Gymnastics injury incidence during the 2008, 2012 and 2016 Olympic Games: analysis of prospectively collected surveillance data from 963 registered gymnasts during Olympic Games

Sports-related pain prevalence in TeamGym during normal and reduced training periods: A survey of 579 Danish gymnasts

OBJECTIVES

To describe the pain prevalence and its regional body distribution in TeamGym gymnasts, and secondly, to compare pain prevalence during a period with normal training load with a period with reduced training load.

DESIGN

Cross-sectional study.

SETTING

Data from (1) a period with normal training load (Aug-Dec 2020), and (2) a period with reduced training load (COVID-19 restrictions, Jan-June 2021) were included.

PARTICIPANTS

TeamGym gymnasts aged 10-30 years.

MAIN OUTCOME MEASURES

Self-reported history of pain/discomfort.

RESULTS

In total, 65 % of the invited gymnasts completed the survey at both time points, which included 579 gymnasts. The pain prevalence due to gymnastics was 80 % with the most prevalent pain regions being knee (20 % [95 %CI 18.1; 21.8]), wrist (17 % [95 %CI 15.5; 19.0]) and foot (16 % [95 %CI 14.4; 17.8]). Gradual pain onset was described in 42 % of all cases. During the reduced training period, the number of painful regions decreased by 26 %, but regional body pain distribution remained unchanged.

CONCLUSIONS

Four of five gymnasts experienced pain/discomfort during a normal five-month training period. Knee, wrist and foot were the most common painful regions with gradual pain onset as the most frequently reported. Reduced training load decreased the absolute pain prevalence, but regional body distribution was unaffected.

The relationship between physical features and patellofemoral-pain in young female gymnasts

BACKGROUND

Patellofemoral pain (PFP) is prevalent in high impact athletes.

OBJECTIVES

To evaluate the prevalence of PFP and examine relationships between physical attributes and PFP in gymnasts.

METHODS

Data collection included the screening of 274 female gymnasts (aged M = 11.8 ± 1.9 years) from three disciplines - rhythmic, acrobatic, and artistic gymnastics. The participants completed Tanner's pubertal stage questionnaire and reported their date of birth and menarche status. They were then assessed for anthropometric measures, bone density, muscle strength, joint range of motion (ROM), hypermobility, and were physically examined for PFP.

RESULTS

A total of 21.5% of the gymnasts had PFP, with a significantly higher prevalence among artistic gymnasts (33.3%) compared to acrobatic gymnasts (11.7%) (p = .008). No significant differences were seen in the age, menarche status, and pubertal stages of gymnasts with and without PFP (p > .05). H/week of training during the current year differed significantly between gymnasts with and without PFP by discipline (PFP X discipline interaction) (F(2, 267) = 3.647, p = 0.027). Logistic regressions showed that decreased tibial bone density (OR = 0.996), increased en-pointe ROM (OR = 1.061), and reduced muscle-strength (knee extensors [OR = 0.003] and hip abductors [OR = 0.001]) were significantly associated with PFP.

CONCLUSIONS

A high prevalence of PFP was seen, especially among artistic gymnasts. Decreased bone density, increased ankle ROM, and decreased knee and hip muscle strength were associated with PFP in young gymnasts. These findings suggest modifying risk factors, such as strength and loads, during the training of young female gymnasts. Moreover, physical features and other factors that may be related to PFP should be screened from a young age. Developing and implementing training programs and injury-prevention exercises is important to decrease loads and strains to the knees, while reducing the chance of knee pain or injuries in young female gymnasts.

Efficacy of a Rhythmic Gymnastics-Specific Injury Prevention Program: An Assessor-Blinded Cluster-Randomized Controlled Trial

Overuse injuries are common among competitive rhythmic gymnasts, with an estimated weekly prevalence of 37% and with the knees, lower back, and hip/groin as the most common injury locations. Reduced physical capacity (e.g., strength and flexibility) has been hypothesized to contribute to the high prevalence of overuse injuries. The primary objective of this trial was to assess if exercises targeting reduced physical capacity in the knees, lower back, and hip/groin reduce the prevalence of overuse injuries compared with usual training. Twenty-three rhythmic gymnastics clubs were cluster-randomized to an intervention group (IG: 12 clubs and 119 gymnasts) and a control group (CG: 11 clubs and 86 gymnasts). Included gymnasts had to be ≥ 12 years of age and training ≥ 3 days per week. The IG performed a targeted injury prevention program (IPP) during training/warm-up for 8 months (November 2022 to June 2023). The CG performed usual training. The prevalence of overuse injuries in the targeted locations was measured monthly in both groups using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2). The response rate to OSTRC-H2 was 94%. There was no difference in the prevalence of overuse injuries in the targeted locations between the two groups; odds ratio = 0.86 (95% CI 0.32 to 2.29); p = 0.77 for intervention vs. control. The results suggest that a targeted IPP alone is not enough to prevent overuse injuries in the knees, lower back, and hip/groin among competitive rhythmic gymnasts. Other measures (e.g., load management and proper training planning) might be targeted in future studies. Trial Registration: ClinicalTrials.gov: NCT05506579.

Analysis of the Characteristics of Patients Visiting the Tokyo 2020 Olympics Polyclinic

OBJECTIVE

To evaluate the characteristics of patients who visited the Polyclinic during the Tokyo 2020 Olympics and analyze geographical and economic correlations with the number of clinic visits.

DESIGN

Cross-sectional study.

SETTING

Polyclinic during the Tokyo 2020 Olympics.

PARTICIPANTS

Patients who visited the Polyclinic.

INTERVENTION

Data from the electronic medical record system of the Polyclinic were extracted.

MAIN OUTCOME MEASURES

The number of visits for each athlete or team official was calculated by country. Relationship between number of visits per patient and total number of team members, total health expenditure per capita, density of medical doctors, life expectancy at birth, and education expenditure per gross domestic product (GDP) were investigated. Independent variables related to medal tables were also investigated.

RESULTS

The average number of visits per athlete was 0.67, and it was higher in athletes from non-high-income countries compared with high-income countries for both male and female athletes. Number of visits per athlete was higher in countries with low life expectancy at birth (95% CI, -0.16 to -0.02, P = 0.012) and education expenditure per GDP (95% CI, -0.17 to -0.04, P = 0.003).

CONCLUSIONS

During the Tokyo 2020 Olympics, the number of visits to the Polyclinic per athlete was higher in countries with low life expectancy at birth and education expenditure per GDP.

Sports Injury Surveillance Systems: A Scoping Review of Practice and Methodologies

Background: Injury prevention/reduction strategies are driven by data collected through injury surveillance systems. The aim of this review was to describe injury surveillance systems that are used for ongoing surveillance in either a professional or amateur sporting environment. This was an update to a review done in 2015 to determine the gaps in injury surveillance. Methods: A systematic search process of five databases (MEDLINE, CINAHL, EMBASE, SCOPUS and ProQuest) was used to discover published research that presented methodological data about the injury surveillance systems implemented by clubs and organisations for ongoing surveillance. Inclusion criteria centred on the population under surveillance and the ongoing nature of that activity. Data extracted and summarised included the level of athlete under surveillance, the data collection mechanism and the personnel involved, the injury definitions applied and the date and country of origin to provide a comprehensive picture of the systems. Results: A total of 21 systems were documented as being used in ongoing injury surveillance, with 57% of these exclusively in the professional/elite landscapes and 33% at the amateur level. Surveillance systems cater for one sport per athlete entry so there is a gap in research for multi-sport athletes at the amateur level, especially where there is no early specialisation in a multi-sport participation environment. Conclusions: Research in this area will lead to a better understanding of subsequent injury risk for multi-sport athletes who have a higher athlete exposure than single-sport athletes.

Dietary intake, energy availability, and power in men collegiate gymnasts

Introduction

The purpose was to examine the prevalence of low energy availability (LEA), explore dietary behaviors in men collegiate gymnasts (n = 14), and investigate the relationships between energy availability (EA), body composition, and plyometric performance.

Methods

Body composition was measured using air displacement plethysmography. Lower- and upper-body peak power (PWRpeak) and modified reactive strength index (RSImod) were calculated from countermovement jump (CMJ) and plyometric push-up (PP) assessments. Energy expenditure was tracked over 3 days, while daily energy and macronutrient intake were recorded. EA was calculated and used to categorize athletes into LEA and non-LEA groups. Pearson correlation coefficients were used to examine relationships between EA, body composition, and performance metrics.

Results

85.7% of athletes (n = 12) exhibited LEA (20.98 ± 5.2 kcals/kg FFM), with non-LEA athletes (n = 2) marginally surpassing the <30 kcal/kg of fat-free mass (FFM) threshold (30.58 ± 0.2 kcals/kg FFM). The cohort (n = 14) consumed insufficient energy (30.5 ± 4.5 kcal/kg/day) and carbohydrates (3.7 ± 1.1 g/kg/day), resulting in LEA (22.36 ± 5.9 kcal/kg/FFM). EA was not correlated with body composition or performance metrics.

Discussion

A high prevalence of LEA may exist in men gymnasts, largely due to a low relative energy and carbohydrate intake.

Monitoring the detrimental impact of congested training periods on the strength levels and landing forces of young female aerobic gymnastics

Identifying indicators of non-functional overreaching during periods of increased training volume and/or intensity is particularly relevant for understanding the detrimental impacts incurred, as well as how these factors contribute to heightened injury risks among exposed athletes. This study aimed to compare the effects of a congested training period versus a standard training period on the strength levels and landing forces of female young aerobic gymnastics athletes. A prospective cohort study design was implemented, spanning four weeks. Fifty athletes (aged 16.2 ± 1.1 years old) at a trained/developmental level, competing at the regional level, were observed throughout the study. During two of these weeks (specifically weeks 2 and 3), half of the group was subjected to a congested training period consisting of six sessions per week (HTF), while the other half continued with their regular four sessions per week (STF). During each week of observation, participants underwent evaluation using the countermovement jump test (CMJ), squat jump test (SJ), and the leg land and hold test (LHT), with measurements taken on a force platform. The main outcomes repeatedly observed over the four weeks were CMJ peak landing force, CMJ peak power, SJ peak power, SJ maximum negative displacement, LHT time to stabilization, and LHT peak drop landing force. Significant interactions (time*group) were observed in CMJ peak power (p < 0.001), CMJ peak landing force (p < 0.001), SJ peak power (p < 0.001), SJ maximum negative displacement (p < 0.001), LHT time to stabilization (p < 0.001), and LHT peak drop landing force (p < 0.001). Furthermore, the results of the final assessment revealed significantly lower CMJ peak power (p = 0.008) and SJ peak power (p = 0.002) in the HTF group compared to the STF group. Additionally, significantly higher values of CMJ peak landing force (p = 0.041), SJ maximum negative displacement (p = 0.015), and LHT peak drop landing force (p = 0.047) were observed in the HTF group compared to the STF group. In conclusion, the increase in training frequency over two weeks significantly contributed to declines in neuromuscular power performance and peak landing forces. This indicates that intensified training periods may acutely expose athletes not only to performance drops but also to an increased risk of injury due to reduced capacity to absorb landing forces.

Differences in Injury Profiles Between Female and Male Athletes Across the Participant Classification Framework: A Systematic Review and Meta-Analysis

BACKGROUND

Female sex is a significant determinant of anterior cruciate ligament (ACL) injury. It is not understood if sex is a key determinant of other sports-related injuries.

OBJECTIVE

The aim of this systematic review was to identify where differences in injury profiles are most apparent between the sexes in all sports across the six-tiered participant classification framework.

METHODS

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the 'implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science'(PERSiST) guidance. The databases PubMed, CINAHL, Web of Science, SPORTDiscus, Medline, Scopus, Cochrane Library and EBSCO were searched from database inception to 24 April 2023. Longitudinal, prospective and retrospective cohort studies and cross-sectional and descriptive epidemiology studies that used standard injury data collection were included. Studies were excluded if injuries were not medically diagnosed and if injuries were not reported and/or analysed by sex. Two reviewers independently extracted data and assessed study quality using the Downs and Black checklist.

RESULTS

Overall, 180 studies were included (8 tier-5, 40 tier-4, 98 tier-3, 30 tier-2, 5 tier-1 studies; one study included data in two tiers). Of those, 174 studies were of moderate quality and six studies were of limited quality. In sex-comparable sports, there was moderate evidence that female athletes had greater risk of knee injury (relative risk (RR) 2.7; 95% CI 1.4-5.5), foot/ankle injuries (RR 1.25; 95% CI 1.17-1.34), bone stress injury (RR 3.4; 95% CI 2.1-5.4) and concussion (RR 8.46; 95% CI 1.04-68.77) than male athletes. Male athletes were at increased risk of hip/groin injuries (RR 2.26; 95% CI 1.31-3.88) and hamstring injuries (RR 2.4; 95% CI 1.8-3.2) compared with females, particularly in dynamic sports. Male athletes were 1.8 (1.37-2.7) to 2.8 (2.45-3.24) times more likely to sustain acute fractures than female athletes, with the highest risk in competition.

DISCUSSION

Most studies in all cohorts were of moderate quality (mean/range of scores tier-5: 17 ± 2.2 [14-20], tier-4: 16.9 ± 1.9 [11-21], tier-3: 16.9 ± 1.5 [11-20], tier-2: 16.3 ± 2.2 [11-20], tier-1 studies: 15.6 ± 1.3 [14-17] out of 28 on the Downs and Black checklist), with only six studies of limited quality. Female athletes' propensity for bone stress injuries highlights opportunities to reinforce development of optimal bone health during adolescence and to outline the effects of energy availability. Earlier strength development and exposure to neuromuscular training programmes and modification of skill development in female athletes may be effective strategies for reducing lower limb injury risk. Key components of neuromuscular training programmes could be beneficial for reducing hip/groin and hamstring injury risk in male athletes. There may be a need for sex-specific prevention and return-to-sport protocols for sports-related concussion in female athletes.

CONCLUSIONS

Female sex was a key determinant of sports-related injuries beyond ACL injury including foot/ankle injury, bone stress injury and sports-related concussion. Male sex was a key determinant of hip/groin, hamstring injury and upper limb injury.

TRIAL REGISTRY

PROSPERO registration number: CRD42017058806 (last updated on 7th June 2023).

Preseason lower extremity range of motion, flexibility, and strength in relation to in-season injuries in NCAA division I gymnasts

OBJECTIVES

To determine if preseason lower extremity ROM, flexibility, and strength differ in collegiate gymnasts (NCAA Division 1) who do or do not sustain an injury during the competitive season.

METHODS

Over four seasons, a total of 15 female gymnasts (age = 20.5 ± 1.0 years) underwent preseason screening (30 gymnast-season). We tested joint ROM (hip: flexion, internal and external rotation; ankle: weightbearing dorsiflexion), muscle flexibility (passive straight leg raise, Thomas,' Ober's, Ely's tests) and strength (hip extensors, abductors, and flexors isometric strength via a handheld dynamometer; knee: quadriceps and hamstring isokinetic strength at 60°/sec). The team athletic trainer tracked overuse lower extremity injuries (restricted gymnasts from full participation, occurred as from participation in organized practice or competition, and required medical attention) during each season. For athletes that tested multiple seasons, each encounter was considered independent, and each preseason assessment was linked to overuse injuries sustained during the same competitive season. Gymnasts were dichotomized into injured and non-injured groups. An independent t-test was used to measure differences in preseason outcomes between injured and non-injured groups.

RESULTS

During four years, we recorded 23 overuse lower extremity injuries. Gymnasts that sustained an in-season overuse injury demonstrated significantly lower hip flexion ROM (mean difference: -10.6°; 95% confidence interval: -16.5, -4.6; p < 0.01) and lower hip abduction strength (mean difference: -4.7% of body weight; 95% confidence interval: -9.2, -0.3; p = 0.04).

CONCLUSION

Gymnasts who sustain an in-season overuse lower extremity injury have significant preseason deficit of hip flexion ROM and weakness in the hip abductors. These findings indicate potential impairments in the kinematic & kinetic chains responsible for skill performance and energy absorption during landing.

Study protocol for a prospective cohort study describing the injury characteristics in elite gymnasts in TeamGym: the Swedish TeamGym Injury Cohort - STIC

INTRODUCTION

Gymnastics consists of several different disciplines, whereof TeamGym is one. TeamGym is a young discipline with sparse research. The aim of the study is to investigate the injury characteristics in Swedish elite gymnasts competing in TeamGym including training load and other physical and psychological factors associated with injury.

METHODS AND ANALYSIS

The Swedish TeamGym Injury Cohort is a longitudinal prospective cohort study for 52 weeks that includes the junior (15-17 years) and senior (≥18 years) Swedish female and male national teams in TeamGym. A baseline questionnaire will be sent out in an online application (SmartaBase) regarding demographics, previous injuries, gymnastics-related factors, for example, time at elite level and psychosocial factors such as stress, athletic identity, coping skills, personality traits and coach-athlete relation. A weekly questionnaire will be sent out in SmartaBase every Sunday and will monitor injuries using the Oslo Sports Trauma Research Centre Overuse Questionnaire, gymnastics-related factors, for example, landing surfaces, stress, recovery and training load. A test battery for the lower extremity will be performed. Data for ankle dorsiflexion, hop tests and ankle plantarflexion strength/endurance will be collected.

ETHICS AND DISSEMINATION

This project was approved by the Swedish Ethical Review Authority (2023-06653-01) and is performed according to the Declaration of Helsinki. The results will be published in peer-reviewed journals, scientific conferences and shared with the Swedish Gymnastics Federation.

Injuries and illnesses at the Munich 2022 European Championships: a prospective study of 5419 athletes from 52 countries involved in 9 sports

Objective

To describe the incidence and characteristics of the sports injuries and illnesses that occurred during the 2022 European Championships.

Methods

We conducted a prospective study on newly incurred injuries and illnesses collected by the national medical teams and the local organising committee physicians using a standardised online report form on a daily basis, in all athletes registered at the 2022 European Championships from 11 August 2022 to 21 August 2022 in Munich (Germany).

Results

In total, 5419 athletes were registered at the 2022 European Championships in 9 sports. A total of 181 in-competition injuries were reported, representing an overall incidence of 33.4 injuries per 1000 registered athletes, with higher values in triathlon, cycling and athletics. More injuries located at the lower limb and involving the muscles and skin were reported in athletics, at the lower limb and involving the skin in triathlon, at the head and trunk and upper limb and involving head and skin in cycling. A total of 65 illnesses were reported, representing an overall incidence of 12.0 illnesses per 1000 registered athletes, with higher values in athletics and rowing. The most affected common system was the cardiovascular system (24.6%), followed by the gastrointestinal (18.5%) and upper respiratory tracts (16.9%). The most frequent causes were exercise (36.9%), infections (30.8%) and 'others' (10.8%).

Conclusion

This was the first injury and illness surveillance during multisports European Championships providing relevant results to help anticipate medical services and athletes' health protection, and highlighting the need for special attention for triathlon and cycling.

Dietary Intake and Menstrual Health among Acrobatics and Tumbling NCAA Division I Student-Athletes

OBJECTIVE

Acrobatics & Tumbling (A&T) is an emerging sport in the National Collegiate Athletic Association that lacks research regarding the dietary intake and health of A&T student-athletes (A&Tsa). This study assessed the dietary intake adequacy, estimated energy availability (EA), self-reported menstrual health, and body composition of A&Tsa.

METHODS

Twenty-four female A&Tsa participated during week 8 of the preseason (11 top: Age= 20.1 ± 0.9 years; BMI= 22.1 ± 1.7 kg/m2; 13 base: Age= 19.5 ± 1.3 years; BMI= 26.2 ± 2.7 kg/m2). Total energy intake (TEI) and macronutrient intakes were assessed via a paper-based 3-day dietary recall. Resting Metabolic Rate [RMR = 500 + 22 * fat-free mass (FFM)] and energy availability [EA = (TEI - exercise energy expenditure)/FFM)] were estimated; and LEAF-Q assessed menstrual health. Body composition was measured using Dual-Energy X-Ray Absorptiometry. Macronutrient intakes and EA were compared to sports nutrition recommendations (carbohydrate: 6-10 g/kg; protein: 1.2-2.0 g/kg) and the Acceptable Macronutrient Distribution Range (carbohydrate: 45-65%; protein: 10-35%; fat: 20-35%).

RESULTS

TEI was 1753 ± 467 kcal (top) and 1980 ± 473.8 kcal (base). A total of 20.8% of A&Tsa failed to meet RMR with TEI, with a higher prevalence in the top (-266 ± 219.2 kcal, n = 3) vs. base (-414.3 ± 534.4 kcal, n = 2) A&Tsa. Top and base A&Tsa had both low EA (28.8 ± 13.4 kcals·FFM-1; 23.8 ± 9.5 kcals·FFM-1) and inadequate carbohydrate intake averages (4.2 ± 1.3 g/kg; 3.5 ± 1.1 g/kg, p < 0.001), respectively. A total of 17% of A&Tsa reported secondary amenorrhea, with a higher prevalence in the top (27.3%, n = 3) vs. the base (7.7%, n = 1).

CONCLUSION

TEI and carbohydrate intake of the majority of A&Tsa were below recommendations. Sports dietitians should encourage and educate A&Tsa about following an adequate diet that meets energy and sports-specific macronutrient needs.

Epidemiology of injuries in elite Women's Artistic Gymnastics: a retrospective analysis of six seasons

Background

Women's Artistic Gymnastics (WAG) is a sport well known for requiring a heavy and difficult training load from a younger age to reach a high level of performance. This also is associated with an injury risk. Epidemiological studies are thus needed to improve injury prevention strategies.

Objective

We aimed to determine the injury epidemiology in French high-level WAG.

Methods

We conducted a retrospective analysis of injury data collected prospectively over six seasons from the 2014-2015 season to the 2019-2020 season among French high-level Women's Artistic Gymnasts from the France Gymnastics National Centre of Saint-Etienne. We performed descriptive analyses, including the calculation of the 1-year injury prevalence.

Results

43 gymnasts were included in this study, representing 111 gymnast-seasons. A total of 285 injuries were collected over the study period, that was, an average of 2.6 injuries per gymnast per season. On average, 91.4% of gymnasts had at least one injury per season. The estimated injury incidence rate was 1.8 injuries per 1000 hours of gymnastics practice. The knee was the most affected joint (16%), followed by the elbow (12%) and the ankle (12%). The most frequent injury type was physis pathologies (16%) and bone injuries (15%). Eighty-eight per cent of injuries required a modification of the gymnastics practice.

Conclusions

The results of this study allowed a description of the epidemiology of injuries in this population of young and elite gymnasts. This very high injury prevalence supports the need to improve injury risk reduction strategies in WAG.

Comparisons of musculoskeletal injuries among three different modalities of Taekwondo (Kyorugi, Poomsae, and Shibum): a one-year follow-up prospective epidemiologic study

The purpose of the study was to report the injury rates and characteristics (body location, type, mechanism, and severity) of musculoskeletal injuries in Kyorugi, Poomsae, and Shibum. A total of 137 Korean collegiate Taekwondo players - Kyorugi (n = 44), Poomsae (n = 46), and Shibum (n = 47) - were prospectively studied in 2019. Injury rates per 1,000 athlete-exposures (AEs) and time-exposures (TEs) during training and competition were calculated. Additionally, body location, type, mechanism, and severity of injury were analysed. The highest injury rate was recorded in Poomsae (172.0/1,000 AEs and 79.5/1,000 TEs) followed by Kyorugi (47.1/1,000 AEs and 25.9/1,000 TEs) and Shibum (57.5/1,000 AEs and 17.0/1,000 TEs). The frequently injured body location was the thigh (Kyorugi = 17%; Poomsae = 25%; Shibum = 18%). The common injury types were muscle cramps/spasms in Kyorugi (33%) and Poomsae (59%), and sprain in Shibum (41%). The common injury mechanisms were gradual onset in Kyorugi (40%) and Shibum (49%), and non-contact trauma in Poomsae (91%). Regarding the severity, the number of days from the injury onset to recovery > 1 week were higher in the order of Kyorugi (78%), Shibum (54%), and Poomsae (28%). Our data provide preliminary evidence that different injury prevention strategies should be applied to each modality of Taekwondo.

A Research and Clinical Framework for Understanding Achilles Injury in Female Collegiate Gymnasts

ABSTRACT

Gymnastics is a popular sport with a high injury rate, particularly at the collegiate level. Achilles tendon rupture is a catastrophic injury with career-changing impact. Over the last decade, there has been a growing incidence of Achilles tendon ruptures, especially in female gymnasts. Currently, neither the effects of contributing risk factors on Achilles tendon rupture nor the research frameworks to guide future intervention strategies have been well described. This article reviews the functional anatomy and mechanical properties of the Achilles tendon, provides precollegiate and collegiate intrinsic and extrinsic risk factors for Achilles tendon rupture, and proposes a research framework to address this injury from a systemic perspective. Potential clinical interventions to mitigate Achilles tendon injury are proposed based on currently available peer-reviewed evidence.

Pilot study: validity and reliability of textile insoles used to measure the characteristics of landing tasks during rehabilitation and artistic gymnastics

OBJECTIVES

Artistic gymnastics is a sport where most athletes start at an early age and training volumes are high. Hence, overuse and acute injuries are frequent due to the load endured during landing tasks. During landing, the ground reaction force (GRF) is up to 15.8 times the body weight and therefore reliable GRF measurements are crucial. The gold standard for GRF measurements are force plates. As force plates are mostly used in a constrained laboratory environment, it is difficult to measure the GRF in representative training settings. Textile insoles (novel GmbH, Munich, Germany) exist, which can be used to measure dynamic GRF. Hence, the motivation of this study is to test the validity and reliability of these insoles during landing tasks. GRF was measured during four different exercises, in two test subjects and compared to concurrent force plate data.

RESULTS

Twelve out of 16 statistical parametric mapping plots showed no significant difference between the measured force curves of insoles and force plates. Across conditions, the root mean square error of the maximal vertical GRF was 21 N/kg and an impulse 0.4 Ns/kg. The intraclass correlation coefficient (ICC 2,1) ranged from 0.02 to 0.76 for maximal vertical GRF and from - 0.34 to 0.76 for impulse. The insoles are a valid measurement tool for GRF curve progression and impulse during landing but underestimate the maximal vertical GRF.

Multicenter Analysis of the Epidemiology of Injury Patterns and Return to Sport in Collegiate Gymnasts

Background

Gymnastics requires intense year-round upper and lower extremity strength training typically starting from an early age. As such, the injury patterns observed in these athletes may be unique.

Purpose

To characterize the types of injuries and provide return-to-sport data in male and female collegiate gymnasts.

Study Design

Descriptive epidemiology study.

Methods

A conference-specific injury database was utilized to perform a retrospective review of injuries for male and female National Collegiate Athletic Association (NCAA) Division I gymnasts within the Pacific Coast Conference between 2017 and 2020 (N = 673 gymnasts). Injuries were stratified by anatomic location, sex, time missed, and injury diagnoses. Relative risk (RR) was used to compare results between sexes.

Results

Of the 673 gymnasts, 183 (27.2%) experienced 1093 injuries during the study period. Injuries were sustained in 35 of 145 male athletes (24.1%) as compared with 148 of 528 female athletes (28.0%; RR, 0.86 [95% CI, 0.63-1.19]; P = .390). Approximately 66.1% (723/1093) of injuries occurred in a practice setting, compared with 84 of 1093 injuries (7.7%) occurring during competition. Overall, 417 of 1093 injuries (38.2%) resulted in no missed time. Shoulder injuries and elbow/arm injuries were significantly more common in male versus female athletes (RR, 1.99 [95% CI, 1.32-3.01], P = .001; and RR, 2.08 [95% CI, 1.05-4.13], P = .036, respectively). In total, 23 concussions affected 21 of 673 athletes (3.1%); 6 concussions (26.1%) resulted in the inability to return to sport during the same season.

Conclusion

For the majority of musculoskeletal injuries, the gymnasts were able to return to sport during the same season. Male athletes were more likely to experience shoulder and elbow/arm injuries, likely because of sex-specific events. Concussions occurred in 3.1% of the gymnasts, highlighting the need for vigilant monitoring. This analysis of the incidence and outcomes of injuries observed in NCAA Division I gymnasts may guide injury prevention protocols as well as provide important prognostic information.

Agreement between force and deceleration measures during backward somersault landings

This study examined the agreement between force platform and inertial measurement unit (IMU) measures of backward somersault landings. Seven female gymnasts performed three trials, taking off from a 90 cm vaulting box and using competition landing technique. Two force platforms (1000 Hz) covered with a 6.4 cm thick carpeted landing surface measured the ground reaction forces. One inertial measurement unit (500 Hz) fixed on the second thoracic vertebra measured peak resultant deceleration of the gymnast. Measurement agreement between vertical and resultant peak force measures, and resultant peak force and peak deceleration was assessed using mean differences, Pearson's correlation, and Cohen's effect size (ES) statistics. There was perfect measurement agreement between vertical and resultant peak forces (R = 1.0, p < 0.001; ES = 0.005), but only moderate measurement agreement between resultant peak force and peak resultant deceleration (Mean Difference = -2.16%, R = 0.4, p = ns; ES = 0.121). Backward somersault landings can be assessed using either uni-axial or tri-axial force platforms to measure ground impact load/force, as the landing movements are almost purely vertical. However, force measures are not the same as peak resultant decelerations from IMUs which give an indication of impact shock. Landing load/shock measures are potentially important for injury prevention.

Association of Lumbar Spondylolytic Spondylolisthesis With the Incidence and Prognosis of Anterior Ring Apophyseal Abnormalities of the Vertebrae in Young Gymnasts

Background

Although anterior apophyseal abnormalities of the vertebrae and spondylolytic spondylolisthesis (SS) are prevalent in gymnasts during growth spurts, no studies have examined the relationship between apophyseal abnormalities and SS.

Hypothesis

A significant relationship will exist between anterior apophyseal abnormalities and SS in young gymnasts.

Study Design

Cohort study; Level of evidence, 2.

Methods

A total of 306 gymnasts (123 male, 183 female; age range, 6-28 years) with >2 weeks of back pain were enrolled in this study. Apophyseal abnormalities were evaluated using radiography. In the primary analysis, multiple logistic regression analysis was performed to assess the odds ratio (OR) for multivariate factors (age, body mass index, sex, skeletal maturity, competitive level, and presence of spondylolysis or SS) influencing the incidence of apophyseal abnormalities. In the secondary analysis, 90 of the 306 gymnasts were followed up radiographically for a minimum of 2 years, and factors contributing to the worsening of apophyseal abnormalities were identified.

Results

In the primary analysis, the chi-square test revealed a relationship between anterior ring apophyseal abnormalities and SS at the L5-S1 segment (OR, 7.6). Multiple logistic regression analysis demonstrated that the presence of SS at L5-S1 (OR, 9.5) and competitive level (international: OR, 6.7; national: OR, 4.5) correlated with the incidence of apophyseal abnormalities. The secondary analysis identified the presence of SS at L5-S1 (OR, 5.9) as a significant factor contributing to the worsening of apophyseal abnormalities.

Conclusion

The presence of SS was a factor affecting the incidence and prognosis of anterior apophyseal abnormalities.

Monitoring of the Training Load and Well-Being of Elite Rhythmic Gymnastics Athletes in 25 Weeks: A Comparison between Starters and Reserves

The objective of this study was to monitor the training loads (TL) and well-being of elite rhythmic gymnastics (RG) athletes, as well as compare these variables between starters and reserve gymnasts during 25 weeks of training. Ten athletes from the Brazilian national RG team (17.4 ± 1.1 y of age) were monitored during the general preparatory period (GPP), specific preparatory period (SPP), and pre-competitive period (PCP). The internal TL was quantified with the use of sessional ratings of perceived exertion (sRPE). We assessed well-being daily with a well-being scale. The TL, duration, monotony, and strain were calculated weekly. We found that the internal TL and session durations were 9242 ± 2511 AU and 2014 ± 450 min, respectively. The internal TL, strain, and monotony were greater in the PCP than in the GPP and SPP for starters. In the SPP, there were statistical differences in internal TL (p = 0.036) and strain (p = 0.027) between starters and reserves. In the PCP, there were also statistical differences between starters vs. reserves athletes regarding internal TL (p = 0.027) and strain (p = 0.05). There was no statistically significant difference in well-being between the periods assessed. In conclusion, RG athletes display a higher TL magnitude during the PCP, whereas only reporting non-significant minor variations in well-being. In addition, there is a discrepancy in the TL between starters and reserves.

ESTIMATING HORIZONTAL DISPLACEMENT DEDUCTION IN TRAMPOLINE GYMNASTICS BY MEANS OF CONSTANT AND VARIABLE ERRORS OF LANDING POSITIONS: A NEW GOLD STANDARD?

The final result in competitive trampoline gymnastics is composed of different subscores. These contribute differentially to the final score and result in a gymnast’s ranking. The present study was designed to investigate the impact that alternative score calculations of the horizontal displacement of the landing positions on the trampoline’s cloth would have on the final competition result. Different approaches for determining a precision measure were compared to the current standard of horizontal displacement deduction. These approaches for calculating precision measures were: (a) “total distance,” (b) the “convex-hull approach,” and (c) the “error approach.”  Results showed that an alternative approach was more precise and differentiated better between gymnasts. The resulting changed rankings are compared to the official final score of the competition in order to demonstrate the impact of alternative calculations.  

THE LEVEL OF DORSIFLEXION IN YOUNG GYMNASTS COMPARED TO YOUNG ATHLETES - PILOT STUDY

Gymnastic training develops strength, flexibility, concentration, balance, precision, and speed. The purpose of the study is to determine if gymnastic preparation leads to an increase in weight-bearing ankle dorsiflexion range of motion in a closed kinematic chain in young artistic gymnasts compared to a different type of sport. The weight-bearing lunge was chosen to measure the dorsiflexion range of motion in the ankle joint in the closed kinematic chain. The first group consists of members of the Slovak national youth team in artistic gymnastics (n-26). The second group consists of members of the Slovak national team in rhythmic gymnastics (n-13). The control group consists of young athletes (n-22). The mean dorsiflexion range of motion in artistic gymnasts was 47.32 ° in the right ankle joint and 44.75 ° in the left ankle joint. The mean dorsiflexion range of motion in rhythmic gymnasts was 44.32 ° in the right ankle joint and 43.41 ° in the left ankle joint. The mean dorsiflexion range of motion in young athletes was 44.27 ° in the right ankle joint and 42.32 ° in the left ankle joint. Results indicate a statistically significant difference in favor of artistic gymnasts compared to rhythmic gymnasts at the right ankle joint (p-0.04). In the left ankle, the two groups did not differ significantly from each other (p-0.38). There was no significant difference between artistic gymnasts and athletes in the right ankle joint (p-0.09) and the left ankle joint (p-0.19). There was no significant difference between rhythmic gymnasts and athletes at the right ankle joint (p-0.38) and the left ankle joint (p-0.24). A greater dorsiflexion range of motion in a closed kinematic chain in the ankle joint was detected in young gymnasts compared to rhythmic gymnasts. There was no significant difference between artistic gymnasts and athletes.

Epidemiology of Pediatric Gymnastics Injuries Reported in US Emergency Departments: Sex- and Age-Based Injury Patterns

Background:

Despite increasing participation rates in youth gymnastics, the majority of epidemiologic literature focuses on older elite athletes or stratifies athletes by level of competition.

Hypothesis:

The authors hypothesized that sex- and age-based patterns in youth gymnastics–related injuries exist, which are otherwise overlooked in an unstratified population.

Study Design:

Descriptive epidemiology study.

Methods:

Publicly available injury data from the National Electronic Injury Surveillance System were collected on pediatric gymnastics injuries presenting to emergency departments in the United States. Participation data from the National Sporting Goods Association were used to calculate national injury incidence rates in 7- to 11-year-olds (childhood) and 12- to 17-year-olds (adolescence) from January 1, 2012, to December 31, 2018. Z tests were conducted for the comparison of injury rates between girls and boys within each age group and for overall injury rate across age groups.

Results:

Girls participated in gymnastics at a frequency 6.5 times that of boys in childhood and 13.5 times that of boys in adolescence. An estimated 72,542 youth gymnastics–related injuries were reported in US emergency departments each year. A large proportion (61.3%) occurred in childhood, with female predominance in both age groups. Overall, there was no difference in weighted annual injury rate (injuries per 100,000 athlete-days per year) by age group (6.9 [childhood] vs 8.8 [adolescence]; P = .19) or sex (7.4 [girls] vs 8.1 [boys]; P = .65). In adolescence, boys were more likely than girls to experience injury (16.47 vs 8.2; P = .003). Wrist and lower arm fractures were more common in childhood than adolescence (1.07 vs 0.43; P = .002) and specifically in girls (childhood vs adolescence, 1.06 vs 0.37; P = .001). Ankle injuries and concussions were more common in adolescence vs childhood (P = .01 and .0002).

Conclusion:

Upper extremity injuries predominated among childhood gymnasts, particularly girls. In adolescence, girls and boys experienced increases in concussions and foot and ankle injuries. Although representing a lower overall number of training gymnasts as compared with girls, adolescent boys experience a higher rate of injuries overall.

Training-Load Management in Rhythmic Gymnastics: Practices and Perceptions of Coaches, Medical Staff, and Gymnasts

PURPOSE

This study described and analyzed practices and perceptions of rhythmic gymnastics coaches, medical staff, and athletes on training-load management.

METHODS

Online surveys were distributed among professionals and gymnasts involved in rhythmic gymnastics training across the world. One hundred (50 coaches, 12 medical staff, and 38 gymnasts) participants from 25 different countries completed the surveys.

RESULTS

Respondents stated using coaches' perception on a daily basis as a method of monitoring external (57%) and internal (58%) load, recovery/fatigue (52%), and performance (64%). Variables and methods (eg, wearable devices, athlete self-reported measures, session rating of perceived exertion), and metrics (eg, acute and chronic load) commonly reported in the training-load literature and other sports were not frequently used in rhythmic gymnastics. The majority of coaches (60.3% [17%]) perceived that maladaptation rarely or never occurred. Medical staff involvement in sharing and discussing training-load information was limited, and they perceived that the measurement of athletes' recovery/fatigue was poor. Gymnasts noted good quality in relation to the measurement of performance. Most participants (≥85%) believed that a specific training-load management model for rhythmic gymnastics could be very or extremely effective.

CONCLUSIONS

In conclusion, rhythmic gymnastics coaches' perception is the most commonly used strategy to monitor load, recovery/fatigue, and performance; although, this could be a limited method to guarantee effective training-load management in this sport.

Screening Tools as a Predictor of Injury in Gymnastics: Systematic Literature Review

Background

Gymnastics requires a high level of physical ability and technical skill which utilises short sets of athleticism and artistry to perform complex and intense movements which can overload musculoskeletal tissues and result in acute injuries which can develop into chronic injuries. The aim of this systematic literature review was to investigate which screening tools predict injury in gymnasts and encompasses all genres, levels and ages.

Methods

An electronic search of seven databases from their inception until March 2021 was conducted. The databases were the Allied and Complementary Medicine Database, CINAHL, eBook Collection (EBSCOhost), MEDLINE, Cochrane Database of Systematic Reviews, SPORTDiscus and PEDro (the Physiotherapy Evidence Base). A combination of the following search terms was used: (1) Gymnastics AND injury AND Screening, (2) Screening AND Gymnastics and (3) Musculoskeletal AND Screening AND Gymnastics. These terms were searched in all text, abstract, title and subject terms. Studies were assessed using a 20-point scoring tool.

Results

The mean methodological quality score was 13.1 points (range 10–17 points). Range of motion, anthropometric and postural measurements, hypermobility, clinical diagnostic tests, movement screening tools, muscle strength, power and endurance were reported in the included studies. Some evidence existed for screening measurement of height and mass as taller and heavier gymnasts might be more susceptible to injury; however, the different methodologies utilised and lack of acknowledgment of confounding variables limit the clinical relevance of these findings.

Conclusions

Height and mass should be recorded during the screening process. A lack of heterogeneity in study methodology prevented a meta-analysis. Studies were limited by a lack of prospective injury design, poor injury definition, self-reporting of injury and only 2 studies reported reliability of screening tools. Further research is required to determine the role of injury screening in gymnastics.

Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42020218339.

Despite maintaining a high daily training availability, a quarter of athletes start the season injured and three quarters experience injury in an Australian State Academy of Sport

OBJECTIVES

To 1) investigate the incidence, prevalence, burden and characteristics of injuries; and 2) explore the frequency of physiotherapy and medical servicing for elite sports academy athletes over a 12-month season.

DESIGN

Prospective cohort study.

METHODS

Medical attention and time-loss injuries were prospectively recorded by Physiotherapy and Medical (Sports Physician) staff for 94 athletes (72.3% females). The number of linked physiotherapy and medical servicing appointments was also recorded. Injury incidence rates (IIR), point and period prevalence, and injury burden were calculated and compared by athlete gender, sport, and categorisation (performance level) using incidence rate ratios (IRR).

RESULTS

The number of injuries reported was 193 in 71 (75.5%) athletes. The IIR was 2.1 (95%CI: 1.8 to 2.4) injuries per 365 days, with no gender difference observed (IRR: 1.1, 0.8 to 1.4). The injury burden was 43.5 (95%CI: 37.8 to 50.1) days absent per 365 days. More than one-quarter (point prevalence, 26.6%) of athletes commenced the season with an injury. In-season injury risk was 2.5 fold greater in athletes who started the season with an injury compared to athletes who started the season without an injury (IRR: 2.5, 1.9 to 3.4). The majority (81.2%) of the 1164 appointments recorded were physiotherapy, with an overall 4.3:1.0 physiotherapy to medical appointment ratio.

CONCLUSIONS

One in four athletes began the elite pathway season with a pre-existing injury, while also demonstrating a 2.5 fold greater risk of subsequent injury in the scholarship period. Sports should not assume their athletes are uninjured at the beginning of their scholarship. Injury profiles, and physiotherapy and medical servicing varied across sports. To reduce health as a barrier in the successful transition of talented young athletes to elite athletes, injury management strategies at the commencement of recruitment and throughout the scholarship should be prioritised in the development pathway.

Body Composition, Dietary Intake and the Risk of Low Energy Availability in Elite-Level Competitive Rhythmic Gymnasts

The aim of this study was to analyze dietary intake and body composition in a group of elite-level competitive rhythmic gymnasts from Spain. We undertook body composition and nutritional analysis of 30 elite gymnasts, divided into two groups by age: pre-teen (9-12 years) (n = 17) and teen (13-18 years) (n = 13). Measures of height, weight, and bioimpedance were used to calculate body mass index and percent body fat. Energy and nutrient intakes were assessed based on 7-day food records. The two groups had similar percentages of total body fat (pre-teen: 13.99 ± 3.83% vs. teen: 14.33 ± 5.57%; p > 0.05). The energy availability values for pre-teens were above the recommended values (>40 kcal/FFM/day) 69.38 ± 14.47 kcal/FFM/day, while those for the teens were much lower (34.7 ± 7.5 kcal/FFM/day). The distribution of the daily energy intake across the macronutrients indicates that both groups ingested less than the recommended level of carbohydrates and more than the recommended level of fat. Very low intakes of calcium and vitamin D among other micronutrients were also noted. The main finding is that teenage gymnasts do not consume as much energy as they need each day, which explains their weight and development. Moreover, they are at a high risk of developing low energy availability that could negatively impact their performance and future health.

Sex and Age-Group Differences in Strength, Jump, Speed, Flexibility, and Endurance Performances of Swedish Elite Gymnasts Competing in TeamGym

Purpose: To analyze sex and age group differences in strength, jump, speed, flexibility, and endurance performances of TeamGym athletes. Methods: A total of 91 Swedish elite gymnasts (junior female, n = 26, age = 15.4 y; senior female, n = 23, age = 20.0 y; junior male, n = 19, age = 15.6 y; senior male, n = 23, age = 20.6 y) participated in three testing sessions on three separate days. These were: (1) a series of flexibility tests for the lower- and upper-body; (2) strength tests for the lower- and upper-body; and (3) various types of jumps, a 20-m sprint-run, and a 3,000-m run test. Results: Males were 24% stronger in the back squat one-repetition maximum (relative to body mass) compared to females (P < 0.001, H g = 1.35). In the pull-ups and dips, 2.4 and 2.3 times more repetitions were completed by the males compared to the females (both P < 0.001, 0.70 ≤ R ≤ 0.77). However, females were similarly strong as males in the hanging sit-ups test (P = 0.724). The males jumped 29, 34, 33, and 17% higher in the squat jump (SJ), countermovement jump (CMJ), countermovement jump with arm swing (CMJa), and drop jump (DJ), respectively, compared to the females (all P ≤ 0.002, 0.14 ≤η p 2   ≤ 0.60). In the 20-m sprint run, males were 4% faster than females (P < 0.001, R = 0.40). Moreover, the females had significantly better flexibility than the males in the trunk forward bending, front split, and side split tests (all P < 0.001, 0.24 ≤η p 2 ≤ 0.54). In the 3,000-m run test, males were 11% faster than females (P < 0.001,η p 2 ≤ 0.54). Compared to junior athletes, seniors performed better in the pull-ups, dips, SJ, CMJ, CMJa, and 20-m sprint-run tests (all P ≤ 0.012, 0.31 ≤ R ≤ 0.56, 0.16 ≤η p 2 ≤ 0.25), with separate within-sex age-group differences (i.e., juniors vs. seniors) that were significant for the males but not for the females in the SJ, CMJ, CMJa, and 20-m sprint-run tests (males: all P < 0.001, 0.67 ≤ R ≤ 0.69, 1.37 ≤ H g ≤ 2.01; females: all P = 0.298-732). Conclusions: Large sex and age-group differences were observed for most physical performance metrics with specific within-sex age-group differences only observed for male athletes, with male seniors performing better than juniors in the SJ, CMJ, CMJa, and 20-m sprint-run tests.

Preseason Upper Extremity Range of Motion and Strength in Relation to In-Season Injuries in NCAA Division I Gymnasts

Background

Gymnastics is a demanding sport that places unique forces on the upper extremity. The repetitive nature of the sport and the high-impact forces involved may predispose the gymnast to overuse injuries. Risk factors for injuries in gymnastics are not well understood.

Purpose/Hypothesis

The purpose of this study was to ascertain whether preseason upper extremity range of motion (ROM) and strength differ between National Collegiate Athletic Association (NCAA) Division I collegiate gymnasts who sustain an in-season upper extremity injury and those who do not. We hypothesized that gymnasts who sustain an upper extremity injury would demonstrate reduced ROM and strength compared with noninjured gymnasts.

Study Design

Cohort study; Level of evidence, 3.

Methods

Over 4 seasons, from 2014 to 2018, a total of 15 female NCAA Division I collegiate gymnasts underwent preseason upper extremity ROM (shoulder: flexion, internal and external rotation; elbow: extension; wrist: extension) and strength (shoulder: internal and external rotation, and middle and lower trapezius) testing. Overuse upper extremity injuries were tracked in each subsequent season. Gymnasts were dichotomized into injured and noninjured groups, and a 2 × 2 analysis of variance was used to measure differences in preseason measures between the groups as well as within arms (injured vs noninjured arm for the injured group; dominant vs nondominant arm for the noninjured group).

Results

A total of 12 overuse upper extremity injuries (10 shoulders; 2 wrist/forearm) occurred during 31 gymnast-seasons. There were no significant interactions for preseason ROM and strength measurements between groups (injured vs noninjured) or within arms (injured and noninjured arm for the injured group; dominant and nondominant arm for the noninjured group; P = .07).

Conclusion

Preseason upper extremity ROM and strength were not different between gymnasts who sustained an in-season upper extremity overuse injury and those who did not. It is possible that ROM and strength measures used to screen other overhead athletes may not capture the unique features and requirements of gymnastics. Further, it may be challenging to discern differences in clinical measures of ROM and strength in gymnastics populations owing to the bilateral nature of the sport.

Injury incidence and characteristics for elite, male, artistic USA gymnastics competitions from 2008 to 2018

OBJECTIVES

To determine the injury incidence and characteristics for elite, male, artistic USA gymnasts during gymnastics competitions, held in the USA, from 2008 to 2018.

METHODS

Injury documentation performed by lead physician and certified athletic trainers at elite junior and senior USA Gymnastics competitions from 2008 to 2018 were reviewed and compiled into an excel database. Injury incidence was computed per 1000 registered gymnasts by competition setting as well as injury location, type, cause, severity, and setting.

RESULTS

From 2008 to 2018, 180 injuries were reported in a total of 2102 gymnasts with injury incidence of 85.6 per 1000 gymnasts (95% CI 73.4 to 97.8). The most common injury site was at the ankle (16.7 per 1000 gymnasts, 95% CI 10.9 to 22.4), and muscle strain/rupture/tear was the most common type of injury (28.5 per 1000 gymnasts, 95% CI 21.2 to 35.9). The most common cause was contact with surface (56.1 per 1000 gymnasts, 95% CI 46.1 to 66.2), and the event where most injuries were sustained was the vault (21.9 per 1000 gymnasts, 95% CI 15.4 to 28.4). Incidence of time loss injuries was 38.5 per 1000 gymnasts (95% CI 30.1 to 47.0). Injury incidence was higher during competition (58.5 per 1000 gymnasts, 95% CI 48.2 to 68.8) than during training (27.1 per 1000 RG, 95% CI 19.9 to 34.3; RR 2.16, 95% CI 1.59 to 2.94, p<0.001); injury incidence was greater at Olympic Trials (RR 3.23, 95% CI 1.24 to 8.47, p=0.017) than at National Qualifier meets. We report concussion incidence in gymnastics (5.7 per 1000 gymnasts, 95% CI 2.3 to 9.2).

CONCLUSIONS

This is the largest injury study to date for male artistic gymnasts (180 injuries, 2102 gymnasts, 11 years).

Training Load and Recovery During a Pre-Olympic Season in Professional Rhythmic Gymnasts

CONTEXT

Rhythmic gymnastics requires a high level of complexity and perfection of technical gestures, associated with well-developed physical and artistic capacities. The training-load and recovery profiles of rhythmic gymnasts across a season are unknown.

OBJECTIVE

To analyze the training load and recovery of professional rhythmic gymnasts during 1 season.

DESIGN

Cohort study.

SETTING

Brazilian National Training Center of Rhythmic Gymnastics and competition facilities.

PATIENTS OR OTHER PARTICIPANTS

Eight gymnasts from the Brazilian national senior rhythmic gymnastics group.

MAIN OUTCOME MEASURE(S)

Session rating of perceived exertion (session-RPE) and total quality recovery (TQR) scores were collected daily for 43 weeks. We obtained the session-RPE after each session and TQR score before the first session of the day. Performances during 5 competitions were also recorded. The season was divided into 8 periods. Total weekly internal training load (wITL), training intensity, frequency, duration, recovery, and acute : chronic workload ratio were calculated for analysis.

RESULTS

The season mean wITL was 10 381 ± 4894 arbitrary units, mean session-RPE score was 5.0 ± 1.6, and mean TQR score was 12.8 ± 1.3. The gymnasts trained an average of 8.7 ± 2.9 sessions per week, with a mean duration of 219 ± 36 minutes. Each competitive period showed increased wITL compared with the previous period. Training-load variables (wITL and session-RPE) and recovery were inversely correlated. Gymnasts were poorly recovered (TQR < 13) during 50.9% of the season (n = 167 times), especially during competitive weeks. Spikes in load (acute : chronic workload ratio ≥ 1.5) occurred across 18.1% of the season (n = 55 times).

CONCLUSIONS

The training-load variables and recovery changed throughout a professional rhythmic gymnastics group season, mainly during competitive periods. The correct distribution of training load is critical to ensure that gymnasts are entering competitions in a recovered state.

Injuries and illnesses among competitive Norwegian rhythmic gymnasts during preseason: a prospective cohort study of prevalence, incidence and risk factors

Objectives

Rhythmic gymnastics is an Olympic sport that demands high training volume from early age. We investigated the extent of, and risk factors for, injuries among competitive Norwegian rhythmic gymnasts.

Methods

One hundred and seven of 133 (80.5%) female rhythmic gymnasts (mean age: 14.5 years (SD 1.6), mean body mass index: 18.9 (SD 2.2)) participated. All gymnasts completed a baseline questionnaire and the ‘Triad-Specific Self-Report Questionnaire’. Injuries, illnesses and training hours were recorded prospectively for 15 weeks during preseason using the ‘Oslo Sports Trauma Research Center Questionnaire on Health Problems’ (OSTRC-H2).

Results

Response rate to OSTRC-H2 was 97%. Mean overuse and acute injury prevalence were 37% (95% CI: 36% to 39%) and 5% (95% CI: 4% to 6%), respectively. Incidence was 4.2 overuse injuries (95% CI: 3.6 to 4.9) and 1.0 acute injuries (95% CI: 0.5 to 1.6) per gymnast per year. Overuse injuries in knees, lower back and hip/groin represented the greatest burdens. Previous injury increased the odds of injury (OR 30.38, (95% CI: 5.04 to 183.25)), while increased age (OR 0.61 per year, (95% CI: 0.39 to 0.97)) and presence of menarche (OR: 0.20, (95% CI: 0.06 to 0.71)) reduced the odds of all injuries and substantial injuries, respectively.

Conclusions

Overuse injuries were common among Norwegian rhythmic gymnasts. Younger gymnasts had higher all-injury risk. Gymnasts who were not menstruating had higher substantial injury risk. Injury prevention interventions should start at an early age and focus on preventing knee, lower back and hip/groin injuries.

[Ligamentous ankle injury: an underestimated trauma?]

Ligamentous injuries of the ankle joint are among the most common injuries in sports, with landing on the opponent's foot or direct contact counting among the most common injury mechanisms. Initial measures most notably include a clinical examination, supplemented by X-rays, sonography or MRI as required. In most cases, conservative treatment is the treatment of choice. At the beginning, pain and swelling have to be reduced. Then function must be regained before patients may return to sports after a return-to-play test. Some injury patterns are more complex with concomitant injuries, and despite all the success of conservative treatment, certain cases remain the preserve of surgery. Not only the downtime of athletes, the severity of long-term damage and chronic functional limitations, but also the associated costs for treatment suggest the recommendation that ankle joint injuries should not be underestimated and adequate treatment should be selected.

Meniscal Injuries in the Olympic and Elite Athletes

INTRODUCTION

Elite and Olympian athletes are often stretching the upper limits of normal physiology and biomechanics of the musculoskeletal system in their efforts to excel in their sport. For them to get back to their sport at the same level after injury, the management, repair techniques, and rehabilitation protocols should be robust to permit healing of tissues to allow supra-normal loading and performance. The knee and the meniscus are commonly injured in these sports. Yet, the incidence, mechanisms, types of injuries to the meniscus, and their management are not known across different sports in the Olympics.

METHODS

We set out to look into the incidence and the trends of publications on meniscal injuries of the knee in Olympic games. A search of the PubMed and Scopus for these injuries using a search strategy gave 79 and 116 articles, respectively.

RESULTS

There were very few publications giving the incidence of meniscal injuries in the Olympics. Football is the sport with the highest rate of meniscal injuries. Different sports are popular in different countries, and depending on the popularity and the country reporting these injuries, incidences differed. There was data available from India and Brazil for Elite athlete from diverse sports, whereas most data from other countries were for football and soccer. Knee was found to be the second most commonly injured part of the body in both Winter and Summer Olympics as well as the Youth Winter Olympics. Data were not available from the Youth Summer Olympics to make any conclusions. The number of publications on this topic is low. We presented the timeline of publications and citations of articles on this topic. The top country, language, journal, university, and author were USA, English, American Journal of Sports Medicine, Hospital of Special Surgery in New York and Brophy RH, respectively. The data on the risk factors for meniscal injuries were analyzed, discussed, and presented for football, as this was the most extensively studied sport.

CONCLUSIONS

Even though the knee is one of the commonly injured anatomical locations in elite athletes, there is a lack of literature on meniscal injuries in this subset of population. We looked at possible reasons and made recommendations to improve data collection on these injuries.

Prevalence of MRI-Detected Ankle Injuries in Athletes in the Rio de Janeiro 2016 Summer Olympics

OBJECTIVE

To describe the prevalence, severity, and location of ankle injuries as assessed on magnetic resonance imaging (MRI) in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games.

METHODS

We analyzed all ankle MRIs that were acquired for suspected injury as reported by the National Olympic Committee medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the Olympic Village Polyclinic. Images were interpreted retrospectively according to standardized criteria.

RESULTS

A total of 11,274 athletes participated in the Games, of which 89 (8.8%) were referred for an ankle MRI. Eighty-eight of the 89 (99%) had at least 1 abnormal finding, and some had as many as 27, for an average of 6.2 abnormalities per examination. Around one-fifth of all abnormal findings were considered pre-existing (21%) and 79% were assumed to be the result of an acute or subacute injury. The highest proportion of acute/subacute injuries per athlete occurred in ball sports (7.0 injuries per examination) and in the age group >30. Most pre-existing findings per athlete were identified in the group of others (no track and field or ball sports athletes) with 2.5 findings per examination and respectively in the age group >30 (1.7).

CONCLUSION

Our study demonstrated a high prevalence of acute and subacute, but also pre-existing injuries in Olympic athletes undergoing ankle MRI. Tendon injuries were the most common acute injuries, found mainly in ball sports athletes. Most pre-existing ankle injuries were identified at the ligaments.

Longitudinal Study of Individual Exercises in Elite Rhythmic Gymnastics

The performance evolution in rhythmic gymnastics depends on changes in code of points. At the beginning of each Olympic cycle the code of points changes and therefore, the content of the competition exercises, as well. This study aimed to analyze - for each apparatus - the evolution of number of technical elements and final score over the last two decades (last 13 world championships), how they have been affected by changed code of points, and how the final score relates to the number of technical elements performed. The sample consisted of 416 exercises in five apparatus: ball (96), rope (40), hoop (96), ribbon (88), and clubs (96). The following variables were gathered: code of points, apparatus, technical group, total number of elements, final classification, and final score. Linear mixed-effects models were used to examine the effects on the number of elements and final score in each apparatus. The number of technical elements increased in all apparatus, between 7.4 and 20% over a 10-year period. There were mixed evolutions of final score between the different apparatus, between -6.3 and 14% over a 10-year period. There is small increase in number of elements in hoop and a small decrease in rope after a code change. There was a small decrease in final score in championships after a code change in hoop, moderate in clubs and ribbon, and large in rope. There was a negative relationship between number of elements performed and final score in clubs. In conclusion, the code change generally effects the final score negatively, but there were apparatus specific effects of code change on number of elements and relationship between number of elements and final score.

Health promotion by International Olympic Sport Federations: priorities and barriers

Objective

To identify changes in International Federations’ priorities and the barriers to implementing athlete and global health initiatives. Results should influence the work of the International Federation medical committees, the IOC and the Association of Summer Olympic International Federation.

Methods

The 28 Summer and 7 Winter International Federations participating in the most recent Olympic Games (2016; 2018) were surveyed to (i) identify the importance of 27 health topics, (ii) assess their progress on implementation health-related programmes and (iii) the barriers to implementation of these programmes. We compared International Federations’ activities in 2016 and 2017.

Results

The response rate was 83%. Health topics which most International Federations regarded as important and in which the International Federations felt insufficiently active were ‘team physician certification’, ‘prevention of harassment and abuse’, ‘eating disorders/disordered eating’, ‘mental health’ and ‘injury surveillance’. Compared with 2016, there was a decrease in International Federations’ activities in ‘injury surveillance’, ‘nutritional supplements’ and ‘hyperandrogenism’. The main barrier to implementing health-related programmes was ‘International Federation political support/willingness’, followed by ‘knowledge’. ‘Time’ and ‘coach support’ were more often reported than ‘finances’, or ‘IOC or Association of Summer Olympic International Federations partnership’.

Conclusion

If International Federations are going to promote health of athletes and global health promotion through physical activity (sport), International Federation leadership must change their focus and provide greater political support for related initiatives. Improving coach and athlete knowledge of the health issues could also facilitate health programme delivery. Time constraints could be mitigated by sharing experiences among the International Federations, Association of Summer Olympic International Federations and the IOC. International Federations should focus on those health-related topics that they identified as being important, yet rate as having insufficient activity.

A systematic review of injuries in gymnastics

OBJECTIVES

To identify all studies of gymnastics injuries and assess injury rates, types, locations, and causes.

METHODS

Seven electronic and two grey literature databases were searched. Two reviewers independently assessed titles/abstracts, abstracted data, and calculated average rates weighted by study size.

RESULTS

One study (n = 963) of three Olympic games (2008,2012,2016) provided injury rates for females of 86.4/1000gymnasts and males 79.9. For 29 databases one study of males (n = 64) provided a rate of 8.8 injuries/1000hours/AE (AE = athletic-exposure) and three of females varied rates (8.5, 9.4, and 91). Three studies for males (n = 153) provided a weighted average rate of 1.4 injuries/1000hours/training, and for females six studies (n = 476) 1.5 injuries. Four studies of males (n = 286) provided a weighted average of 678 injuries/1000gymnasts per year and eight studies of females (n = 1,764) a rate of 306. Of 19 surveys, eight provided rates for females (n = 1,463) of 596 injuries/gymnast per year and two for males (n = 40) a rate of 1,036. In the Olympics injuries were preponderately lower limb (63%) then trunk (23%) and upper limb (14%); injury type was sprains (35%) followed by tendinopathy/arthritis/impingements (17%), contusions (10%), and fractures (7%). Five database studies provided injury location data for 274 males: averages weighted by study size were upper extremity 42.8%, lower extremity 33.6%, torso/spine 11.8%, and head/neck 4.9% and 12 studies with 843 females provided average rates for lower extremity 51%, upper extremity 30.8%, torso/spine 13% and head/neck 0.8%. Official gymnastics organizations' websites provide no readily available data about injury rates or methods of prevention.

CONCLUSIONS

Studies need to collect comprehensive data for injury rates by training/competitions, gender, age, injury location/type/cause. Studies could assess whether trainers and physiotherapists monitoring gymnasts closely for injury risk would reduce injuries. Studies including randomized controlled trials (RCTs) of interventions in training, videotaping and performance feedback to reduce injury rates would be helpful.

Systematic review of musculoskeletal injuries in professional golfers

OBJECTIVE

The distribution of injuries affecting professional golfers is yet to be fully understood. We performed a systematic review of the clinical literature to establish the epidemiology of musculoskeletal injuries affecting professional golfers.

DESIGN

Systematic review.

DATA SOURCES

Searched databases in July 2018 were PubMed, SPORTDiscus and Embase.

ELIGIBILITY CRITERIA

Published observational research articles relating to the incidence or prevalence of musculoskeletal injuries in professional golfers, which were written in the English language and not restricted by age or gender.

RESULTS

Of the 1863 studies identified on the initial search, 5 studies were found to satisfy the inclusion criteria for analysis. The mean age of the golfers in these studies was 34.8 (±3.6) years. The gender of patients in included studies compromised 72% males and 28% females. Four studies reported that lumbar spine injuries were the most common (range 22%-34%). Excluding injuries to the spine (lumbar, thoracic and cervical), the hand/wrist was the next most common region of injury (range 6%-37%). The quality of the studies was relatively poor with no study satisfying >50% of the quality assessment tool questions and only one study giving a clear definition of how they defined injury.

CONCLUSION

There is a paucity of well-designed epidemiological studies evaluating musculoskeletal injuries affecting professional golfers. Injuries to the spine are the most frequently affected region, followed by the hand/wrist. This study has identified targeted areas of future research that aims to improve the management of injuries among professional golfers.