Inside Gymnastics Perspective: Timing Is Everything for Shilese Jones

Inside Gymnastics Perspective: Timing Is Everything for Shilese Jones

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Times are CT and subject to change

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Inside Gymnastics Perspective: Timing Is Everything for Shilese Jones

By Gina Pongetti, MPT- Physical Therapist for Inside Gymnastics 

After consideration throughout podium training this week in Fort Worth, Shilese Jones and her coaches, with the help of her medical team, have made the decision to withdraw from competition at the 2024 Xfinity U.S. Gymnastics Championships. She will be submitting a petition to the Olympic Trials which take place in a mere 28 days from today. 

“Unfortunately, I won’t be participating in the Xfinity Championships this year,” Jones stated in a quote from USA Gymnastics during session one of the Junior/Senior women’s competition on Friday. “With Paris as my ultimate focus, it’s best for me to prioritize recovery and resting my shoulder this weekend. Both the medical team and I are confident this is the right decision to ensure I’m at full strength for Trials. I’m excited to support my fellow athletes and teammates this weekend. I am submitting a petition to USAG for Olympic Trials and hope to have the opportunity to compete in Minneapolis!” 

Covered in leopard Kinesiotape this week, clearly drawing visibility in her short-sleeved training leotard, she wore more than this supportive accessory. She wore pain and a stoic determination with every turn on bars. Balancing the concept of pushing through but not too much, of talking about pain but showing coaches and the selection committee that it was – or could be – competition tolerable. 

Originally injured in 2022, Jones has been managing since then with what was assumed to be recovery and then a major flare up at the 2024 Classic. 

“So two years ago, I tore my labrum, and they think it’s something with my bicep,” Jones  said during the press conference following podium training Wednesday. “It’s just really flared up. So, we’ll see what goes on tonight. But [I’m] just trying to get as much treatment as I can for this weekend.”

Jones continued. “The day right after I got off the floor. I didn’t hear it click. I didn’t hear any pops, nothing major. I was just, ‘Oh, my shoulder’s a little sore.’ And then I was like, ‘No… it’s really sore.’ I got home Sunday and on Monday, went to see the doctor and everything. And it just flared up. [There’s] not really time to rest. I still have to push with the season. So Thursday, I tried to push it out — there’s not a lot of time to train. And then Friday, I barely could raise my arm.”

Regarding the petition process, USA Gymnastics stated in an email on Friday following Jones’ announcement:

“Complete selection procedures for the women’s artistic Olympic Team can be found in their entirety on the USA Gymnastics website.

Those procedures speak to the petition process on pp. 4-5. In summary: Any athlete seeking to petition for entry into the 2024 U.S. Olympic Trials – Gymnastics must submit their petitions in writing to the Vice President of Women’s Program as soon as practical after the athlete becomes aware of her inability to participate in the process, no later than the conclusion of the 2024 Xfinity U.S. Gymnastics Championships.  The Athlete Selection Committee will make a determination on the petition as soon as feasible.

Any athlete whose petition for entry into the Olympic Trials is accepted will be placed onto the National Team.”

Annie Heffernon, vice president of women’s gymnastics for USA Gymnastics, the selection committee should have a decision regarding Jones’ petition as soon as possible, as all petitions are due before the end of the competition.

There is also another petition possibility- quite literally- directly on to the Olympic team. 

The details to this, however, are challenging. 

Someone who competes All-Around at Championships and finishes first or second may be absent from Olympic Trials (illness or extenuating circumstances only) and submit a petition along with supporting and verified documentation. If an athlete does not participate at Championships, however, they must participate at Olympic Trials. Injury petitions will not be accepted. 

By comparison, in 2008, the rules allowed injury petitions directly to the Olympic Team. In 2024, they will not. This year, per the selection procedures, allowable are illness or extenuating circumstances only. The most recent example of this is Paul Hamm in 2008, where just over 10 weeks before the start of the Games, he broke a bone in his right hand. Dennis McIntyre, then the Men’s Program Director for USA Gymnastics, stated, “I think it just comes down to having a reasonable expectation that he would be able to perform at the highest level.” He simply needed the extra time. 

Time is what Jones is fighting against right now.

On repeat, as Jones said, “No time to rest.”

The question of the decade of course is how much is just too much?

With only four weeks until Olympic Trials, two weeks after that until the team departs for Paris, and then more than two weeks of training on site, it’s about the long game. And the right plan.

Rest now and decondition. Don’t rest and make it worse. Counter the pain with meds and modalities and push to train, possibly creating more damage. But don’t train, lose strength and then risk an unstable shoulder and not enough power production to complete her skills.

For certain, there’s no time for surgery. 

Compared to Brody Malone’s catastrophic knee injury just over a year ago, there was time. Not eternity, not enough to comfortably restrain the push, but calculated time. And that is mentally difficult. 

Decisions made whether to push or pull back are often the “art” part of sports medicine. Medical ethics, external pressures, self-induced goal achievement, coaches needing athletes to be their outcome. After all, there are no medals given for the best practice gymnast. 

“[Tuesday], it hurt. I’m not going to lie. It definitely did hurt, but not given up on myself,” Jones explained when inquired about the level of pain she is in. 

Our sport, and its culture, have come a long way. Communication is more open. Athletes are more respected. Coaches are being taught to be equally as concerned about their health as outcomes. 

No matter the stated acceptance and support from coaching staff both personally and nationally, personal pressure is often hard to overcome. Jones is frequently featured on NBC in promotional video spotlighting the Games. In retrospect, in 2021, even Simone Biles referenced that the hype and interviews, magazines, appearances were just too much. 

Jones consistently presents herself as a mature, poised and well-spoken athlete during press interviews, clearly ready to balance and make decisions for her ultimate Olympic goal. Without time on her side, there is hope that her natural talent, amazing fundamental gymnastics, and precisely conditioned body can withstand lower numbers, some days off, and healing.

For more on Shilese Jones, Click Here!

Explainer: The Shoulder- Labral Tears and Related Rotator Cuff Issues

By Gina Pongetti, Physical Therapist, for Inside Gymnastics Magazine

There is nothing worse than an injury for a gymnast. 

Except when the timing is oh, so inconvenient…

Years past have shown us examples of this. From John Orozco in the 2016 Olympic year after trials to Ragan Smith at 2017 World Championships. Traumatic and chronic injuries can be equally as challenging to the athlete, coaches, medical staff and the comeback route. 

The biggest challenge for the shoulder is that it is required to be equally stable and flexible, and even yet, stable in all its available motion. Which is a lot. 

There are fractures of the arm, impingement (where tendons get smashed because of mechanical issues, swelling, or injury). One can have a stuck shoulder (adhesive capsulitis), nerve issues, and even thoracic spine and rib dysfunction that cause shoulder inefficiency and pain. The most common for gymnasts are labrum, rotator cuff and bicep tendon irritation. 

So, what the heck is the shoulder labrum? 

It is very thick connective tissue in the shoulder joint- which is the ball (end of the humerus, upper arm bone) and socket joint (glenoid, a part of the scapula or shoulder blade). This tissue is technically categorized as cartilage. Because of its placement, it essentially helps keep the joint in place to roll and move within the socket. Think of it often as bumpers in a bowling alley.  Ligaments are present as well to help guide the ball and socket and keep it in place. Those ligaments can be affected by extra stress when there is a labral tear as the ‘mechanics’ of the joint are not as fluid and the stress not equally distributed. Other small ligaments also root in to, or attach to, the labrum itself. 

Then, how do we get to the diagnosis? 

The gold standard is MRI- T3 weighted (clear advanced view) or arthrogram (contrast injected dye). Xrays show bone, CT is advanced boney imaging. What is needed is an examination that shows tissue presence and health.  Diagnostic ultrasound can be used but is less effective and often produces false negatives (meaning it misses the diagnosis). The best way to confirm, invasively, is through arthroscopy (surgical procedure with scope holes for cameras and tools to perturbate and check tissue health). At times, these tests miss the diagnosis- whether the tear is too large or too small to see- pending position of the patient as well within the exam itself. 

What are medical professionals looking for in diagnosis? 

The labrum itself can tear off the bone where it attaches. There can be tears within the labrum, too, sometimes presenting as fraying. Ligaments can tear from the labrum, making the shoulder less stable when those ligaments cannot do their job. Subluxations- or small shifts outside of the joint- can happen, wearing away at the articular cartilage (carpet padding) on the ends of the bone. If traumatic, it can fracture bone in the process of popping out. When severely unstable over time, or a part of massive external forces and an acute injury, the shoulder can dislocate (come out of joint completely). The bicep is at risk for being an injury in and of itself (tearing the tendon off of its labral attachment) or having the labrum be loose and injured, and the bicep not able to work the way it is supposed to from its anchor point. 

Before diagnostic procedures of course are external testing, or positions that the shoulder can be placed in for a physical therapist or physician to stress the structures to reproduce the pain, weakness or other symptoms. 

What does the athlete feel? 

The first and most obvious answer may be pain. But often, because of the strength and stability of a highly trained athlete (in addition to higher-than-normal pain tolerance), instability may be felt first.  This comes in the form of ‘sliding’ in and out of place, not having the control over the joint than the athlete is used to feeling and shifting motions. 

When it is a question of pain vs healing…

At times, the order of events is as inconvenient as the injury itself. An athlete’s shoulder may begin to bother them, and yet they will still muster ability to push through. They do more strengthening- to try to support the joint. This overuse, per se, of extra pressure, may cause more damage. When still doing the same skills, the body begins to “adapt” and shift which muscles are used to get to the same positions and provide the same force and stability.  Often the bicep begins to be aggravated especially at the MT junction (where the muscle meets the tendon) and at the attachment of the tendon to the labrum itself.  The rotator cuff muscles (subscapularis, supraspinatus, infraspinatus and teres minor) 

Major treatment options?

Surgical repair of the labrum when it is torn off of the bone is necessary to restabilize the joint. If pieces are catching or getting stuck in motion, removal of these frayed pieces can give both pain relief and restore smooth arthrokinematics, otherwise known as coordinated motion.  Surgical reattachment can take 6-9 months to return to elite competition. Allowing the anatomy to heal and reattach completely takes 4-6 if not 8 weeks with rest. Then, external stress can be placed while the labrum responds to this stress for the next few months, adding more, and allowing the body to respond. Though protocols exist, it is treated best as an in this, then this situation. 

What can be done in the short term? The question in everyone’s mind…

Swelling is often present whenever there is dysfunction in the joint itself. NSAID (non-steroidal anti-inflammatory medicines) can be given to try to relieve the swelling. However, when activities continue to be performed, inflammation will continue to build unless the reason- or external stress- is taken away, thereby restoring proper motion. Cortisone injections are too often done which will assist more quickly in helping the edema (making more room for proper motion) but dichotomously also often masking pain. This, unfortunately, allows the athlete to press forward stressing the joint and therefore regularly increasing the potential for causing further injury. 

PRP, or platelet rich plasma, is a treatment that is rising to treat shoulder labral tears. Containing growth factors in concentrate from your own blood, it stimulates healing.  It is not, however, an immediate solution or pain relief option. In order to work time must allow for the tissue to heal thus rest is often prescribed in parallel with PRP injections. It is essentially a ‘booster’ to your own healing process. And to work best, cannot be taken with anti-inflammatory medicine (as PRP stimulates the tissue injury response purposely). Again, performing activities that mechanically cause irritation could cause irritation, counterproductive to the treatment. 

Physical Therapy is the gold standard for non-operative shoulder issues and of course after surgical intervention as well. Decreasing inflammation, restoring proper end range of motion. Addressing flexibility in surrounding tissue. Creating stability in the joint. Strengthening in many ways- power, endurance of the muscle, active production as well as ability to absorb load. Manual techniques such as ART (Active Release), Trigger Point Dry Needling, cupping, joint mobilization and adjustments, Graston if indicated, taping and more are symptom abolishing in appropriate cases. 

The biggest long-term cure to a chronic issue is addressing the biomechanics of why the injury crept up in the first place. A lack of shoulder range of motion, or too big of a difference in what a person has vs what the skills that they are doing demands means stress to the tissues. Spine health, abdominal strength and ability to form stacked handstand positions properly and repeatedly (being the key- from compulsory on, creating fundamental and basic habits). Thoracic spine (upper back) flexibility plays in to how the scapula moves and how “arching” is performed by the gymnast. Strength imbalances front to back, shoulder rotation, and actually in all six motions that the shoulder performs (flex and extend, abduct away and adduct toward the body, and rotate in and out). 

Modalities can be used such as ultrasound for tissue healing, electric stimulation for muscle relaxation and blood flow, acupuncture, heat-based treatments, cryo and flushing focused ice modalities, upper body compression sleeves and much more. 

In the end, it is just like a bank account, how people often refer to nutrition. You have a certain amount of calories in, burn them or use them, and you are either in excess or deficit. The shoulder- or any body part to be honest- needs certain variables in excess of zero to heal: time, blood flow, external assistance, an absence of edema, hormone levels in balance, restorative sleep and more. If these are not present, then the trajectory of success for tissue healing to have its best chance will be changed. 

Pushing through pain has always been a topic of discussion from a physical perspective and in an all-encompassing mental health perspective, a pervasive umbrella issue for elite sports.  When pain and physical injury alter the ability for an athlete to perform properly, performance is affected. If it is a matter of pain (a burn on the skin of the forearm, a nail injury that does not affect grip), then the mind game and tenacity can essentially win that battle.  

For anyone in the middle of the diagnostic process, rehabilitation, or returning to gymnastics, weighing options of risk vs reward need to be at the forefront of the decision tree. Always!

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