Coaches Injury prevention

[gymisforeveryone]

What do you do in your gym to prevent injuries? I'm mostly interested about overuse injuries and especially back problems since that is something that my gym is struggling with.

We have three competitive groups and the injury statistics don't look that good to me right now.

The lower compulsory group has one girl with un-diagnosed back pain, one girl with spondylosis (out of gym for 3 months), one girl with ankle overuse injury and 2-3 girls with jumpers knee

The upper compulsory/lower optional group has had three girls with pre osteopathy in the lower spine. Two of them are healed now and the third one just showed up. One girl had severe jumpers knee problems but is mostly healed now (was out of normal training for 3 months)

The upper level optional group has 2-3 girls with back pain (one of them refuses to go to see a doctor because she's so scared of hearing the diagnosis), one girl recovering from a elbow dislocation and fracture, one girl almost fully healed from wrist dislocation and fracture. One girl has Severe's.

The back problems in all of the groups make me super worried. I want to do something to prevent them but so far everything that comes to mind is doubling the core conditioning and limiting the back bends and hard landings to the minimum numbers.

How are the statistics in your gym and what do you think about them?

 

[raenndrops]

45 girls ... We have 3 that we are extremely limiting bridges and back walkovers as prevention (PT suggestion). One has Ehlers Danlos- Hypermobility Type. The other two have had back pain in the past, but no official diagnoses even after several tests.

We do have 6 in knee braces: 2 with ED-H, 2 with structural knee problems (one just had surgery on knee #1 and will have surgery on knee #2 after track season), 1 with a history of sprains, and 1 that wears one as needed for occasional knee instability.

There are around 4-5 with ankle braces, 3 with cheetah cups for Severs, and 9 wear tiger paws for Floor and Vault.

We actually have 3 girls on team with diagnosed ED-H and one waiting for her appointment to be tested. They all do their PT recommended "training" and tape / brace as needed.

As a gym, we already limit the numbers of BWO and bridges. We have the girls "rock and roll" after bridges because it helps.
We also have short practices, so there isn't much time to worry about getting high numbers on anything.

 

[Aussie_coach]

Doubling conditioning is not nessesarily the answer. How much time is spent on conditioning now?

Strength and flexibility testing is very helpful. Before you even put a kid on any kind of team, I would start with a strength and flexibility test. If there are any deficiencies, they should be corrected before starting Team, because skills as such as back walkovers, as we well know cause back pain. I would be consistently testing the kids on their strength and flex and be working on any weaknesses.

If a gymnast lacks flexibility in either their hip flexors or their shoulders, then when they do back walkovers, they will need to compensate by bending excessively in the lumber spine. In a Team gymnast, this is going to eventually lead to back pain, and if not treated stress fractures in the back.

Ankle and foot strengthening exersices and wrist and grip strengthening exercises should be included in the program daily to avoid chronic wrist and or ankle pain. These joints work hard in gymnastics and they need to be very strong. The way you structure your work outs is also important. If you have the kids on their hands a lot, don’t back it up by another set if skill work on their hands. If you have stations on their hands in a circuit, vary it with stations not using their hands etc. The same with a lot of rebounding work. Switch it up.

Knee pain is reduced when the thighs and bottom are very strong, so work this a lot too. Avoid leg exersizes like pistols that require extremely deep bends, as these stress the knees and not in a good way.

A lot of work on hard surfaces is not great for the joints, so making sure tumbling and dismounts are done onto softer surfaces, in drills etc and not just always on a competition surface, helps to reduce pounding on the joints. Dismounts in particular cause more risk, so these should be limited and softer surfaces used where possible.

Short practices aren’t nesssesarily the key either. When practice is short it can cause catches to feel pressured to shorten warm ups, not do enough drills etc. But research has shown once practices pass the
3 1/2 hour mark, the risk of injury gets significantly higher. As does training tool early in the morning or too late at night.

Puberty is also another big factor. Girls have a much higher risk of injury from 11-13, when they are going through significant growth spurts and body changes. This can occur earlier or later, depending on the physical development of the child. How you time your team experience will often lead to major injuries at this age. This is one of the key reasons to take kids onto team at a young age. If they are significantly increasing their hours, training intensity etc at this age, then they are significantly increasing their injury risk. Fundamental optional skills and training regimes should be in place before kids reach this age, especially around 13. Coaches need to be wary of the vulnerability of this age and back off the nu,bed and be guided by physics as issues arise.

Next thing to be vary wary of is training through pain. This should be unacceptable in your program. Issues dealt with early are likely to be corrected quickly. The only times I have every seem a gymnast or any athlete have a truly career ending injury is when they continued to push through and made the problems worse. Allowing a gymnast with chronic back pain to continue training, and refuse to go to the doctor out of fear of the diagnosis is also neglect on the part of the gym. I would not allow her to continue training until she has been looked at. So,times the issue is the kids and sometimes it is the parents. I have in the past suspended a gymnast from training until she produced a doctors certificate to confirm there were no fractures and she was safe to train. Amazing how fast it happened then.

 

[gymisforeveryone]

Thank you both!

The practice hours are: lower level compulsories 9 hours a week, higher level compulsories 12 hours a week and the optionals do 15-18 hours a week (15 for those who are not in the morning program). The practices are never longer than 3 hours. This is the ideal situation but actually we have pretty many cancelled practices because we don't have an own gym and the gym that we are using is closed pretty often because of other events. The time spent on conditioning is currently roughly 2,5-3 hours for the lowest group, 3,5-4 hours for the second group and 5-6 hours for the optionals. We are now doing planning for the next season and I think that we should use more periodization and more individual conditioning excercises. And we should tilt the focus towards core conditioning.

Now that I think this deeper I think that the flexibility is a factor that almost all of the gymnast are lacking. They have splits down etc but a physical therapist that visited us a few months back mentioned that most of the optionals seem to have tightness in the hamstring area and cluteal muscles. We also have many with pretty tight shoulders. We all do much of upper body conditioning but not enough stretching for the shoulders, arms and wrists. I feel like we don't have enough time at the end of the practice, the strength training almost always takes longer that we planned and then we have all the cleaning up to do before going home... So the time spent on stretching at the end is usually under 10 minutes.

You also made some good points about puberty and injury risk. Unfortunately most of our gymnasts have not started training at a young age (something that we current coaches had no control over) and they are practicing hard skills and increasing hours around puberty. That's something we cannot change now but of course we are putting the effort on the new young pre team gymnasts and they will hopefully have easier time when they enter puberty.

The one gymnast who refuses to see a doctor... I'm planning on talking to her again and making her promise that she'll go. She comes from a super athletic family (her grandfather, dad and brother were/are professional athletes in a different sport) and I think that she has just accepted the mentality to train through pain, she's dedicated and ambitious and has set herself high goals for a national competition that takes place at the end of May. I know that she knows that if there's something in her back, she'll have to miss 3 months of normal practice and that will most probably make it impossible for her to compete in May. But I will tell her that if she doesn't go to see a doctor I will contact her parents and tell them to take her even if she doesn't want to. I have tried to explain to her that every day she trains through pain the situation will probably get worse. I'm sure she doesn't want to face a career ending fracture in her back.