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

Rebecca Bross' Knee Injury: Broader Implications for Injury Prevention and Rehabilitation in Gymnastics

In the aftermath of Rebecca Bross’ disastrous knee dislocation at the Visa Championships, we’ve heard the gymnastics community assign blame in a variety of places.  I won’t embed the video here because most with an interest in this topic will have seen it and it’s not a scene that we need to reply endlessly.  Nevertheless, I will provide a link for those that care to view it again or who haven’t seen it (honestly, I did not see it live having turned away from the TV to get something for my grandfather…).

Some reasons the gymnastics community has advanced to explain this unfortunate incident....

1) The code of points for this Olympic cycle is too demanding and unsafe

2) Valeri (her coach) pushed her too hard and got lucky that the same thing didn’t happen to Nastia (who recovered from a serious ankle setback to ultimately excel at the Beijing Olympics)

3) The whims of Marta’s selection process forced her hand

4) She was tired at the end of the meet

5) She wasn’t hitting the vault in practice anyway

6) There was no need for her to attempt a relatively difficult vault based on where she stood in the meet (too far out of first place; comfortably ahead of third)

7) It was a freak injury that’s “part of the game” in gymnastics

8) She has lower limb structural abnormalities that predispose her to injury

9) Bush did it

10) Obamacare doesn’t work

Ok, so maybe those last two are fanciful notions, but the gymnastics community has been searching over the past two weeks for a definitive explanation.  In fact, there may be grains of truth in each of the eight other reasons speculated upon.  In our opinion, most of the commentary has ignored key risk factors that precipitated this unfortunate incident that will likely keep her off the Olympic team in 2012, although the inherent structural abnormalities are closely tied to the following discussion.

Most are aware that Rebecca missed significant time last year with a stress reaction in around her ankle that ultimately was operated upon.  To those familiar with the joint-by-joint approach to training popularized by Gray Cook and Mike Boyle, it should not be surprising to see a knee injury result after a serious ankle injury.  Lose mobility in the ankle and you lose stability and gain unwanted mobility in the knee.  There’s perhaps nothing more hypermobile than a joint that is dislocated!  The dislocation was likely the final event in a long process of compensation-filled motor learning in which Rebecca’s body had trained itself to transfer energy upward into the knee either due to lack of use in the ankle or to protect the injured structure(s) in and around the ankle.

Do I know that Rebecca had any ankle mobility deficit at the time of this incident?  I honestly don’t.  But I do know that someone with a serious ankle injury will subconsciously take steps to avoid loading the painful site, not to mention any mechanical restrictions there might developed due to the underlying pathology.  Shortly before Worlds last year, Rebecca’s own words from are even more revealing: “The doctors told me I could I keep going as long as I was able take it.”  That approach may produce results in the short term, but if there is not a concomitant strategy in place to retrain movement fundamentals, there may be long term consequences.

Also note the pictures in an article from International Gymnast showing both a full ankle brace and taping on the affected ankle

Not does is the brain affecting motor control subconsciously in response to an injury, we also see outside interventions restricting the ankle!  Such interventions may be necessary on occasion, but eventually there is a need to relearn proper mechanics with the immobilized joint.  If Rebecca was being told to “keep going as long as [she] could take it,” I highly doubt she was advised to take time for movement reeducation in the affected limb.   

Why does this incident matter so much?  The plight of one of the United States’ brightest stars is but one example of sloppy injury prevention and conditioning practices frequently seen at all levels of the sport.  We happen to believe that despite the criticisms of non-gymnastics people, high level performance in the sport is possible without compromising health.  Unfortunately, a battlefield approach to injuries combined with a rejection of best-practices in the strength and conditioning field leads to disastrous results that not only give the sport a black eye to the general public but also prematurely drive young athletes away.   

Comments

Good Points

I am a Certified Strength and Conditioning Specialist through the NSCA. I don't work with gymnasts but I do work with other power athletes, and I have a keen interest in WAG. You make some great points about compensation in the kinetic chain after injury, and I would not doubt that that mechanism contributed to Bross's unfortunate knee injury. Some of the other items listed, such as pressure from Marta Karolyi to execute in my opinion I believe is misplaced criticism. I would put more weight on the mind set of a determined competitor and coach who may have opted to "tough it out," rather than to take a conservative approach. Nevertheless, while gym fans can argue the fine points, the take away from the blog is my questioning the system that gym clubs use when fielding previously injured athletes or the understanding of athletic injuries, rehab and neuromuscular reeducation. I know that WAG has one of the best physicians in the country on hand to treat national team athletes. What I am curious about, however, is how grounded club coaches are in best practices when it comes to athletic injuries, rehab and return to play. What educational resources does USAG offer to clubs and their staff when it comes to dealing with the inevitable injuries and return to play? In my professional area concussions are of great concern. A few years ago when an athlete got their bell rung coaches just said, "Walk it off." Now, coaches are being told that they have to get certified in concussion awareness and management for youth athletics. As far as WAG is concerned, is there a need for a programmatic approach to understanding the rehab and reconditioning process? I'd also like to say that I really believe that Rebecca will overcome this setback and be primed and ready to go by the time the Olympics roll around next summer.

@georgegert.  Thanks for your

@georgegert.  Thanks for your comment.  Just to clarify, Katherine and I agree with you that Marta herself is not to blame for this particular injury.  Do we agree with everything in how she runs the national teams program?  No, but it's certainly a bit of a reach to blame her directly in this case.  I included that 1-10 list as a sample of how the gymnastics world has been pointing a finger of blame just about every place you can think of. 

"is how grounded club coaches are in best practices when it comes to athletic injuries, rehab and return to play. What educational resources does USAG offer to clubs and their staff when it comes to dealing with the inevitable injuries and return to play?"   "  "

We believe that knowledge of best practices in these areas has a long way to go.  That said, USAG has made concerted efforts to improve the rehab support system.  Concussion awareness is taken very seriously. 

One obstacle to progress is that most coaches on the floor at most gyms are relatively young (i.e. college age), who aren't invested in coaching as a career and whose only experience in teaming with medical staff has been sitting in doctors offices in preparation for surgery or in a PT office with a bag of ice on a sore body part.  It's not that they are bad coaches; these are just complex issues that require a level of maturity/experience and we operate on such a fine line of health vs. injury in this sport as compared to others. 

However, leadership starts at the top...it is also on the head coach/gym owner to embrace best-practices in these areas, but unfortunately many of those in power choose to insulate themselves from best practices in rehab and conditioning because they fear losing control of their programs.  Ultimately, it comes down to improved lines of communication across the medical, coaching, and conditioning fields. 

Even within these fields, communication can improve: Better teamwork between MDs with PTs/DCs/ATCs, more strength coaches who understand the language and the specifics of the sport, and gymnastics coaches who embrace what the strength coaches have to offer.    

-ap

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