Armor Up

November 13, 2005

I'm with Geoffrey Taucer:

I know I'm in the minority on this, but I think we as coaches tend to be way overcautious of braces. The old refrain goes that wearing a brace weakens the associated muscles, but I've only ever heard that from coaches -- every medical professional I've talked to has said that braces are ok, and I know of a couple who even RECOMMEND tiger paws for anybody level 7 and up as a preventative measure, even if they don't have any wrist problems.

I'm not aware of any sort of scientific studies backing up the idea that muscles get significantly weaker when supported by a brace during workouts. And even if they did, this could easily be counteracted with a bit of extra conditioning.

Most coaches- present company included- have long advocated for resorting to Tiger Paws and other wrist supports only if needed; and fear over-reliance on them will prevent the wrists from "toughening up".

But overuse injuries is a major problem in a sport where, in order to make significant gains, the athlete usually needs to put in a significant amount of hours in the gym.  Even if the number of hours in the gym are reduced, the mileage remains the same (i.e., being productive and squeezing in a 4 hour workout into 3).

 Gymnastics Coaching.com:

David C. Rehak, MD:

… A gymnast’s wrist is inclined to injuries because many routines (1) place the body’s weight on the wrist while bending it backwards, and (2) often require fast, jolting movements to the wrists and hands. This results in injuries that are both acute, such as fractures, dislocations and sprains, and chronic (long-term).

Most acute gymnastic injuries are treated like any other sport injuries, however, two chronic injuries, dorsal wrist impingement and distal radial stress fractures, require specific treatment. …
Wrist Problems for Gymnasts

Coaches such as John Geddert actually recommends wrist braces be worn before an injury ever develops for an event like optional level vaulting.

The issue for coaches is whether or not to encourage athletes with chronic pain to use dorsal-wrist-block supports like Tiger Paws or the Ezy ProBrace.

Conventional wisdom is to delay using wrist bracing as long as possible. To take them off when possible. And to specifically strengthen the wrists to handle the impact.

Yet more and more coaches — including John Geddert — are encouraging girls to use wrist supports as part of required training equipment to prevent overuse pain.

It is not natural for the human body to run full steam ahead at an immovable object then collide with it backward, hyper-extending the wrists with tremendous force.  How many turns will the gymnast be required to take, day in and day out like this?

It only takes one bad vault to come in at a bad angle onto the table and really crunch the wrists. 

JBS:

I heard all three of the above vault practices from a great coach that is very active in the US elite scene. While I do not currently make all of my optionals were Tiger Paws…he insists that one bad Yurchenko is enough to ruin a wrist forever. He believes the JF table and the Tiger Paws are very helpful in keeping his kids in the gym when that accidental wrist jamming vault happens.
He has a very good point…can human wrist strength really stand up to an 80 foot run straight into a wall?

I had modified my thinking quite a while ago to believe that Yurchenko vaults were the exception (comments #2 and #7), where Tiger Paws should be recommended wearing before any wrist issues arise.  Now I'm modifying my thinking further into thinking this applies to tumbling as well.  If the wrists do become reliant upon the supports, so what?  At what other time is the athlete ever going to do hard tumbling and vaulting in their daily life where they'll need to get by without the wrist supports?

Wearing Tiger Paws for high impact, high repetitive skills should be as acceptable as wearing grips on bars.  It's to protect the lifespan of the gymnast.  Using them will not make the wrists brittle.  Overuse workload on the wrist joint will make the wrists brittle.  "Prevention is better than the cure".

Dr. Bill Sands weighs in on comment #8:

Just some food for thought.

A classic book on physical therapy and rehabilitation:

Muscles: Testing and Function, with Posture and Pain
Florence Peterson Kendall
Elizabeth Kendall McCreary
Patricia Geise Provance
Mary McIntyre Rodgers
William Anthony Romani
From Lippincott Williams & Wilkins.

These authors take on the “bracing makes you weaker” idea by indicating that “correct” bracing aligns joints such that the “correct” muscles and their contractile relationships are emphasized. Failure to use correct alignment and whatnot usually means that the strong (sometimes wrong) muscles overwhelm the weaker muscles that are usually involved in stabilization. Thus, they support intelligent bracing.

Also, in a study done by Gabriella Penitente, myself, and Jeni McNeal at the USOC placed two force platforms on the vault table and recorded hand contact forces in two dimensions (up/down, forward/backward). The vault performed was a handspring, and the “high” force values (group) exceeded 0.7 x body weight. (Penitente, G., Sands, W.A., McNeal, J.R. (2011). Vertical Impact Force and Loading Rate on Gymnastics Table Vault. Portugese Journal of Sport Sciences, 11 (Suppl 2). 667-670.). The values obtained on handsprings were slightly less than body weight because the gymnast never really stops in a handstand position. Moreover, the dynamic nature of hand contact ensures that forces are transitory. However, that’s not the whole story. You also need to look at loading rates, durations, and repetitions. Time to peak loads in the high load group took on average 0.016s (16 thousandths of a second). The low load group took about 0.007s (about half as long). Generally speaking, the quicker a force is applied to biological tissues the better those tissues are able to withstand the forces (this is called rate dependency). As you can see, the high load group is also the “long” load group in terms of time. Afterall, it takes a while to develop high forces. Thus, be aware that those people who hit the table the hardest are also at the most risk, be sure that training load volumes are modified and monitored accordingly.

Take home: you need to consider, forces, impulses (force x time), rates of force development, position of the limb(s), and repetitions. It is unlikely, although possible, that a single countermeasure such as wrist guards will solve all wrist problems on vaulting. Repetitions certainly play a role. One might also consider that if the wrists are braced where do the forces of impact go – into the brace or into the forearm or elbow? I don’t have the answer, but I suspect that forces will move up the arm as well as into the brace. Finally, consider that repetitions may be the main enemy here, especially when poor technique and or fatigue are present. Also, consider the position of the wrist while braced – is the alignment anatomical or some jeopardizing position.

Also from the same forum thread that began this post, note this parent's link:

Here is a study on ankle braces from UW

UW Studies: Ankle Braces Keep High School Athletes in the Game

This is advice from one of the manufactures FAQs - Active Ankle
If it hurts, a little tape or a brace can keep it from getting worse.

Train smart.  Especially when training often....so you can train often.