Wrist Guards/Supports in Gymnastics: Are They Helping or Hurting You?

BACKGROUND: The prevalence of wrist pain among gymnasts ranges from 46% to 79%. To alleviate wrist pain, gymnasts wear wrist guards/supports (WG/S). PURPOSE: To investigate the effect of WG/S on the wrist joint through joint moment, angles, total joint range of motion (ROM) arc, and ground-reaction force (GRF). STUDY DESIGN: Controlled laboratory study. METHODS: A cross-sectional study design was used to investigate 23 female gymnasts (mean ± SD: age, 12.3 ± 1.5 years; height, 143.4 ± 7.6 cm; mass, 37.7 ± 6.6 kg; body mass index, 18.6 ± 2.9) who performed back handsprings (analyzed by first half [phase 1] and second half [phase 2]) with the following 3 conditions: no WG/S, Skids/Ultimate Wrist Supports (S/UWS), and Tiger Paws (TP). Wrist joint moments, angles, total ROM arc, and GRF were examined by the 3 conditions using analysis of variance with Bonferroni correction and effect size (Cohen d). RESULTS: For mean wrist flexion moment, both S/UWS and TP showed significantly higher values than the no-WG/S condition in landing phase 1 (S/UWS: P = .001, d = 1.30; TP: P = .019, d = 0.87). In angle comparisons in landing phase 1, no WG/S showed greater mean wrist extension angles compared with S/UWS (P = .046; d = 0.80), but no significant differences with TP (P = .096; d = 0.65). Also, in landing phase 1, total ROM arc of the right wrist was greater in the no-WG/S condition compared with S/UWS (P = .018; d = 0.88), but there were no differences with TP (P = .400; d = 0.52). CONCLUSION: These data show an increased wrist flexion moment using S/UWS and TP compared with the no-WG/S condition in landing phase 1 of back handsprings. Also, increased wrist extension angles and total arc ROM of the right wrist were found in the no-WG/S condition compared with S/UWS, but not with TP in landing phase 1. S/UWS may be helpful to reduce wrist joint angles, specifically wrist extension in landing phase 1, but both S/UWS and TP caused higher wrist flexion joint moment in landing phase 1. There were no differences found in GFG among the three variables. CLINICAL RELEVANCE: In the first half of the back handspring, wrist guards can limit wrist extension joint angles and total arc ROM; however, an increased wrist flexion moment was found when wrist guards were worn, which may potentially lead to an increased risk of injury. Injury history, especially overuse signs/symptoms, and previous surgery on the wrist joint need to be well considered before the application or use of wrist guards. Also, the amount of time/exposure wearing wrist guards should be carefully controlled in young female gymnasts.

Long-Term Follow-up of Skeletally Immature Patients With Physeal-Sparing Combined Extra-/Intra-articular Iliotibial Band Anterior Cruciate Ligament Reconstruction: A 3-Dimensional Motion Analysis.

BACKGROUND: The physeal-sparing iliotibial band (ITB) anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-established technique for treating skeletally immature patients with ACL rupture. However, the long-term implications of the procedure on the intricacies of kinetic and kinematic function of the knee have not been comprehensively investigated. PURPOSE: To assess the short-, mid-, and long-term effects of ITB ACLR on kinetic and kinematic parameters of knee functions. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 38 patients who had undergone an ITB ACLR as a skeletally immature child were recruited to participate in a 3-dimensional (3D) motion analysis testing protocol at an institutional injury prevention center between 1 and 20 years after reconstruction. Exclusion criteria were congenital ACL deficiency and any other major knee injury (defined as an injury requiring surgery or rehabilitation >3 months) on either knee. 3D and force plate parameters included in the analysis were knee moment, ground-reaction force, and vertical jump height measured during drop vertical jump and vertical single-limb hop. Paired t tests and equivalency analyses were used to compare the parameters between cases (ITB ACLR limb) and controls (contralateral/nonsurgical limbs). RESULTS: Paired t tests showed no statistically significant differences between limbs, and equivalency analyses confirmed equivalency between limbs for all tested outcome variables. CONCLUSION: The ITB ACLR appears to restore normal, symmetric, physiologic kinetic and kinematic function in the growing knee by 1 year after reconstruction, with maintenance of normal parameters for up to 20 years.

Functional Elbow Range of Motion in Children and Adolescents.

BACKGROUND: The functional elbow range of motion in children and adolescents has not been previously reported. In adults, a functional motion arc of 30 to 130 degrees of elbow flexion and 50 degrees of pronation to 50 degrees of supination is well established. Contemporary tasks such as cellular phone use and keyboarding require greater elbow flexion and pronation than the functional motion arc. Whether or not this is true in children has yet to be established. We hypothesize that to perform functional and contemporary tasks, children and adolescents use a greater range of elbow motion and forearm rotation as compared with adults. METHODS: Twenty-eight subjects performed 8 functional tasks and 4 contemporary tasks. Kinematic data were captured using a 3-dimensional motion analysis system as previously described. Mean and SD was collected for elbow flexion, extension, pronation, and supination. Unpaired t tests were performed to compare elbow kinematics of children 6- to 11-year-old (n=14) to that of adolescents 12- to 17-year-old (n=14), with a significance criterion of P-value <0.05. RESULTS: The mean arc of motion to achieve functional tasks was 28 to 146 degrees of elbow extension/flexion and 54 degrees of supination to 65 degrees of pronation. Contemporary tasks utilized 40 to 148 degrees of elbow extension/flexion and 49 degrees of supination to 65 degrees of pronation. A greater supination/pronation arc (107 degrees) and greater elbow flexion (148 degrees) were used to bring a cellular phone to the ear, whereas greater pronation (65 degrees) was used to type on a keyboard. Statistically significant differences were observed between children and adolescents in each of the 12 tasks, with the exception of using a fork. CONCLUSIONS: A motion arc of 30 to 130 degrees of elbow flexion and 50 to 50 degrees of pronation/supination is sufficient to achieve most positional and functional tasks in children and adolescents. However, specific contemporary tasks such as the use of a cellular phone and typing on a keyboard utilize more elbow flexion and pronation. Awareness of greater use of flexion and pronation to achieve contemporary tasks may help guide surgeons in the care of patients with posttraumatic elbow and forearm deformities and contractures. LEVEL OF EVIDENCE: Level II-investigation of a diagnostic test.

The Effect of Stride Length and Lateral Pelvic Tilt on Elbow Torque in Youth Baseball Pitchers.

High elbow torque during a pitch may contribute to injury risk. Our objective was to determine the pitch mechanics associated with elbow varus torque in youth baseball pitchers. Eighteen male youth pitchers (age = 15.5 ± 1.6 years) threw 3 fastballs and 3 change-ups from a windup position while undergoing 3-dimensional kinematic analysis. Independent variables included ball release point distance, stride length, lateral pelvic tilt, and ball velocity. Two multiple regression models, separated by pitch type (fastball, change-up) were used to determine the association of independent variables with peak varus torque at the elbow. Fastball and change-up regression models indicated that stride length (ß = 0.301, p = .015; ß = 0.46, p < .001, respectively) and lateral pelvic tilt (ß = -0.50, p < .001; ß = -0.25, p = .04, respectively) were significantly associated with peak elbow varus torque. During fastballs, pitch velocity was significantly associated with peak elbow varus torque (ß = 0.38, p = .002), while release point distance was significantly associated with peak elbow varus torque during change-ups (ß = -0.33, p = .015). Youth pitchers with longer strides and less lateral pelvic tilt demonstrated greater elbow torque regardless of pitch type, while the association of ball velocity and release point to elbow varus torque was dependent on pitch type.