The treatment of a gymnast is a delicate balance between injury prevention, anticipating trends based on level progression, analysis of individual strengths and deficits, balancing training programs, relative rest for treatment and return to sport. It is imperative that the medical staff treating gymnasts understands the terminology of the sport, scheduling demands, and most importantly the kinesiology/physics behind skills so as to understand the method of injury whether acute, repetitive or chronic. An ankle sprain of a gymnast, for example, is treated very differently than that of a marathon runner, taking into consideration landing positions, one vs two foot take off and landings, compliant and non-compliant surfaces, plyometric demand and body-weight force multiples, abilty to wear/not wear bracing, the demand of the ankle to be both stable and flexible, balance and proprioception demands and more. In a sport where all of the joints of the body are stressed, medical professionals and coaches alike should be aware of numbers/repetitions, small pains that could snowball into deeper issues and compensation patterns and how each joint is related. The balance between pushing through soreness and taking time off for healing is one that will be forever difficult.
On-site analysis of athletes performing is crucial to assessment of injury and progression to return. Video analysis in slow motion, for example, of vault pre-flight and beam flight series may tell one a great deal of information on spine overload trends due to a lack of shoulder flexibility or poor technique. Viewing handstand position on bars, men’s or women’s, can tell a therapist how well the athlete is transitioning abdominal strength knowledge into action…or not!
Certain diagnosis trend throughout the sport of gymnastics. To name a few: spondy-category spine injuries, TFCC wrist injuries, OCD of the elbow, labral issues in the hip, talus fractures and stress in the ankle and more.
There are 6 events that make up men’s gymnastics. In addition to floor and vault and high bar (similar to uneven bars for women), the men have pommels, parallel bars and still rings. Stress on the shoulder and upper body on these additional events leads to a plethora of different injury trends than with women. The shoulder is demanded to be as much mobile as it is stable and strong, which sets in confusion often for rotator cuff, rib, and upper spine muscles. Core strength is stressed on pommel horse given the lever arm of an extended body with the velocity of rotation, balance on one hand at a time, for example.
The gymnastics training demands on women often start over 30 hours a week at the age of 10-11 for budding national team-caliber members. Topics to consider with this population, potentially different form other sports, are body fat percentage, vertical load and bone stress, estrogen during development of strength, menstruation cycle abnormalities, growth plate stress and subsequent risk for injury, the potential for female athlete triad, orthopedic and ligament injuries with need for repair prepubescently, and more. There are specific trends as well per level, with increase in demand for upper body weight bearing between level 6 and 7, ankle stress with tumbling from level 8 to 9, wrist health when starting Yurchenkos, release moves on uneven bars coming along with falls and shoulder stress, and many more. Treating this population is a delicate balance of time off for proper recovery to avoid acute injuries turning chronic, and staying in the gym to not lose muscular and aerobic fitness.
The demand on the joints, muscles, ligaments, and tendons in a sport that demands hyperflexibilty is intense. Therefore, proper flexibility and strength programs are needed. In addition to the balance needed for artistic gymnastics, rhythmic has a demand on hand, foot, ankle, and releve’-based balance often performed dynamically with motion, and not statically. The spine is often a source of pain and injury due to the hyperlordotic posturing that is needed for the performance of many elements. Children without proper flexibility struggle early in the sport, so those who are advanced are there after natural attrition. In addition to working elements, additional time is spent on warm up, cool down, dance education, spine bracing, nutrition and more.
Tumble and Trampoline
In addition to normal gymnastics concerns is the aspect of different safety concerns. Concussions are more common here than in artistic, and having knowledge of awareness of diagnosis, and when to refer to a medical professional is crucial. With a great deal of stress on the lower body, the joint force multiple is very large through the ankles, knees, hips and spine with every jump and subsequent reaction force to the body. Because the tumbling done is performed at greater speeds and often includes a combination of higher numbers of flips and twists, core stability and air sense is a good way to help reduce the risk of injury.
Sport-Specific Treatment & Injury
Coming soon…In the section, as a Member, you will be able to access step-by-step protocols for full-body injuries, per joint, per diagnosis, of a guide to physical therapy/manual treatment, exercise, in-gym ramp-up programs, protocols and more!