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ITP 201: Basic Injury Care for gymnastThis lecture was given at the Gymnastics Association of Texas conference 2011. Importance of Emergency Action Plan and triage in the gym.
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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
Make sure the gym is a safe environment
Account for injuries before they happen
Make sure every area is covered with mats (no gaps in mats)
Move all unused equipment close to the walls or in designated areas
Have designated walking areas
Update old unsafe equipment
Keep the younger kids separate from the team when possible
Keep coaches always conscious of safety
All coaches CPR & first aide certified annually or biannually
Push up position
Push up
When taking off or
landing on the wrist it
is imperative to have
good mechanics.
Improper mechanics lead to repetitive abnormal
stress
Leads to inefficient performance
Leads to injury
Fingers facing fwd
Maintain palmar arches
Antecubital fossa (“Smiley face”) points inward (“kiss each other)
Elbows straight but not locked out
Shoulder blades cinched up to the rib cage (no winging)
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
Straight back
Hips square
Hip inline with the knee
Knee inline with the 2nd toe
Hips slightly flexed
Knees bent with the knee falling over the midfoot
Drills
Drills
Drills
More…..drills
Make sure an athlete is strong enough,
flexible enough, done the proper
progressions and done the skill safely in a
safe place before progressing
Do NOT let an overzealous athlete convince
you to let them chunk things
Give a specific number of trials for a skill
Especially at the end of practice
Do NOT let an athlete say….I just want to do
one more at the end of practice or after they
have done a ton of bad or unsuccessful
attempts
When an athlete is physically and mentally
tired…one more turns into a nightmare real
quick!
Adhesive Bandages-large
Standard Band-Aides
Knuckle Bandages
Fingertip Bandages
Iodine Swabs
Alcohol Pads
Burn Ointment
Antibiotic Ointments
Eye Patches
Eye Wash
Gauze Pads-4x4 and 2x2
Latex gloves
Ace Wrap- 6 in, 4 in, & 2 in
Scissors
Tape
Tweezers
Tylenol-*DO NOT administer
medication with
acetaminophen
First Aid Guide
*Hepacleanse- 4-10 drops in
about 1/2 cup of water till the
water is tinted a light pink.
Ice Pack
Splinting Supplies-air splint, SAM splint, Vacuum Immobilizers
Arm Sling
Crutches
CPR Mask
CPR guide
AED machine (Cardiac Rescue Systems www.cardiacrescue.com)
www.henryschein.com
Please contact:
Bert Cattoni
Phone: (630)
541-5469
Cell: (630) 854-
5150
bcattfway@aol.
com
www.cardiacres
cue.com
PO Box 5522
Woodridge
IL, 60517
CARDIAC
RESCUE
SYSTEMS, INC.
CAB- Chest compression, Airway, Breathing
30 chest compressions
Clear air way
2 breaths
30:2 until help arrives
www.heart.org
Orthopedic Surgeon Doctors who specializes or fellowship trained (ie
fellowship trained ankle, knee or board certified spine specialist)
Specialize in sport injuries
Specialize in pediatric sport injuries
Physical Therapist Board certified orthopedic specialist
Fellowship trained manual physical therapy, sports PT, movement dysfunction
www.apta.org or www.aaompt.org
911 Do not hesitate to call if uncomfortable with broken
bone, concussion, seizure, or any other emergency
Have PT come every week or every other week to the gym
Triage
Screen for injury prevention/wellness once every quarter lower levels or more frequent for elites (once every 4-6 wks)
Assess conditioning program for areas of weakness or overtraining
Implement injury prevention program
Help come up with Active Recovery program for injured athletes
Provide educational talks for staff or parents
Get to the doctor more rapidly
Have an emergency action plan
Train your staff annually on the action plan
Who goes to the aide of the injured athlete
When to call 911
Who calls 911
What the other coaches do to assist the
primary provider or with other athletes or
parents
Who waits for the ambulance if needed
What first aid is administered
Have plans for various incidences which may
arise
What to do if an athlete is unconscious after
landing on their head
What to do in the event of a fracture or
dislocation
Practice Pit extractions with local fire
department
Minor injury no obvious deformity or serious injury
Rest
Ice
Elevation (above the heart)
Compression
Call the therapist or team medical provider have gymnast assessed to decide need for further medical care.
Small sprains & strains untreated can lead to more serious injuries or troubles
Care within 24-48 hrs dec recovery time & inc success full recovery
Apply splint to immobilize
Apply ice
Elevate above heart
Contact doctor to get an appointment or
have parent take the gymnast to Urgent care
or ER if the gymnast excessive pain an unable
to wait until the next
DO NOT move the gymnast from the area
Call 911
If profuse bleeding occurs apply direct
compression with gauze over wound
DO NOT try to relocate a dislocated
joint or set a bone. You can do MORE harm and permanent damage to the athlete
Use the SCAT 2 for assessment
-Grade I- Dazed look; patient completely lucid (no amnesia, confusion) in 0-5 minutes
-Grade II-Slight Confusion: mild posttraumatic amnesia that last less than 60 min; possible ringing in the ears: headache; may develop post concussion syndrome that can last several weeks to several years
-Grade III- Symptoms listed above in addition to retrograde amnesia in which events prior to the concussion are forgotten
-Grade IV- Loss of consciousness for less than 5 minutes followed by stupor, confusion, automatism and finally full alertness
-Grade V- Unconsciousness for greater than 5 min; symptoms listed above but more severe, nausea, and vomiting; possible permanent neurological deficits
*Any gymnast with a head injury needs to be
seen by a doctor as soon as possible. If
Grade IV or V concussion occurs call 911.
-Apply direct pressure with gauze to control
bleeding.
-Send gymnast to Urgent Care or ER for
sutures
-Improper technique
-Improper warm-up
-Lack of flexibility (typically true
shoulder, hip flexibility) or range of motion
-Improper conditioning
-Overuse
*Muscle imbalances
-Emphasize technique from the beginning
-Focus on all muscle groups
-Build core strength early on (true internal/external abdominals, transverse abdominus…not just the “6 pack muscles” rectus)
-Do not forget to train the shoulder blade stabilizer and the hip stabilizers
-Be specific and meticulous with conditioning, a stickler for form
-Cross train/selectively train
-Prevent overtraining by taking advantage of soft landings
-Wrist guards (Tiger paw) for gymnast doing yerchenko vaults
-Regular medical screenings with a therapist or doctor
-Treat aches and pains before they become full blown injuries
-Deal with the minor injuries to prevent recurring injury, domino affect, or worsening of injuries
*A therapist can help with all the below
and closely guide modified workouts along
with progressive return to full workouts
based on tissue healing.
-Identify the cause
-Eliminate the cause
-Allow inflammation or acuteness of the
injury to subside
-Strengthen weak muscles, stretch tight
muscles, and retrain muscle firing patterns
when a muscle is dominant
-Maintain strength and endurance while
treating an injury
-Progressive loading to return to gymnastics
without further injury (i.e. start with less
numbers, low impact and progress slowly to
full numbers and high impact)
-First 24-48 hours R.I.C.E.
-Normalize joint mechanics (See manual
physical therapist)
-Normalize ROM and strength
-Normalize proprioception
-Ankle taping/bracing during the protective
phase where ankle is subject to re-injury.
-Normalize joint mechanics (See manual physical therapist)
-Assess possible hypermobility L5-S1, if positive; brace with simple back brace/wrap during painful activities for up to 300 days (collagen fibers replenish; tissue healing)
-Proper lumbar stabilization (using blood pressure cuff; 40-50 with flexion bias)
-Avoid hyperextension (no backbends, bridges, back walkovers)
-Insure shoulder and hip ranges of motion are normal
-Normalize joint mechanics (See manual physical therapist)
-Assess possible hypermobility L5-S1, if positive; brace with simple back brace/wrap during painful activities for up to 300 days (collagen fibers replenish; tissue healing)
-Proper lumbar stabilization (using blood pressure cuff; 40-50 with flexion bias)
-Avoid hyperextension (no backbends, bridges, back walkovers)
-Insure shoulder and hip ranges of motion are normal
- Stretch hip flexors (iliopsoas and quads)
-Strengthen hip abductors, extensors, flexors, and external rotators (glut med, glut max, iliopsoas, superior/inferior gemelli)
-Normalize joint mechanics (See manual physical therapist)
-Assess resting position of the shoulder (Anterior medial glide syndrome)
-Assess cervical and scapular strength
-Stretch pecs and lats
-Neck (deep cervical flexors) and shoulder blade (Upper trap, middle trap, lower trap, serratus anterior) strengthening
-Rotator cuff strengthening
-Make sure rhomboid not doing all the work with shoulder external rotation (re-train if it is)
-Technique
-Normalize joint mechanics (See manual physical therapist)
-Scapular and deep cervical strengthening
-Make treat shoulder and elbow issues to
-Wrist extension strengthening (make sure move wrist straight back, not inward) (ECRB tends to dominate)
-Finger flexor strength/grip strength
-Proper loading of the wrist in plank, pushup, handstand, etc)
-Wrist guards (Lion Paws, tiger paws)
*There is no such thing as tendonitis in most
cases. They have found there is no
inflammatory response. It is tendonopathy
which translates to micro-tearing of the
tendon, which if goes untreated can truly
rupture the tendon.
-Technique
-Normalize joint mechanics (See manual
physical therapist)
-Normalize muscle imbalances affecting the
tendon and loading response
• Low loading, lots (1,000s) of repetitions
(biking, elliptical, total gym. minimal
numbers in the gym, low impact [tumble
track, air track, sting mats, pits, etc]) A
therapist can give specific tendon training
exercises for the involved tendon.
• Tendon healing truly takes 10-12 weeks in a
good environment with no re-injury to heal.
• Careful not to over train, Signs of
overtraining: Tightness, stiffness, aching,
swelling or pain directly over the tendon
• Early signs of tendonopathy; Pain at the beginning of workout, decreased once warmed up, and worse within a few hours after workout or towards the end of practice.
• Signs tendonopathy progressing: Begin to have pain during activity, no change with warm-up, and increasing after
completion of activity, increased intensity of pain.
• Signs of tendon partial rupture: Increasing pain intensity, pain during activity, and inability to relieve the pain or swelling
(SEE AN ORTHO DOCTOR OR THERAPIST IMMEDIATELY)
• Signs of tendon full rupture: Visible defect, possibly hear/feel a pop, inability to activate muscle attaches to the tendon, pain with contraction, pain during activity, inability to relieve pain or swelling. Increased intensity of pain and increased swelling.
Technique
-Normalize joint mechanics (See manual physical therapist)
-Normalize muscle imbalances affecting the tendon insertion and loading response
• Indentify the cause; improper loading on the knee
• Address core, hip, and foot weakness
• Address proper squatting, jumping, landing mechanics on the knee
• Decrease numbers and decrease impact; all guide by pain.
• Tendon training, along with proper strengthening and stretching.
• Chopat Strap
-Technique
-Normalize joint mechanics (See manual physical therapist)
-Normalize muscle imbalances affecting the tendon insertion and loading response
• Indentify the cause; improper loading on the ankle/foot
• Address core, hip, and foot weakness
• Address proper squatting, jumping, landing mechanics on the ankle/foot
• Decrease numbers and decrease impact; all guide by pain.
• Proper foot wear out side of the gym to decrease the stress.
• Tendon training, along with proper strengthening and stretching.
Most injuries can be prevented with:
Injury prevention (balance the muscle imbalances)
Training proper biomechanics or loading techniques
Proper skill progression
Facility and equipment safety
A working relationship with a PT and doctor
Wellness screens (including ROM, flexibility, strength, &
balance)
When injuries do occur:
Be prepared
Have a plan
Train your staff
Learn from the experience for further injury prevention
If it doesn’t look right…don’t touch it
Contact a medical provider
Perfect 10.0 Physical Therapy
& Performance Training
512-426-6593
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