Your Gymnast’s Knees
By Karen Goeller, CSCS
I’ve spent many years coaching gymnastics and as a CSCS. The CSCS is responsible for effectively training the athlete for sports performance. The CSCS also helps bring the injured athlete back to competition fitness once cleared from their physical therapist or doctor. That step in-between physical therapy and all-out competitive workouts is often missing. It is the job of the CSCS to fill that void.
Sometimes after a gymnast is “medically cleared” they continue to have knee pain. It is not that the doctor or physical therapist was not effective. Once cleared, the gymnast often is not aware on how the body should function; it is a lack of awareness.
I was asked by a gymnastics club owner to “go over some knee exercises” with some of her gymnasts who had a previous knee injury and some who were recently cleared by their doctors. I would be willing to bet the owner and coaches had no idea I would be teaching their gymnasts how to properly stand, bend, and straighten their knee, but that is what these gymnasts needed. AWARENESS. Below is a summary of what we did so that you can help your gymnast.
As many of you have seen, a high percentage of gymnasts have over-pronation. That is a rolling inward of the feet. Many have one that is more severe than the other. That causes poor alignment of the ankle, knee, and hip. You see the knees fall in laterally towards one another. With that poor alignment, the gymnast often performs skills adding stress to the joint because of the force involved with skills. The poor alignment is often seen in the take-off for the cartwheel, round-off, side aerial, and front handspring. This poor knee alignment is also seen in the landings of dismounts and jumps. Over the course of time, performing skills and landing can cause severe damage to the body if the gymnast is using incorrect technique and/or has poor alignment.
So here is the report from the quick clinic I gave to this group. Throughout each exercise I reminded these gymnasts how each drill related to the sport, landing mechanics and skill take-offs. When an athlete knows the purpose of a drill they get more benefit.
Out-In-Neutral-Foot
I asked the gymnasts to stand straight with their feet together, simple. (Well, sort of.) Many in this group could not do that without over-pronating. It is very common for gymnasts to have over-pronation. They train barefoot with no arch or heel support several hours each week. (That’s why they need high-quality shoes when not in the gym.)
I asked these gymnasts to gently roll their feet out towards their little toe, then back in towards the arch in their foot, and finally back to straight/neutral so they could feel the difference between the three positions. (It is very important to be sure they do not roll too far in any position. You do not want them causing damage to the ankle or foot.) As they did this slow-motion movement, Out-In-Neutral Drill, I instructed them to look and their knees to see the difference in alignment. Some seemed surprised at the difference foot placement made in the knee.
After that and asked these gymnasts to bring their feet hip-width apart and again to slowly roll their feet out, in, then back to neutral. At this point, they all were able to clearly see the difference in ankle and knee alignment with foot position. I asked the gymnasts to perform this simple Out-In-Neutral Drill several times in order to see and feel their neutral foot position and proper leg alignment.
After the gymnasts performed the Out-In-Neutral Drill on two feet, I asked them to lift one foot off the floor and perform the Out-In-Neutral Drill on one foot. Again, some seemed surprised at the difference the slight movement of the foot had on the knee alignment. I reminded them that the single leg alignment is important on the one-foot take-off and leap landings.
Once the gymnasts did a few repetitions they seemed to understand the relation between foot alignment and knee alignment really well. Before that moment, these gymnasts never realized that the alignment of the foot had so much effect on the rest of the body.
Side-Side-Neutral
After the Out-In-Neutral Foot Drill we did a simple weight shift drill. I call it the Side-Side-Neutral Drill. Believe it or not, when many gymnasts squat they tend to lean on one side more than the other. This is not something many people notice during the landing of the dismount because it happens so fast and the focus is on sticking the landing. The technique of the landing is imperative to maintain low body health.
I asked the gymnasts to stand hip-width apart and keep their feet in the neutral position. I then asked them to perform a ½ squat position as if they were landing a dismount. As I suspected, many were leaning on one side/leg. Others were bending at the knees with hardly any hip bend. We made adjustments to proper landing mechanics at that point. (Landing a jump on beam is different than landing from a double back on floor or a dismount from equipment. Since the force is so much greater, it is imperative to teach proper weight distribution when landing.)
Once all were in the correct position, I asked them to perform the Side-Side-Neutral Drill, shift their weight to one leg, neutral/center, and to the other leg. This was to remind the gymnasts that they must land with their weight centered, evenly distributed between both sides.
Remember, the force on the body when landing from a double-back can be 10-13 times the gymnast’s body weight. With some gymnast’s, one side could be taking more force than the other and in other cases the front of the legs could be taking on more force than the back. With gymnasts who are primarily bending at the knees, the front of the legs-knees and quads take a much higher percentage of force than the back of the body-glutes and hamstrings. The front-load landing can put enormous force on the knees and over time may cause damage.
Since gymnasts dismount daily, it is imperative they line up their knees with their ankles and hips, but they must also evenly distribute their weight from side to side and from front to back. Sometimes it is just as important to teach awareness as it is to physically strengthen the body.
We took this a few steps further and added a medicine ball with more complex movements. We carefully performed the chop exercise in order to simulate a landing but to also involve the core and upper body. We did this with both legs and then single leg. Adding the medicine ball made the movements challenging, but they were able to safely perform. This exercise is a great value because it forces the gymnast to focus on landing mechanics while building a little added upper body strength for bars.
Finally, during this session, we did include some traditional knee rehab exercises. Many gymnasts with knee pain have weak gluteal muscles.
I assigned the physical therapy bridge. I call it a hip lift. The gymnasts lied on their backs, bent their knees and lifted their buttocks off the floor a number of times. In the hip lift position we also did the marching exercise, but I only allowed the gymnasts to lift one foot 2 inches off the floor in order to keep their hips up.
Next, I assigned the clamshell exercise. I instructed the gymnasts to lie on their side and bend their knees, keeping their heels in line with their spine. Once in position, I instructed them to keep their heels together, but lift the top knee towards the ceiling, opening their legs. We did both sides.
Another exercise we did that day was the side plank. Added to the side plank hold we did plank hip dips. In the side plank position, I instructed the gymnasts to lower their hip to the floor and lift it back up. We did a number of receptions on each side.
And we did plank leg extensions and small kicks. In the plank leg-extension, I asked the gymnasts to lower their knees to the floor then bring them back up to a straight position. We did single leg plank leg extension too. With that one the gymnast kept one foot 2 inches off the floor as they worked on the supporting leg, lowering and lifting the knee. That leg extension is simple, but a great quad strengthener and form drill. And for the small plank low back kicks I asked the gymnasts to lift one foot 2 inches off the floor. I instructed them to keep their foot pointed and lower their toes to the floor and lift the foot 2 inches. I had them alternate these slow, low kicks.
There are so many things you can do to maintain or improve your gymnast’s health. Keep doing much of the conditioning that is well known, but also consult with physical therapists, chiropractors, and CSCS’s for ideas.
Karen Goeller, CSCS
www.BestSportsConditioning.com
www.KarenGoeller.com
Exercise List to go with Video and Article
- Out-In-Neutral Foot Drill
- Side-Neutral-Side Drill
- Physical Therapy Bridge (Hip Lift)
- Clamshell
- Chops
- Single Leg Chops
- Plank-Leg Extensions (Bothe legs and single leg)
- Plank-Low Back Kicks
- Side Plank with Hip Dips
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You can avoid frustration and high risk of injury by planning ahead and allowing your gymnast enough time to prepare.
Confidence takes time to build. It happens after a series of successes and good days in the gym, school, or work. Confidence in an athlete/child is greatly affected by a coach, parent, or teacher. It is the adults along with those small successes often that help a child become more confident.
How many of your clubs/teams have a CSCS to consult with? How many teams have 30% of athletes (3 of every 10) dealing with chronic pain or injuries? (Too many!)
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