For Parents Overuse Injuries in Young Gymnast

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bogwoppit

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Thought it was very interesting. We have had many dicussions in the Parent forum about pain and gymnastics.
 

gymjourneymom

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Mar 9, 2008
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Thank you Buckhead for posting this informative link:) It's interesting that this MD recommends Tiger Paws for ALL optional gymnasts. I know that is a controversial recommendation among coaches, but his medical explaination does make sense.
 
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bpatient

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Why Tiger Paws are controversial

It's interesting that this MD recommends Tiger Paws for ALL optional gymnasts. I know that is a controversial recommendation among coaches, but his medical explaination does make sense.
As Dr. Marshall noted, Tiger Paws not only limit the wrist hyperextension that can produce dorsal wrist pain, they also--by design--redistribute the load on the joint. With that in mind, it's important to understand that all growing kids do not have the same joint conformation: While there is considerable variation even among children of the same age, in general the ulna (the smaller bone in the forearm) is comparatively shorter than the radius (the larger bone) in younger kids than in older adolescent or skeletally-mature athletes. Thus a device that correctly redistributes the load in an older athlete (e.g., a girl with a comparatively long ulna) might be inappropriate for a (typical) child or adolescent with a shorter ulna.

The role of protective wrist braces in young gymnasts used to prevent wrist pain has not been studied. Biomechanical and clinical studies indicate such devices may protect against acute injury and may reduce ulnocarpal joint pressure during loading. The latter finding may be more applicable to skeletally mature gymnasts with positive ulnar variance. Biomechanical studies of wrist bracing have not been performed in specimens with negative ulnar variance. Thus, the potential effects of using such braces in young gymnasts, who typically have negative ulnar variance, are not known. [DiFiori, JP, Caine DJ, Malina RM. Wrist Pain, Distal Radial Physeal Injury, and Ulnar Variance in the Young Gymnast. Am J Sports Med. 2006 May;34(5):840-9.]

As DiFiori and others have noted, it's plausible that simple mechanical protection from wrist hyperextension may protect against acute wrist injury and, by reducing loading across the joint, could be beneficial in the context of repetitive loading for some athletes. Although the one-padding-type-fits-all approach with Tiger Paws may be imperfect, the devices might be helpful.​

Unfortunately, Tiger Paws seem to be controversial for an unrelated reason: Some coaches clearly misunderstand the nature of these common wrist injuries in young gymnasts, and think that they are due to weakness; with that mindset, Tiger Paws may be thought to further weaken the forearm muscles or at least to interfere with attempts to strengthen the muscles that act across the joint. Oops.​
 
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bpatient

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Some benefits of Ezy ProBrace from Gibson

Note that the objection I mentioned to Tiger Paws (the one-padding-type-fits-all approach to support for gymnasts with ulnas that are either relatively short or relatively long compared to the radius) is addressed by the Ezy ProBrace, which is available from Gibson.

Gibson Athletic - Gymnastics Equipment, Gymnastics Grips & Mats, Ballet Bars, Cheer & Fitness Equipment

The patent discussed below indicates that the palm pad can be adjusted to accommodate athletes with various problems, or the pad can be removed entirely (to retain the beneficial protection from hyperextension while leaving the palm free).

Variance wrist brace - - US Patent 4881533


Although the Ezy Probrace may have some significant advantages,Tiger Paws seem to be the dominant product in this small niche; I've never seen the Ezy ProBrace--I only learned of the product by reading of some experiments on force transmission in wrist joints. My dd's mild wrist pain is responding very well to a program of rest followed by a gradual return to pain-free activity and limited training hours, but perhaps I'll order the Ezy ProBrace for her--might help. . . . (Also, since my child is an eleven year old in a ten year-old body (radiographs show that, like many gymnasts, her skeletal age is well below her chronological age) with negative ulnar variance, the Ezy ProBrace might be a good match for her--although I'd guess that she will prefer to use just the dorsal wrist support and to leave her palms free.)
 
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Granny Smith

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Although the Ezy Probrace may have some significant advantages,Tiger Paws seem to be the dominant product in this small niche; I've never seen the Ezy ProBrace--I only learned of the product by reading of some experiments on force transmission in wrist joints. My dd's mild wrist pain is responding very well to a program of rest followed by a gradual return to pain-free activity and limited training hours, but perhaps I'll order the Ezy ProBrace for her--might help. . . . (Also, since my child is an eleven year old in a ten year-old body (radiographs show that, like many gymnasts, her skeletal age is well below her chronological age) with negative ulnar variance, the Ezy ProBrace might be a good match for her--although I'd guess that she will prefer to use just the dorsal wrist support and to leave her palms free.)
I am in the same boat. My dd is a 12 yr old in a 9 yr old body (determined by her Endocrinologist - bone age scan), she is very far from even starting puberty, her growth plates are wide open. She is a L8 this yr and in addition to all the backward tumbling, she has been doing giants for well over a yr and is now doing a Yurchenko vault. The amount of pressure that is being applied to her wrists has definitely increased. My goal is to keep my dd healthy while she is in this sport so that she can last through college if that is what she chooses. I may talk to her coach about the Ezy ProBrace and see if they would allow her to wear it at least for vault. Most braces are discouraged and not allowed in our gym, so at least I could ask and see what they say.

Thank you rbw for your timely post, it was very informative.
 

Imat3

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Jan 10, 2008
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rbw, thanks for posting all the useful information. My daughter has recently had a growth spurt and with that has had increased pain in her wrists. It has gotten to the point that she has just had an MRI...we should get the results in a few days. She uses Lion Paws (which I found out are the original and better than the knock-offs). I think the ez probrace sounds like it might be worth trying to see if it gives her relief from the pain. She has now taken about 4 weeks off of weight bearing stuff and is very anxious with our competitive season coming up. I really do appreciate all the information you have posted....very helpful.

Imat3
 
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bpatient

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I hope that I haven't confused anyone--but I'm a bit confused, myself. While I think that the Ezy ProBrace sounds good for the technical reasons that I mentioned, the fact that it might ride up the wrist (and reduce its effect on hyperextension) if the removable palm pad is not used could be an issue for my child. I just discussed this with a helpful coach/saleswoman at Gibson, who recommended the Tiger (or Lion!) Paws-type support for that reason.
 
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bpatient

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So what would they recommend the EZ support for?
I think the Ezy ProBrace was originally developed to deal with the forces of pommel horse work. Since I haven't seen that type of brace, I'm not sure how suitable it would be for female gymnasts. I'd be interested in hearing from anyone who is familiar with the use of the Ezy ProBrace for women's gymnastics.

One tiny study (only fourteen gymnasts with chronic wrist pain) seemed to suggest that the Ezy ProBrace (with the pad in place) more effectively reduced wrist pain than did the Ezy ProBrace without the pad, Tiger Paws, or a neoprene brace, and that athletic tape wasn't helpful. There were no comments regarding which type of brace the gymnasts preferred or found more acceptable during athletic performance, etc.
 
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bpatient

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Some of you may be interested in this material, which I extracted from an interview with Dr. John DiFiori (the first author of the paper on gymnast's wrist injuries that I quoted earlier); I believe this was from Training and Conditioning magazine in May/June of 2000.


What, then, are some of the signs and symptoms [of overuse injuiries] that you look for in a clinical evaluation?

. . . [W]hat you want to do is get at the cause of the problem, not just the extent of the injury. For that, the most important thing is to get a thorough history from the youngster. Analyze the training program in the weeks preceding the injury. Because these injuries are generally caused by problems in training, the questions should focus on uncovering any changes in training intensity, frequency, or duration. . . . Next, find out when the pain is worse—whether it’s during activity, just after activity, the next day—and specifically what actions make it worse. . . .

Once you have made a diagnosis of one of these growth-related disorders, what are some of the treatment considerations?

Rest and icing the injury are recommended to interrupt the overuse process. Then, a program of rehabilitation is implemented. . . . Return to activity should be preceded by a gradual resumption of sport-specific skills. Pushing through that phase too quickly can lead to re-injury. . . . If the child is going to return to sports, anything improper in the training has to be corrected. . . . It’s important to include the child’s parents and coach in the discussions, to make sure they understand what’s needed to prevent another injury.

In getting them back to their sports, we really focus in on any training errors that resulted in the injury in the first place, such as changes in frequency, duration, intensity of training, whether there have been proper rest periods as part of the training program, whether there’s been an appropriate progression of training with those periods of rest. The training always needs to be individualized in the sense that one child may be progressing at a much faster rate of maturity than another.
 
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