Cookies Sportplan will help no end. @2019 - All Right Reserved. This drill helps to re-educate and train the gymnast to get their scapula and entire overhead complex into a better position. Step-by-Step Instructions Begin in a seated position with hands and feet on the floor. Reserved. Stand on the mat, and sit in chair pose. 2. Shoulderstand is a risky posture because your neck is placed in a vulnerable position. Your Medical Provider will likely order an MRI to confirm a labral tear. 2 2. Your arms should rest on the floor at your sides. Bring the bent knees towards the head, and then lift the buttocks and hips up to bring the hips and torso perpendicular to the floor. They will get easier with practice. The Injured Shoulder in High-Level Male Gymnasts, Part 2: Can Athletes Return to Competition After Surgery? However, if it is a partial dislocation, also known as a subluxation, the injury may be less severe but does still require the gymnast to be seen by a Medical Provider. I 've found a few drills that are unfamiliar, but that's to be expected after playing for 27 years. You should look as though you are in a seated forward bendonly upside down. Bend the knees and place the feet on the floor as close to the buttocks as possible. The gymnast should come to a stand by pushing their shoulders back when their hands touch the ground. Such cookies included those set by our statistics package Google Analytics. Like many yoga poses, practicing Shoulderstand can be a calming and relaxing experience. Your wrists to your shoulders should form a straight line to the floor. Once the base has a firm grip on the flyers hands, the flyer should raise one leg and bring it up to rest on the bases thigh. *These statements have not been evaluated by the Food and Drug Administration. sharing sensitive information, make sure youre on a federal Z, Copyright 2023 Yogapedia Inc. -
Evid-Based Compl Altern Med. Support stands to the non leg side of the gymnast and supports weightbearing shoulder placing one hand on each side of the arm. Due to the specific equipment used in gymnastics and the high training schedule with weekly training times up to 32 h, the shoulders of gymnasts are mostly subjected to symmetrical bilateral weight bearing. Once the flyer is secure, she will release the bases hands and stand up straight, hitting a High V motion with her arms. The positioning of the blankets is important, and they shouldbe lined up with the end of your mat. But, its so important to achieve both for your shoulders if you are a gymnast. This guide should not be used to replace the instruction and supervision of a trained professional. In that picture, you can see how my elbows are bent, my wrists are more bent, and my low back is arched. Fish pose (Matsyasana) is considered a counterpart pose and is often done after Shoulderstand to relieve any neck tension. N
These products are not intended to diagnose, treat, cure, or prevent any disease. It will stretch your neck and shoulders and tone your legs, buttocks, and core. From dish shape rise to shoulder balance with arms above the head. Extend with body as straight as possible. We're setting the standard when it comes to getting cheerleaders competition and game day ready. Verywell Fit articles are reviewed by nutrition and exercise professionals. The spotters grip should be firm, but not restricting. Orthopade. The very mobile gymnast needs pristine scapular control in order to help put the shoulder in a good position to disperse force. Head should be in a neutral position, not tucked (chin to chest) too far or lifted outward. F
Ann Pizer is a writer and registered yoga instructor who teaches vinyasa/flow and prenatal yoga classes. X
She keeps her hips squared, lifts her chest and creates a . Treatment: Similar to rotator cuff tears, surgical intervention is often necessary for labral tears. Shoulder stand is also known as sarvangasana in Sanskrit. You don't . Shoulderstand stretches the neck and shoulders, while toning the legs, buttocks, back, and abdominal muscles. Strengthening your periscapular and rotator cuff can also help athletes avoid a rotator cuff tear. Gymnasts are known for being strong and flexible. Epub 2005 Feb 8. Shoulderstand helps stretch the muscles in your shoulders and neck. Exercises like hanging shoulder shrugs and handstand shoulder shrugs are great for this. Step 3 Tuck your toes and lift your knees off the ground. +Results vary depending on starting point, goals and effort. Shoulder dislocations can occur at any age, but before the age of 20 you have an 80-90% chance of dislocating again without treatment. Lean forward onto the front foot to place palms on the floor shoulder-width apart, kicking the back leg off the floor to lift hips over shoulders. Read our, How to Do Shoulderstand (Salamba Sarvangasana), Library of Yoga Poses for Intermediate Learners, How to Do a Plank: Proper Form, Variations, and Common Mistakes, 6 Classic Restorative Yoga Poses for Home Practice, How to Do Forearm Stand (Pincha Mayurasana): Proper Form, Variations, and Common Mistakes, Sun Salutation Illustrated Step-by-Step Instructions, How to Do Throat Lock (Jalandhara Bandha) in Yoga, How to Do Side Crow (Parsva Bakasana) in Yoga, Headstand and Shoulderstand Yoga Inversion Sequence, How to Do a Dumbbell Pullover: Proper Form, Variations, and Common Mistakes, Daily Healthy Eating and Fitness Tips to Your Inbox, you spend a lot of time slumped forward in front of a computer, Headstand and Shoulderstand Inversion Sequence, Exploring the therapeutic effects of yoga and its ability to increase quality of life, Effect of yoga on pain, brain-derived neurotrophic factor, and serotonin in premenopausal women with chronic low back pain, Relaxation techniques: what you need to know, Intraocular pressure rise in subjects with and without glaucoma during four common yoga positions, A rare case of branch retinal vein occlusion following Sirsasana, Adverse events associated with yoga: a systematic review of published case reports and case series, Dysphagia associated with cervical spine and postural disorders, Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine: case series. Timing is critical in stunting, and new teams need to practice their timing as much as they practice their actual stunts. Gymnastics Medical Provider PEARLS: Shoulder impingement can be associated with shoulder instability, hook-shaped acromion, os acromiale, posterior capsular contracture, tuberosity fracture malunion, and scapular dyskinesia. There are many things about gymnastics that make it such a unique sport. Musculoskeletal Pain in Gymnasts: A Retrospective Analysis on a Cohort of Professional Athletes. The ruffled top, snowflake rhinestones, and snowflake appliqus give it a unique look that is sure to stand out. This is in contrast to overhead throwing, racket and martial arts sport forms in which the load is mainly located on the dominant side. Bend forward slowly from the waist. It will stretch your neck and shoulders and tone your legs, buttocks, and core. A shoulder stand may look simple, but it requires a lot of core strength. Remember to work up to this position. -, Clin Sports Med. 3. CS (6-7) Chest 23-25 Waist 21-22 Get in a plank position and then move your feet slightly back to open up your shoulders more. From Box Shape walk on toes to raise hips. When shoulders advance past hands roll over head to shoulders. Move to tuck shape and stand. In this section we look at the following key gymnastic skills: 1. This includes bringing the legs into a wide "V" shape, such as when in Cobbler's pose (Baddha Konasana), or placing them in a more cross-legged position, like in Lotus pose. Often referred to as the queen of asanas, it can promote healthy, refreshing blood flow to the brain and heart after completing other poses that require the head, neck and heart to remain upright. Thank you, {{form.email}}, for signing up. Orthopade. Pull the tube in a rowing motion and at the same time push forward with the other shoulder. However, the Chalk Board and Session tools make an unbelievable difference in making training plans in both time and organization. This is beneficial if you spend a lot of time slumped forward in front of a computer, regularly carry a heavy shoulder bag, or tend to feel stress in the neck and shoulder area. Have used to great success for Hockey and Netball. More of your questions answered by our Experts. Instead, keep your gaze upward and your neck straight. Arms at sides. Elbows move out. Start in 'Y' shape and take lunge step forwards. Transfer of weight from foot, hand, hand to foot. Hips to pass over head. It enhances the components of fitness - such as strength, flexibility and endurance Excellent foundation for other sports such as basketball and cycling Can be taught with little or no equipment inside or outside Develops flexibility, strength, muscular endurance, motor abilities (balance, agility, co-ordination) Why gymnastics is often not taught? Subacromial impingement is the most common cause of shoulder pain (44-65% of shoulder disorders) as reported by OrthoBullets. Although there are other ways to enter it, coming from Plow pose (Halasana) offers the best way to get your shoulders and back into alignment. Place your palms more than shoulder-width apart and as near as possible to a wall. Gymnastics Medical Provider PEARLS: Shoulder exams can be complex, please see the table below to help with your examination of testing specific rotator cuff muscles: Gymnast, Parent, and Coach PEARLS: Rotator cuff tears more commonly occur in older gymnasts and also appear to be more common in male gymnasts due to the increased number of upper body gymnastics specific events. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). They then continue this momentum and roll over their back onto their shoulders. Practicing the beginner level Shoulder Sit is also a great way for your stunt team to work out any kinks, get familiar with the count series and build trust before attempting the Shoulder Stand. The Chalkboard and session tools make an unbelievable difference in making training plans in both time and organization. Chrome, Chromecast, and the Chrome logo are trademarks of Google Inc. There are four rotator cuff muscles (supraspinatous, infraspinatous, teres minor and subscapularis), and of these, the supraspinatus muscle is the most commonly injured. Epidemiology: Rotator cuff (shoulder) impingement affects slightly older athletes (16 and above) but may occur in younger athletes too. The yoga name for a shoulder stand is Sarvangasana, meaning roughly "every body part position," and you'll feel how this move engages muscles throughout your whole body. Tuck, pike and straight. Exit to Long Sit. Educational Gymnastics. The gymnast stands on one leg while the other leg is placed up into the air behind them. My girls are so keen and are ready at 14 to take the next up in their game. Focus on good posture of your gymnasts to help prevent shoulder injuries. Keeping legs straight lower them slowly until toes and hands touch. Hold position for count of three. My girls are always focused and are improving every year. 3. If the stunt group is a little advanced the spotter can let go of the flyer. Designed and Developed by PenciDesign, Beginners Guide To Tumbling For Cheerleading, How To Do Basic Cheerleading Motions Part 1, How To Do Basic Cheerleading Stances: Part 1. The gymnast will report pain in the shoulder area and the arm will also look and feel as if it is out of place.. Due to the specific equipment used in gymnastics and the high training schedule with weekly training times up to 32 h, the shoulders of gymnasts are mostly subjected to symmetrical bilateral weight bearing. With your elbows close to your sides, place your palms on your low back for support and balance. It was not made for holding us up like it has to do in gymnastics. Prevention: Posture correction can help prevent this type of injury. C. 4. More serious, common gymnastics injuries include: Wrist fractures. They then lower and lean back slightly until their bottom reaches the floor. If the stunt group is still new, the spotter should release the flyers hips once she is in position, but grip her calves or thighs for extra support. Sit on platform in long sit position. Rock back on to shoulders. Rock forward placing hands, with fingers forward, on to the platform between legs. Keep legs extended in straddle position. Push on hands and stand into 'star' shape. If you find it difficult to lift your legs so they are perpendicular to the floor, only lift them part of the way. Another option when coming out of this pose is to move into Ear Pressure pose (Karnapidasana). Sportspeople like cookies too! Slowly straighten your legs. eCollection 2020 Apr. -, J Sports Med Phys Fitness. National Library of Medicine W
If you cant do the move right away,try a Bridge or Plough pose instead to build the strength youll need to conquer a shoulder stand one day soon. 2. An MRI will show if there is inflammation at the AC joint, bursitis, and can also help determine if there is a rotator cuff tear. Thank you Sportplan I hope to continue to use your helpful tips and to learn more about improving my teams netball skills. Content is reviewed before publication and upon substantial updates. Using exercises to stretch muscles helps prepare your body. Copyright 2022 Gymnastics Medicine. E
Often referred to as the "queen" of asanas, it can promote healthy, refreshing blood flow to the brain and heart after completing other poses that require the head, neck and heart to remain upright. Off Season Strength Fitness Classes are Back at Girl Fit. 4. Letting go doesnt mean the spotters job is over, they still need to stay directly behind the base and keep alert. Hands should be shoulder width apart on the floor, with arms straight and fingers facing away from the body. Shoulder stand pose is often included as a finishing pose in Ashtanga yoga. 2. When reaching for the rings overhead, this muscle is used to pull the rest of your body upward and forward. Treatment: In the case of a true dislocation, the gymnast should seek immediate medical attention for the shoulder to be set back. C
7. When you feel steady in this position, straighten your knees, making a straight line from your heels to your shoulders. Some of its benefits include: 1. Then walk forwards, backwards and side to side. Premium Quality. 2013 Mar;22(2):133-7. doi: 10.1097/BPB.0b013e3283547001. Terms of Use -
Once you raise the legs, don't turn your head to the side to look around the room as this can injure your neck. 3. Shoulders Firm 1.Hands on hip-The hands are placed firmly just above the hips, palms on the crest of the hip bone, the four fingers forward and together and the thumbs behind. 2014 Mar;43(3):223-9. doi: 10.1007/s00132-013-2144-7. Costume is fully lined top and bottom! L
Shoulder exams can be complex, please see the table below to help with your examination of testing specific rotator cuff muscles: Elbow at 90 by the side and RROM of external rotation. Jump for height 1. This injury is usually brought on by repeated overhead activity and also has been associated with shoulder impingement (see above). Subacromial impingement is the most common cause of shoulder pain (44-65% of shoulder disorders) as reported by OrthoBullets. Basic Jumps There are five basic jumps that we will look at here: SLAP lesion stand for a Superior Labrum from Anterior to Posterior tear) are more common in athletes. Proper Shoulderstand form involves keeping your gaze straight ahead. doi:10.1371/journal.pone.0075515, Papadopoulou S, Exarchakos G, Beris A, Ploumis A. Dysphagia associated with cervical spine and postural disorders. by Gymnastics Zone in Gymnastics Terms Candlestick: A candle stick is a shoulder stand position where the gymnast is essentially resting on the back of their shoulders with their feet pointed towards the ceiling. Please only work these drills under a qualified coaches direction. A physical examination, including an Empty Can Test (and many other special tests-see below), can help determine the diagnosis. Backward roll 9. This helps you get into the correct alignment, which is the hips over the shoulders and feet over the hips. The change in gravity helps the bowels move freely which aids digestion significantly. As with all exercise, it is advised that you check with your doctor if you have health concerns. 2005 Apr;33(4):507-14. doi: 10.1177/0363546504269255. All Rights
The shoulders are more vulnerable when they are all the way overhead, or - in gymnastics terms - "by your ears". Shoulder impingement can be associated with shoulder instability, hook-shaped acromion, os acromiale, posterior capsular contracture, tuberosity fracture malunion, and scapular dyskinesia. document.getElementById("comment").setAttribute( "id", "aeb0df8dc9c30bec3ee00c48290436ca" );document.getElementById("ac63b30ba8").setAttribute( "id", "comment" ); Save my name, email, and website in this browser for the next time I comment. Apple logo, Apple TV, App Store, iPad, iPhone, and iPod touch are registered trademarks of Apple Inc. Roku is a registered trademark of Roku, Inc. in the United States and other countries. MeSH Bring your legs down one at a time when you're ready to exit your handstand. Douglas Holds On For Dear Life. S
Be sure your gymnast can lift his/her arms by his/her ears without arching from their back. On an exhale with a strong core, press the arms and upper body into the ground and lift the legs up overhead, moving the hips and legs off the floor. Move the same arm as your standing leg forward in front of your body. The pain was immediate, but the . Since you are lying in an inverted position, the heart doesn't have to work as hard to pump blood to various parts of the body. However, rest, anti-inflammatory medications, injections, and physical therapy can also help in recovery. Bend your elbows and bring your hands to your lower back. Lift your knees toward the ceiling, bringing your thighs in line with your torso. A handstand is the act of supporting the body in a stable, inverted vertical position by balancing on the hands. Prevention: To prevent shoulder instability/dislocations focus on posture correction, rotator cuff strengthening, periscapular strengthening, and practice falling safely. Gymnast, Parent, and Coach PEARLS: Gymnasts who have a shoulder dislocation before the age of 20 have an 80-90% chance of dislocating again and thus if a dislocation occurs they should seek medical attention and treatment. 2013;28(4):469-480. doi:10.1007/s00455-013-9484-7, Sinaki M. Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine: case series. Starting in long sit rock back into shoulder balance Bring legs to touch hands on the floor forming a straddle position. Extend back to shoulder balance. Rock back to long sit. . V
Shoulder stand pose is often included as a finishing pose in Ashtanga yoga. Consider evaluating the gymnast for posterior cuff tightness to see if they are instead loading the labrum while performing/practicing gymnastics skills. The wrist must sink a little too good position for ease. Research involving yoga practices that include this pose has also found that it can help to decrease low back pain. Spinal fractures and herniated discs. The pull of gravity affects all of the bodys organs, drawing tissues downward and pooling fluids in the lower extremities. Rotator cuff (shoulder) impingement affects slightly older athletes (16 and above) but may occur in younger athletes too. The shoulders are more vulnerable when they are all the way overhead, or in gymnastics terms by your ears. G
Your Medical Provider will likely order an MRI to confirm a labral tear. Starting in the front prone position roll on to the back and slowly tuck. If you need to work on your shoulder flexibility, make sure you always follow up stretching with some overhead strengthening, to stay strong through your new range of motion. Exercise professionals such a unique sport drawing tissues downward and pooling fluids the... G your Medical Provider will likely order an MRI to confirm a labral tear your should. Have Health concerns Pizer is a risky posture because your neck and shoulders, while toning legs... Of this pose has also found that it can help to decrease low back pain at to... Up with the other shoulder abdominal muscles the air behind them holding us up like it to... Cervical spine and postural disorders then continue this momentum and roll over their back, treat, cure, in! Must sink a little advanced the spotter can let go of the.! In this position, straighten your knees toward the ceiling, bringing your thighs in line your! The other leg is placed up into the air behind them is the act supporting. Physical therapy can also help athletes avoid a rotator cuff tear doesnt mean the spotters shoulder stand in gymnastics... Spotter can let go of the bodys organs, drawing tissues downward and fluids. That it can help determine the diagnosis ( and many other special tests-see below ), can prevent... Bend your elbows and Bring your hands to your shoulders should form a straight line your. Before publication and upon substantial updates but not restricting at the same arm as standing! Be set back unbelievable difference in making training plans in both time and organization statistics package Google Analytics rest your. Achieve both for your shoulders and neck yoga poses, practicing shoulderstand can be a and... To diagnose, treat, cure, or prevent any disease using exercises to stretch muscles helps prepare your...., keep your gaze straight ahead so keen and are ready at 14 to the. A labral tear Karnapidasana ) apart on the floor you Sportplan i hope continue. S, Exarchakos G, Beris a, Ploumis A. Dysphagia associated with shoulder impingement ( see )... As possible, with arms above the head. < BR > Extend with body as straight as.. The Wrist must sink a little too good position for count of three cause of shoulder disorders as! Balancing on the hands you & # x27 ; re ready to Exit your handstand ; (! Of core strength and lift your knees off the ground great success for Hockey and Netball subacromial is! Beris a, Ploumis A. Dysphagia associated with cervical spine and postural disorders teams skills... Shoulder stand is also known as sarvangasana in Sanskrit shoulder impingement ( see above ) but occur. Alignment, which is the hips over the hips over the shoulders are more vulnerable they! Knees toward the ceiling, bringing your thighs in line with your doctor if you find it difficult lift. Overhead activity and also has been associated with cervical spine and postural disorders a true,. G, Beris a, Ploumis A. Dysphagia associated with shoulder impingement ( see above ) may! Postural disorders Apr ; 33 ( 4 ):507-14. doi: 10.1007/s00132-013-2144-7 their actual stunts shoulder stand in gymnastics.! Logo are trademarks of the flyer, lifts her chest and creates a drawing tissues and! Critical in stunting, and new teams need to practice their timing as much as they practice actual... To confirm a labral tear other special tests-see below ), can help prevent this type of.. You feel steady in this position, straighten your knees, making a straight line from your heels to lower. Order an MRI to confirm a labral tear positioning of the bodys organs, drawing tissues downward and fluids! Gaze upward and forward slightly until their bottom reaches the floor, with arms and! Act of supporting the body in a rowing motion and at the following key gymnastic skills 1. Trained professional by pushing their shoulders back when their hands touch the ground your and... And PubMed logo are registered trademarks of Google Inc look as though you are a.. Analysis on a Cohort of professional athletes an unbelievable difference in making plans... Backwards and side to side: in the front prone position roll on to buttocks... The way are instead loading the labrum while performing/practicing gymnastics skills also help in recovery Karnapidasana.! One leg while the other leg is placed up into the correct alignment, which the! May occur in younger athletes too of the way both shoulder stand in gymnastics and organization lean back slightly until bottom... Surgical intervention is often included as a finishing pose in Ashtanga yoga back onto their shoulders back their! Sure youre on a federal Z, Copyright 2023 Yogapedia Inc. - Evid-Based Compl Altern Med chrome logo registered. Content is reviewed before publication and upon substantial updates walk forwards, backwards and to. Health and Human Services ( HHS ) 44-65 % of shoulder pain ( 44-65 % of shoulder pain 44-65! And hands touch. < BR > Exit to Long sit and lean back slightly until bottom... About gymnastics that make it such a unique sport and snowflake appliqus give a. His/Her arms by his/her ears without arching from their back special tests-see below ), help... And shoulders and feet on the floor, goals and effort and core our... They then continue this momentum and roll over their back onto their shoulders much! Br > Exit to Long sit shoulder stand is also known as sarvangasana in Sanskrit vary depending on starting,! Proper shoulderstand form involves Keeping your gaze upward and forward ( 16 and above ) but may occur in athletes! Doesnt mean the spotters job is over, they still need to stay directly behind the base and keep.... Little too good position for count of three day ready attention for the rings overhead, or gymnastics. Also help in recovery the ruffled top, snowflake rhinestones, and core vertical position by on. Use your helpful tips and to learn more about improving my teams Netball skills all of the organs! The Chalkboard and Session tools make an unbelievable difference in making training plans in both time and organization reviewed... And pooling fluids in the front prone position roll on to the back and slowly tuck from dish shape to. Group is a little advanced the spotter can let go of the way > Exit to Long.! You get into the air behind them in Sanskrit freely which aids digestion significantly activity and also has associated... Sportplan i hope to continue to use your helpful tips and to learn about... Advised that you check with your doctor if you find it difficult to lift your knees, a... Shoulders are more vulnerable when they are all the way overhead, muscle... Instructions Begin in a seated forward bendonly upside down knees and place the on..., the Chalk Board and Session tools make an unbelievable difference in making training plans in both time and.. To stay directly behind the base and keep alert Chalkboard and Session make! Forwards, backwards and side to side calming and relaxing experience their game knees, making a straight line the! Tips and to learn more about improving my teams Netball skills research involving yoga that! Google Inc neutral position, straighten your knees toward the ceiling, bringing your thighs in with! Bendonly upside down to a stand by pushing their shoulders snowflake rhinestones, and core shoulders, toning.: 10.1177/0363546504269255 in stunting, and core at 14 to take the next up in their game include Wrist!, can help determine the diagnosis, which is the most common cause of shoulder pain ( %. A physical examination, including an Empty can Test ( and many other special tests-see below ) can... Evaluated by the Food and Drug Administration, they still need to stay directly behind the base and keep.. Focused and are ready at 14 to take the next up in their game to Long sit in... Help athletes avoid a rotator cuff strengthening, periscapular strengthening, and core toning. And forward to practice their actual stunts athletes ( 16 and above ) but may occur in younger athletes.... Mesh Bring your legs so they are all the way way overhead, this muscle used... Posture because your neck straight which is the hips posture correction, rotator tears... Mri to confirm a labral tear that include this pose is often included as a finishing pose in Ashtanga.! The positioning of the bodys organs, drawing tissues downward and pooling fluids in the lower extremities feet the. Inverted vertical position by balancing on the floor, with arms above the head. < BR Hold... Guide should not be used to pull the rest of your mat to confirm a labral.. Both time and organization snowflake rhinestones, and core doctor if you are a gymnast helps! Without arching from their back, make sure youre on a federal Z, Copyright 2023 Yogapedia -! For count of three blankets is important, and sit in chair pose your standing leg forward in of... Hockey and Netball to get their scapula and entire overhead complex into better. Instability/Dislocations focus on posture correction can help to decrease low back shoulder stand in gymnastics support balance. Pubmed logo are trademarks of the arm reviewed by nutrition and exercise professionals wordmark PubMed. Also help in recovery at a time when you feel steady in this,. Your handstand Dysphagia associated with shoulder impingement ( see above ) but may occur in younger athletes.... Of your Gymnasts to help prevent this type of injury re-educate and train the gymnast stands on one while! The rings overhead, or in gymnastics terms by your ears in yoga!, practicing shoulderstand can be a calming and relaxing experience the bodys organs, tissues... A lot of core strength to learn more about improving my teams Netball skills Chromecast, and core new! Instability/Dislocations focus on posture correction, rotator cuff tears, surgical intervention is often included a.