Ankle Injuries in gymnastics

Brandi Smith-Young, PTPerfect 10.0 Physical Therapy

www.perfect10physicaltherapy.comperfect10pt@gmail.com

Fellowship trained manual therapistBoard certified orthopedic specialist

Introduction

Competitive gymnastTwo time USAG Collegiate

National Champions at TWUBachelors in Kinesiology at TWUMasters in Physical Therapy at Tx

St

Practicing for 5 years Fellowship trained in Orthopedic

manual physical therapy Board certified orthopedic specialist

in PT One of 300 therapist in the US with

these certifications

My passion:To bring sport specific quality

care to gymnastDecrease the number of injuries

in gymnast Improve recovery time, decrease

time lost in the gym, and improve return to sport status

Enhance performance

Common Complaints

Pain on the outside of the ankle Pain on the inside back of the ankle Pain in the midfoot; many times

outside Pain in inside of shin Pain in outside of shin Pain in the Achilles

What plays a role in ankle injuries

Ankle Injury can be caused by and cause:– Decreased joint motion (rolling and

gliding) – Decreased range of motion (flexibility)– Decreased strength (hip, knee, ankle)– Balance and propriocetion deficits

Anatomy of the ankle

Anatomy cont’d

All these muscle provide stabilization for the ankle and foot.

If these muscles are not functioning properly increased stress will eventually lead to injury.

Muscle imbalances

Some muscles are strongWhile opposing muscles are

weakSome muscles are stretched outWhile opposing muscles are too

tight

Due to the stringent requirements placed on gymnast certain muscles tend to develop stronger than others

Certain muscles get weakOther muscles develop tighterSome develop looser or

stretched

Common muscle imbalances

Poor hip, knee, and foot control Weak hip muscles Weak posterior tibialis Posterior tibialis doing too much and

the gastroc not doing enough Weak Soleus muscle (the other toe

pointer) Weak foot intrinsic muscles Tight calf muscles

Balance

3 systems make up balance:

– Visual System (eyes)– Vestibular System (inner ear)– Propriocetion system (receptors in joints)

Visual System

Eyes give input into the system indicating the environment around us and movements we are making.

I have found gymnast tend to be visually dominant.

Any change in vision can affect balance.

Vestibular System

The inner ear monitors the position of the head.

Any inner ear infection or injury (ie cold, fluid in the ear, sinus infection or ear infection) can affect balance.

Proprioception System

The receptors in our joints give sensory input from your lower extremities to give your brain feedback about the floor.

Any joint injury can cause damage to these receptors and affect balance (does not have to be a major injury).

Demonstration Time

Foot Mechanics

Single leg standing

Single leg ¼ squat

When taking off or landing it is imperative to have good mechanics.

Improper mechanics lead to repetitive abnormal stress

Leads to inefficient performance Leads to injury

Foot Mechanics & Balance

Single leg standing (SLS)– Mechanics– Eyes open hard surface – Eyes closed

(-visual system) (test proprioception and vestibular)

– Eyes closed on soft surface (- visual –proprioception) (test vestibular)

– Eyes closed on soft surface head back (challenge vestibular system)

Eyes open on hard surface

Eyes closed on hard surface

Eyes closed on soft surface

Eyes closed head backon 8 incher

Demonstrate

Muscle testing – Hip– Ankle– Foot

Flexibility testing– Gastroc– Soleus

Proper foot mechanics can be achieved by

Balancing muscle imbalances– Hip, ankle, and foot strength and

flexibility Improving balance or proprioception Training proper take-off and landing

mechanics

Strengthen Hip muscles Clam ph I (fig 1)

– Sidelying, roll hip forward.

– Tighten abs, tighten buttock.

– Keep heels together and lift one knee up.

– Monitor hips, no motion.

– Hold 10 sec x5

Figure 1

Clam ph II (fig 2)– Begin with clam ph

I.– Then lift from the

knee straight up with heels a few inches apart.

– Hold 10 sec x5 Clam ph 2.5

– Same as ph III– Against a wall– Hip rolled forward,

heel touching wall.– Hold 10 sec x5

Figure 2

Clam ph III (fig 3)– Roll hip forward.– Tighten abs, tighten

buttock.– Turn top foot out,– Raise leg.– Hold 10’ x5– No motion at the

hips. Keep rolled forward.

Figure 3

Hip & knee control

Squatting (card pickups near wall)– Both legs– Create arch– Hinge from hips– Bend straight down– Knee over second toe

Hip & knee control Single leg ¼ squat (fig 4)

– Standing on one leg, hips level– Use a pen, golf ball, or card – Squat to set ball down with R

hand– Back to start position– Squat and pick up ball with L

hand– Continue alternating which hand

picks up the ball.– Knee must stay over 2nd toe and

no motion at the hips.– Weight evenly through the foot– DO NOT let the arch of foot

collapse– 2x20 (can follow with balance

postures)

Figure 4

These exercises can lead up to landing drills:– Make sure the gymnast’s foot is not

collapsing when landing– May start with just a jump to a stick.– Then jumping from the beam or vault to

a stick.

When doing plyos and other conditioning the key is for the gymnast to control their foot on push-off and landing.

Do NOT allow the foot to collapse or be loose.

Retrain calf muscles

Heel raise with knee straight (fig 5)– Progress from 2 ft to

1– Raise heel up.– Heel must stay in line

over the 2nd toe.– DO NOT let the heel

move inward.– 2x15

Figure 5

Soleus

Bent knee heel raise (seated) (Fig 6)

– Start seated, 1 leg crossed with arms rested on knee.

– Slow and controlled.– Raise heel over 2nd toe.– 2x15

Figure 6

Soleus

Bent knee heel raise (standing) (fig 7)

– Progress to standing, start both feet at same time progress to 1 foot

– Use beam for balance.– Slow and controlled.– Raise heel over 2nd toe– 2x15

Figure 7

Strengthen foot/toe muscles

Towel curls (fig 8)– Place a towel on a smooth surface (tile

works well) Do in standing and 1 foot at a time.

– Curl the towel with your toes towards you until reach the end of the towel.

– Start again x 5 min– May add 1-8 pounds on towel.– Heel must stay on the ground.– Do NOT let arch collapse. Figure 8

Balance Training progression

SLS eyes open– Balance postures

SLS eyes closed– Balance postures

SLS on 8 incher eyes open SLS on 8 incher eyes closed SLS on 8 incher head back eyes

closed SLS balance postures on beam

Balance training

Balance Postures Maintain arch in

foot. Hold 20 sec-1 min

– Tree (Fig 9)

– Front Scale (Fig 10)

Figure 9

Figure 10

Balance Training Cont’d Balance Postures

– Back Scale (Fig 11)– Bent knee back

Scale(Fig 12)– Sneaky Lunge (Fig

13)

Figure 11

Figure 12Figure 13

Challenge balance– Add 4 incher, 8 incher, BOSU ball (Fig

14)– Progress from

2 feet stable surface (floor) 2 feet unstable surface

– Sting mat to 8 incher to BOSU ball 1 foot stable surface 1 foot unstable surface Put them on beams

– Stand 1 leg balancing– Add ball tossing Figure 14

Beam ball toss

Stretch calf muscles

Calf stretch (fig 15)– Against a wall or

stationary object.– Place foot

stretching back with toes straight forward.

– Create an arch.– Gently lean forward– DO NOT let foot

collapse.– Hold 1 min

Figure 15

Contact Information

Perfect 10.0 Physical Therapy & Performance Training

www.perfect10physicaltherapy.com

perfect10pt@gmail.com 512-426-6593Follow Perfect10PT on gymanstike, facebook, and twitter

All information from:

– The Manual Therapy Institute– http://www.mtitx.com/

– Shirley Sahrmann. Diagnosis and Treatment of

Movement Impairment Syndrome.