Sports Medicine: Just the Facts

CHAPTER 85 • GYMNASTICS 501

is a missed move, followed by falls from an apparatus

and dismounts (Lindner and Caine, 1990). The many

hours of training throughout multiple years predis-

pose gymnasts to overuse injuries.

• Injuries increase with the degree of difficulty of gym-
  nastics maneuvers (Pettrone and Ricciardelli, 1987;
  Caine et al, 1989). Over the time the difficulty of
  gymnastics skills has continued to increase as equip-
  ment and athleticism improve (McAuley, Hudash, and
  Shields, 1987).


• The equipment itself may predispose to injury due to
  falls onto the apparatus. In addition, the bar and vault
  height, springboard placement, and location of mats
  or spotters are specific for each gymnast. Any unan-
  ticipated alteration in these preparations can lead to
  injury.

INJURY CHARACTERISTICS

• The most common injuries in gymnastics are strains
  and sprains (Caine et al, 2003).
  •Severity of injury has been assessed by calculating the
  duration of restricted training. While most injuries are
  minor, resulting in less than a week away from train-
  ing, 12.5% (Caine et al, 2003) to 25.9% (Caine et al,
  1989) result in a time loss of greater than 3 weeks.
  One study found that the average time until full par-
  ticipation resumed was almost 4.5 weeks per injury
  (Lindner and Caine, 1990).


• Many gymnasts continue training with pain. Studies
  have found that as many as 71% of female gymnasts
  train with an injury (Sands, Shultz, and Newman,
  1993). Gymnastics may be unique in that the injured
  gymnast can alter his or her workout depending on the
  injury, for example a gymnast with an ankle injury can
  continue full training on the uneven bars, provided
  they avoid the dismount.

RISK FACTORS FOR INJURY

• Level of competition:Many studies have found that
  gymnasts at advanced or elite levels suffer more
  injuries (Caine et al, 1989; Lindner and Caine, 1990;
  McAuley, Hudash, and Shields, 1987; Caine et al,
  2003). This is felt to be due to an increased number of
  training hours, increased skill difficulty, and less
  supervision (Caine et al, 1989; 2003). The high preva-
  lence of chronic injuries in this group has been asso-
  ciated with more time spent in the gym (Pettrone and
  Ricciardelli, 1987).


• Event:Multiple studies cite the floor exercise as the
  most common event for injuries (Pettrone and

Ricciardelli, 1987; McAuley, Hudash, and Shields,

1987; Garrick and Requa, 1978). Up to 40% of acute

injuries occur during this event (Lindner and Caine,

1990). The fewest injuries occur with the vault.

Twisting dismounts and landings are common mecha-

nisms of injury (Pettrone and Ricciardelli, 1987;

Caine et al, 1989; Lindner and Caine, 1990).

• Competition: Although most injuries occur while
  training, the incidence when calculated per exposure
  is higher for competition (Garrick and Requa, 1978).
  This is especially true among advanced level gym-
  nasts (Caine et al, 2003). The timed warm-up period
  before a competition seems to be an especially high-
  risk time for injuries (Caine et al, 2003), perhaps
  because the gymnasts are in a stressful and hurried sit-
  uation.


• Physical characteristics:Greater body size and body
  fat percentage have been correlated with higher risk of
  injury (Caine, 2003b; Steele and White, 1986); how-
  ever, these studies did not control for such variables as
  training hours and age (Caine, 2003b).


• Anatomic location:Most gymnastics injuries are to
  the lower extremity (Caine et al, 1989; Dixon and
  Fricker, 1993).


• Gender:Male gymnasts have a higher percentage of
  upper extremity injuries, while females have rela-
  tively lower extremity injuries (Dixon and Fricker,
  1993). This variation is likely the result of differences
  in the events: most men’s events such as the parallel
  bars, high bar, rings, and pommel horse primarily
  require use of the upper extremities.


• Age:Risk of injury may be greater during the adoles-
  cent growth spurt (Caine et al, 1989). The rapid
  change in height alters the moment of inertia for cer-
  tain skills, requiring gymnasts to make gradual
  changes in technique. Growth-related changes affect-
  ing the articular cartilage and physes may also con-
  tribute.


• Prior injury:The reinjury rate in gymnastics is high:
  32.7% in one year (Caine et al, 1989). As many as one
  in four injuries is a reinjury (Caine, 2003b). Overuse
  injuries are especially prone to reinjury, and the lower
  back is the most common site of recurrent injury
  (Caine et al, 1989). The high rates of reinjury in gym-
  nasts are felt to be due to premature return to training
  and inadequate rehabilitation (Caine et al, 1989).

COMMON INJURIES IN GYMNASTICS

• Studies have found that the most common anatomic
  sites for injury in gymnastics are the ankle, low back,
  knee, foot, wrist, and elbow (Caine et al, 1989;
  Lindner and Caine, 1990; Caine et al, 2003; Garrick