Hand and Wrist Injuries in Gymnasts
Leave a CommentGymnastics is a unique sport where athletes spend a large amount of time on their hands. Handstands, tumbling, rings, and bars require the athlete to place their entire body weight through the arms and into the hands. Other sports do not place these heavy demands on the upper extremity. When tumbling, the athlete puts not only their entire body weight through the hands but can have up to 16 times their body weight in force going across the wrist2. No wonder 80% of gymnasts will experience wrist pain at some point in their career!6 In a study comparing injuries in male and female collegiate gymnasts, men suffered more hand and wrist injuries than their female counterparts1. We will be taking a closer look at the types of hand and wrist injuries both male and female gymnasts may experience and how to treat or prevent these injuries.
Grip lock3
Grip lock is a high bar injury suffered by male gymnasts and occurs when they are rotating around the high bar. Grip lock can lead to forearm fractures or tendon injuries of the wrist. Grip lock is related to the grip that the men wear to hold onto the high bar during their event; the leather can become locked on the high bar, and the athlete’s momentum continues to carry them forward, leading to forearm, wrist, or hand injuries. Treatment of grip lock depends on the type of injury, either bone or tendon or both.
To prevent grip lock, ensure you are using good grips that are not overstretched or worn out. Grips are used to decrease friction between the hand and the bar and to improve grip strength. But proper fitting and maintaining grips are essential to prevent this rare injury.
Gymnast Wrist4:
A gymnast wrist is used to describe a variety of overuse injuries that can occur in adolescent gymnasts. It includes a combination of injuries to the bone and the ligaments of the wrist. Gymnast wrist occurs as a result of the repetitive compressive forces applied across the wrist during the weight-bearing activities of gymnastics. Most frequently, the term “gymnast wrist” refers to a chronic stress fracture of the distal radius, which is near the growth plate of the wrist on the thumb side. This can present as pain, tenderness, or swelling over the wrist, decreased grip strength, and pain with weight bearing.
Treatment for gymnast wrist is focused on rest, managing swelling and pain, use of a brace initially, and strengthening the wrist, forearm, and arm for a gradual return to all sports activities.
Scaphoid Fracture5
Stress fractures in the upper limb are rare, but due to the weight bearing in gymnastics, these athletes have a slightly increased risk. The scaphoid is a bone in the wrist near the thumb. The scaphoid bone can be fractured by a fall onto the arm or repetitive stress on the wrist and hand. Fractures present as pain with wrist range of motion, pain with palpation over wrist near the thumb side, pain or inability to put weight through the hands, and swelling.
Treatment for scaphoid fracture could include rest and a cast or possibly surgery. The scaphoid bone is located in a place that does not get the best blood flow, so healing can sometimes be limited, which would lead to surgical repair of the fracture site. It is possible that wrist and hand strengthening may decrease injury risk for gymnasts. It is also important to be aware of how much training gymnasts perform each day and throughout the week. Adolescent gymnasts are still growing; therefore, coaches, parents, and healthcare providers must work together to protect their growing bones and avoid overuse injuries.
TFCC injuries4
The Triangular fibrocartilage complex (TFCC) is on the ulnar, pinky side of the wrist. The TFCC helps provide stability to the wrist. For gymnasts, stability is important to help transmit the body’s load through the hands when weight bearing and allow for flexibility and forearm rotation for hanging skills. The most common way the TFCC is injured is a fall onto the outstretched hand or when there is too much force over the wrist when the wrist is in an extended position (i.e., tumbling). The TFCC can also be at risk with gripping or pulling tasks, which would occur during bar or ring events in gymnastics. There is also a possibility of overuse injuries of the TFCC with gymnasts.
TFCC injuries include pain on the pinky side of the hand, weight-bearing, wrist rotation such as turning a doorknob, tenderness along the pinky side of the wrist/hand, swelling, and weakness. Treatment for TFCC injuries depends on the severity. The ligaments in the TFCC tend to heal slowly; therefore, more severe injuries may need surgical repair. Generally, rest, ice, and brace use are recommended initially. There are also brace options for when the athlete can begin a return to gymnastics that will provide more wrist stability while allowing them to perform their sports skills.
Examples of strengthening for the wrist, forearm, and upper body
- Wrist curls in both directions with a weight or resistance band
- Gripping exercises for the hands – use putty, bands, or finger webs
- Wrist rotation exercises such as hand weight rolling- make sure to go both directions
- Supination/Pronation with a hand weight or band
- Resistance band exercises for the upper body, including rows, shoulder extension, diagonals, internal/external rotation
- Tricep extension with band or hand weight
- Bicep curls with band or hand weight
- Gradual return to weight-bearing exercises, including push-ups, planks, and handstands, can be added when the athlete is pain-free in the wrist
- Any hanging exercises (bars) should only be performed when the wrist is pain-free pull-ups, hanging leg lifts, casting
Use of Wrist Guards
Many gymnasts choose to wear wrist guards such as Tiger Paws, Pegasus wrist supports, or the Wrist Widget as they progress to more advanced skills or if they are returning after injury. While wrist guards help to protect the wrist, they are not a substitute for a good wrist strengthening program. Prolonged use of wrist guards can weaken the muscles surrounding the wrist as these muscles no longer have to work as hard during sports activities. Gymnasts should always perform a good strength and conditioning program, including wrist and hand strengthening exercises, whether they wear a brace or not.
Seek Treatment at the First Sign of Pain
If you or your athlete are experiencing pain, don’t wait for it to resolve. Schedule a Free Assessment at an Athletico near you. Free Assessments are available in-clinic and virtually through our Telehealth platform.
Athletico provides rehabilitation services to gymnasts at all levels and abilities. Our goal is to evaluate, treat, and educate athletes in the prevention of practice and competition-related injuries. Technical evaluations can be performed to improve postural awareness and maximize the function of each athlete. We have physical therapists and athletic trainers, including former gymnasts and cheerleaders at the high school, collegiate and Olympic levels, involved with our Gymnastics and Cheerleading Program. Our clinicians understand the demands of the sport and use their personal and professional experience to effectively address the physical and psychological needs of each athlete.
For more information contact a Gymnastics and Cheerleading Rehabilitation Clinician by emailing Gymcheer@athletico.com.
*Per federal guidelines, beneficiaries of plans such as Medicare, Medicaid, Tricare, VHA and other federally funded plans are not eligible for free assessments.
The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.
Sources:
1. Westermann RW, Giblin M, Vaske A, Grosso K, Wolf BR. Evaluation of Men’s and Women’s Gymnastics Injuries: A 10-Year Observational Study. Sports Health. 2015;7(2):161-5.
2. Webb BG, Rettig LA (2008) Gymnastic wrist injuries. Curr Sports Med Rep 7:289–295
3. Bezek EM, Vanheest AE, Hutchinson DT. Grip lock injury in male gymnasts. Sports Health. 2009;1(6):518-521. doi:10.1177/1941738109347965
4. Dwek JR, Cardoso F, Chung CB. MR imaging of overuse injuries in the skeletally immature gymnast: spectrum of soft-tissue and osseous lesions in the hand and wrist. Pediatr Radiol. 2009;39(12):1310-1316. doi:10.1007/s00247-009-1428-x
5. Nakamoto JC, Saito M, Medina G, Schor B. Scaphoid stress fracture in high-level gymnast: a case report. Case Rep Orthop. 2011;2011:492407. doi:10.1155/2011/492407
6. Bak K, Kalms SB, Olesen S, Jargansen U. (2007) Epidemiology of injuries in gymnastics Scan j Med & Sci Sport 4(2): 148-154.
