Wrist pain is a very common issue in gymnastics due to the nature of the sport. With the high frequency and force production that a gymnast experiences can place excessive stress on the wrist joint during weight bearing skills, which include by are not limited to handstands, tumbling, vaulting and single hand transitions on the uneven bars. Some research suggests that forces up to 2.5 times an athlete’s body weight can be loaded through the wrist during some gymnastics skills, and up to 5x during heavy tumbling and vaulting. These numbers are most likely to dramatically increase if a gymnast performs “short” tumbling with shallow joint angles or during uneven weight bearing that may occur during skills.

Overuse stress forces

As gymnasts, many athletes simply know how to “push through the pain” not fully understanding the consequences that may develop further down the road. If the issue is left unaddressed, the overuse stress forces may progress into a variety of problems like tendonitis, bone bruising, ligament damage, growth plate irritation, scar tissue build up, and possible stress fractures.

Overall, the structures of the wrist and hand are not designed for heavy weight-bearing, like the ankle joint is, which in turn compromises the internal joint stability during excessively high forces. Further understanding the concepts as to why a gymnast may develop wrist pain, in addition to several techniques to help an athlete possibly manage their problems, are described below:

Functional ability

A huge contributor to wrist pain is the functional ability of the structures and joints above the wrist. These include the elbow, shoulder, scapulae (shoulder blade) and thoracic spine (upper to mid back region), as well as the adjacent muscles surrounding these areas. Problems can arise if there is a lack of mobility and poor arm alignment, static stability (e.g. handstand) or dynamic stability (e.g. handsprings and other movement skills). When the alignment of the entire chain is not functioning properly, the small stabilizing muscles are not able to do their job causing unnecessary compression stress and instability within subsequent joints.

Muscle tightness & restricted mobility

Muscle tightness and restricted mobility within the arm, shoulder and spine can additionally be considered as a possible cause to wrist pain. The chain of muscles in front of the arm connects to muscles in the chest and the back such as the pecs, lats, biceps and forearm flexors – all contributing to wrist range of motion. These structures are linked through a fascial layer that can create tightness throughout the whole assembly. In the majority of cases, there are two limiting factors to the ability to move into excessive wrist extension: tightness in (1) forearm flexors muscles – front part of the arm; and (2) latissimus dorsi muscles – back muscles.

Range of motion

Another contributing factor to the development of wrist pain in a gymnast is their available range of motion in the wrist – how far the wrist can move into extension (bend backwards) comfortably. In normal motion, the wrist joint usually permits about 70 degrees of extension for everyday use. Gymnast often develop hyper mobility in the wrist joint, attaining about 80 degrees of motion comfortably. However, when the athlete is in a handstand or performing a skill, the force goes far beyond the 80 degrees, often up to 90 -95+ degrees. If the gymnast lacks the ability to move their wrist joint into hyperextension, the joint will push past its limitations leading to pain symptoms.

Use of wrist guards

A common use of protection against wrist pain is wearing wrist guards to limit the hyperextension motion during gymnastics-specific weight bearing skills. More often than not, an athlete who has discomfort in their wrist will most likely have poor joint mobility and flexibility throughout their upper body. Wrist guards are used for wrist joint protection against the high weight bearing forces, however they do not make a gymnast more flexible elsewhere. They may be worn to limit pain symptoms, but the gymnast needs to address the leading causing and/or combination of causes to their wrist pain. Becoming dependent on wrist guards all the time tends to limit the strength development in the wrist flexor and extensor muscles – affecting joint stability and grip strength.

What is Sever’s disease?

Although the name sounds pretty frightening, Sever’s disease is a common heel injury that occurs in children, especially those who participate in high-impact sports such as gymnastics. Sever’s disease, also called calcaneal apophysitis, is a temporary painful bone disorder that results from inflammation (swelling) of the growth plate in the heel. Typical onset usually occurs during the growth spurt of adolescence, beginning at any time between the ages of 8 and 13 years old for girls and 10 to 15 years old for boys. The condition rarely occurs in older teens due to the fusion of the growth plate and bone maturity.

Possible Causes

• “You are 1 in a million”

  Or so the saying goes, which happens to be 100% true. In terms of risk for injury, it is important to understand the difference between a young athlete’s chronological age and developmental age. For example, an athlete may be “12” years old, but developmentally may only be “11” as seen in late bloomers. Understanding this concept of long-term athletic development is crucial to appropriately adjust training conditions. In doing so, can help the young athlete through a high risk injury period with as minimal symptoms as possible.

• Poor Landing Mechanics

  Although there is not one perfect way to land in gymnastics due to the variability in skills, it is important for each gymnast to learn and practice landing mechanics with use of a proper squat. It is very common for a gymnast to demonstrate a very stiff, feet together, knee dominate, hollowed spine landing – increasing the force of the load at the ankles. Therefore, using proper squat form becomes essential to help control high forces throughout the legs by dispersing the load up the chain.

• Mobility verses Stability

  Another high indicator to the onset of Sever’s disease is how the structures above the ankle joint are functioning. Problems can arise if there is a lack of mobility and poor lower leg alignment, static stability (e.g. standing on a single leg) and/or dynamic stability (e.g. movement skills). When there is poor muscle control from the foot to the ankle, ankle to the knee and up to the hip, the alignment of the leg becomes unstable. This can lead to reduced function of the small stabilizing muscles, allowing the bigger muscles to over-perform (e.g. calf muscle).

Pain Management

The immediate goal of treatment is pain relief. Because symptoms generally worsen with activity, the main treatment for Sever’s disease is REST to allow a decrease in pressure on the heel bone and decrease in swelling, ultimately reducing the pain. Additional treatment can include possible immobilization (boot), ice, and medication for the reduction of inflammation.

Protecting the heel itself, may also reduce the pain symptoms of Sever’s disease. It is important for the athlete to select a shoe that provides the proper heel lift and/or arch support to decrease the stress on the calcaneus and Achilles’ tendon. Heel lifts or heel cups, which can be placed in a shoe or taped to an athlete’s foot for barefoot activities, can be used to prevent excessive stress on the bone and adjacent structures.

So what can be done to improve flexibility and decrease the stress to the heel?

The following exercises can be performed to increase ankle range of motion, stability, tendon extensibility and strength:

1. Calf & Heel Cord Stretch

Hold your stretch for at least 30 seconds up to 1 minute for each position.

2. Single Leg Balance

At first you may use your hands, like holding onto the back of a chair, table, or the wall. As balancing gets easier, takes your hand(s) away and place them out to the side. Challenge yourself by bringing your arms across your chest. Close your eyes for an even greater challenge.

3. Heel Raises

Count to “3” on the way down to focus on the motor control and calf strengthening without excessive side-to-side movement.

4. Lunges

Focus on alignment of your knee over your ankle to maintain ankle stability.

* Strengthening exercises can be performed 10 times for 2 sets of each activity.

CrossFit has become one of the most popular workouts in the last few years. The main goal is to improve “general” fitness for athletes, bodybuilders and pretty much anyone who wants to get in the best shape of their lives. It is advertised as an effective muscle-building program that incorporates varied functional movements executed at high intensities, which may lead to significant injury if safety is not the top priority. The effective results of CrossFit is a product of the 10 Physical Skills Model philosophy that includes the following:

The Workout Of the Day (WOD)

To incorporate all the areas of the Physical Skill Model, all workouts will consist of a variety of free weight movements, Olympic lifts, bodyweight exercises, plyometric and aerobic activities. The typical setup of a CrossFit workout is as follows:

• 10-minute dynamic warm-up: A combination of active stretching and light warm up activities using movements that will be incorporated during the actual workout.
• 20-30 minutes of strength development: Strength building with heavy, low volume, intense weightlifting or the building of technical skills. Such activities include Olympic lifting and/or gymnastic movements that require a large amount of skill and practice.
• 10-20 minute WOD: Comprised of 4-6 different exercises or aerobic activities that is based on the number of “rounds”/sets that can be completed within a given amount of time. Such exercises can include burpees, sprinting, box jumps, push-ups, pull-ups and/or kettle bell swings – just to name a few.

The Competition

CrossFit is based on a team/group workout environment. The workouts can be performed on your own, however it is encouraged to participate at a CrossFit gym, known as “the box.” All participants in the class warm-up together, work on skills together, and perform the workout of the day (WOD)—pushing, encouraging and helping each other along the way. Each WOD involves an effort to beat the time/rounds that was required for the workout previously performed, which leads to competition not only with yourself but competition with those around you.

The Controversy

With any exercise program, there are plenty of risks and contraindications – especially when the workouts are performed with poor technique. No matter what type of exercise you do, improper form is guaranteed to lead to injury. However, with CrossFit, the risk of injury is even greater due to the emphasis on time and speed. Done in a competitive group environment, it is very easy for one to over exert themselves leading to a compromise in form. Injuries may also occur due to the complexity of the movements used, requiring significant joint mobility and adequate motor control.

Additionally, CrossFit is a risk factor in the development of rhabdomyolysis – a rare, but serious muscular injury. Rhabdomyolysis is a condition where excessive strain is placed upon skeletal muscle causing breakdown of the tissue fibers resulting in severe damage. The ruptured muscle cell(s) can leak contents into the blood leading to kidney dysfunction and/or failure. Of course, just doing CrossFit does not mean you will develop the condition, however it is always essential to understand the risk factors prior to participation in this form of exercise.

Education

As CrossFit becomes the leading exercise craze, it is very important to become educated about the fitness program and any potential risk factors that you may be subject to. From personal experience, CrossFit is an amazing workout, and when done correctly, can lead to great results in muscular strength and endurance. To make sure that you properly prepared, make sure that:

• Your CrossFit Coach has the appropriate educational background with supporting credentials.
• You have participated in a basic strength training program – Exercise newbies have an increased risk of injury.
• Your health permits such vigorous exercises.

Are you sitting at your desk ALL DAY during school/work hours?

Are the tasks that you are responsible for constraining you to your desk chair?

Do you find yourself with progressing neck and/or back pain when sitting at your work station?

The American Medical Association (AMA) reports that sitting for extended periods of time can be detrimental for one’s personal health. Research has shown that individuals who sit for long periods of time (more than half of their waking hours) have a:

• 112% increase risk of diabetes
• 147% increase risk of cardiovascular events
• 90% increase risk of death caused by a cardiovascular event
• 49% increase in mortality from any cause

Every 45-60 Minutes

Standing and/or moving around for 3-5 minutes every 45-60 minutes has been a helpful tip in reducing your time sitting. You can set an alarm to remind you, stand up when talking on the phone, and/or take walking breaks. Below are some effective positions that you can do right at your desk! These exercises will help you take a mental breather and make sure that your neck, back, hips, arms and wrists remain pain free and in good condition to continue productivity.

Forward Fold

When sitting, place your legs wider than hip-distance apart. Inhale and exhale as you bend forward towards your legs. Inhale and round your back, exhale and relax your entire body into your lap. Drop your head between your knees for complete relaxation of your neck. Hold for 5 to 8 deep breaths, then exhale when bringing your trunk back to sitting, resting posture.

Seated Twist

Inhale and turn your shoulders to your left. Use your left hand on the back of the chair to slowly deepen the twist. Hold for 5 to 8 breaths, then exhale when bringing your body back to neutral position. Rest and repeat to the right.

Downward Facing Dog

Inhale and place your palms at the edge of your desk or chair (only if chair is stable). Spread your fingers part and stretch through the palm of your hands. With your arms straight, walk backwards until your body is in an “L” shape. With soft knees (not fully straight), deeply exhale and allow your chest yearn towards the floor. Hold for 5 to 8 deep breaths, then exhale when bringing your body back to neutral, upright position. May also be performed in seat position, as in the picture on the right.

Chair Pigeon Pose

Inhale and place your left foot onto your right knee. Exhale and let the left knee slowly lower towards the floor, opening up the left hip. Keep your back straight. Slowly lean forward for a deeper stretch, if needed. Hold for 5 to 8 deep breaths, then exhale when bringing your left foot off of your right knee. Rest and repeat with the right leg.

Seated Mountain

Inhale and lift your arms overhead; clasp your hands and rotate your palms towards the ceiling. Hold for 5 to 8 deep breaths, then exhale when bring your arms slowly downward to resting position. May also be performed in the standing position.

Neck Stretch

Inhale and sit up tall placing your right hand under your thigh and your left hand on top of the right side of your head. Exhale and gentle bring your left ear down towards your left shoulder. For a deeper stretch, gently rotate your head towards your left arm. Hold for 5 to 8 deep breaths, then exhale when bringing your head back up to neutral position. Rest and repeat with your right hand on top of the left side of your head.

Do you just feel too tired to function?

Do you feel like sitting on the couch and relaxing rather than getting your body up and moving?

How do you find motivation to participate in a workout after a long day of work?

A famous quote by Woody Allen puts it all into perspective: “80% of success is showing up.” It does not matter if you work out at a fitness center, the park, in your backyard or on the living room floor. The 80% can be difficult, however, it is possible with a little bit of motivation! Below are 10 tricks that I like to use to motivate myself to stay active regardless of a busy 40-hour work week:

• 1. Schedule time!

  If you feel like you NEVER have the time to work out, you have to learn how to MAKE the time. According to research, the Department of Health and Human Services recommends the following guidelines:

  Aerobic Activity: 150 minutes a week of moderate aerobic activity. Guidelines suggest that you should spread out the duration of exercise during the course of a week, equaling 30 minutes a day for 5 days per week. Moderate aerobic exercise can include brisk walking, swimming, riding a bike and/or dancing.

  Strength training: Strength training exercises should be done at least twice a week at no specific amount of time interval. Strength training can include weight machines or activities such as rock climbing and/or gardening.

• 2. Buddy system

  The buddy system can be defined as a cooperative arrangement whereby a friend, significant other, and/or trainer teams up with you to assume responsibility. The pair of you operate together in order to monitor and help each other succeed towards your goals. Having a “buddy” will make you more accountable in going to the gym, because they are relying on you to be there! A “buddy” can also be a good motivation when trying to push through difficulty workouts and/or provide encouragement for a JOB WELL DONE!!

• 3. Positive thinking

  Positive thinking helps with stress management and can even improve your overall health! Some studies show that personality traits like optimism and pessimism can affect many areas of your health and well-being. Optimistic people tend to live healthier lifestyles and are more likely to engage in physical activity and follow a healthy diet. Additional health benefits to thinking positively may include, but are not limited to the following:

  • Greater resistance to the common cold
  • Lower rates of depression and/or stress
  • Better coping skills during hardships
  • Reduce risk of death from cardiovascular disease
• 4. Reward yourself

  Because, why not reward yourself after a gym session? You have worked so hard, you deserve one! Such examples can include treating yourself to your favorite meal, online/television mental break, and a little retail (controlled) therapy. Bribing yourself to workout is not a bad thing! Just make sure that it is reasonable and in moderation.

• 5. Never miss a Monday!

  The start of the week is actually a great time to recommit to staying fit. According to the American Journal of Preventative Medicine, research shows that people tend to think about and act upon being healthy and participate in activities more on Mondays than any other day of the week. Working out on a Monday will also motivate you in setting the tone for the rest of week.

• 6. Enjoy the activity

  Find an activity that you love doing! Exercise should be fun, and if it isn’t then try a different kind of activity that you enjoy. By knowing what you love to do is half the battle in getting yourself to stay active. Have fun!

• 7. Appropriate Wardrobe

  Having an appropriate wardrobe can also make you feel more athletic and encourage you to workout more often. Choosing the right fitness clothes is important to stay comfortable and avoid embarrassing fashion disasters at the gym. It is a good way to provide foot/ankle support and protect you against injury to foot, knee, hip and back. Guidelines to picking out appropriate wear may include:

  • Invest in a quality, active specific shoe
  • Easy to move in clothes (no jeans)
  • Comfortable socks to decrease friction and risk of blisters
• 8. Start slow

  It is OKAY to go at your own pace. Do not get discouraged that someone can walk/run faster than you on the treadmill or that you cannot lift a 10 lb. dumbbell during Boot Camp class. There are plenty of ways to modify an activity! If you do not know how to go about modifying a specific movement/activity, do not hesitate to ask.

• 9. Mental vs. Physical fatigue

  Instead of spending $3.00 for another Starbucks or a can of energy drink, exercise! Research has shown a link between mental fatigue and physical fatigue. It demonstrated that participants stopped exercising 15% earlier when they were mentally exhausted. No wonder you just want to relax after a long work day! However, only after 20 minutes of exercise, you will increase your brain’s release of dopamine, norepinephrine, and serotonin. These natural occurring chemicals in the brain promote energy level and reduce fatigue by enhancing your mood.

• 10. JUST DO IT!!

  It is not only a good slogan for an athletic shoe (Nike), it also makes for a good slogan for an active lifestyle. Saying to yourself that “Today, I am going to TRY to go workout” will always set you up for failure. To “try” is to make an attempt, which does not always follow through especially when you are faced with resistance (e.g. dinner with friends, date night, favorite TV show, etc). Make exercise a habit! When you make it a habit, you will find yourself more willing to participate in activity without excessive effort.