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Athletic development specialists dedicated to the art and science of excellence in movement

Interview with Brandi Smith-Young, PT

Brandi Smith-Young, PT is a physical therapist and owner of Perfect 10.0 Physical Therapy in Austin, Texas.  You can learn more about her and her practice at www.perfect10physicaltherapy.com.    

1) Thanks for taking time for this interview, Brandi!  Before we get into your current practice, can you tell us about your own background as a gymnast?

I started gymnastics at age 2.  My parents say I was too busy "flipping around on the couch and walking on the ledge of the couch" that they had to find something for me to do.  They enrolled me in a small gym in Temple, TX.  Here I fell in love with the sport! My one class a week quickly went to two and then three and then on to team.  I started competing at 7 years old.  I remember at that time my favorite leotard was my Mary Lou Retton red, white, and blue Olympic long-sleeved leo.  I would wear that leo in the middle of the summer in the Texas 100 degree weather in our poorly air-conditioned metal building.  I still have that leo in my hope chest today. smiley I moved several times but always had a gym we could get to. I went to several small gyms in Texas.  At one point we commuted an hour to practice and an hour home.  It was a big sacrifice for my family, but I loved it so much that we did it.  Growing up in a small town and going to a small gym allowed me to train 25 hours a week at gym and still participate in other sports.  I did high school varsity cheerleading, varsity track, and varsity power lifting.  I tried volleyball and briefly cross country.  Volleyball was fun but not my sport.  Cross country had to go when my parents said I was too grumpy from training 3 sports at once, and it started at 5:30 am, so that was a "no brainer" for me. smiley I also started coaching gymnastics at age 14.  I started with parent and tot classes, then preschool, and beginners, working my way up to assisting in coaching team girls throughout undergraduate and physical therapy school.

I always knew I wanted to compete in college.  Throughout my dabbling in other sports, gymnastics always took priority.  I was a competitive gymnast for 15 years competing up to level 10 and finishing my career as a collegiate gymnast at Texas Woman's University.  I became a vault and beam specialist in college.  College gymnastics was an experience like no other!  To be a part of a team with a national championship goal in all of our minds... To be a part of strong traditions.... To be a part of working together to accomplish our goals... To feel the passion we all had for the sport of gymnastics was priceless.  I loved every moment of my gymnastics career!  The coaches I had, the teammates I had, the failures, the successes, the injuries, and all of the experiences I had throughout my gymnastics career has made me who I am today.

2) You have a fairly unique niche the rehabilitation field.  Please tell us about Perfect 10.0 Physical Therapy and how you got started.

I started Perfect 10.0 in 2008.  I felt a deep desire to share all of my experiences and knowledge with the sport I love so much.  My company helps gymnast, cheerleaders, dancers, figure skaters and parkour athletes return to sport after an injury and achieve optimal performance to reach their goals.  After many injuries, multiple surgeries, and years of schooling for physical therapy and exercise science I have seen every aspect of performance, injury, and return sport in these acrobatic sports.  There are no performance programs or injury care geared towards these athletes.  There is a large gap in completion of physical therapy and full return to sport.  My business fills this gap.  As a coach it was hard to know what an athlete could and could not do in the gym and when to start what.  I felt I had a unique set of skills to share with the gymnastic and cheerleading community.  I am here to prevent injuries and optimize performance with performance training in the gyms.  I help catch injuries early and get them addressed before they become season ending.  I promote active recovery during the rehab process, allowing for highly specified modified sports progression during the rehab process. 

In many cases I found gymnasts and cheerleaders don’t get care for their injuries.  Many times this is due to lack of knowledge or fear of having to completely stop their sport.  I felt I could offer education to both athletes and coaches so they realize it is better to take care of a small injury than to wait until it ends the season or it is time to have surgery.  I also want to educate both of them that many times, specifically modified gymnastics or cheerleading is more beneficial than no activity.

3) What are the more common injuries you see among gymnasts and other acrobatic athletes?  Any trends in recent years?

I would say the three most common injuries I see are back pain, ankle sprains, and wrist pain.  I have seen a rise in the last 2 years in growth plate injuries. I am not sure if this is because I am seeing more athletes, if they are being diagnosed more thoroughly, or if increased repetitions or intensity of training has changed.

The most common time for athletes to get hurt is when they change levels, start a new team, or start training a new skills.  This change in frequency and intensity in training in combination with being a novice at the new skills place athletes at high risk to develop injuries. 

4) Do you see any common themes among your patients, such as imbalances, weaknesses, or other movement impairments that can be linked to their injuries?

All athletes are walking muscle imbalances.  In order to be good at something you must do a lot of repetitions of the same or similar activities.  These muscle imbalances develop as the athlete performs conditioning and drills to facilitate the skills along side with the repetition required to achieve a skill.  Add in poor technique during the beginning phases of learning and you have a perfect storm for compensations, muscle tightness, and muscle weakness. 

Now it is an important note, to say that athletes need muscle imbalances to a degree to perform their sport.  This is what makes them good at their sports.  The same thing which helps them perform can also hinder performance.   It is when these muscle imbalances become too great that we start to cross over into the realm of injury, be it repetitive micro trauma from each landing, each jump, each leap to every step they take or be it an acute macrotrauma (big injury) event.  I believe it is important to attempt to balance out the muscle imbalances to create more room for error biomechanically, realizing that as long as they continue their sport these imbalances will persist.

In gymnast one of most common muscle imbalances I find is what Shirley Sahrmann calls dominant hamstrings where the athlete fires their hamstrings greater than their gluteals to extend their hip (kick backwards).  This is important because if they are not using their gluteals then they lose a main contributor to stabilization of the back and they are not jumping or moving efficiently.

The second most common muscle imbalance which typically is present with dominant hamstrings in gymnast is what Shirley calls extension syndrome or extension rotation syndrome.  This is when an athlete has the preference of moving (arching and/or arching and twisting) from the low back when they move their limbs.  This is related to tight hip flexors, tight quad, tight TFL and ITB, with weak and/or loose abdominals.  This also goes in conjunction with athletes with "tight shoulders", typically tight lats and pecs with weak shoulder blade stabilizers.  These are the athletes who stand with their knees locked out, their bottom stuck out, shoulders rounded, with an arch in their back and many times with their abdominal muscles hanging forward.  I believe this imbalance is one of the keys which leads to issues from back pain to hip, knee, ankle, and even wrist pain. If an athlete cannot control their torso it is impossible to have proper biomechanics in the limbs.  This imbalance if left untreated and left to dominate the athletes movement will not only give the athlete trouble with shaping but lead to every coaches nightmare...the dreaded diagnosis of spondylolisthesis, aka "spondy".

5) Is it challenging to treat “adult” types of injuries in youth?

Youth injuries are challenging.  The biggest difference in youth injuries verse adult injuries is where the weak links are.  Where an adult would tear a ligament or fracture a bone, a young athlete is more likely to sustain a growth plate injury.  The growth plates are very vulnerable especially in growing athlete.  Growth plates are cartilage which as the athlete grows turns into bone.  Cartilage can be a tough thing to heal, taking a lot of time (10-12 weeks) and low loading with lots of repetitions, which can be tough in a high impact sport. When growth plates are involved the risk to benefit ratio comes into play, if allowed to continue to impact and not heal we risk separation of the growth plate, stunting growth, having uneven growth, and leading to persistent pain  and sometimes only fixable with surgery.  With patience and the proper workout modifications they can heal great and the athlete is back on track.

6) You not only treat patients, but also help with performance and injury prevention.  What are the most important elements to address in acrobats?  Do you offer any training to deal specifically with these elements?     

I think the two most important things I address in performance training is balancing out the muscle imbalances, and retraining or teaching proper mechanics.  I address everything from the proper way to engage your core using your transverse abdominis, internal and external obliques (not 6 pack muscle which most acrobats use) to muscle firing pattern training for the gluteus to scapular strength training, to stretching the hip flexors, quads, calfs, lats and wrist.  I address jump mechanics for the lower body and loading mechanics of the upper body.  There are tidbits of this information on my website www.perfect10physicaltherapy.com in the presentation section or on my YouTube channel perfect10pt.

It is in the works for me to put together some exercise DVDs with exercises addressing the common problems in acrobats.  Look for them on www.GymMomentum.com sometime Fall 2012.  You can check my website, Facebook, twitter, or Gymnastike for updates when they will be released.

7) Can you discuss the importance of building open lines of communication with coaches and parents?  Has your background as a high level competitor helped in this area?

I think the first step in a healthy happy athlete is good open lines of communication. Communication between the athlete and their coach, the athlete and their parents, the parents and the coach and when a medical provider is involved the medical provider and everyone.  It is important everyone is clear on what troubles or symptoms the athlete is having, what activities are going on in the gym, school, and home and what the ultimate individualized goal is for this athlete.  With everyone on the same page and understanding the rehab plan the athlete can successfully return to full sport without any repercussions later and many times in better shape than previous to the injury, now that they know how to keep their body "tuned-up".

I would say being a high level athlete has helped me to understand where the communication gets broken down and sympathize with both the coach, parent, and athlete the frustrations of having to hold back the reigns for a period of time.  I have seen personally the other side of pushing through it and the ramifications immediately with subpar performances and later in life requiring surgery.  The understanding that taking some time to heal with active recovery, still working towards their goals in the gym, will pay off in the long run when it counts is something I feel I can personally and professionally share with my athletes, their coaches and families.

8) The past few months have been quite eventful for USA Gymnastics with serious injuries to some of our brightest stars.  Can the gymnastics community learn anything from these unfortunate events?

I think the gymnastics community is learning from this last year's injury rate.  Just in the last week Bruno Grandi the president of FIG has come out with a proposed code of points change which may help address the issue, balancing out the risk to reward ratio for international competition.  I have not had a chance to read it in detail, but at first glance there seems to be more emphasis on artistry and execution to balance out the difficulty score.  Only time will tell as to how this all plays out, but I am confident USA Gymnastics and FIG will come to a solution with our athletes health at the top of their priorities.

9) Do you have any upcoming projects or seminars you’d like to share?

I look forward to being on the medical staff and possibly lecturing at USA Gymnastics Congress in San Jose, CA June 29- July 1 2012

I look forward to speaking at Gymnastics Association of Texas in Austin, TX  Sept. 1-2 2012

10) One final thing…please tell us about your budding career as a trapeze artist.  Is a Cirque du Soleil audition in your future?

You guys are too funny!  Yes I recently tried the flying trapeze!  It was amazing!!  Being an old gymnast when I go and "play" gymnastics my body will ache.  On the trapeze you get to swing and flip and no aches the next day, just a good old fashion muscle soreness. I had a blast and look forward to taking some classes. It is definitely an experience everyone should try.  As for Cirque du Soleil...I don't think they'll be calling me for my acrobatic abilities, but maybe they need a good physical therapist!!  smiley

Thanks for a great interview, Brandi.  Happy New Year!

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