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Overcoming Gymnast’s Wrist – A Tale of a Gymnast Named Delaney

Overcoming Gymnast’s Wrist – A Tale of a Gymnast Named Delaney

by | Jun 28, 2022 | Sports Medicine

Delaney, 12 of Lewisville, has been tumbling and flipping her whole life, well almost. Starting around 18 months old, this level 7 gymnast practices 20 hours per week. She is so happy to be back in her normal rhythm after a season of modified training because of a wrist injury. Delaney credits her occupational therapist, Lindsey Williams, O.T.R., C.H.T., with helping her focus on new goals to work toward while she was getting better.

After a teammate and her mom described the gymnast’s wrist pain and treatment plan, Delaney and her mom took their advice to see someone at Scottish Rite for Children about her similar complaints. Pediatric sports medicine physician Jane S. Chung, M.D., confirmed that Delaney also had gymnast’s wrist, an overuse injury, in one hand and was showing signs of it developing on the other. The treatment plan started with immobilization, a cast on one arm and a removable splint on the other, and a new approach to training while protecting her wrists. Delaney was committed to this plan. At one point, Delaney even opted to extend her time in the cast just to be sure she didn’t go back too soon. “I wanted to be sure my wrist was ready, so I listened to Lindsey and kept working on my other goals like stretching for splits.”

“We were very concerned when we learned this could affect her growth. She had only complained of pain for a couple of weeks, we are glad that we received the advice to get it checked out.” Delaney’s mom recalls their initial surprise and hopes others will learn to watch out for signs of gymnast’s wrist.

Delaney, and sometimes her brother Luke, have enjoyed the activities that Lindsey has given her to increase the use and strength in her hand, wrist and arm. Delaney and her mom appreciate that Lindsey can talk-the-talk. Her mom says, “she knows gymnastics lingo, and she knows the demands of the sport.” Lindsey worked her magic with Delaney, getting to know her as an individual, looking for her motivations and challenging her to find ways to keep moving forward even when she was ordered to “rest.”

Lindsey says, “I’m excited to see Delaney ready to graduate from occupational therapy and return to her sport. I love my job and seeing kids getting to do what they love makes me love it even more.”

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Learn about overuse injuries in gymnasts wrist.

Gymnast’s Wrist

Gymnast’s Wrist

by | Jun 27, 2022 | Sports Medicine

Success in gymnastics requires a high volume of training and early specialization. Together, these can take a toll on a young athlete’s growing body. Lindsey Williams, O.T.R., C.H.T., is an occupational therapist who takes care of gymnasts with wrist pain. “I really like working with gymnasts because they are motivated and very compliant with their rest and exercises, but knowing this condition is preventable makes me want to help them catch it before it starts.”

Not too many athletes spend as much time on their hands, so this condition is most common in gymnasts. Because of this, it’s commonly referred to as, “gymnast’s wrist.” Take a few minutes to learn more about this condition and how to recognize early signs and better yet, prevent it.

What is gymnast’s wrist?
Gymnast’s wrist is an overuse injury that causes pain and tenderness in one of the forearm bones, the radius. Distal radial epiphysitis is inflammation in the growth plate near the wrist. This injury is seen, not only in gymnasts, but also in active growing children and teens and is more common in girls than boys. This commonly occurs during periods of rapid growth and/or increased activity.

What causes epiphysitis of the distal radius?
A growth center or epiphyseal plate is an area near the end of long bones that allows for continued growth of a bone. This area is made up of soft cells called cartilage. These weaker cells are at a higher risk of injury.  Repeated stress or compression in this area causes damage and inflammation that can be painful.

Activities that require repetitive weight-bearing through the hands, particularly in extension, include:

  • Tumbling or vaulting
  • Impact or loading in wrist extension with cheerleading and stunting
  • High volume or intensity of training

Treatment is imperative to prevent long-term damage of the wrist. Without treatment, continued trauma to this area can cause the growth plate to become bone (ossify) early which may require surgery in the future to correct. With early and proper treatment, most recover well without surgery.

The initial treatment is rest from impact and weight-bearing activities. A gradual and guided return to normal movement and activities is important.

When pain has improved, an occupational therapist (OT) will guide the progression of exercises, and when cleared by the physician, introduce weight-bearing activities and transition back to sport as strength and pain allow.

How long do symptoms of gymnast’s wrist last?
Untreated, symptoms may persist until completion of growth in this area. In time, stronger bone cells replace the soft cartilage cells, but pain may still come and go for months to years.
To prevent recurrence, it is important to continue the recommended exercises and to avoid excessive training and impact. Pain may come back or worsen during sports or strenuous activities and treatment may be started again. With proper management, most athletes can return to their sport within 3-6 months from the start of treatment.

Can epiphysitis of the distal radius be prevented?
Any athlete that participates in repetitive weight-bearing and loading of the wrist is at risk for this injury.

Some actions to help prevent this include:

  • Warming-up and stretching before participating in weight-bearing activities will reduce stress on joints.
  • Limit or vary physical activities to avoid overtraining and overuse. Spread out training for high-impact activities such as tumbling and vault to separate days and allow a day or two of rest between them.
  • Rest when sore or in pain.
  • Maintain wrist and grip strength to help support the joint and absorb some of the impact.
  • Wear wrist braces such as Tiger Paws® wrist supports to prevent wrist hyperextension and help decrease stress on your wrists.
  • Be aware of changes in wrist pain with increases in training time or when training for a higher level of competition.

 Learn about other overuse injuries in gymnasts.

Muscle Strain Q&A

Muscle Strain Q&A

by | Apr 22, 2022 | Sports Medicine

Our world-renowned sports medicine experts are ready to help your injured athlete get back in the game. We have unparalleled experience providing nonoperative and arthroscopic care to treat common sport-related injuries including concussions, ligament injuries and cartilage conditions in the knee, ankle, shoulder, elbow and hip in young and growing athletes.

Sports Medicine expert Jacob C. Jones, M.D., RMSK, shares information about muscle strains and how to handle these types of injuries in young athletes.

What is a muscle strain?
A muscle strain is a disruption of the muscle fibers in a certain muscle group. Muscle strains can be mild or they can be severe, causing muscle tearing.

What causes a muscle strain?
Muscles are constantly being pushed and pulled, but when a muscle contracts at the same time that it is being pulled, a strain can occur. This type of muscle movement is called an eccentric contraction. 

What are the symptoms of a muscle strain?
In mild strains or low-grade muscle disruptions, the most common symptom will be pain in the area. Severe disruptions or tears can also cause swelling, more noticeable weakness, and even bruising.

Should you seek medical treatment for a muscle strain?
It is definitely wise to seek medical treatment for muscle strains. In mild cases, a young athlete may want to consult with their athletic trainer for advice and recommendations on reducing the pain. Athletic trainers can also help determine whether the athlete needs to see a physician for the injury.

Relative rest, in combination with muscle rehab, is the best treatments for a strain. It is important to allow the muscle to heal while also building strength and flexibility to avoid further injury. Even in high grade muscle tears, surgery may not be commonly recommended. 

Are certain muscles more at risk for strains?
Yes, muscle groups that are at the highest risk for strains are those that cross multiple joints. For example, some hamstring and quadricep muscles cross both the hip and knee joints and calf muscles cross the ankle and knee joints. Any muscle can be strained, but those groups are more likely to be injured.

How can you avoid muscle strains?
Muscles are less likely to have a strain if they are flexible and strong. Stretching daily can help provide your muscles with more flexibility and strength. Additionally, it is important to also warm up your muscles before working out or playing a sport. Muscles are less likely to strain or tear when they are warm, so it is important to not skip warm-ups before practice.

What does recovery from a muscle strain look like?
Once pain allows, it is important to do some rehabilitation to the muscle before returning to regular activity. In mild strains or low-grade disruptions, recovery time may take weeks. In more severe cases that lead to muscle tears, recovery time may take months. We look for good range of motion, minimal to no pain, and good strength prior to return to sport.

What happens if an athlete returns to sports or activity before the strain is healed?
The biggest risk of returning to athletics or sports too soon is re-aggravating the muscle and extending the recovery time. Additionally, having a strain may cause you to favor one leg or arm and could lead to further injury.

How can ultrasound be used to diagnose and treat muscle strains?
Specially trained experts can use musculoskeletal ultrasound to evaluate injured joints, ligaments, tendons, muscles and bones. Ultrasound can visualize soft tissues like muscle well with a high level of detail. When looking at a muscle using ultrasound, a low-grade strain may show some edema, swelling caused by fluid in tissue, while a more severe strain that has already torn will clearly be visible. Using ultrasound can also allow physicians to determine where additional treatment or care is needed in treating muscle strains. Ultrasound can also be used for treatment of chronic muscle tears not improving with other conservative measures.

Sports medicine is a medical and surgical specialty that considers the comprehensive needs of athletes and provides management for sport-related injuries and conditions. Young and growing athletes are highly competitive and have unique conditions that require care by a pediatric team of experts. Learn more about our Center for Excellence in Sports Medicine and how board-certified pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other sports medicine specialists work side-by-side with each athlete, their parents and coaches to develop the best game plan for treatment, rehabilitation and safe return to sport.

Spondylolysis: A Common Cause of Back Pain in Young Athletes

Spondylolysis: A Common Cause of Back Pain in Young Athletes

by | Dec 29, 2021 | Sports Medicine

Back pain is a common complaint in young athletes. Most often, it is caused by an overuse injury related to repetitive extension-based motions. Muscles may become fatigued and sore, and some may progress to injury to the structures of the spine itself. Stress placed on the vertebrae (the bones in the spine) due to repetitive movements related to sport participation can lead to a bone stress injury or stress fracture. This condition is called spondylolysis.

Sports medicine physician Jane S. Chung, M.D., says, “Athletes and parents should be aware of the symptoms of spondylolysis, as this is one of the most common causes of low back pain in adolescent athletes that we see in pediatric sports medicine.”

What sports are most likely to cause spondylolysis? 
Spondylolysis is often associated with sports that require repetitive back extension (arching of the back, or bending backwards), such as tumbling during gymnastics or cheer, blocking as a football lineman, dancing or serving in volleyball or tennis. Our experience has been that spondylolysis can occur in any sport, including baseball, soccer and others that are not thought of as involving excessive back extension.

Is this a condition diagnosed in children only?
There are different types of spondylolysis that occur in all ages, but it is more commonly diagnosed in adolescent athletes because of the extreme demands of physical activities and sports.

What symptoms are reported with this condition?
Back pain and stiffness during and after activity are most common.

How is it diagnosed?
A thorough history and physical exam will often provide information that raises the possibility of spondylolysis. The diagnosis is usually confirmed with imaging. Sometimes, if there is a complete fracture or crack in the bone, this can be seen on X-rays. More often, an MRI is helpful to identify stress injuries that may not be visible on X-rays.

What is the treatment for this condition?
Shane M. Miller, M.D., sports medicine physician, says, “With increased demands placed on young athletes including year-round sport participation and specializing in one sport, we are diagnosing this condition more frequently. When identified and treated early, athletes tend to miss less time from their sport, and have a greater success rate of returning to sports and continuing to play at a high level.”

Initial treatment often requires resting from any activity that causes or increases the pain, such as sports, running and lifting weights. In some cases, a brace is recommended to help with pain.

Physical therapy may also be recommended to help improve flexibility and core strength. Muscle imbalance caused by tight hamstrings and weak stomach muscles can be improved with appropriate exercises. Stronger muscles support the spine and help decrease the stress placed on the bones and discs.

Is surgery needed?
It is unlikely that surgery would be needed unless the spondylolysis progresses to a more severe condition called spondylolisthesis. Even with this progression, rest and bracing are often successful. Surgery may be necessary in cases if the non-surgical treatments do not work.

With increasing trends of single sport specialization and the pressure of performing year-round, this is a common injury we treat in our young athletes. Chung and Miller encourage athletes and parents to not ignore these symptoms and to seek further evaluation by a pediatric sports medicine specialist if they are concerned. Early detection and treatment lead to a greater chance of returning to same level of sport.

Learn more 

A Bridge Back to the Game

A Bridge Back to the Game

by | Nov 18, 2021 | Sports Medicine

Specially designed for young athletes, Scottish Rite’s training classes help build strength, conditioning and confidence for both patients following rehabilitation after an injury and participants interested in overall athletic performance improvement.
Program coordinator Ian Wright, P.T., D.P.T., CSCS, USAW, TSAC-F, O.C.S., and additional Physical Therapy team members certified in strength training provide focused, intense instruction so sports medicine patients like Lillian, who has recently recovered from an ACL reconstruction surgery, can return to playing soccer.
“Physical therapy sessions may end long before the body is back to sportready,” Wright says. And that’s where this program comes in. Ninety percent of training class attendees are Scottish Rite patients, and the others are athletes looking for performance coaching and movement training that may help reduce injury risk.
Three individuals performing resistance band exercises in a gym, all wearing masks.
“Even though I’m training as hard as I can, the class is still so enjoyable because you do it with so many different kids who have come through so many different injuries. It’s very inspiring,” Lillian says.

Poor movement patterns are associated with growth and increased injury risk, so an ongoing or periodic conditioning program can be important to young athletes. Training participants attend from one to three classes a week and are categorized based on any activity restrictions and individual skill level coupled with the specific demands of the individual’s sporting position.

“If I could give parents advice, I would say there’s something really remarkable when your child is doing therapy in an environment around other children,” Lillian’s mother, Debbie, says. “To do it around other kids is super, super important. Lillian realized she was not the only one.”

Wright and the team care for the unique challenges of busy student athletes and take external stressors participants face on a daily basis into consideration. “Maybe it’s a stressful midterm week or it’s out-of-season or maybe it’s a hectic game schedule coming up, our therapy staff can adapt and change the classes to fit whatever our participants are going through on and off the court,” Wright says.

The benefits to Lillian are clear to her parents and teammates. “These training classes have actually made Lillian stronger, faster and given her more confidence,” Lillian’s dad, Sergio, says. “It’s created such a good habit, and she’s able to break away with the ball so easily now.”

For information about attending the training classes, contact Therapy Services at bridgeprogram@tsrh.org