Injuries in women's gymnastics. The state of the art

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.

Gymnast's wrist in a 12-year-old female with MRI correlation

We describe a case of chronic overuse injury of the distal radial physis (gymnast's wrist). While the radiographic appearance of this entity has been reported, there are limited studies highlighting the MR appearance of this entity. This lesion is being seen with increasing frequency in young, elite gymnasts. If this injury goes unrecognized, there is potential for abnormal osseous development, with premature physeal fusion, abnormal joint inclination and even Madelung deformity.

Injury, Anxiety, and Mood in Competitive Gymnasts

Psychological factors related to injury were investigated in 115 competitive gymnasts. The subjects were administered the Profile of Mood States-Bipolar Form (POMS-BI) and Competitive State Anxiety Inventory-2 (CSAI-2). Direct discriminant function analysis showed that the best predictors for distinguishing between gymnasts with four or more injuries and those with fewer than four injuries were CSAI-2 Cognitive Anxiety and the POMS-BI Composed-Anxious and Energetic-Tired scores. The more-injured gymnasts were more anxious and tired, and reported higher scores on the CSAI-2 Cognitive Anxiety scale. Males could be differentiated from females by scores on the CSAI-2 Self-confidence and the POMS-BI Composed-Anxious, Confident-Unsure, Energetic-Tired, and Clearheaded-Confused scales. The female gymnasts were more anxious, unsure, tired, and confused, and reported lower levels of CSAI-2 Self-confidence. The findings were interpreted as further evidence of the anxiety-injury link in athletes.

Greater lower limb flexion in gymnastic landings is associated with reduced landing force: a repeated measures study

High impact forces during gymnastic landings are thought to contribute to the high rate of injuries. Lower limb joint flexion is currently limited within gymnastic rules, yet might be an avenue for reduced force absorption. This study investigated whether lower limb flexion during three gymnastic landings was related to force. Differences between landings were also explored. Twenty-one elite women's artistic gymnasts performed three common gymnastic techniques: drop landing (DL), front and back somersaults. Ankle, knee, and hip angles, and vertical ground reaction force [(vGRF) magnitude and time to peak], were measured using three-dimensional motion analysis and force platform. The DL had significantly smaller peak vGRF, greater time to peak vGRF and larger lower limb flexion ranges than landing from either somersault. Peak vGRF and time to peak vGRF were inversely related. Peak vGRF was significantly reduced in gymnasts who landed with greater hip flexion, and time to peak was significantly increased with increasing ankle, knee, and hip flexion. Increased range of lower limb flexion should be encouraged during gymnastic landings to increase time to peak vGRF and reduce high impact force. For this purpose, judging criteria limitations on lower limb flexion should be reconsidered.

Injury Types and Incidence Rates in Precollegiate Female Gymnasts: A 21-Year Experience at a Single Training Facility

BACKGROUND

With childhood sports opportunities continuing to increase at an enormous rate along with participation starting at younger ages, the number of female participants in sports has increased in paramount fashion over the past few decades. A review of the current literature reveals a very small number of studies (<30) that document specific injuries suffered by competitive female gymnasts.

PURPOSE

To retrospectively evaluate the incidence of various injuries and injury rates for different gymnast levels among young precollegiate female gymnasts over a 21-year period, from 1985 to 2005.

STUDY DESIGN

Descriptive epidemiological study.

METHODS

This institutional review board-approved study retrospectively evaluated young, precollegiate female gymnasts over a 21-year period. Gymnasts were stratified into 1 of 4 competition levels based on the number of hours spent training. In addition to the frequency of injuries and hours trained, data collected on each gymnast included the following: age at the time of injury, body part injured, laterality of the injury, and diagnosis.

RESULTS

Over the 21-year period, 3681 new injuries were evaluated by a single physician. The injury incidence (2.155 per 1000 exposure hours) was slightly lower when compared with previously reported injury rates. There were 1,452,574 total exposure hours documented from training facility records. The injury rate per 1000 exposure hours was 2.859 for elite, 2.820 for high-level, 1.667 for intermediate, and 0.687 for novice gymnasts. The lower extremity was injured more often than the upper extremity (60.9% compared with 22.6% of total injuries). This difference was statistically significant across all levels.

CONCLUSION

The injury incidence in this study was 2.155 per 1000 exposure hours. This was slightly lower when compared with previously reported injury rates. Although those studies only lasted 3 years or less, the injury rates can be directly compared because they are reported as injuries per 1000 training hours.

CLINICAL RELEVANCE

With the variability in data available and limited studies reported, a conclusive analysis is needed because of the long-term effects of injury seen on gymnasts, such as early degenerative disorders, cost of injury treatment, and reduction of well-being. In our 21-year study, we found the incidence of injury was slightly lower than that shown in prior shorter studies. In addition, we were able to evaluate specific injuries seen in this population over that time period. Also, this extended study revealed the longitudinal nature of a series of injuries over a period of time that has not been seen in other studies, thus giving insight into the effects of increased gymnastics in the young, female, adolescent population, which could be potentially used in guidelines for gymnasts in the future.

Investigation of Spinal Posture Signatures and Ground Reaction Forces During Landing in Elite Female Gymnasts

The link between static and dynamic landing lumbar postures, when gymnasts are exposed to large ground reaction forces, has not been established. This investigation aimed to (a) determine if a relationship exists between sagittal static and dynamic landing lumbar spine angles at peak ground reaction force (GRF) and (b) quantify how close to end-range postures the gymnasts were at landing peak GRF. Twenty-one female gymnasts’ upper and lower lumbar spine angles were recorded: statically in sitting and standing, during landing of three gymnastic skills, and during active end-range lumbar flexion. Pearson’s correlations were used to investigate relationships between the angles in different postures. Significant correlations (r= .77–.89,p< .01) were found between all the static/dynamic postures in the lower lumbar spine angle, while fewer and less significant upper lumbar spine correlations were reported. Thirty percent of gymnasts landed a backsault with their lower lumbar spine flexed beyond their active end-range while experiencing GRF 6.8–13.3 times their body weight. These results inform low back pain prevention and management strategies in this population and highlight areas for future research.

Effects of mat characteristics on plantar pressure patterns and perceived mat properties during landing in gymnastics

Shock absorption and stability during landings is provided by both, gymnast ability and mat properties. The aims of this study were to determine the influence of different mat constructions on their energy absorption and stability capabilities, and to analyse how these properties affect gymnast's plantar pressures as well as subjective mat perception during landing. Six mats were tested using a standard mechanical drop test. In addition, plantar pressures and subjective perception during landing were obtained from 15 expert gymnasts. The different mats influenced plantar pressures and gymnasts' subjective perception during landing of gymnasts. Significant correlations between plantar pressures at the medial metatarsal and lateral metatarsal zones of the gymnasts' feet with the different shock absorption characteristics of the mats were found. However, subjective perception tests were not able to discriminate mat functionality between the six mats as no significant correlations between the mechanical mat properties with the subjective perception of these properties were found. This study demonstrated that plantar pressures are a useful tool for discriminating different landing mats. Using similar approaches, ideally including kinematics as well, could help us in our understanding about the influences of different mats upon gymnast-mat interaction.

Reducing ground reaction forces in gymnastics' landings may increase internal loading

The aim of this study was to use a subject-specific seven-link wobbling mass model of a gymnast, and a multi-layer model of a landing mat, to determine landing strategies that minimise ground reaction forces (GRF) and internal forces. Subject-specific strength parameters were determined that defined the maximum voluntary torque/angle/angular velocity relationship at each joint. These relationships were used to produce subject-specific 'lumped' linear muscle models for each joint. Muscle activation histories were optimised using a Simplex algorithm to minimise GRF or bone bending moments for forward and backward rotating vault landings. Optimising the landing strategy to minimise each of the GRF reduced the peak vertical and horizontal GRF by 9% for the backward rotating vault and by 8% and 48% for the forward rotating vault, compared to a matching simulation. However, most internal loading measures (bone bending moments, joint reaction forces and muscle forces) increased compared to the matching simulation. Optimising the landing strategy to minimise the peak bone bending moments resulted in reduced internal loading measures, and in most cases reduced GRF. Bone bending moments were reduced by 27% during the forward rotating vault and by 2% during the backward rotating vault landings when compared to the matching simulations. It is possible for a gymnast to modify their landing strategy in order to minimise internal forces and lower GRF. However, using a reduction in GRF, due to a change in landing strategy, as a basis for a reduction in injury potential in vaulting movements may not be appropriate since internal loading can increase.

Orthotic effect of a stabilising mechanism in the surface of gymnastic mats on foot motion during landings

The purpose of this study was to examine two hypotheses: (a) mat hardness affects foot motion during landing; (b) the influence of a surface stabilising interface integrated in a mat on foot motion is detectable. Two studies were carried out: In the first one, six female gymnasts performed barefoot landings from different falling heights onto three mats having different hardness. In the second study, a stabilising mechanism was integrated in the surface of three new mats with different hardness. Three high speed video cameras (250Hz) captured the motion of the left leg and foot. These were modelled by means of a four rigid body system. The maximal eversion at the ankle joint was not influenced by the different mats (hard: 4.6 degrees +/-1.9 to 9.3 degrees +/-3.4, medium: 3.1 degrees +/-2.7 to 7.4 degrees +/-3.5, soft: 4.8 degrees +/-2.1 to 8.4 degrees +/-3.5). The soft mat without the stabilised surface showed higher eversion values (p<0.05) between forefoot and rearfoot (medial joint: hard: 5.1 degrees +/-3.2 to 7.3 degrees +/-3.3, medium: 6.9 degrees +/-3.1 to 7.5 degrees +/-2.9, soft: 12.7 degrees +/-4.1 to 13.4 degrees +/-3.3; lateral joint: hard: 8.5 degrees +/-3.1 to 9.7 degrees +/-1.1, medium: 9.5 degrees +/-2.6 to 11.2 degrees +/-3.3, soft: 12.1 degrees +/-2.3 to 15.7 degrees +/-3.3). For the mats with the surface stabilising interface, the different hardness did not cause any significant differences in maximal eversion values at the medial (hard: 1.5 degrees +/-3.3 to 5.5 degrees +/-4.5, medium: 1.3 degrees +/-3.5 to 5.1 degrees +/-3.6, soft: 0.7 degrees +/-4.9 to 5.4 degrees +/-4.2) nor at the lateral (hard: 11.3 degrees +/-4.2 to 17.3 degrees +/-4.2, medium: 12.3 degrees +/-4.8 to 17.1 degrees +/-3.7, soft: 11.5 degrees +/-4.6 to 17.1 degrees +/-4.3) forefoot joints. The structure of the mat and the consequent deformation hollow did not influence the kinematics of the ankle joint during landings, but it influenced the motion at the medial and the lateral forefoot joints. By means of a stabilised surface, it is possible to reduce the influence of mat deformation on the maximal eversion between forefoot and rearfoot.

Balancing the risk of injury to gymnasts: how effective are the counter measures?

BACKGROUND

To minimise injury risk and maximise gymnastics performance, coaches, parents, and health professionals working with young gymnasts need to understand and practise safe gymnastics.

AIMS

To (a) identify the various injury counter measures specific to gymnastics, (b) critically review the literature describing each injury prevention measure, and (c) assess, using available risk factor and injury data, the weight of evidence to support each of these counter measures. Specific recommendations for further research and implementation strategies to prevent injury and improve safety are also given.

METHODS

The relevant literature was identified through the use of Medline (1966 to May 1998) and SPORT Discus (1975 to May 1998) searches, hand searching of journals and reference lists, and discussions with key Australian gymnastics organisations.

RESULTS

The key gymnastics injury counter measures identified in this review include coaching (physical preparation, education, spotting, and performance technique), equipment, and the health support system (medical screening, treatment, and rehabilitation). Categorisation of the type of evidence for the effectiveness of each of these counter measures in preventing injury showed that most of it is based on informal opinion/anecdotal evidence, uncontrolled data based studies, and several prospective epidemiological studies. There is no evidence from formally controlled trials or specific evaluation studies of counter measures for gymnastics.

CONCLUSIONS

Although gymnastics is a sport associated with young participants and frequent high volume, high impact training, there is a paucity of information on injury risk factors and the effectiveness of injury practices. Further controlled trials are needed to examine the extent to which injury prevention counter measures can prevent or reduce the occurrence of injury and re-injury. Particular attention should be devoted to improving training facilities, the design and testing of apparatus and personal equipment used by gymnasts, and coaching and the role of spotting in preventing injury.

Gymnastic wrist injuries

Wrist injuries in the gymnast are due to the transformation of the upper extremity into a weight bearing entity. Both acute and chronic disorders occur and are difficult to manage in these athletes because of the intensity of training and competition. Treatment is dependent on the injury as well as the expectations of the patient, coach, and family--a situation that at times may alter the usual management program.

Does the menstrual cycle and use of oral contraceptives influence the risk of low back pain? A prospective study among female soccer players

Female sex hormones have been suggested to affect the risk of low back pain. One reason is the fact that back pain is a very common symptom during pregnancy. It also seems to be a more common problem among female than male athletes, e.g. in soccer. Although there are few scientific data supporting a relationship between female sex hormones, use of oral contraceptives and low back pain, many doctors and physiotherapists advise women with low back pain to avoid oral contraceptives. The aim of this study was to evaluate whether low back pain fluctuated during the menstrual cycle and differed between women using and not using oral contraceptives. A questionnaire was sent to 12 female soccer teams; 261 players answered and 50 players (28 with back pain and 22 controls) fulfilled the prospective study. At baseline the players underwent a thorough clinical examination and then filled in a diary concerning menstrual data, back pain, training and matches during one season. A total of 296 menstrual cycles was analysed. No difference in prevalence or severity of back pain was seen between the different phases of the menstrual cycle or between users and non-users of oral contraceptives. Our data do not support the hypothesis that low back pain is influenced by hormonal fluctuations during the menstrual cycle or by use of oral contraceptives.

Factors associated with wrist pain in the young gymnast

We conducted a cross-sectional survey of 52 nonelite gymnasts (32 girls, 20 boys; average age, 11.8 years) to assess their history of training and wrist pain within the last 6 months. An intensity index was created using the number of training hours per week and the athletes' skill levels. Wrist pain was prevalent in 38 (73%) of the gymnasts. Gymnasts with wrist pain were older (12.6 years versus 9.7 years; P = 0.0002), trained more hours per week (13.5 versus 7.7; P = 0.0002), trained at a higher skill level (P = 0.01), and began training at an older age (7.0 years versus 5.1 years; P = 0.006). Analysis of intensity versus age suggested that a threshold of training intensity may be important in the development of wrist pain. Logistical regression found these factors to be independently associated with wrist pain: intensity (P = 0.036), age > 10 years (P = 0.018), age < 14 years (P = 0.016), and the age of initiation of training (P = 0.020). This study demonstrates that wrist pain is a common problem among nonelite young gymnasts. Training intensity, relative to the age of the participant and the age when training was initiated, appears to be an important determinant of the development of wrist pain in this population.

Landing Strategies Used by Gymnasts on Different Surfaces

In this study, landing strategies of gymnasts were hypothesized to change with different landing surfaces. This hypothesis was tested by comparing the kinematics and reaction force-time characteristics of two-foot competition-style drop landings performed by male and female collegiate gymnasts onto three surfaces (soft mat, stiff mat, no mat). Significantly lower peak vertical forces, longer landing phase times, and greater knee and hip flexion were observed between the no mat condition and the mat conditions. Knee flexion and peak knee flexion velocities were also observed to be significantly greater for landings on the stiff mat than those on the soft mat. These results indicate that the gymnasts in this study modulated total body stiffness in response to changes in landing surface conditions by using a multi joint solution. In addition, the presence of a mat may reduce the need for joint flexion and may alter the vertical impulse characteristics experienced during landing.

Injury, anxiety, and mood in competitive gymnasts

Psychological factors related to injury were investigated in 115 competitive gymnasts. The subjects were administered the Profile of Mood States-Bipolar Form (POMS-BI) and Competitive State Anxiety Inventory-2 (CSAI-2). Direct discriminant function analysis showed that the best predictors for distinguishing between gymnasts with four or more injuries and those with fewer than four injuries were CSAI-2 Cognitive Anxiety and the POMS-BI Composed-Anxious and Energetic-Tired scores. The more-injured gymnasts were more anxious and tired, and reported higher scores on the CSAI-2 Cognitive Anxiety scale. Males could be differentiated from females by scores on the CSAI-2 Self-confidence and the POMS-BI Composed-Anxious, Confident-Unsure, Energetic-Tired, and Clearheaded-Confused scales. The female gymnasts were more anxious, unsure, tired, and confused, and reported lower levels of CSAI-2 Self-confidence. The findings were interpreted as further evidence of the anxiety-injury link in athletes.

Kinetics of the lower extremities during drop landings from three heights

In this study, the landing preferences of gymnasts (n = 6) and recreational athletes (n = 6) were determined by comparing the changes in lower extremity kinetics of drop landings performed from three heights (0.32-1.28 m). Net joint moments and work done on the extensor muscles of the ankle, knee, and hip were selected as variables representative of the demand placed on the muscles responsible for controlling flexion and dissipating the load. Kinematic and kinetic two-dimensional data were acquired simultaneously using high-speed film (202.4 fps) and a force plate (1000 Hz). Reaction forces and lower extremity joint motions were used to calculate net joint forces, net joint moments powers, and work done on the extensor muscles of the ankle, knee, and hip. Results indicated that the extensor joint moments tended to peak earlier after contact with increases in velocity, but the temporal sequence of events was maintained independently of velocity or group. As impact velocity increased, net peak extensor moments and work done on the extensor muscles significantly increased. Significantly larger ankle and hip peak extensor moments were observed for the gymnasts across velocities as compared to the recreational athletes. No significant differences in work done on the extensor muscles were noted between groups. Significant interaction effects indicate that gymnasts chose to dissipate the loads at contact by using larger ankle and hip extensor moments at higher impact velocities than the recreational athletes, whereas recreational athletes chose to adjust their strategy by using greater degrees of hip flexion (McNitt-Gray, Int. J. Sport Biomech, 7, 201-204, 1991) and longer landing phase durations than the gymnasts. The greater demands placed on the ankle and hip extensors by the gymnasts, as compared to the recreational athletes, may be explained by the need to maintain balance during competitive gymnastics landings or, perhaps, by the inability of recreational athletes to produce larger extensor moments at the ankle or hip during landings from great heights.

Injuries and Special Concerns in Female Gymnasts

In brief Medical concerns for female gymnasts vary from medical problems such as nutrient deficiencies to orthopedic concerns such as wrist injuries. Physicians who treat gymnasts-from recreational to elite-must be aware of the most common problems. They can then expand their role in educating athletes about prevention and in treating sports-specific injuries and associated diseases.

Women's intercollegiate gymnastics. Injury patterns and "permanent" medical disability

A prospective study was established to record the patterns of injury incurred by all members of women's college gymnastics team. Twenty-six women were followed over a 4-year period (53 gymnast seasons) from 1983 to 1987. To identify which injuries resulted in persisting impairment, these same athletes were contacted again 3 years later. The 26 athletes sustained 106 injuries. Sixty (57%) of these were of acute onset and were related to an identifiable gymnastics event. The remaining 46 (43%) were of gradual onset or overuse injuries. For the follow-up phase, 22 of the 26 women were contacted from 10 to 70 months (38.5 average) after completion of their gymnastics careers. Forty-five percent of the injuries recorded in their competitive years still bothered them at the time of followup, especially low back, ankle, great toe, shoulder, and knee injuries. Athletic and recreational activity exacerbated the complaints. Twenty-nine percent felt that their sports activity level was now limited. Forty-six percent felt that their injury was at less than full recovery, yet most felt that they were capable of strenuous physical activity and continued to be active despite complaints such as pain and stiffness.

Women's gymnastics injuries. A 5-year study

A 5-year prospective study on the time course of women's gymnastics injuries was conducted on a successful NCAA Division I team. Gymnasts recorded injuries on a computer terminal or via computer dot sheets immediately before each training session, including the injured body part, the event or activity, and the date of the injury. The definition of injury was "any damaged body part that would interfere with training." Athletes recorded injuries on the 1st day of onset and subsequently until the injury was healed. The initial onset of injury was considered a new injury. Subsequent records of the injury were considered continuing injury. Thirty-seven athletes participated through five collegiate seasons. They accounted for 5602 total training exposures with an average of 151.4 exposures per athlete. The analyses showed that gymnasts trained with an injury approximately 71% of the exposures, and a new injury could be expected from a gymnast during approximately 9% of the exposures. The largest number of injuries were of the repetitive stress syndrome type. The time series information showed that total injuries tended to increase until the middle of the competitive season, while new injuries showed prominent increases during specific training periods and during competition preparation and performance.

Stress changes of the distal radial growth plate. A radiographic survey and review of the literature

We conducted a radiographic survey to determine skeletal age and the nature and prevalence of stress-related changes affecting the distal radial growth plate in 60 young competitive gymnasts (39 females, 21 males). Comparison of results for chronological and skeletal age revealed a significant delay in maturation for girls (P less than 0.001). Radiographic evaluation revealed 5 gymnasts (4 girls and 1 boy) with stress-related changes of the left wrist, and four of these were considered to be minimal. These results, in conjunction with our previous findings and the review of related literature, reveal three important observations. First, the widening and irregularities of the distal radial physis that we described previously appear to be the first in a spectrum of abnormal changes secondary to overuse and probably represent a stress fracture of the distal radial growth plate. The radiographic changes associated with this injury are not the normal adaptive changes seen in young, competitive gymnasts. Secondly, more serious long-term abnormality may result even though the injury may initially resemble a Salter-Harris type I or II stress fracture. Long-term complications may include symmetrical or asymmetrical retardation or halted growth at the affected site, positive ulnar variance, and associated pathoanatomic sequelae. Thirdly, the incidence of distal radial growth plate stress injury remains unclear; we recommend a further, large-scale prospective epidemiologic study involving both male and female gymnasts. We urge that physicians and other health professionals associated with gymnastics clubs educate coaches about the possibility of significant injury to the distal radial physis, risk factors, and suggested preventive measures.

Gymnastic injuries

In the past 15 to 20 years gymnastics has become very popular. The increased participation exposes a greater number of athletes to potential injury. The risk of gymnastic injuries seems to be proportional to the level of the athletes; the higher the level of gymnastics, the more hours are spent in practice, with a greater exposure time. With the increased risk in gymnastics, the incidence of acute injuries will also increase, and as the skill level increases, the load during the workout will also increase, providing more opportunity for chronic injuries. As in many sports, the ankle is the most injured body part. Some injuries, however, seem to be specific to gymnastics. In gymnastics the upper extremities are used as weightbearing limbs, so high impact loads are distributed through the elbow and wrist joint. Back problems appear to result not only from single episodes of macrotrauma, but also from repeated microtrauma caused by specific impact loads during vaults and hyperextension. Early detection is the key to treating elbow, wrist and back pain in the gymnast. Reinjury following an acute injury may be reduced by allowing for complete rehabilitation before returning to full practice. Some studies indicate that maturation rate could play a potential role in injury predisposition. The combination of periods of rapid growth and intense training could provide for conditions where the gymnast is more injury prone.

Injuries to elite wheelchair athletes

The purpose of this project was to describe the nature, type, and frequency of athletic injuries incurred by the elite wheelchair athlete. Nineteen athletes participated in a 1-year injury recall study at an elite wheelchair training camp. An injury was defined as anything the athlete expressed concern about and (a) caused a loss of participation due to an injury or illness or (b) an injury in which a fracture, dislocation, or subluxation occurred and the athlete was able to continue participation. There were 10 male and 9 female subjects who reported their injuries from 1 June 1987 to 31 May 1988. Fifty injuries were reported, strains and muscular injuries accounted for almost half of the injuries. Physicians were the primary care provider for 37% of the injuries, followed by physical therapists and athletic trainers at 26% and 15% respectively. Slightly over 57% of the injuries were classified as minor, missing 7 days or less of participation and 32% were classified as major, missing 22 days or more of participation. The upper extremity was the most frequently injured, followed by the lower extremity, head and spine, and illnesses. Conventional treatments of ice, heat, modalities, and medications, were the most common methods of treating these injuries. Flexibility and strength training programmes should be implemented throughout the competitive season. Careful consideration of the training programme and workout intensity should also be evaluated.

An epidemiologic investigation of injuries affecting young competitive female gymnasts

A prospective study of injuries affecting 50 highly competitive young female gymnasts was conducted over a period of 1 year. Many of the findings of this investigation were consistent with previous studies and suggest particular injury trends in women's gymnastics. These results included injury location, injury severity, nature of onset, event, and activity at the time of injury. Some of the descriptive results, however, provided information that was heretofore unreported or inconsistent with previous investigations. These findings involved injury rate, reinjury rate, time loss, injury type, hours of practice, and incidence of physician-seen injuries. Some of these findings were disturbing and echo concerns registered in the professional literature. In particular, the reinjury rate is alarming and points to the need for complete rehabilitation before return to full participation. The results of the analytic component of the study alluded to the potential role of competitive level and maturation rate in the profile of the injury-prone gymnast. Specifically, rapid periods of growth and advanced levels of training and competition appeared to be related to injury proneness. Pursuant to the descriptive and analytic results of the investigation, recommendations for injury prevention and continued research are made.

Common injuries in preadolescent and adolescent athletes. Recommendations for prevention

In general, children and youth sports are safe. The great majority of injuries which are sustained are minor and self-limiting. Fortunately, catastrophic acute injuries such as paraplegia, quadriplegia and major limb insults are rare. The 2 mechanisms of injuries at these age groups are acute traumatic insults and unresolved sequelae of repetitive microtrauma. The latter usually results from inappropriate training and coaching techniques. In the United States, adolescents and children are becoming involved in sport at earlier ages and with higher levels of intensity and competition. Factors which lead to injury include the athlete and his/her own psychobiology, inappropriate equipment, the sports environment (playing surfaces, temperature), training and coaching errors, and parental influences. Preparticipation assessment usually reveals extremely healthy children with rare factors which contribute to non-sports participation. Preventative efforts must be made to provide these children with the appropriate equipment and coaching to limit the number of overuse injuries. Management of acute sports problems and rehabilitation of significant injuries are as important in childhood and youth sports as in those of their older sibs in order to prevent lifelong sequelae of musculoskeletal injury. The appropriate goal of children and youth sports must remain one of enjoyment with acquisition of sport-specific skills.