out a calcaneal stress fracture. Management of heel
pad contusions is conservative: ice, rest, anti-inflam-
matory medications, and a heel cup or donut pad.OTHER GYMNASTICS-RELATED
CONCERNS
CATASTROPHIC INJURY
- Although catastrophic head and neck injuries still
occur, the overall number of gymnastics injuries
resulting in paralysis or death appears to have
declined. In 1976, the trampoline was discontinued as
a gymnastics event due to the high number of associ-
ated cranial and spinal cord injuries. As a result, the
number of head, neck, and spine injuries decreased
(Garrick and Requa, 1978).
FEMALE ATHLETE TRIAD
- Although the exact prevalence is unknown, gymnasts
are at risk for the female athlete triad of disordered
eating, amenorrhea, and osteoporosis (Ott, 2002). - Eating disorders, ranging from anorexia nervosa and
bulimia to less severe forms of disordered eating, are
felt to be underdiagnosed. - The focus on body image may begin at an early age:
Girls involved in aesthetic sports such as gymnastics
reported higher weight concerns at ages 5–7 than con-
trol groups (Davison, Earnest, and Birch, 2002). - When compared with age-matched controls, gym-
nasts have a later onset of menarche (Lindholm,
Hagenfeldt, and Ringertz, 1994). Menstrual dysfunc-
tion occurs more commonly in athletes (3.4–66%)
than in the general population (2–5%) (ACSM,
1993); the specific prevalence in gymnasts is
unknown. The etiology of menstrual dysfunction in
athletes is currently felt to be related to inadequate
caloric intake relative to energy expenditure, termed
“negative energy balance” (Loucks, Verdum, and
Heath, 1998). - Gymnasts typically have a higher bone mineral density
than other athletes, despite the presence of disordered
eating and menstrual dysfunction (Robinson et al,
1995). The repetitive impact-loading characteristic of
gymnastics training appears to have a salutary effect
on bone mineral density, and it seems to offset any
negative effects of disordered eating and/or menstrual
dysfunction (Robinson et al, 1995).
•Treatment of each component of the female athlete
triad involves a multidisciplinary approach: physi-
cians, nutritionists, and psychologists should be
involved. Coaches, trainers, parents, and athletes need
to be educated regarding the symptoms, signs, and
potentially devastating effects of the triad.PSYCHOLOGIC CONCERNS- Psychologic stress has been related to increased rates
of injury. In one study, injured gymnasts had higher
scores for anxiety than healthy gymnasts (Tofler et al,
1996). - Advanced gymnastics training involves many hours
and years of commitment. A gymnast who has created
a sense of self-worth primarily on the basis of suc-
cesses in gymnastics may continue to train long after
losing interest in the sport (Tofler et al, 1996). In such
cases, gymnasts may create an injury (either imagi-
nary or self-inflicted) in order to discontinue the sport
without disappointing family, coaches, or themselves
(Tofler et al, 1996). - Research of gymnasts often finds high rates of non-
participation (dropouts). Studies have found that from
16.3 to 52.4% of gymnasts may withdraw due to
injury (Caine et al, 1989; 2003).
PREVENTION OF INJURY- Protective equipment may decrease the incidence of
injury and should be used when possible. This
includes crash mats, pits, low beams, and foam beam
and bar covers. Floor mats and pads should be
checked often to ensure that there are no cracks that
could lead to an ankle injury. - Some changes aimed at injury prevention in gymnas-
tics have already been made. A safer vault horse was
instated at the senior levels in 2001 in order to
decrease injuries. Trampoline was discontinued as a
fifth event in 1976 as the result of a number of cata-
strophic injuries. Padded mats are now allowed on
the floor exercise at college competitions. Certain
high-risk skills, such as the Yurchenko (round-off
entry) vault, are restricted to only the most advanced
levels. - As a result of the high rate of recurrent injury, gym-
nasts should not return to full training until rehabilita-
tion is completed (Caine et al, 1989). Ideally, gymnasts
should have a physical therapist or trainer available to
guide the return to training. Primary rehabilitation, or
prehab, may help to avoid common overuse injuries,
such as those to the Achilles tendon or knee (Mackie
and Taunton, 1994). - Injury prevention is of special concern among gym-
nasts, since young, skeletally immature participants
504 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS