Coaches Gymnast's Wrist Diagnosis. What's next?

[Aero]

One of my athletes was diagnosed with having swelling around the growth plates in her wrists, which I understand is the onset of Gymnast's wrist (Distal Radial Epiphysiolysis). Incidentally, she is the "handstand master" of the team, and is quite good at balancing stationary handstands because she practices all the time. It is my educated guess that this is most likely the main reason for this overuse injury.

Now what I want to know is what should I do to effectively help her through this? Her mother called me and told me the orthopedist said she is to rest for three weeks. I'm going to write her a modified training plan that avoids using her wrists. I plan on including a lot of beam work, dance and leap/jump training, and vault running and jumping drills, as well as lots of stretching and conditioning. What I'm not sure about are hanging skills on bars, though, such as tap swings and glide swings, with and without straps? Since there is no compression in the wrist during these bar skills, would it be okay to have her do these? I've never dealt with this injury before, so any do's and don'ts would be super helpful. I want her to get the most out of each practice while simultaneously putting her in the best position for her wrists to fully heal.

As far as strengthening and rehab, what are the preferred methods? I have a rice bucket, so I'm wondering if she should do exercises in it during this three week period. I know this is not really a muscle issue, as it has to do with the growth plate, so is using the rice bucket a good idea at this stage? Or should I wait until she is healed to start on that? And about stretching the wrists, it involves a lot of bending at the wrist joint and putting weight/pressure on it in order to get a sufficient stretch. Is this a good idea at this stage? I really don't want to do anything that will delay the healing process or make it worse.

So yeah, I'm reaching out to any coaches who have experience in dealing with this injury, and what you may have done with your athletes that has produced a positive outcome. I'm currently a n00b with this situation!

A few other things of note: she doesn't have stellar shoulder flexibility, and as a result she has a bit of an arch in her back during handstands. She also has an incredibly difficult time keeping her arms straight in most skills, especially back handsprings and the front handspring flatback vault for Xcel Silver. I'm wondering if this is all potentially connected. Is it possible that her bad habit of arm bending is related to the shoulder flexibility deficiency, which in turn causes more stress on her wrists? Maybe? I don't know, any input on this?

Also, if there are any doctors or medically proficient individuals out there, is there a difference between Distal Radial Epiphysiolysis and Distal Radial Epiphysitis? I found both terms while searching Google for "Gymnast's Wrist." Are they synonyms? Or different in some way? This is just out of my own curiosity on the subject.

 

[gopuckgo]

You mean epiphyseolysis? Epiphysitis is inflammation of the growth plate. Epiphyseolysis is widening of the growth plate. She probably has both. Rest it and follow the doctors orders. Coaches run into problems by trying to treat the injuries themselves when they are not medically trained the same way. Let the doctors and therapists tell you what is acceptable to do and listen to them, that is my advice. Run any treatment plan by the doctor for approval if it involves using the upper extremities. If the doc says 4 weeks then it is seriously 4 weeks.

Pushing them through will only worsen it. 4 weeks in a young career is nothing in the grand scheme of things. It just sucks in the middle of season when it occurs. It is great of you to ask and search for better understanding, it shows that you are a good coach. Contact the doctor or therapist directly with written authorization from the parent and get a dialogue going with them. You can be part of the team to help heal it, but just speak directly to them for their treatment plan.

 

[coachmolly]

Those kind of Dr. mandated rest periods are rough for coach and athlete. She is going to want to push the limits because she "feels fine", and you are going to want to let her, but it is so much better in the long term if you follow the plan set by the Dr., even if it seems excessive. Stay off the wrist completely for the time being, if you really think she is capable of more, have the mom talk with the Dr. to get some more specifics. Usually they are willing to give advice on exercises that would be good, as well as let you know when the appropriate time to start those exercises would be.

As far as the bent arms and shoulder flexibility, lack of shoulder flexibility can absolutely lead to bent arms and other oddities as the gymnast attempts to compensate. I don't know that it would place more pressure on the wrists, more often I find it places extra stress on the back, especially in walkover skills. There are shoulder stretches you could work on during her down time. When she returns to full practices, some coaches swear by doing handstand work and presses on parallettes to reduce stress on wrists, especially if you do a lot of handstand work (which I imagine you do at this level).

 

[Aero]

Thank you both for your responses! I talked to the mom and she gave me the okay to talk to the doctor about the situation. I'm going to call the doctor tomorrow (Monday). Any ideas about what I should ask specifically? I'm not sure if this orthopedist is well versed in sports, let alone gymnastics.

On a good note, I am noticing improvements already in her leaps and jumps, as well as pirouettes, all things I've had her practicing lots of. Any suggestions on ideas and drills to work on for the four events that don't involve wrists? She is an Xcel Silver, approximately USAG level 3.

 

[gymdog]

The mom will probably have to sign a medical release form with the doctors office for them to give you any info. It's a HIPAA violation and they would need written permission on file for liability reasons, not just someone's word that the mom said they could call.

 

[Deleted member D3987]

Thank you both for your responses! I talked to the mom and she gave me the okay to talk to the doctor about the situation. I'm going to call the doctor tomorrow (Monday). Any ideas about what I should ask specifically? I'm not sure if this orthopedist is well versed in sports, let alone gymnastics.

On a good note, I am noticing improvements already in her leaps and jumps, as well as pirouettes, all things I've had her practicing lots of. Any suggestions on ideas and drills to work on for the four events that don't involve wrists? She is an Xcel Silver, approximately USAG level 3.

that she doesn't have a torn ligament OR that Positive Ulnar Variance has been ruled out. these 2 things are dangerous to a gymnast's career.

 

[Aero]

@dunno | The doctor has suggested absolutely zero use of the wrists for three weeks. No compression, weight bearing, hanging, stretching, etc. Would this be a sufficient amount of time for these two ailments to resolve, if they were present? My athlete states that the pain is present in both wrists, but slightly more in the left than the right. There were no X-rays or MRIs done, with the doctor stating that it was just simple swelling around the growth plates in the wrists.

 

[Deleted member D3987]

@dunno | The doctor has suggested absolutely zero use of the wrists for three weeks. No compression, weight bearing, hanging, stretching, etc. Would this be a sufficient amount of time for these two ailments to resolve, if they were present? My athlete states that the pain is present in both wrists, but slightly more in the left than the right. There were no X-rays or MRIs done, with the doctor stating that it was just simple swelling around the growth plates in the wrists.

no