Gymnastics Elbow OCD Best Practices

May 13, 2025

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Rehabbing elbow injuries in young gymnasts requires a specific approach, especially when dealing with osteochondritis dissecans (OCD) lesions and other complex conditions that lack standardized return-to-sport protocols.

• Elbow OCD occurs when repetitive compression creates a "pothole" in the cartilage of the capitellum
• OATS procedure uses a bone plug from the knee to replace damaged elbow cartilage
• Young patients who are casted post-surgery develop significant stiffness issues
• Creative approaches like using heat while allowing distractions help children tolerate stretching
• Weight-bearing should typically be delayed until 12 weeks post-surgery, unlike knee/ankle protocols
• Strength training with BFR can help maintain muscle mass during non-weight-bearing phases
• Handstand progressions should begin with sideways walking against a wall to control loading
• Return-to-sport protocols should follow 2-week phases with progressive increases in repetitions and surface hardness
• Hand position during skills affects injury risk—neutral or slightly turned in positions distribute forces better
• Strength testing should assess shoulder, elbow, and grip symmetry before return to full gymnastics

We're finalizing a comprehensive paper for the Journal of Sports Physical Therapy that will provide detailed rehab protocols from day one post-surgery through six months of recovery, creating a resource for clinicians who don't regularly work with gymnasts.

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