This post was 100% inspired by Chris Johnson of Zeren PT, who recently wrote a great piece related to common things he seems to always say to injured runners. I laughed to myself when I saw the title, because of how true it seems to be. When you spend a lot of time working with a certain population (myself with gymnasts, Chris with runner, etc) patterns emerge. I always try to take the “N of 1” approach making every patient evaluation/ program individualized. With that said, I do seem to end up discussing similar concepts with many gymnasts despite having different injuries. Here is my version of Chris’s 10 phrases in relation to the gymnastics population.
1. See The Forest Behind The Trees: Being a coach and former gymnast, I know there are times where managing an injury to compete in a big meet will come up. With that said, in 95% of the gymnasts I work with this phrase leads to discussing how short term rest and taking care of an injury will lead to significant gains in the long term. I recently said to a level 10 gymnast I was working with “would you rather make regional team this year with a nagging injury and suffering performance, or make national team next year pain free firing on all cylinders?”. A big light bulb moment for her.
2. The Same Issue That Contributes To Injury, Limits Performance: It’s often really hard to get someone on board with the importance of preventative injury approaches, or taking time for “boring” pre workout exercises. However, I tell gymnasts the same hip extension control issue that is causing their back to hurt is also draining their tumbling of power output to fully extend the hips for double backs. Taking the time to step back and address the movement issue can help for both.
3. Strength and Control Are Two Very Different Things: Despite being ripped and having a 6 pack, many gymnasts I work with lack proper core control. This means they are unable to coordinate their core unit to protect their spine against high force leading to injury. It also in turn means they can’t maximally produce the power they want during skills. Being able to carefully dial in movement patterns, brace the entire core unit together, and handle inevitable errors during skills all fall into the control category. I feel a big contributing factors to common gymnastics injuries is always living in a high threshold, power output state and not being able to use low threshold, fine tuned reflexive control.
4. Only Passive Stretching Doesn’t Change Movement I can’t tell you how many gymnasts come to me with shoulder or hip injuries that are partially caused by aggressive passive stretching methods. They many times are stretching already hyper mobile joints, and may be stretching the area that isn’t really the issue. Read this article for more insight, but I strongly feel doing only passive stretching is dangerous before high force training. I also don’t think it will automatically transfer over to better hip or shoulder angles people are looking for during skills. To make changes stick you have to first learn to use the new range of motion and then apply it to skills. These are both important steps that many people miss.
5. You Have Plenty of “Flexibility”, You Just Don’t Know How To Access It: Similar to the point above, I see many gymnasts who with active movement appear to have tightness but when you check their range of motion passively they clearly have enough. In this case, they likely don’t need more mobility interventions and should pursue drills that challenge the gymnast to use the range. Then between good strength programs and skill technique it can be held onto. I think people missing this concept sparks a lot of overuse injuries and headaches /frustrations related to skill development.
6. The Site of Pain Usually Isn’t Site of a The Problem : In the case of accidental or traumatic injury (like ACL tear), the site of the pain is definitely the issue. However, in many overuse injuries I see the wrist or lower back that hurts isn’t what needs to be tackled. For the wrist it’s commonly a lack of thoracic mobility or overhead motor control. For the lower back pain it’s commonly poor hip extension control and lacking motor control to “spread the bend” across the entire body system during skills. A detailed movement assessment is always need to get to the root cause, rather than just guessing and blindly applying some exercises seen online.
7. You Must Jump and Land Properly: There probably isn’t one perfect way to land for every gymnast, and rarely will it be the same because of so much variability in skills. With that said, I am constantly spending time with gymnasts, coaches, and parents talking about why landing using a proper squat form and angular displacement through the hips is essential to help control the high forces of gymnastics skills. This is opposed to what many gymnasts come in and show me which is a very stiff, feet together, knee dominated, hollowed spine ,and usually painful landing. I have treated many gymnasts with spine and lower body nagging/recurring injuries that saw huge progress when they learned a proper squat and applied it to all of their landings in training. As a coach, I harp on my gymnasts at practice for proper landings just like I do their skill technique.
8. Don’t Fear Weights: I wrote this article after finding myself say this over, and over to patients. There are many myths and misconceptions of using weights with gymnasts. If the forces of gymnastics are more than the gymnasts body system can handle, the chance of overuse injury and acute injury grows. Weight training is one research supported (article here) method for reducing risk. Not only this, when done properly it can skyrocket power output and performance for gymnasts. Granted, you need to work with a good strength coach who understands programming and technique. In my opinion, periodized strength programs with well thought out exercise selection are essential to a gymnasts safety and success.
9. Everyone Grows At Different Rates: Someones chronological age and their developmental age are very different. Despite someone being “12” they may really be a late bloomer and developmentally may be barely 11. Quite a few patients I have worked with were very talented, but haven’t developed yet, leading to higher level skills like releases or big tumbling passes causing injuries. Gymnasts, parents, and coaches need to understand this concept of long term athletic development and make sure they adjust training appropriately. Doing this can help get a young athlete through a high risk injury period with a lot less headaches down the road.
10. It’s Up To You Apply What We Change To Skills: With every gymnast I work with, I try to emphasize that what we talk about and do in rehabilitation is up to them to change in practice. If we spend a few sessions rebuilding and learning how to properly extend without hinging at the lower back, it’s pointless unless the gymnast applies it to their Yurckenko or back handspring drills. I also drive this point home related to doing the assigned “pre warm up” I give them, dedicating themselves to strength programs, recovery, nutrition, etc if they want optimal performance.
Thanks to Chris for sparking the idea, maybe another one of these will come out soon for other populations I work with. Hope this is helpful!
– Dr. Dave Tilley, DPT