Dr. Jessica Gingerich // #ICEPelvic // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Jess Gingerich discusses the sport-specific nature of gymnastics to the fitness athlete, introduces the strict pull-ups, considerations for when to modify, including the rack pull-up and box-assisted pull-up.

Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

JESSICA GINGERICH
Good morning! Hello, my name is Dr. Jessica Gingrich. I am on faculty with the ice pelvic division here at ice. And today we are going to jump in to treating the pregnant athlete during gymnastics. So gymnastics is a broad term and it encompasses a lot of different movements that are utilized in a lot of different sports. So sports like gymnastics, kind of what we typically think of like with the beams and the floor routines and the uneven bars. That's what we typically think about. We also have cheerleading and we have yoga and trampoline, um, um, stuff, um, and CrossFit. So CrossFit is what we are going to focus on today. There are many movements in CrossFit that are under the term gymnastics. So we have pull-ups, we have handstands, we have toes-to-bar, we have muscle-ups, rope climbs, and even things like pistol squats are considered gymnastics. And of course these movements can be done either strict or kipping. The term gymnastics is defined as physical exercise used to develop and display strength, balance, and agility, especially those performed on or with an apparatus. You will see a lot of things on social media around the dangers of kipping movements within the sports of or in the movements of gymnastics. You may even think that yourself. And so what I want to do, I want to challenge you to reframe how you view kipping. So we're not going to talk about this today, the kipping, uh, any kipping movements. I'm going to talk about that next time I'm on the podcast, but I want you to start thinking about this because this is sports specific, right? So let that sit for a second.

GYMNASTICS IS SPORTS-SPECIFIC FOR SOME PATIENTS
We talk about sports specific as physical therapists all the time. So if you are talking to an athlete and you're talking about how dangerous and how funky it looks or whatever, it is part of their sport. And you see it in CrossFit and you also see it in gymnastics. We don't tell the baseball player or the baseball pitcher specifically to stop pitching, even though his arm goes through a really gnarly range of motion and kind of looks funky in those pictures once they're slowing down. What we do as physical therapists is we prepare them. We prepare them from a mobility perspective, a strength perspective. We talk about things like programming, sleep, nutrition, stress management, and we try to maximize their recovery so they can maximize their performance. So I wanted to mention this before we dive in to what we're going to talk about today, because I'm going to talk about it later. And then also during pregnancy, we also get that same language, right? We get the language around something being unsafe or dangerous, and it's simply just untrue. It's more about preparedness. So pregnancy does not mean that you have less of an athlete in front of you. So what does it mean for our pregnant athletes that want to come in and they want to continue doing gymnastics movements?

THE STRICT PULL-UP
So today we're gonna talk about specifically the pull-up, and even more specific, the strict pull-up. So first and foremost, we want to talk about points of performance. Whether your client listens to you or not with the points of performance, because you will run into that, that is something we should be teaching in our space. So the points of performance for a pull-up are your hands are just outside your shoulders, You have a full grip on the bar, so your thumb is wrapped, it's not here. And you start in a full hanging, full elbow extension position. And the movement is complete once you pull and your chin is over the bar. So, is pull-ups during pregnancy dangerous? No. Short answer and long answer, no. When coaching or modifying the pull-up, we want to consider those points of performance that I just talked about. We even want to consider having that athlete get into a hollow position, maintaining a hollow hang throughout the range of a pull-up. If your athlete just simply cannot do it, we modify. But if they can do it, and they are doing a strict pull-up, but they break the points of performance, then we also modify. Now, I know that a lot of you are thinking, what about coning? What about doming? What do we do when we see that? If your athlete is maintaining points of performance at any point or any modification, if you will, in a pull-up, so that is a strict pull-up, that's a band-assisted, that's a box-assisted, we're gonna talk about a couple of modifications. If they're breaking that point of performance in whatever modification they're using, then we further modify.

CONSIDERING CONTINUING
If they're maintaining their points of performance, but they're still coning, you may consider letting them continue. Now, all of you may be like, oh boy, that's not what we see. Right. However, that's where also when we program, when we talk about sleep and nutrition, all of this stuff comes together. So if you have someone who is, who is maintaining points of performance, but they're also coning, you're not going to necessarily say, Hey, go do a hundred pull-ups. That's where our skills and programming can also benefit these athletes. Remember that some of your athletes may have been able to do, these pregnant athletes may have been able to do a strict pull-up even one week ago during their pregnancy. So that can be incredibly frustrating when they come in and they're like, gosh, I could do this a week ago, what happened? Even five pounds of weight gain, if you've ever done a weighted pull-up, it's significantly harder. Now that weight gain is normal, but it's sometimes really difficult from a mental, physical, emotional perspective. But we want to still be able to give them the appropriate challenge. So their grip strength, their core strength is continued to, is able to continue to grow. So when we modify, we are encouraging movement. We are encouraging strength. we are encouraging that mental load, something where they can go to the gym and just like let the day go and not be even more frustrated by something they can't do. So now, before we go into the modifications, I will say I have had athletes that have maintained points of performance in strict pulling even well into their third trimester. So they keep going. We just let them go. We talk about symptoms to modify for, so if they're doing a pull-up and they're peeing in their pants on that pull, we wanna modify. If they're losing those points of performance, we wanna modify. Those who can't, when we modify, we really just wanna encourage the pull strength. When we talk about the strength, talk about grip and I've talked about core, I am lumping lats into core because I know some of you guys are thinking that.

MODIFYING THE PULL-UP: THE RACK PULL-UP & BOX-ASSISTED PULL-UP
So, two of my favorite pull modifications are the rack chin pull up in the box assisted pull up. So, where you're uh you got your feet assisted on the box. So, the rack chin pull up is going to be on a low bar or the child's pull-up bar. And so the athlete will stand and you want the bar just under their chin. Then they're going to hang from the bar and they're going to pull from that low bar, both feet on the ground. The box assisted pull-up is going to be the same setup, just with a box. Maybe they have to put a plate on top of the box and they'll stand up and their bar or their chin should be over the bar that they're doing their pull-up on. So the reason we love these is if you have a foot-assisted pull-up, you can use as much or as little assistance as you need in that moment. And if you haven't tried these, I'm gonna encourage you in your clinic or at the gym, try them. I've done these modifications for some shoulder stuff before, and they are hard. I am very sore after using these as a modification. And so this can be awesome. A really awesome, awesome modification. They're on the rig, they're feeling really good. With that box assisted, you can also use one foot instead of two. You can work on negative, so time under tension. They're really, really awesome. This will allow your athlete to continue pulling vertically instead of horizontally with a ring row at really any point in their pregnancy. They can use these as modifications in their workout. They can also use it as accessory work. They can do EMOMs, you can do anything with it. And so, as you go out this week, you've got your pregnant athlete, maybe you even have a postpartum athlete and they're wondering about pull-ups, try these modifications. They're hard, they're challenging. Do it with them so you can see what it feels like. Maintain those points of performance. Get that hollow position. and see how you do.

SUMMARY
So before I hop off, I'm gonna talk quickly about some of our upcoming courses. So our next online course is already sold out. So if you are wanting to hop on that course, head over to ptonice.com to sign up for our next one. It's gonna be April 29th is that start date. We are on the road this month. We'll be in Newark, California on March 2nd, and then Bismarck, North Dakota on March 9th. So we hope to see you out on the road. And like I said earlier, stay tuned for when I am on the podcast. Next, I'm going to talk about kidney and pull-ups during pregnancy. Have a great week.

OUTRO
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