WAG Handling injuries- what I've learned

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kimute

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This is not intended to be medical advice at all. I am not a medical professional. Just a mom whose daughter is learning to get through injuries as rapidly as she can with less frustration. These are just anecdotes about what has worked for my DD, but I thought sharing this might benefit others. This article on why pro athletes recover faster got me thinking about this.

Our kids are generally not pro athletes but they train almost as much and therefore have a lot on the line, even if it isn't million dollar contracts. It is important for them to get back in the game quickly for their own emotional well-being. So here is my two cents:

1) RICE! Especially for sprained ankles, but for anything, wrap and ice immediately. You can cut down on recovery time by limiting initial inflammation. This is relevant only the first two days.
2) Boot/splint/tape not cast where you can. Or at least ask the Dr. about this option. My DD had her wrist in a cast for a simple broken pinky. I CHOSE this because I wanted her to be able to tumble and ski without risk to the broken bone. This was a mistake that led to two years of wrist weakness and pain. If I could do it again I'd buddy tape it for three weeks and wait on the tumbling.
3) Start PT before the injury is healed. My DD shattered the head of her second metatarsal seven weeks ago. First Dr. said six weeks in a cast. If we had done that her calf would now be weak and atrophied and we'd be starting PT. We opted for a boot and from week 2 DD would do ankle circles, alphabets, bone stim, and I'd massage her calf. After another week she started using a thera-band to keep her calf strong. She now has very little leg atrophy, can do calf raises pretty equally on both sides and will start some tumbling today. The bone didn't heal faster but I expect now she'll get back to gymnastics more quickly and safely and has been running around like a kid again since before the cast was due off!
4) Talk to coaches about a plan/schedule. Our coaches were great about developing a part-time schedule and plan for our DD when injured. Had she gone full-time I think she would have been bored and frustrated. Had she not gone at all it would be worse.
5) Look at preventative care. This could be a monthly PT check-in. Or we have a center near us that will do motion analysis of young athletes. My DD was assessed with needing to work on her shoulder and hip flexibility more in order to not put strain on her wrists (or back) in a bridge position. The same analysis using wrist guards fixed some of the issue too. This was great input for our coaches and for us to know that she should always wear wrist guards.

Happy healing!
 

Faith

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This is not intended to be medical advice at all.

Neither is this, but for the sake of discussion :)

There is evidence that measures to prevent inflammation can slow down healing. Swelling and inflammation serve a purpose- to bring blood flow to a damaged area- and therefore bring those immune and other components that are necessary for repair.

What strikes me about many injury posts on here is that it's mainly focussed on getting back to, or not missing training. As quickly as possible. Training in casts, boots, splints. As a coach I see many kids who become uneven if they train on an injury- they will compensate to protect the injury and it affects things like take off- they start leaning away from the injured side, use the uninjured side more- and risk further injury. I can spot a kid who has been training while injured a mile off.

I don't agree that "It is important for them to get back in the game quickly for their own emotional well-being" I think it is more important that they are physically healed, it can be very difficult still being in the gym with an injury, wanting to join in. And going back too soon can mean the injury never heals fully. I also think these kids train so much a couple of weeks away from the gym healing in mind and body can make the world of difference.

An anecdote- one of the young senior elites at DD's gym fell and injured herself back in november. She had full medical support as a pro. She stayed in the gym and is still rehabbing, can't train fully and isn't competing. DD did the same thing in Dec- at first thought to be much more severe. She has no specialist medical care, just the excellent staff in our local A+E. She had two weeks off fully, then went in for light conditioning and rehab exercises only, then another two weeks fully off at christmas. She is now training pain free and is back to senior competition.

So my own thought are that if you have pain from an injury that is a sign that something is wrong. And it is better to take time out now, than rush back and risk carrying long term injuries. I read that article on pro's- observing ours yes they do get the best medical care and in competition season they will grin and bear it to an extent. But they have no hesitation in pulling out of all but very important competitions, and once those are over they get home and rest until the injury heals properly.

If mine are injured I ask them to avoid even taking painkillers, as they need to know if it is hurting so they don't do further damage. I don't want kids in boots or casts in the gym - to my mind it's no different to training with a weight on one ankle or wrist, not a good idea.

Lastly- just a comment on the recent controversy about conditions and the treatment of children in gymnastics- we need to establish a culture where it is OK for a child to take time off if they're injured, and get away from the pressure to get back to training asap. A child should be able to say if something hurts, and ask to go home, or sit out. There are too many kids training in pain because they feel pressured to not "be a wimp" or feel that their coach or parent doesn't approve of time off.
 

ldw4mlo

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Lastly- just a comment on the recent controversy about conditions and the treatment of children in gymnastics- we need to establish a culture where it is OK for a child to take time off if they're injured, and get away from the pressure to get back to training asap. A child should be able to say if something hurts, and ask to go home, or sit out. There are too many kids training in pain because they feel pressured to not "be a wimp" or feel that their coach or parent doesn't approve of time off.

This, very much this.
 

mommyof1

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I would add a #6: Do not be afraid to take time off.

During her first season of L3, my daughter had a bout with tendonitis. Ortho and PT assured us that there was no need to take time off from practice and that PT would resolve the issue quickly. After weeks of time-consuming PT, the pain was worse. I finally demanded that the PT write a note to excuse her from PE and practice, and after a couple weeks of rest the injury was healed. The delay in resolving the injury cost my daughter a lot of confidence and progress and caused her and our entire family loads of unnecessary misery.

A few months later she developed Sever's. We went to a different ortho, who immediately put her in a boot and ordered rest. The pain resolved within a couple of weeks and she went on to have a happy and successful season. I will never ever again hesitate to demand rest as soon as an injury occurs.
 

kecks

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in my experience it is key to understand in competitive sports that there is a good kind of pain and a bad kind of pain. good kind of pain can be worse than the bad kind. good pain is being sore after new programs start, being sore during extensive training phases when numbers do ramp up, good pain is pain from holding the position just a few seconds longer than you thought you can or doing 15 reps when asked to do 12. good pain is feeling slightly ill after an anaerobic endurance program and so on. i think everyone who has ever trained in or coached elite sports understands. being a whimp gets you nowhere not even in recreational activities.

bad pain is being injured and training on it anyway. no one but the athlete can feel (!) this difference. no new athlete can tell this difference. it takes years of experience for the individual to learn to make these decisions. parents can not make them, coaches can not make them, and some athletes never learn to make them. train smart, train hard, but some never figure out what that means.

now wag and it's speciality of needing to train little kids like elite athletes because peak performance age is 16-20 at best comes in: a kid under - let's say - 14 or 15 years of age is never ever mature enough to understand let alone make those decisions. they will most of the time do anyway what they feel their loved ones expect them to do (coaches, parents, peer group).

so this leaves you at the dilemma that yes, you probably will lose very valuable training time by making a kid sit out, but better fail on the side of caution...
 

Splat

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I will disagree that being in the gym while injured is a bad thing, however, it really depends on the gymnast. If the gymnast is injured they should take time off or at least modify their training. However, I know that continuing to be in the gym during all my injuries is what helped my keep going. While for some it would cause problems or wanting to be training like the rest and I faced problems like that. Although my favorite things about still being is the gym is continuing to gain strength with specialized workouts. I also enjoyed seeing and talking to my teammates as they are the main ones that helped me get through each injury.
 
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aerials

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Lots of great advice above. However each child and injury is different and has to be managed with a doctor. My dd broke her leg and was out in a cast for 4 weeks and then 2 weeks in a boot. Only after that did we start PT, this was all doctors orders. I had asked about getting her in earlier to condition and the doctor said "sure but if she falls on her leg we could be looking at surgery with pins and an additional 6 weeks out". It just wasn't worth it. Her break was bad and she had to be completely off it for at least 4 weeks. Surprisingly at her first PT appointment they measured her strength and flexibility for each leg, they were almost the same for both! :eek: She didn't lose any strength only a little bit of flexibility. She came back quickly because of it and was completely healed too because she took time off. Vault came last due to the pounding of the event and it hurt too at first. 8 months later she is still a tiny bit behind, but not much and more importantly she has no issues or pain with her leg. She moved up a level with being out for 3 months (she was out over the summer) and has qualified for states already.
 
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Pea'sMom

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I want to add our experience on the rush back to gym during/after injury, with the caveat that she's not a high level gymnast (L6/7). Pea has been not actively training since January of last year. She had 3 surgeries over the last year to fix her elbow OCD. She did go to gym for a modified time to stay connected and do the limited things she could (abs, legs, turns, jumps) until we found out her surgery had failed in July. She was out totally from July until this January. Her last surgery was in November and she has been in PT 3 times a week from December on. She is back on a modified schedule following a 'return to gym protocol' from her ortho. In the past month she has gained back all her floor, bar and beam skills. Vault is still a work in progress. This is after a YEAR of not training. There is no rush, I promise ;)
 

CoachAlex

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It definitely depends on the injury and the athlete - we had a kid with an elbow fracture in a hard cast allowed to condition and we had a kid with broken fingers, not hard casted, not allowed to do anything because of the kind of fracture, so sometimes what seems like a smaller injury may not be.

If a doctor says absolutely no to anything in the gym, then that’s that. A few weeks/months rest is NOT going to be the end of the world (or their sports “career”). But if a doctor says that an injured athlete is allowed in the gym, please please ask for specifics! Speaking as a coach and not a medical professional, if one of my athletes is injured but is allowed to do modified workouts I want to know what the DR considers “modified.”
 

sce

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I will disagree that being in the gym while injured is a bad thing, however, it really depends on the gymnast. If the gymnast is injured they should take time off or at least modify their training. However, I know that continuing to be in the gym during all my injuries is what helped my keep going. While for some it would cause problems or wanting to be training like the rest and I faced problems like that. Although my favorite things about still being is the gym is continuing to gain strength with specialized workouts. I also enjoyed seeing and talking to my teammates as they are the main ones that helped me get through each injury.
I agree with this. With many injuries you can rest the injury and still do a modified workout. It dies depend on the injury and severity though,
 

Muddlethru

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In my opinion, there is way too much fear of losing ones skills and strength, missing meets, getting a scholarship that gymnasts, parents and coaches find every way to get back to gym quickly after an injury. We fell into this trap when my daughter was an 11 year old Level 9. I believe we (my daughter, her coach, my husband and I) rushed her after every injury. She was not trying to be an elite and she was young. Why we felt we could not wait is beyond me now. She did however want to do college gym. So we thought it was best to get her back right away. Worse decision. Her performance at meets were not good because she was not fully recovered and ready. Worse part is she just kept getting injured. She eventually needed surgery. Even though this is her 4th year as a Level 10 and with a couple more years before she graduates, her dream of doing college gym is hanging on a thread. While recovery from every injury is different, proper and full healing, instead of return to the gym quickly should be the priority. I also can't emphasize physical therapy enough.

That said, in my experience, many doctors take an abundance of caution by perhaps keeping kids in a boot/cast longer than they need to be. So, I agree to some degree that pt (not full gym practice) can be started sooner. But unless you are racing against time (i.e., something has to happen this year or it will never happen, like an elite preparing to make the national team or an older Level 10 trying to get a scholarship), taking the risk to return to gym sooner may not be in your daughter's best interest. Every time I read a compulsory or young lower level optional racing to get back to gym after injury, I cringe. At that level, if they lose their skills, struggle to get the skills after the injury or are already struggling to get their current skills, getting back to gym early is not going to change the outcome later on. If they have the physical ability, mental strength and motivation to get their skills back and progress through the levels, they will. If they don't, getting back to the gym earlier than they are ready will not change that. Additionally, missing a meet is not as catastrophic as we think it is.

Returning before they are ready could delay the healing process and could cause further injury and frustration. When it comes to remedies/protocol for injuries, the standard stays true. Rest is the biggest factor. Then ice for acute injuries (first 48 hours), be under a doctor's care, physical therapy and smart conditioning at the gym.
 

aerials

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In my opinion, there is way too much fear of losing ones skills and strength, missing meets, getting a scholarship that gymnasts, parents and coaches find every way to get back to gym quickly after an injury.

Yes. I have seen this over and over and some of the girls ended up quitting because they kept getting hurt due to not letting their injuries properly heal. One girl tore her acl and one week after surgery was swinging giants on the strap bar :confused: guess what...her recently patched acl tore again due to the force of the giants and she had to had surgery again. Her and her parents unwillingness to let her injuries heal led to her quitting gymnastics. Another girl with her back and another girl with a broken wrist...and all the parents actively looked for doctors that weren't "conservative" and "knew" gymnastics. I'm all for finding a good fit with a doctor but when you go to multiple doctors just to get the answers (back to the gym soon) you want, you might reconsider. They all asked me what doctor my dd used because she healed so well....she healed well because she took time off. Taking time off may be the hardest thing our daughters ever do in their gymnastics career but it's worth it.

Now of course I'm not talking about all injuries there are plenty that you can go back to the gym earlier but I am continually amazed at how many parents are terrified about having their daughter take time off to heal.
 

LGnyc

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Now of course I'm not talking about all injuries there are plenty that you can go back to the gym earlier but I am continually amazed at how many parents are terrified about having their daughter take time off to heal.

But it's not just the parents. In fact, I'd say it is often just as much the girls. I know that we are supposed to BE the parents, to put limits on them, but implying it's all parents means you miss out on the reality that the girls WANT in and feel the pressure to get back in. And by pressure I mean from coaches, the gym itself, or internally. I guess I'm not very articulately stating that citing the parents misses aspects of this situation.
 
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CoachAlex

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But it's not just the parents. In fact, I'd say it is often just as much the girls. I know that we are supposed to BE the parents, to put limits on them, but implying it's all parents means you miss out on the reality that the girls WANT in and feel the pressure to get back in. And by pressure I mean from coaches, the gym itself, or internally. I guess I'm not very articulately stating that citing the parents misses aspects of this situation.

Correct - I would say whether its the parents or the athlete pushing to comeback - it is the coach(es) who allow it. If an injured athlete is coming into the gym while injured then they need a doctor/PT/note that specifies what they are allowed to do. As a coach you have to know your kids - the kids I coach are competing, but not high level optionals - if they are injured and allowed in the gym, I will usually say to the parents, if they can come in to do some conditioning for an hour fine. Some kids need to feel like they are part of the team still and I understand that. But I’d rather an athlete completely heal than risk re-injury (or another injury). I am a high level athlete in another sport so I do understand the push and the want to cross-train, etc., sometimes, the best thing a coach can say to an athlete is “no, you NEED to rest.”
 

aerials

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But it's not just the parents. In fact, I'd say it is often just as much the girls. I know that we are supposed to BE the parents, to put limits on them, but implying it's all parents means you miss out on the reality that the girls WANT in and feel the pressure to get back in. And by pressure I mean from coaches, the gym itself, or internally. I guess I'm not very articulately stating that citing the parents misses aspects of this situation.

Absolutely! I agree with you. The girls do feel pressure but it's our job as the parents to make the rational decision. And it is hard, I get that. I'm just shocked by some of the behavior I see by the parents. While the girl was doing giants one week from acl surgery, the mom kept saying "I'm not sure she should be doing that". Now this was during her sister's private and there was not practice for her group she just went and got on the strap bar on her own, there were no coaches.
 
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LGnyc

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I think I’m also feeling hyper sensitive to this play of parent vs child vs coach right now. Dd was starting to show wear on her right knee. I begged her to take off on Tuesday knowing Wed was a no practice day so extra rest. She insisted on going and idiot that I am I let her. She gets there and tells coach I didn’t want her to come bc of pain. Coach high fives her basically reinforcing that she was right to go. And then torqued her knee and has been on crutches since. I blame myself and the coach and dd. It was unnecessary.
 
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duyetanh

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She gets there and tells coach I didn’t want her to come bc of pain. Coach high fives her basically reinforcing that she was right to go. And then torqued her knee and has been on crutches since. I blame myself and the coach and dd. It was unnecessary.
ARGH!
 
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kimute

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OP here. This has created an interesting discussion and I learn from each perspective. Thank you for sharing. I need to look into and better understand the benefits of initial inflammation. Faith, your comments make logical sense and is so important since what we do for injuries before we even get to the Dr. depends on our knowledge.

My DD is on her final days of Dr. care for a broken metatarsal. One Dr. has eased her back in very slowly, starting back in earlier. Other Dr. cleared her today to go back to everything after recommending very little. They get to the end at the same point-- once the bone has healed. I just think the gradual approach with PT starting earlier works better for her ultimate goal of doing all her gymnastics again pain free and without new injuries.

One more anecdote-- my DH had shoulder surgery. The Dr. said we'll start PT in six weeks and maybe you'll play volleyball again in six months. My DH ignored the Dr. and started his own PT at home (with some help from trainers we work with and the internet). At his six week appointment (where he would have been cleared to start PT) the Dr. said he'd never seen a shoulder heal so well and that my DH would be back to volleyball in a month.

All that said, my whole family clearly does have a bit of a risk taking ethos that we need to keep in check :)
 
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