker Handstand HoldsFloor/pommel/Pbar handpositionBars hand position 48. Handstand wobble board 49. Rocker Slides & Slide to Press up 50. Rockers Press ups floor hands 51. Rockers Press ups floor hands 52. Rockers Press ups Bar hands 53. These exercises can lead up to tumbling and vaulting: Make sure the gymnasts hand is not collapsing whenloaded Make sure the gymnast is not locking the elbows out May start with just fixing the position in push ups andthen in handstands Progress to tumbling, etc 54. When doing pushups and other conditioning the keyis for the gymnast to control their shoulder, elbow, andwrist . Do NOT allow the arch of the hand to collapse or theelbows to roll out and hyperextend. 55. Stretch Lats Robots lat stretch (fig 11) Lie with knees bent. Pull ribs toward hips withabs. Elbows close together. Keep ribs down andelbows in as reach towardthe floor. Hold 10 sec repeat 5 timesFigure 11 56. Stretch pec muscles Pec stretch (fig 12) Stretch as pictured or Have a partner sitting atgymnasts head. Place heel of the handon the front of bothshoulders. Gently lean into thepartner, pushing towardthe floor. Hold 1 minuteFigure 12 57. Stretch Pronator muscles Pronator stretch (fig17) Place hand palm up on awall at waist height. Straighten the elbow. Gently lean hip into theelbow, pushing towardthe ceiling and wall. Hold 30 sec- 1 minute Figure 17 58. Stretch Wrist Extension Place the wrist you arestretching fingers facingstraight forward. Place the other hand on topresting over the bend in thewrist Press the bottom hand flatwith the top hand as youlean your body weightforward. Be sure to keep the arch ofthe hand 59. How to incorporate in the Gym Station at Vault or Bars Station during routines at Floor or Beam Drills during vault or conditioning During handstand holds or pushups or otherconditioning make the athletes aware of propermechanics. Stretch at the beginning or end of workout or whenwaiting for turns 60. Contact InformationPerfect 10.0 Physical Therapy& Performance Trainingwww.perfect10physicaltherapy.com perfect10pt@gmail.com 512-426-6593Follow Perfect10PT on gymanstike, facebook, and twitter 61. All information from: The Manual Therapy Institute http://www.mtitx.com/ Shirley Sahrmann. Diagnosis and Treatment of MovementImpairment Syndrome.