and Requa, 1978; Caine, 2003b; Dixon and Fricker,
1993). The majority of studies have been performed
with female gymnasts. The most common injuries
will be discussed below.- Ankle ligament sprains:Typically caused by inversion
injuries, ankle ligament sprains are the most common
acute injuries in gymnastics (Caine et al, 1989; Lindner
and Caine, 1990; Dixon and Fricker, 1993). They are
usually the result of an incorrect landing or fall. One
study found an alarming number of ankle injuries from
gymnasts landing with their foot inside a crack in the
floor or between mats (Mackie and Taunton, 1994).
Evaluation and treatment of gymnasts’ ankle injuries are
similar to that in other athletes (see Chap. 63).- Gymnasts should initially return to sport with the
use of an ankle brace or tape for support. Many
gymnasts do not tolerate long-term use of ankle
braces since the brace may cause slipping from the
apparatus, and it alters their form and appearance.
Flesh-colored tape is typically the best-tolerated
intervention. There is little information on the use
of prophylactic bracing and taping in gymnasts.
- Gymnasts should initially return to sport with the
- Low back pain:Low back pain caused by lumbar
strain and sprain injuries is common in gymnasts. It
should be managed as with other athletes (see
Chap. 42). Repetitive hyperextension, a necessity in
gymnastics, predisposes these athletes to chronic
injuries of the low back. Strengthening and core sta-
bility are especially important in gymnasts. Despite
the large number of young gymnasts with back pain,
a study comparing former elite gymnasts with age-
matched controls concluded that fewer former gym-
nasts (27%) had subjective back problems than did the
controls (38%) (Tsai and Wredmark, 1993). - Spondylolysis:Spondylolysis (or stress fracture of the
pars interarticularis) is common in young gymnasts,
especially those between the ages of nine and thirteen.
It occurs in gymnasts secondary to repetitive flexion
and hyperextension of the back: backbends, walkovers,
tumbling, and high-impact landings (Goldberg, 1980).
The incidence of spondylolysis is higher in gymnasts
(11%) than for the general population (5–6%)
(Jackson, Wiltse, and Cirincoine, 1976; Fredrickson
et al, 1984).- Gymnasts with spondylolysis typically have uni-
lateral back pain that localizes to the lumbar area.
The pain increases with activity (especially hyper-
extension) and decreases with rest. Physical exam-
ination may find tenderness to palpation at the
lower lumbar spine. A single-leg standing hyperex-
tension test (stork test) is sensitive and specific for
spondylolysis (Keene, 1983). - Diagnostic testing begins with plain radiographs,
which may show the classic pars interarticularis
- Gymnasts with spondylolysis typically have uni-
fracture on the oblique view: the “collared scottie
dog.” Single photon emission computerized tomog-
raphy(SPECT) bone scans are highly sensitive for
diagnosing spondylolysis and should be performed
to confirm the diagnosis of an active lesion
(Moeller and Rifat, 2001). Thin-sliced computed
tomography(CT) is more specific than bone scan
and can also be used to confirm the diagnosis.
Magnetic resonance imaging (MRI) with thin
slices has been reported to be effective in visualiz-
ing the pars interarticularis (Udeshi and Reeves,
2000), but more information is needed before the
diagnostic role of MRI can be established.- Treatment involves modification of activity (no
running, jumping, or gymnastics activities that
cause pain) for at least 4 to 6 weeks (Moeller and
Rifat, 2001). Physical therapy should target spine
stabilization, abdominal muscle strengthening, and
hamstring flexibility. The use of bracing is contro-
versial. Some reserve the use of a brace for those
patients with no improvement or worsening symp-
toms during initial therapy. Others may implement
bracing if a bone scan demonstrates an active
lesion. Decisions regarding bracing should be
made on an individual basis (Moeller and Rifat,
2001). - Return to sport depends on progress with activity
modification and physical therapy. Many gymnasts
can return to a low level of participation after 4 to
6 weeks (Moeller and Rifat, 2001). Activity is then
advanced as tolerated. Maintenance exercises
should be continued for the remainder of the gym-
nast’s career.
- Traumatic knee injuries:Can be severe and dis-
abling (McAuley, Hudash, and Shields, 1987). The
typical mechanism is a landing or fall while the gym-
nast is still completing a twisting rotation. Anterior
cruciate ligament(ACL), medial collateral ligament
(MCL), and meniscal injuries are the most common.
As a result of the nature of the sport, most gymnasts
require surgical reconstruction of an ACL tear in order
to continue gymnastics. In young athletes, this proce-
dure is typically delayed until after physeal closure.
Gymnasts do not tolerate large knee braces because
bulky braces impair the gymnasts’ form and appear-
ance. See chapters 57 and 58 for further description of
the evaluation and treatment of acute knee injuries. - Overuse injuries of the knee:These injuries result
from the repetitive running, jumping, and landing
required in gymnastics. Common diagnoses include
Osgood-Schlatter disease, patellofemoral disorders,
and patellar tendonopathy. Treatment involves relative
rest and physical therapy, including strengthening
exercises (see Chap. 60 and 61).
502 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS