Factors associated with wrist pain in the young gymnast

A kinetic and kinematic comparison of the two-footed and step-out back handsprings on the balance beam

The back handspring is one of the most commonly performed skills on the balance beam in women's gymnastics. Despite this, quantitative research on the beam has often been overlooked. This study aimed to investigate the kinetic and kinematic variables during the performance of two back handspring techniques on the beam: the back handspring with two footed landing and the back handspring step-out. A modified balance beam was fixed to a force plate with an isolated mat for landing to allow analysis of the take-off and hand contact phases. Kinetic and kinematic data were recorded for twelve gymnasts performing both techniques. No statistically significant differences between techniques were found during take-off. However, average peak vertical and horizontal ground reaction forces (4.1 bodyweights ± 1.1 BW, and 0.7 BW ± 0.2 BW, respectively) were higher and time to peak force shorter during the hand contact phase for the two footed variant. A more vertical trajectory, along with a greater hand contact ground reaction force were found in comparison to the back handspring performed on the floor. These results highlight the need for more specific investigation to understand the factors which could contribute to reducing the load faced during balance beam performance.

Abnormal Wrist Sagittal Kinematics in Gymnasts With Dorsal Wrist Pain: A New Syndrome

BACKGROUND

The pathology of dorsal wrist pain in gymnasts without abnormal radiographic findings remains unclear.

PURPOSE/HYPOTHESIS

The purpose of this study was to identify abnormal wrist sagittal kinematics in gymnasts with dorsal wrist pain. It was hypothesized that gymnasts with dorsal wrist pain would show abnormal sagittal kinematics with reversible hypermobility of the intercarpal joint.

STUDY DESIGN

Controlled laboratory study.

METHODS

Participants included 19 wrists in male gymnasts with dorsal wrist pain, 18 wrist in male gymnasts without wrist pain, and 20 adult men without a history of wrist pain. Magnetic resonance imaging (T2-weighted sagittal images) findings at 0°, 30°, 60°, and 90° of wrist extension were used in kinematic analysis. The angles and translations of the radiolunate, capitolunate, and third carpometacarpal joint were measured and compared between the 3 groups.

RESULTS

At 90° of wrist extension, gymnasts with dorsal wrist pain had a significantly lower radiolunate joint angle (28.70°± 6.28° vs 36.19°± 7.81°; P = .020) and a significantly higher capitolunate joint angle (57.99°± 6.15° vs 50.50°± 6.98°; P = .004) and distal translation (1.17 ± 0.50 mm vs 0.46 ± 0.62 mm; P = .002) than gymnasts without dorsal wrist pain.

CONCLUSION

Gymnasts with dorsal wrist pain showed abnormal wrist sagittal kinematics. These novel findings may facilitate understanding of dorsal wrist pain, which can be recognized as a new syndrome termed "gymnast's lunate dyskinesia."

Trapezoid Stress Fracture in an Olympic-Level Gymnast: A Case Report

CASE

A 23-year-old elite-level gymnast presented with insidious-onset pain near the base of the second metacarpal. The patient was found to have a trapezoid stress fracture and was treated nonoperatively in a thumb spica cast for 4 weeks. He resumed gymnastics without limitations 8 weeks from the time of diagnosis.

CONCLUSION

Trapezoid stress fractures must be considered when evaluating patients presenting with pain about the base of the index finger metacarpal, particularly those who perform activities that repetitively place high loads across the wrist. Wrist immobilization and a supervised return to participation resulted in an excellent outcome for this patient.

Effect of weight-bearing wrist movement with carpal-stabilizing taping on pain and range of motion in subjects with dorsal wrist pain: A randomized controlled trial

STUDY DESIGN

Randomized control trial.

INTRODUCTION

During weight-bearing wrist movement, potential stabilizing forces caused by carpal stabilizing taping (CST) may restrict movement of the carpal bones, allowing greater wrist joint extension.

PURPOSE OF THE STUDY

The purpose of study was to investigate the effect of CST during weight-bearing wrist movement on pain intensity and range of motion (ROM) of wrist extension in subjects with dorsal wrist pain.

METHODS

Thirty participants with dorsal wrist pain when weight bearing through the hand were randomly allocated into 2 groups: (1) a CST group using rigid tape and (2) placebo taping (PT) group using elastic tape. Subjects performed weight-bearing wrist movements with CST or PT in 6 sessions for 1 week. Active and passive ROM (AROM and PROM), and the visual analog scale (VAS) were assessed at baseline and after the intervention.

RESULTS

The AROM and PROM of wrist extension increased significantly in both groups compared with preintervention values (P < .01). Comparing the PT and CST groups, the differences between preintervention and postintervention AROM (mean difference [MD] = +8.6°) and PROM (MD = +6.8°) were significantly greater in the CST group than in the PT group (P < .01). The CST group also showed greater improvement in VAS compared with the PT group (MD = -18 mm) (P < .01).

CONCLUSION

We recommend CST during weight-bearing wrist movement as an effective intervention for both increasing wrist extension ROM and decreasing pain in patients with dorsal wrist pain during weight bearing through the hand.

Gymnast's Wrist (Distal Radial Physeal Stress Syndrome)

The distal radial physis is a common site for injury in gymnasts because of the significant amount of load applied during upper extremity weight-bearing. Wrist pain has been reported in up to 88% of gymnasts. The long-term consequences of overuse wrist injuries, such as distal radial physeal arrest, include degenerative conditions that often cause pain and functional limitations. In the more immediate stage of many overuse injuries, early diagnosis can promote quicker care and recovery and thus faster return to play. Less time lost to injury can be very important in maintaining an athlete's quality of life.

Wrist pain: a systematic review of prevalence and risk factors- what is the role of occupation and activity?

OBJECTIVE

To evaluate the prevalence and risk factors of wrist pain.

METHODS

Systematic review.

DATA SOURCES

The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from database inception to 9th March 2018. Specific criteria were used to define inclusion and exclusion. Data was extracted independently by a pair of reviewers.

RESULTS

In total 32 cross sectional studies were identified for inclusion (1 with a longitudinal component). The median prevalence of wrist pain in the general population and non-manual workers within the short term (within last week) was 6 and 4.2% within the medium term (> 1 week and within a year). The median prevalence of wrist pain in physically demanding occupations and sports people was 10% within the short term and 24% within the medium term. Non-modifiable factors associated with wrist pain included increased age (1 study in adults and 3 studies in children/adolescents) and female sex (2 studies). Modifiable risk factors included high job physical strain (2 studies), high job psychological strain (1 study), abnormal physeal morphology in children/adolescents (2 studies), high frequency impact tool use (1 study) and effort reward imbalance (1 study).

CONCLUSIONS

Wrist pain is highly prevalent in groups who partake in physically demanding activities from day to day such as manual labourers and sportspeople. It is less prevalent in the general population and non-manual workers, although there is a relative lack of research in the general population.

TRIAL REGISTRATION

The review protocol was registered with PROSPERO under the registration number CRD42018090834.

LEVEL OF EVIDENCE

1 (Prognostic study).

Content validity of the SOS-WRIST questionnaire for timely identification of wrist overuse in young athletes

Objectives: Young athletes do not always seek medical help for overuse wrist injuries, risking invalidating long-term consequences resulting from late diagnosis. This study aimed to develop a questionnaire to identify overuse wrist injuries in young athletes. Methods: According to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria, items were collected from literature and 6 focus groups of sports physicians and of young athletes with (previous) overuse wrist injuries. An expert panel and 40 Delphi study participants performed item reduction. Young athletes evaluated comprehensiveness during interviews and English translation was performed according to linguistic validation guidelines. Results: In total 323 items were generated and 110 were marked important by focus group participants. The resulting questionnaire consists of 18 multiple-choice questions about wrist pain during sports (e.g. pain during training, skipping training sessions/elements) and daily life activities (e.g. writing, turning a key), and other symptoms (e.g. reduced strength, swelling). Conclusion: The SOS-WRIST questionnaire for identification of overuse wrist injuries in young athletes has good content validity. It can be used to promote awareness and timely treatment of overuse wrist injuries in young athletes.

Damage of the distal radial physis in young gymnasts: can three-dimensional assessment of physeal volume on MRI serve as a biomarker?

Objective

To explore the use of quantitative volume assessment to identify the presence and extent of stress-related changes of the distal radial physis in gymnasts with suspected physeal injury, asymptomatic gymnasts, and non-gymnasts.

Methods

Symptomatic gymnasts with clinically suspected distal radial physeal injury, asymptomatic gymnasts, and non-gymnasts (n = 69) were included and matched on skeletal age and sex. Volume measurements were performed on coronal water selective cartilage MRI images by creating three-dimensional physeal reconstructions semi-automatically using active-contour segmentation based on image-intensity thresholding. Inter- and intra-rater reliability of the measurements were assessed using intra-class correlation coefficients (ICC) for absolute agreement.

Results

Twenty-seven symptomatic-, 18 asymptomatic-, and 24 non-gymnasts were included with a median age of 13.9 years (interquartile range (IQR) 13.0–15.0 years). Median physeal volume was significantly increased (p < 0.05) in symptomatic- (971 mm³, IQR 787–1237 mm³) and asymptomatic gymnasts (951 mm³, IQR 871–1004 mm³) compared with non-gymnasts (646 mm³, IQR 538–795 mm³). Inter-rater (ICC 0.96, 95% CI 0.92–0.98) and intra-rater (ICC 0.93, 95% CI 0.85–0.97) reliability of volume measurements were excellent. Of the 10 participants with the highest physeal volumes, nine were symptomatic gymnasts.

Conclusion

Increased volume of the distal radial physis can reliably be assessed and is a sign of physeal stress that can be present in both symptomatic- and asymptomatic gymnasts, but gymnasts with suspected physeal injury showed larger volume increases. Future studies should explore if volume assessment can be used to (early) identify athletes with or at risk for physeal stress injuries of the wrist.

Key Points

• The volume of the distal radial physis can be reliably assessed by creating three-dimensional physeal reconstructions.

• Stress-related volume increase of the distal radial physis is present in symptomatic and asymptomatic gymnasts.

• Gymnasts with clinically suspected physeal injury showed larger volume increases compared with asymptomatic gymnasts and may therefore be a valuable addition in the (early) diagnostic workup of physeal stress injuries.

A hidden mismatch between experiences of young athletes with overuse injuries of the wrist and sports physicians' perceptions: a focus group study

BACKGROUND

Although overuse wrist injuries can have serious consequences, young athletes often do not immediately report their injury to a physician. This qualitative study aimed to identify symptoms and limitations related to overuse wrist injuries that young athletes consider important and to compare those with sports physicians' opinions, in order to improve the diagnostic process for early identification of overuse wrist injuries.

METHODS

Twenty-one athletes aged 13-25 years in wrist-loading sports (gymnastics, tennis, judo, field hockey, volleyball and rowing) with a (previous) overuse wrist injury were included. In five focus groups, participants discussed important signals and limitations of their injury, as well as a list of relevant items previously composed by sports physicians. Data were grouped into themes and (sub)categories and subsequently coded.

RESULTS

Of the resulting 224 signals and 80 limitations, respectively 81 and 20 were labelled important. Athletes considered both pain and limitations during daily life activities important indicators of overuse wrist injury, as well as long pain duration, acute onset of pain, and accompanying symptoms like swelling, cracking and discoloration. All of the sports physicians' items were also considered important by the athletes, but sport-related pain and limitations were regarded by many athletes as a natural part of their sport.

CONCLUSIONS

Discrepancies exist between the opinions of young athletes and sports physicians on sport-related pain reporting and competing regardless of pain or limitations. Although clinicians may be inclined to focus on these aspects, they are advised to also inquire specifically about limitations and pain during daily life activities in young athletes with overuse wrist injuries.

Injury epidemiology and risk factors in competitive artistic gymnasts: a systematic review

Background

Artistic gymnastics is reported to have some of the highest injury rates in sports, which limits participation and often involves considerable medical expenses.

Purpose

To critically appraise the epidemiological literature on injury patterns and risk factors in competitive artistic gymnastics.

Study design

Systematic review.

Methods

Six databases were searched for articles that investigated injuries in competitive artistic gymnasts. Injury incidence, prevalence and risk factor data were extracted, alongside information on injury location, type, severity, nature and mechanism of injury. Quality and level of evidence were assessed using a modified Downs and Black quality index checklist and the Oxford Centre for Evidence-based Medicine guidelines.

Results

The search identified 894 articles, with 22 eligible for inclusion. Descriptive analysis showed that injury incidence and prevalence varied from 0.3 to 3.6 injuries per gymnast (female=0.3–3.6, male=0.7) and 2.0–2.3 (female=2.0–2.3, male=2.0), respectively. Male gymnasts sustained mostly upper limb injuries, while female gymnast reported lower limb injuries. Floor was associated with the greatest number of injuries for both male and female gymnasts. Higher competitive level and exposure to competition were risk factors for gymnastics injury: age, body mass, body size, training duration and life stress were significant associated factors.

Conclusion

Injury incidence and prevalence results are substantial among artistic gymnasts of all competitive levels. Gymnasts who train at highly competitive levels and are exposed to competition environments are a greater risk of injury. Future researchers should implement consistent reporting methods.

Examination and physical therapy management of a young gymnast with bilateral wrist pain: A case report

BACKGROUND

Wrist pain associated with weight-bearing gymnastic activities may be linked to musculoskeletal impairments, faulty movement patterns, and poor training techniques. Inadequate proximal control may adversely impact the loading mechanics throughout the upper extremities and contribute to a gymnast's complaint of wrist pain. The purpose of this case report is to describe the management of a young gymnast with primary complaint of bilateral wrist pain associated with upper extremity weight-bearing activities.

CASE DESCRIPTION

A 10 year-old male gymnast presented with a 6-month history of bilateral wrist pain aggravated by weight-bearing gymnastic activities. Based on the findings from a physical therapy examination, a 3-stage progressive rehabilitation program was designed using an impairment-based, multi-modal approach to treat key musculoskeletal impairments and movement deficiencies. Consistent with the principle of activity simulation, treatment targeted areas of weakness considered key to activity performance and included a progression of exercises and techniques that simulated activities reported by the gymnast to be painful.

OUTCOMES

The gymnast was treated for 11 visits over 8 weeks. He demonstrated improved strength, motor control, and self-reported outcome scores that allowed pain-free return to all gymnastic activities.

Overuse wrist injuries in young athletes: What do sports physicians consider important signals and functional limitations?

This study's objective was to collect items from experienced sports physicians, relating to the presence and severity of overuse wrist injuries in young athletes, for developing a measurement instrument for signals of overuse wrist injury. Seven Dutch elite sports physicians involved in guidance and treatment of young athletes in wrist-loading sports (gymnastics, tennis, judo, field hockey, volleyball and rowing) participated in a focus group. They discussed signals and limitations related to overuse wrist injuries in young athletes. Data were coded and categorised into signals and limitations with subcategories, using an inductive approach. Of the resulting 61 signals and limitations in nineteen (sub)categories, 20 were considered important, forming a comprehensive item set for identifying overuse wrist injury in young athletes. Signals such as pain, "click", crepitations, swelling and limited range of motion were marked useful for early identification of overuse wrist injury. Limitations in movement and performance were considered indicative of severe overuse injury but less relevant for initial injury identification. The focus group provided 17 important signals and 3 important limitations indicative of overuse wrist injury. These provide the basis for a valid measurement instrument for identifying overuse wrist injury in young athletes, with equal emphasis on pain and on other symptoms.

Pediatric Elbow and Wrist Pathology Related to Sports Participation

Pediatric overuse injuries are becoming more prevalent in today's society with more children competitively playing year-round sports at a younger age. The importance of prompt diagnosis and treatment is paramount to the treatment for these injuries, second only to rest and activity modification. This article will focus on overuse injuries of the upper extremity, specifically: little league elbow, elbow osteochondritis dissecans, and gymnast wrist. It will also discuss the pathophysiology, diagnosis, imaging, and treatment of each of these entities.

Extensor Tendon Impingement in a Gymnast

Wrist injuries in the gymnast are due to the transformation of the upper extremity into a weight bearing entity. Gymnast wrist pain presents a difficult diagnostic and therapeutic challenge. Here, we present a new case of extensor tendon impingement in an elite gymnast. To our knowledge, there is no similar report in the literature.

FREQUENCY OF WRIST GROWTH PLATE INJURY IN YOUNG GYMNASTS AT A TRAINING CENTER

Objective:

To assess the frequency of physeal injuries and wrist pain in young competitive gymnasts according to their training characteristics.

Methods:

This is a cross-sectional study (January-June 2015) of a male gymnastics team in São Paulo, SP, Brazil. Nineteen gymnasts, mean age 13.3 years, were evaluated in three ways: a questionnaire, physical examination and radiographs.

Results:

On average, they trained since 6 years-old and during hours per week. Eighty-two percent had wrist pain and 65% had wrist physeal injury. The pain was worse in practitioners of (82%) and soil (17%) exercises. A greater frequency of physeal injury was found in those with more years of training and higher weekly working hours, wrist pain was more frequent in those with higher weekly working hours, and a decreased range of motion was observed in those with physeal injury, results statistically significant.

Conclusions:

We found that 65% of gymnasts had wrist physeal injury and 82% had wrist pain. There were statistically significant relationships between physeal injury and years of training, physeal injury and weekly working hours, pain and weekly working hours, and physeal injury and range of motion. Level of Evidence IV, Case Series.

When Is It Too Early for Single Sport Specialization?

Over the past 15 years, there has been an increase in youth sports participation with a concomitant increase in early year-round training in a single sport. Many factors contribute to the desire of parents and coaches to encourage early single sport specialization, including the desire to give the young athlete an edge in competition, pursuit of scholarships, and potential professional status, and the ability to label a young athlete as elite at an early age. Despite these perceived advantages, some data suggest that early sport specialization does not lead to a competitive advantage over athletes who participate in multiple sports. Although the data are limited, there is some evidence that early sport specialization may put the young athlete at risk for overuse injuries. The focus of this review is to highlight the evidence regarding early sport specialization and risk for injury; discuss the risk factors for overuse injury in high-risk sports including ice hockey, swimming, gymnastics, and baseball; and discuss future potential research that would help define the risk of injury for young athletes who participate in early sport specialization.

Effects of pre-exercise alkalosis on the decrease in VO2 at the end of all-out exercise

PURPOSE

This study determined the effects of pre-exercise sodium bicarbonate ingestion (ALK) on changes in oxygen uptake (VO2) at the end of a supramaximal exercise test (SXT).

METHODS

Eleven well-trained cyclists completed a 70-s all-out cycling effort, in double-blind trials, after oral ingestion of either 0.3 g kg(-1) of sodium bicarbonate (NaHCO3) or 0.2 g kg(-1) body mass of calcium carbonate (PLA). Blood samples were taken to assess changes in acid-base balance before the start of the supramaximal exercise, and 0, 5 and 8 min after the exercise; ventilatory parameters were also measured at rest and during the SXT.

RESULTS

At the end of the PLA trial, which induced mild acidosis (blood pH = 7.20), subjects presented a significant decrease in VO2 (P < 0.05), which was related to the amplitude of the decrease in minute ventilation (VE) during the SXT (r = 0.70, P < 0.01, n = 11). Pre-exercise metabolic alkalosis significantly prevented the exercise-induced decrease in VO2 in eleven well-trained participants (PLA:12.5 ± 2.1 % and ALK: 4.9 ± 0.9 %, P < 0.05) and the decrease in mean power output was significantly less pronounced in ALK (P < 0.05). Changes in the VO2 decrease between PLA and ALK trials were positively related to changes in the VE decrease (r = 0.74, P < 0.001), but not to changes in power output (P > 0.05).

CONCLUSIONS

Pre-exercise alkalosis counteracted the VO2 decrease related to mild acidosis, potentially as a result of changes in VE and in muscle acid-base status during the all-out supramaximal exercise.

Sport Specialization, Part I: Does Early Sports Specialization Increase Negative Outcomes and Reduce the Opportunity for Success in Young Athletes?

Context:

There is increased growth in sports participation across the globe. Sports specialization patterns, which include year-round training, participation on multiple teams of the same sport, and focused participation in a single sport at a young age, are at high levels. The need for this type of early specialized training in young athletes is currently under debate.

Evidence Acquisition:

Nonsystematic review.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Conclusion:

Sports specialization is defined as year-round training (greater than 8 months per year), choosing a single main sport, and/or quitting all other sports to focus on 1 sport. Specialized training in young athletes has risks of injury and burnout, while the degree of specialization is positively correlated with increased serious overuse injury risk. Risk factors for injury in young athletes who specialize in a single sport include year-round single-sport training, participation in more competition, decreased age-appropriate play, and involvement in individual sports that require the early development of technical skills. Adults involved in instruction of youth sports may also put young athletes at risk for injury by encouraging increased intensity in organized practices and competition rather than self-directed unstructured free play.

Strength-of-Recommendation Taxonomy (SORT):

C.

Correlation between elite male Iranian gymnast's wrist injuries and their anthropometric characteristics

BACKGROUND

In gymnastics, wrists are under considerable force that causes various injuries. The influences of various risk factors have not been studied sufficiently to date to reduce the wrist injuries of gymnasts. The aim of this research was to determine the relationship between anthropometric characteristics and the wrist injuries of elite male gymnasts who took part in the Iranian Premier League and Division One in 2012.

METHODS

This was a cross-sectional correlation study concerning the injuries of 43 elite male gymnasts. The extent of their wrist injuries was determined by a questionnaire and interviews. Also, their anthropometric characteristics were collected according to the criteria established by the International Society for the Advancement of Kinanthropometry. Event tree analysis and the Spearman rho correlation coefficient were used for statistical analysis.

RESULTS

Among the gymnasts, 53.5% experienced wrist injuries over the past year, and the rate of wrist injuries was three per gymnast for one year. The incidents of skin and muscular injuries were the most prevalent type of injuries followed by Injuries to ligaments and bones respectively. Body weight was the only anthromopetric characteristic of the participants that was found to have a significant positive relationship with wrist injuries (P < 0.05).

CONCLUSION

Gymnasts and their coaches should pay special attention to gymnasts' weight as an intrinsic risk factor and take the required actions to prevent wrist injuries.

Additive effects of beta-alanine and sodium bicarbonate on upper-body intermittent performance

We examined the isolated and combined effects of beta-alanine (BA) and sodium bicarbonate (SB) on high-intensity intermittent upper-body performance in judo and jiu-jitsu competitors. 37 athletes were assigned to one of four groups: (1) placebo (PL)+PL; (2) BA+PL; (3) PL+SB or (4) BA+SB. BA or dextrose (placebo) (6.4 g day⁻¹) was ingested for 4 weeks and 500 mg kg⁻¹ BM of SB or calcium carbonate (placebo) was ingested for 7 days during the 4th week. Before and after 4 weeks of supplementation, the athletes completed four 30-s upper-body Wingate tests, separated by 3 min. Blood lactate was determined at rest, immediately after and 5 min after the 4th exercise bout, with perceived exertion reported immediately after the 4th bout. BA and SB alone increased the total work done in +7 and 8 %, respectively. The co-ingestion resulted in an additive effect (+14 %, p < 0.05 vs. BA and SB alone). BA alone significantly improved mean power in the 2nd and 3rd bouts and tended to improve the 4th bout. SB alone significantly improved mean power in the 4th bout and tended to improve in the 2nd and 3rd bouts. BA+SB enhanced mean power in all four bouts. PL+PL did not elicit any alteration on mean and peak power. Post-exercise blood lactate increased with all treatments except with PL+PL. Only BA+SB resulted in lower ratings of perceived exertion (p = 0.05). Chronic BA and SB supplementation alone equally enhanced high-intensity intermittent upper-body performance in well-trained athletes. Combined BA and SB promoted a clear additive ergogenic effect.

Weight, muscle and bone loss during space flight: another perspective

Space flight is a new experience for humans. Humans adapt if not perfectly, rather well to life without gravity. There is a reductive remodeling of the musculo-skeletal system. Protein is lost from muscles and calcium from bones with anti-gravity functions. The observed biochemical and physiological changes reflect this accommodative process. The two major direct effects of the muscle loss are weakness post-flight and the increased incidence of low back ache pre- and post-flight. The muscle protein losses are compromised by the inability to maintain energy balance inflight. Voluntary dietary intake is reduced during space flight by ~20 %. These adaptations to weightlessness leave astronauts ill-equipped for life with gravity. Exercise, the obvious counter-measure has been repeatedly tried and since the muscle and bone losses persist it is not unreasonable to assume that success has been limited at best. Nevertheless, more than 500 people have now flown in space for up to 1 year and have done remarkably well. This review addresses the question of whether enough is now known about these three problems (negative energy balance, muscle loss and bone loss) for to the risks to be considered either acceptable or correctible enough to meet the requirements for a Mars mission.

Effect of the rest interval duration between contractions on muscle fatigue

Background

We aimed to investigate the effect of rest interval, between successive contractions, on muscular fatigue.

Methods

Eighteen subjects performed elbow flexion and extension (30 repetitions) on an isokinetic dynamometer with 80º of range of motion. The flexion velocity was 120º/s, while for elbow extension we used 5 different velocities (30, 75, 120, 240, 360º/s), producing 5 different rest intervals (2.89, 1.28, 0.85, 0.57 and 0.54 s).

Results

We observed that when the rest interval was 2.89 s there was a reduction in fatigue. On the other hand, when the rest interval was 0.54 s the fatigue was increased.

Conclusions

When the resting time was lower (0.54 s) the decline of work in the flexor muscle group was higher compared with different rest interval duration.

Pediatric overuse injuries in sports

Overuse injuries in the pediatric and adolescent population are a growing problem in the United States as more children participate in recreational and organized sports. It is not uncommon for children and adolescents to play on multiple teams simultaneously or to be involved in sports year-round. Without adequate rest, the demands of exercise can exceed the body's ability to repair tissues, leading to repetitive microtrauma and overuse injury. Unlike in adults, the consequences of overuse injury in the pediatric and adolescent athlete are far more serious because the growing bones are vulnerable to stress. The ability to identify individuals who are at risk of overuse injuries is key so that education, prevention, and early diagnosis and treatment can occur. Preventive measures of modifying training factors (ie, magnitude, intensity, and frequency of sports participation) and correcting improper biomechanics (alignment, laxity, inflexibility, and muscle imbalance) should always be part of the management plan.

Sports-related injuries in the young female athlete

The number of females participating in sports continues to increase. Adolescent and preadolescent females are at a risk injury to both their open growth plates as well as their joints. The purpose of this article is to review the common injuries seen with the most popular sports with females. Mt Sinai J Med 77:307-314, 2010. (c) 2010 Mount Sinai School of Medicine.

Age-related resistance to skeletal muscle fatigue is preserved during ischemia

During voluntary contractions, the skeletal muscle of healthy older adults often fatigues less than that of young adults, a result that has been explained by relatively greater reliance on muscle oxidative metabolism in the elderly. Our aim was to investigate whether this age-related fatigue resistance was eliminated when oxidative metabolism was minimized via ischemia induced by cuff (220 mmHg). We hypothesized that 1) older men (n = 12) would fatigue less than young men (n = 12) during free-flow (FF) contractions; 2) both groups would fatigue similarly during ischemia; and 3) reperfusion would reestablish the fatigue resistance of the old. Subjects performed 6 min of intermittent, maximal voluntary isometric contractions of the ankle dorsiflexors under FF and ischemia-reperfusion (IR) conditions. Ischemia was maintained for the first 3 min of contractions, followed by rapid cuff deflation and reperfusion for 3 additional minutes of contractions. Central activation, peripheral activation, and muscle contractile properties were measured at 3 and 6 min of contractions. Older men fatigued less than young men during FF (P </= 0.02), ischemia (P < 0.001), and reperfusion (P < 0.001). During FF, activation and contractile properties changed similarly across age groups. At the end of ischemia, central (P = 0.02) and peripheral (P </= 0.03) activation declined more in the young, with no effect of age on the changes in contractile properties. Thus age-related fatigue resistance was evident during FF and IR, indicating that differences in blood flow and oxidative metabolism do not explain the fatigue resistance of old age.

Wrist pain, distal radial physeal injury, and ulnar variance in the young gymnast

In gymnastics, the wrist joint is subjected to repetitive loading in a weightbearing fashion. In this setting, chronic wrist pain is quite common. Because gymnasts ordinarily enter the sport at very young ages and train for several years before skeletal maturity is attained, the growth plates of the wrist are at risk for injury. In addition, imaging studies have identified evidence of injury to the distal radial physis and the development of positive ulnar variance. Recent studies provide more information on the relationships between these findings, as well as factors that may predispose some gymnasts to wrist pain. This article provides a comprehensive review of these issues and offers suggestions for management, preventive measures, and future research.

Impact Modeling of Gymnastic Back-Handsprings and Dive-Rolls in Children

This study was to determine estimates of the stiffness and damping properties of the wrist and shoulder in children by examining wrist impacts on the outstretched hand in selected gymnastic activities. The influence of age, mass, and wrist and torso impact velocity on the stiffness and damping properties were also examined. Fourteen young gymnasts (ages 8 to 15 yrs) were videotaped while performing back-handspring trials or dive-rolls. Kinematic and ground reaction analysis provided input for computer simulation of the body as a rheological model with appropriate stiffness and damping. A significant positive linear relationship was obtained between wrist damping in dive rolls and age, mass, and wrist and torso impact velocity, while shoulder damping in the back-handsprings had a significant positive linear relationship with body mass. This new information on stiffness and damping at the shoulder and the wrist in children enables realistic mathematical modeling of children's physical responses to hand impact in falls. This is significant because modeling studies can now be used as an alternative to epidemiological studies to evaluate measures aimed at reducing injuries in gymnastics and other activities involving impact to the upper extremity.

Hand Injuries in Sports Medicine

Many athletic injuries of the hand commonly present to, and can be managed by, primary care physicians. Knowing when to refer is also obviously important. This article is not meant to be an exhaustive list of all possible hand injuries. Rather, it is meant to serve as a useful guide to the primary care physician. For the busy primary care physician, a thorough assessment of the hand or wrist complaint includes a focused history and physical and the judicious use of supportive diagnostic testing. Know your anatomy and sport. This will set the foundation clinically for the best possible outcome. Ultimately,the goals of assessment and management are to restore, maximize, and preserve function.

Special concerns of the female athlete

The majority of injuries sustained by female athletes are due to participation in sports rather than their sex. Anatomic, hormonal,and functional differences should be understood when treating the female athlete. Screening should be done for eating disorders and the female athlete triad. Female athletes have increased rates of injury to the anterior cruciate ligament and patellofemoral disorders compared with their male counterparts.

Effect of a prophylactic brace on wrist and ulnocarpal joint biomechanics in a cadaveric model

BACKGROUND

Wrist pain from repetitive dorsiflexion and compression during pommel horse exercises is common among male gymnasts.

PURPOSE

To determine the biomechanical effects of a prophylactic wrist brace on the wrist and ulnocarpal joints during mechanical loading in a cadaveric model.

HYPOTHESIS

The lateral wedge of the palmar pad of the brace will compensate for positive ulnar variance, distributing contact forces more evenly across the radioulnar carpal joint.

STUDY DESIGN

Controlled laboratory study.

METHODS

Six male and six female fixed cadaveric forearm-wrist specimens were subjected to a 32.13-kg compressive load applied through the long axis of the pronated forearm with a dorsiflexed wrist in contact with a support surface. Wrist joint dorsiflexion angle and ulnocarpal joint intraarticular peak pressure were assessed under three brace conditions: Ezy ProBrace with and without palmar pad and a nonbraced control.

RESULTS

Wrist joint dorsiflexion angle was significantly reduced by the Ezy ProBrace with and without the palmar pad. However, ulnocarpal joint intraarticular peak pressure was reduced only by the brace with pad.

CONCLUSION

Prevention of pathologic wrist changes requires intervention in pressure attenuation, which was achieved with the Ezy ProBrace with palmar pad.

CLINICAL RELEVANCE

This brace may decrease the cumulative effects of repetitive stress of pommel horse exercise training.

Wrist pain, distal radial physeal injury, and ulnar variance in young gymnasts: does a relationship exist?

BACKGROUND

Chronic wrist pain affects up to 79% of young gymnasts. Distal radial growth plate injury and positive ulnar variance have also been reported in this population.

HYPOTHESIS

There is a relationship between wrist pain, radiographic findings of distal radial growth plate injury, and ulnar variance in skeletally immature young gymnasts.

STUDY DESIGN

Cross-sectional study.

METHODS

Fifty-nine gymnasts (28 girls and 31 boys; average age, 9.3 years) completed a questionnaire detailing training and wrist pain symptoms. Each received a wrist examination, grip strength measurement, and bilateral wrist radiographs.

RESULTS

Wrist pain was reported by 56% of the gymnasts (33 of 59), with 45% (15 of 33) describing pain of at least 6 months' duration. Factors significantly associated with wrist pain included higher skill level, older age, and more years of training. For those between 10 and 14 years of age, 83% had wrist pain, compared with 44% for those outside of that age range. Fifty-one percent of the gymnasts (30 of 59) had findings of stress injury to the distal radial physis of at least a grade 2; 7% (4) had frank widening of the growth plate. Wrist pain prevalence was significantly related to the grade of radiographic injury. Mean ulnar variance was significantly more positive than established norms. Ulnar variance was not associated with wrist pain or radiographic injury of the distal radial physis.

CONCLUSIONS

Radiographic findings of distal radial physeal injury are associated with wrist pain among young nonelite gymnasts.

Wrist pain in young gymnasts: frequency and effects upon training over 1 year

OBJECTIVE

To determine the frequency and characteristics of wrist pain in young, nonelite gymnasts over a 1-year training period, and to describe the effects of chronic wrist upon gymnastics training.

DESIGN

Prospective cohort study.

SETTING

Los Angeles-based gymnastics club.

PARTICIPANTS

Forty-seven nonelite female and male gymnasts between 5 and 16 years of age.

ASSESSMENTS

Each subject completed an interview-based questionnaire and received a physical exam at the study onset and at the end of 1 year of training. The questionnaire detailed training habits and elicited a history and description of wrist pain.

MAIN OUTCOME MEASURES

The frequency of wrist pain and several measures of training were reported at the study onset and at 1 year. Gymnasts with wrist pain were compared with those who were pain-free.

MAIN RESULTS

Wrist pain was reported by 57% (27 of 47) of subjects at the study onset. Eighty-nine percent (24 of 27) reported wrist pain both at the study onset and 1 year later. Nineteen gymnasts (40%) were pain-free at each collection. The floor exercise, the pommel horse, and the balance beam were most frequently associated with wrist pain symptoms. Multivariate analysis revealed that adolescent gymnasts between 10 and 14 years of age were significantly more likely to report wrist pain at each survey than those who were either above or below this age range (p = 0.03). Forty-two percent of subjects with wrist pain at each survey reported that the symptoms interfered with training. Only five gymnasts with wrist pain were seen by physicians. Training intensity increased in gymnasts with and without wrist pain. The relative increase within each group was statistically significant among pain-free gymnasts (p = 0.003), but was not for those with wrist pain (p = 0.08).

CONCLUSIONS

Wrist pain among young, nonelite gymnasts is common, and appears to persist with continued training in the vast majority of those who report symptoms. Adolescent gymnasts between 10 and 14 years of age training at this level are significantly more likely to have wrist pain. Wrist pain appears to have a negative effect upon training, based upon both self-report and training intensity measures; however, more study is needed with respect to this issue.

Balancing the risk of injury to gymnasts: how effective are the counter measures?

BACKGROUND

To minimise injury risk and maximise gymnastics performance, coaches, parents, and health professionals working with young gymnasts need to understand and practise safe gymnastics.

AIMS

To (a) identify the various injury counter measures specific to gymnastics, (b) critically review the literature describing each injury prevention measure, and (c) assess, using available risk factor and injury data, the weight of evidence to support each of these counter measures. Specific recommendations for further research and implementation strategies to prevent injury and improve safety are also given.

METHODS

The relevant literature was identified through the use of Medline (1966 to May 1998) and SPORT Discus (1975 to May 1998) searches, hand searching of journals and reference lists, and discussions with key Australian gymnastics organisations.

RESULTS

The key gymnastics injury counter measures identified in this review include coaching (physical preparation, education, spotting, and performance technique), equipment, and the health support system (medical screening, treatment, and rehabilitation). Categorisation of the type of evidence for the effectiveness of each of these counter measures in preventing injury showed that most of it is based on informal opinion/anecdotal evidence, uncontrolled data based studies, and several prospective epidemiological studies. There is no evidence from formally controlled trials or specific evaluation studies of counter measures for gymnastics.

CONCLUSIONS

Although gymnastics is a sport associated with young participants and frequent high volume, high impact training, there is a paucity of information on injury risk factors and the effectiveness of injury practices. Further controlled trials are needed to examine the extent to which injury prevention counter measures can prevent or reduce the occurrence of injury and re-injury. Particular attention should be devoted to improving training facilities, the design and testing of apparatus and personal equipment used by gymnasts, and coaching and the role of spotting in preventing injury.

Epidemiology of hand and wrist injuries in sports

This article addresses the prevalence of various hand and wrist injuries in a variety of sports. Multiple resources and references have been utilized to draw a perception of the types of injuries and the sports with which they are most commonly associated. It is hoped that this article will give the physician a greater understanding of the types of hand and wrist injuries they may expect to encounter in athletes.

Epiphysiodesis for bilateral irregular closure of the distal radial physis in a gymnast

Wrist pain is a common complaint in gymnasts. Repetitive stress on the distal radial physis may lead to either gradual slipping of the epiphysis or growth disturbances. In some cases growth disturbances of the distal radial physis lead to triangulation of the distal radius and secondary ulnar overgrowth, and eventually a Madelung-like deformity. The present case report is the first to describe the outcome of epiphysiodesis of the distal radial and ulnar growth plates in a skeletally immature gymnast as a surgical treatment to prevent Madelung's deformity.

Distal radial growth plate injury and positive ulnar variance in nonelite gymnasts

To assess the prevalence of stress injury to the distal radial growth plate and of positive ulnar variance in a nonelite gymnast population, we administered a radiographic survey and questionnaire to 44 skeletally immature nonelite gymnasts (27 girls and 17 boys). The subjects trained an average of 11.9 hours per week. Radiographic findings consistent with stress injury of the distal radial physis were found in 25% (11 of 44) of participants. Ulnar variance was found to be more positive in the gymnasts when compared with age-predicted norms. An average side-to-side difference in ulnar variance of 0.9 mm was observed. Radiographic findings of stress injury to the growth plate and the amount of ulnar variance were not associated with age, sex, training intensity, wrist pain, height, or weight. There was also no significant relationship between ulnar variance and radiographic findings. The mean ulnar variance in nonelite gymnasts was between that measured for elite gymnasts and nongymnasts. These results indicate that stress injury of the distal radial growth plate occurs in a significant percentage of nonelite gymnasts. It also appears that ulnar variance is more positive than would otherwise be predicted, suggesting growth inhibition of the distal radius, a growth stimulation of the ulna, or a combination of both.

Wrist pain in a young gymnast: unusual radiographic findings and MRI evidence of growth plate injury

A 10-yr-old gymnast, training well below the elite level, reported a 3-wk history of bilateral dorsal wrist pain. Physical examination and radiographic findings were consistent with stress injury to the distal radial growth plates. The patient's radiographs also displayed rare findings including cleft radial and ulnar epiphyses, as well as epiphyseal spur formation. Magnetic resonance imaging (MRI) demonstrated evidence of metaphyseal and epiphyseal ischemia of the growth plate. The patient responded well to conservative treatment, including ice, splinting, and activity modification. This case illustrates several potentially confusing radiographic abnormalities and the emerging role of MRI in evaluating wrist pain in young gymnasts.