during putting. It is believed that performance anxiety
contributes to the cause of this disorder. No medica-
tions have been proven to be of benefit.REFERENCES
Fu FH, Stone DA: Sports Injuries, 2nd ed. Philadelphia, PA,
Lippincott Williams & Wilkins, 2001.
Jobe FW, Pink MM: Shoulder pain in golf. The Clinics of Sports
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McCarrol JR: Overuse injuries of the upper extremity in Golf.
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pay. Phys Sports Med10(7):64–70, 1982.
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golfer. Phys Sports Med18(3):122–126, 1990.
Mellion MB, Walsh WM, Shelton GL: The Team Physician’s
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Philadelphia, PA, Hanley & Belfus, 1997.
85 GYMNASTICS
John P DiFiori, MD
Julie Casper, MDINTRODUCTION
- Gymnastics is an extremely popular sport in the
United States and worldwide. There are an estimated
85,000 competitive gymnasts and an additional three
million recreational gymnasts in the United States
(USA Gymnastics Online, 2003). Over 1400 partici-
pate in National Collegiate Athletic Association
(NCAA) gymnastics each year (NCAA Online,
2003). - Children begin gymnastics training at a very young
age. The average age at onset is 5–6 years for girls and
6–7 years for boys (McNitt-Gray, 2001). Most girls
reach their highest competitive level by age sixteen
(Nattiv and Mandelbaum, 1993).
•Physicians caring for gymnasts must be familiar with
the requirements of the sport, common and unique
injuries, and potential methods to prevent such
injuries.
GYMNASTICS FACTS•Women and men compete in different individual
events. Most gymnasts train for all of the events.
Gymnasts acquire new skills for each event via repe-
tition of individual elements and series (groups of ele-
ments).- The competitive levels in women’s gymnastics are
levels 1–10 and elite, with level 10 and elite being the
most advanced. Collegiate gymnasts are typically the
equivalent of level 9 or higher. Male gymnasts cur-
rently compete in classes 1–7; class 1 is the most
advanced. There are also over 150 elite male gym-
nasts in the United States (USA Gymnastics Online,
2003). - The code of pointsdictates the degree of difficulty for
each skill. There is a specific list of requirements for
each level of competition. The code of pointsevolves
with the sport and is revised every 4 years, essentially
increasing the required levels of difficulty with each
revision. The training regimen for gymnastics is rig-
orous. An advanced or elite level gymnast practices an
average of 25–35 h a week throughout the year. Even
young, beginning level gymnasts may train 10 h per
week or more. - Special equipment used by gymnasts includes grips
with or without wooden dowels for the bars, beam
shoes, and wrist supports. Gymnasts may also train
using crash mats, foam pits, beam and bar pads, low
balance beams, and twisting or spotting belts.
EPIDEMIOLOGY OF INJURY- Gymnastics has the highest incidence of injury among
all women’s intercollegiate sports (NCAA Online,
2003). It ranks among the top four men’s and women’s
college sports in total injuries (NCAA, 1997). - Studies have found that the rate of injury ranges from
5.3 (Pettrone and Ricciardelli, 1987) to 294 (Caine
et al, 1989) per 100 participant seasons. This differ-
ence has been attributed to variations in the definition
of injury, competitive level of subjects, and training
hours. The incidence of injury is 0.5 (Lindner and
Caine, 1990) to 3.7 (Caine et al, 1989) per 1000 h of
exposure. One study found that collegiate gymnasts
experienced a new injury in 9% of all exposures
(Sands, Shultz, and Newman, 1993).
MECHANISMS OF INJURY- Both acute and overuse injuries are common in gym-
nastics. The most common mechanism of acute injury
500 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS