Prevention and Treatment of Gymnastics Rips

Richard J. Carey, MS, ATC/L, Co~unm Editor

n women's and men's gym- nastics, those who perform on the uneven bars and high bars constantly encounter skin trauma to the fingers, wrists, and palms. More specifically, friction "hot spots" and blisters form at the dis- tal and midpalm areas. These are the areas where the hands are in grips-thick leather or dowel and leather straps that go up across the palm, over the fingers, and down the back of the hand, attaching around the wrist.

These friction hot spots and blisters can evolve into "rips" that bleed and produce annoying flaps of skin in the palm, thus interfer- ing with the gymnast's grip on the bar. In this column I will discuss the procedures for counteracting this problem faced by gymnasts who must grab the bars in their events.

Most gymnasts in "bar special- ties" realize that their hands must go through an agonizing phase of trauma during preseason to reach permanent callus formation, which is the ultimate goal. I have encoun- tered high school gymnasts who at- tempt to treat themselves. They may rub more magnesium carbonate (gymnastics chalk) into the rips, chew on the rips or calluses, or even use a razor blade, fingernail clip

Other gymnasts ignore their symptoms. Sometimes they de- velop calluses over the rips and achieve natural protection for their hands. But they can also de- velop larger blisters, blood blisters, more extensive tissue ripping, and eventual cellulitis complications. They then seek help from an ath- letic therapist. Unfortunately, the athletic therapist has no alterna- tive in these cases but to hold the gymnast out of competition and perhaps seek the services of a phy- sician to allow proper healing.

The prevention of hand rips is the key to the longevity and suc- cess of gymnasts who perform on bar events. It can be accomplished if the gymnast is willing to keep the hands protected during participa- tion, giving proper attention to callus buildup once this occurs. Common sites for calluses are:

Skin areas at the middle and proximal phalanxes of the fingers; Distal skin area of the palm (the bases of all 4 fingers); Center creases of the palm; Proximal base of the thumb on the radial side; Ulnar side of the wrist.

Once calluses build up above the

an emery board or pumice stone. If he or she seeks your services as an athletic therapist, you should use a Parex callus shaver to do the task. The blade is protected in a sheath of curved metal connected to a plastic handle. Neither you nor the gymnast can be injured by using such a device.

Regardless of how the calluses are shaved, the goal is to shave them down to the skin level. Do not remove the entire callus; it protects the affected area. The calluses should be shaved down about every 2 or 3 days in order to prevent nearby blisters and/or rips in the skin.

Additional protection can be accomplished by applying a skin moisturizer over the callus areas before bedtime. Due to the exten- sive use of chalk during a gym- nast's workout, the skin gets very dry, predisposing the calluses to cracks and rough edges. The fol- lowing procedure is for calluses that do rip or for isolated rips in the affected areas. It is only a sug- gested solution to the problem and does not preclude referral to a physician or a dermatologist.

Procedure

per, or some other cutting device skin level, the gymnast should Instruct the gymnast to wash to remove rips or calluses. shave off the excess dead skin with his or her hands to remove any

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July 1996 Athletic Therapy Today 49

excess chalk and dirt from the skin, then pat the hands dry.

1. Using the tape scissors, cut an inch strip of the Telfa pad transversely (with adhesive sides of the pad still intact).

2. Then cut the strip in half, leav- ing two sections that have an adhesive end to them.

3. Place some petroleum jelly on one of the halves and place it over the rip, using the adhesive end to attach to good skin.

4. Lightly spray the palm, dor- sum, and wrist areas with QDA.

You can secure the pad in place in one of two ways, depend- ing on whether the cost of supplies is a problem. If cost is not a con- cern, you can apply elastic tape over the pad, over the 3 middle fingers, and down the back of the-hand, securing both edges at the wrist. Specifically,

- - - 1. Pull off a 10-in. strip of elastic

tape and place one edge on the end of a countertop.

2. Make 3 half-inch folds about

1/4in. apart in the middle of the strip of elas- tic tape. Cut the folds off with the tape scissors; throw away the little scraps of tape, leaving 3 identi- cal holes in the middle of the tape. Place the holes over the gym- nast's 3 middle fingers, bringing the 3 holes down to the distal end of the palm.

5. Smooth down the elastic tape over the Telfa bandage and on the back of the hand.

6. Apply underwrap around the wrist initially, then place the ends of the elastic tape to the underwrap.

7'. Secure in place with 1-1/2-in. adhesive tape; two or three underwings are sufficient.

Be sure the ends of the adhesive tape finish at the top of the wrist to avoid rolling up when the gymnast returns to the bar events. The corrugation of the elastic tape allows for a better grip on the bar. Also, elastic tape is more durable.

If cost of supplies is a concern, fashion a protective device from 1-1/2-in. adhesive tape. Clear off a countertop and place '7 strips of adhesive tape approximately 12 in. long on top of each other. Then,

1. Pull off the combined strips and make a single fold about 3/4 inches long in the middle of these combined strips.

2. With tape scissors, cut the fold away, leaving a hole behind.

3. Place the hole of the com- bined strips of tape over the finger closest to the rip and pull the hole down to the dis- tal end of the palm.

4. Mold this tape strip over the Telfa pad in the palm and over the back of the hand.

5. Place underwrap around the wrist and attach both ends of the combined tape strips to it.

6. Secure the two ends, making sure the tape finishes on top of the wrist.

An additional strip must go around the palm, finishing on the back of the hand to ensure that the entire dressing is secure. These two tape securings allow the gym- nast to participate in practices and meets; afterward the gym- nast should return to you for daily treatment.

Daily treatment includes washing the affected rips with soap and water, then patting dry. Cut away any loose skin flaps with the skin forceps and curved iris scis- sors. It is critically important to use astringent to heal and tighten the skin. I have had good success with zinc oxide and Bag Balm for over- night treatment of rips. The zinc oxide should be applied on the first 3 days; the Bag Balm can be applied from Day 4 onward. How- ever, if the gymnast is allergic to any sulfa drugs, do not use Bag Balm.

Once the skin has healed over the rip area, usually in 2 to 4 days, you can use a cotton tip applica- tor to paint the former affected area with swabbings of Tincture of Benzoin to toughen the skin and encourage callus formation.

50 Athletic Therapy Today July 1996