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July 22, 2019

Protecting gymnasts from injury

In gymnastics, the demand for strength, flexibility and aesthetics — or form and appearance — combined with repetitive impact can be taxing on young bodies and put them at greater risk for injuries and strains.

"The most common location of injury for female gymnasts is the lower extremity, ankle sprains and knee overuse injuries. Traumatic knee injuries include a cruciate rupture or meniscus tear," said Jan Mussallem, UW Health physical therapist. "Male gymnasts tend to experience upper extremity injuries in the shoulder and wrist."

Gymnastics is a demanding sport even at early ages. Mussallem shares that a rule of thumb is 1 hour of practice per years of age per week. And yet, young gymnastics can be asked to practice upwards of 15 hours a week with competitions on the weekend.

"Frequent or long training sessions are not limited to gymnastics, but it is a reason we see certain types of injuries in young athletes," Mussallem said.

While higher-level gymnasts tend to experience more injuries, the repetitive strain and impact on the joints can lead to injuries at all levels of the sport. Tumbling skills, such as handsprings or flips, lead to the floor event being one of the most common sources of injuries. Mussallem adds that 40 percent of acute injuries occur on landings or dismounts.

Common injuries for gymnasts

  • Spine: Approximately 25-85 percent of gymnastics experience back pain. Spondylolysis, a type of stress fracture in the vertebrae of the back, is the most common. The extension and forces on the spine can also result in compression fractures.

Upper extremity

Gymnastics involves multiple skills that result in considerable force and torque on the upper extremities. Limbs not necessarily meant to absorb that kind of impact — shoulders and wrists — can experience injuries as a result of the repetitive impact.

  • Shoulder: The most common shoulder injury in gymnasts is a muscle strain, but impingement, labral tears, dislocations and multidirectional instability are also common.

  • Elbow: Repetitive high impact loading on the elbow can result in multiple types of issues including sprains and tears, dislocation and tendinosis.

  • Wrists: During gymnastics athletes can put up to 16 times their body weight on their wrists during movements such as tumbling or vaulting. The most common injury is known as "gymnast wrist," which is an overuse injury affecting the growth plate at the wrist. Scaphoid fracture — a break in the scaphoid bone of the wrist — is another common injury. For male gymnasts, grip lock injury can occur when the hand grips used by the athlete sticks to the bar but their momentum continues to carry them through the movement. The result is injury to the wrist and forearm.

Lower extremity

Approximately 50 to 70 percent of gymnasts experience injuries in the lower extremities. Significant force is placed on the lower extremities including the hip, knee and lower leg from tumbling and landings and over time, those joints can become irritated and weakened. Mussallem said that even stepping off a mat wrong can result in injuries to the ankle.

  • Hips: The anterior (front) hip muscles are called the iliopsoas. The repetitive hip movements in gymnastics can result in inflammation of these muscles. Hip labral tears, or tears in the cartilage that lines the hip joint, can also occur due to a sudden twisting movement or even fall.

  • Knees: This is the second-most common body part injured among gymnasts. Gymnasts commonly experience patellofemoral stress syndrome (knee cap pain) due to improper alignment and strength imbalances causing repetitive stress to the patellofemoral joint. The anterior cruciate ligament (ACL) is one of the major ligaments in the knee. It can become injured or even torn as a result of the repetitive jumping and landing required in gymnastics. Similarly, the medial collateral ligament (MCL) and lateral collateral ligament (LCL) can become inflamed or injured when they are forced beyond their normal range of motion.

Mussallem said most gymnasts are adolescents or teenagers and likely going through their adolescent growth spurt when they're at the highest level of gymnastics (most female gymnasts wrap up competition by the time they are 18).

As their bodies try to adjust to new heights and limb lengths, they can lack a certain amount of neuromuscular control. Parents of teens might recognize there are times where they seem more "clumsy" — often this is during periods when kids' bodies are experiencing growth spurts. But, this also can result in a greater risk of injury.

Ways to reduce injury risk

While some injuries happen despite best efforts to prevent them, there are ways to help reduce the risk.

  • Warm up and cool down: Some research suggests that "cold" muscles are more prone to injury. Warm up by riding a few minutes on a stationary bike or doing jumping jacks. At the end of practice, stretching can help reduce soreness and keep muscles flexible.

  • Stay fit, especially in the offseason: Maintaining fitness levels year-round can help athletes improve in their sports and reduce their risk of injury. Strength training and jump training can increase frontal plane (side-to-side) control and help reduce the risk factors associated with lower extremity injuries. Posterior shoulder strengthening — exercises that help develop the rear deltoid muscles — and stabilization exercises can help reduce the risk of upper extremity injury. Maintaining and improving strength and endurance can help gymnasts as they attempt more complex moves.

  • Stay hydrated: Even mild dehydration can affect an athlete's performance. Staying hydrated can help performance and provide the body with what it needs to perform. A general rule is 8 ounces of water for every 20 minutes of exercise.

  • Have an offseason: Focusing on one sport and training all year increases the risk of overuse injuries. For younger athletes especially, consider limiting the number of activities during a single season so the body has a chance to recover. And, take a break — playing other sports is essential to developing a well-rounded athlete.