Inventory (Garner et al. 1983) and the Eating
Attitude Test (Garner & Garfinkel 1979) when
applied to athlete populations (Sundgot-Borgen
1994). Despite these problems in determining
incidence data, there is no question that the
female athlete triad exists, and represents a
serious and potentially life-threatening reality in
gymnastics (Rosen & Hough 1988; Sundgot-
Borgen 1994). Therefore, it is important for every-
one associated with gymnastics, including team
and personal physicians, nutritionists, judges,
coaches, parents, and the athletes themselves, to
become sensitized to the warning signs of the
triad to ensure that its frequency and seriousness
is controlled.
Weight preoccupation appears to be associated
with gymnastics training, but disordered eating
patterns are reduced following retirement from
gymnastics (O’Connor et al. 1996b). It also
appears that, in initiating disordered eating
behaviours, gymnasts are trying to achieve an
ideal body (i.e. small, muscular, strong appear-
ance) rather than trying to achieve an ideal body
fat (O’Connor et al. 1996b).
Eating disorders have also been shown to have
a negative impact on athletic performance,
although this area has not been well studied.
Athletes who lower water intake or increase
water loss to lower weight have been shown to
lose endurance and have reduced exercise per-
formance (Webster et al. 1990). Fasting, which
would encourage a faster depletion of muscle
glycogen (a critical factor in high-intensity activ-
ity such as gymnastics), has also been shown to
reduce performance (Sundgot-Borgen 1994).
There is a relationship between dietary
restraint and menstrual cycle difficulties (short-
ened luteal phase length), both of which may be
associated with lower bone density of predomi-
nantly trabecular bone (Prior et al. 1990; Barr et al.
1994). Trabecular bone, which has a higher
turnover rate than cortical bone, is more sensitive
to low circulating oestrogen, while cortical bone
may be stabilized or even increase in density
with physical activity, even in the presence of
inadequate oestrogen (Slemenda et al. 1991;
Carbon 1992). This has been clearly demon-
strated in one study evaluating elite college gym-
nasts, which showed an increase in bone mineral
density despite the presence of amenorrhoea
or oligomenorrhoea (Nichols et al. 1994). (See
Chapter 40 for information on eating disorders in
athletes, Chapter 32 for information on the
young athlete, and Chapter 31 for information on
the female athlete.)Gymnastics injuries
Although gymnastics is commonly mentioned as
a hazardous sport, a review of all the injuries
reported between 1982 and 1991 in 42 male and
74 Australian female elite artistic gymnasts
found a low number of severe injuries and no
catastrophic injuries (Dixon & Fricker 1993). In a
study analysing posture, spinal sagittal mobility,
and subjective back problems in former female
elite gymnasts, it was determined that the gym-
nasts had fewer problems than an age-matched
control group (27% vs. 38%, respectively; Tsai &
Wredmark 1993).
Despite these data, it is clear that gymnastics
injuries do occur, and often it is an injury that
takes talented gymnasts out of the sport. In the
study by Dixon and Fricker (1993), stress frac-
tures of the lumbosacral spine accounted for 45%
of all bony injuries in female gymnasts. The feet
accounted for 32% of stress fractures and 28% of
all bony injuries. In male gymnasts, stress frac-
tures of the lumbosacral spine accounted for 33%
of all stress fractures and 16% of all bony injuries.
In the male gymnasts, there were approximately
the same number of stress fractures and fractures
(Dixon & Fricker 1993). A 5-year prospective
study by Sands et al. (1993) determined that a
new injury was expected to occur nine out
of every 100 training exposures, with the most
frequent injuries related to repetitive stress
syndrome. There was a higher injury incidence
associated with competitions and performance
of full routines than training (Sands et al. 1993).
The nutritional relationship to injury is diffi-
cult to prove, but several studies have demon-
strated a relationship between injury frequency
and nutritional factors. Muscle-glycogen deple-