Why Do Our Sports Medicine Experts Focus on Gymnastics?

At Cincinnati Children’s Hospital, we specialize in providing top-ranked, quality healthcare to young and adolescent individuals. Our team of sports medicine specialists work with gymnasts every single day and understand the complexities of the sport and the physical demands on the young gymnast’s body. When diagnosing and treating a gymnastics-related injury, our physicians use a well-rounded approach to address the unique concerns surrounding the young or adolescent gymnast. 

Key factors that Cincinnati Children’s Sports Medicine examines: 

  1. Growth and maturation 
  2. Skeletal health
  3. Dietary concerns
  4. Biomechanics
  5. Injury Prevention

Our goal is for you to be better post-recovery than you ever were before your injury. 

What is the impact on the body?

Gymnastics is a truly unique sport. Few other sports demand such a combination of strength, flexibility, balance, speed, and resilience from the young athlete. A talented gymnast may start moving into the upper levels of the sport at an early age, often peaking between 14 to 17 years old for females and 19-26 years old for males. As the athlete advances in the gym, the sport requires increasingly more difficult skills and increased practice times to master them. A combination of forceful movements, twisting, and repetitive loads on both the arms and legs, plus the maturing body’s nutritional needs and hormonal factors can lead to injury. Some of these injuries are unique to gymnastics and seldom seen in other sports or recreational activities. In both men’s and women’s gymnastics, most injuries occur to the lower extremity. However, male gymnasts endure a greater proportion of upper extremity (i.e. shoulder, wrist) injuries which reflects the different skills and events used in men’s gymnastics.

Common Gymnastics Injuries

Ankle sprains - These are some of the most common injuries to occur in the sport of gymnastics. This injury occurs most commonly during landings or dismounts from an apparatus when one or more of the ligaments connecting the ankle bones becomes overstretched or torn. In a growing gymnast, ankle sprains may be accompanied by a growth plate injury and special care should be taken by the medical professional when evaluating the ankle. Conservative care of RICE (rest, ice, compression, elevation) is frequently used to treat ankle sprains, in combination with activity modification.

Fractures - Gymnasts are no strangers to falling during training or competition. The gymnast may hit the foot or land awkwardly during a fall, especially with bar and beam skills, sometimes resulting in foot and toe fractures. These fractures are often caused by a direct blow or a violent twisting motion of the injured structure. Treatment typically includes a period of non or partial weight-bearing before gradually returning to activity once normal motion and strength are restored. 

Sever’s Disease - This is a common cause of heel pain in the young gymnast. This pain is a result of traction from the Achilles tendon on the growth center at the back of the heel. In gymnastics, overuse or repetitive hard landings, especially with bare feet, may lead to this injury. Conservative treatment often consists of a stretching program, heel cups, and activity modification. 

Ankle impingement - A gymnast may complain of pain at the front of the ankle after landing “short.” This ankle impingement is a result of extreme compression in the ankle joint. Due to the high impact of landing from a great height or under-rotating a backwards somersault, this happens frequently in gymnastics. Usually ankle impingement involves soft tissue inflammation but, in a more advanced case, may involve damage to the bony structures of the ankle. Treatment often begins with conservative care including modifications to training, anti-inflammatories, physical therapy, and taping to limit the end ranges of ankle motion.

Anterior knee pain (or pain at the front of the knee) is common in gymnastics, as well as many other sports that involve running, jumping, punching, and landing. Two frequent causes of this pain are patellofemoral pain syndrome or Runner’s knee (abnormal tracking of the kneecap on the knee joint) and patellar tendinitis or Jumper’s knee (inflammation of the patellar tendon). In the young or adolescent gymnast, growth-related issues may be to blame, including Osgood-Schlatter’s Disease (irritation of the growth plate at the patellar tendon insertion just below the kneecap) or Sinding-Larsen-Johansson Syndrome (irritation of the growth plate at the bottom of the kneecap). A majority of anterior knee pain is managed conservatively under the care of a sports medicine doctor. In many cases, the gymnast is able to continue training during the course of treatment.

Spondylolysis is a common cause of low back pain in gymnasts. This happens most frequently in the lumbar spine as a result of the repetitive back extension and rotation that is prevalent in gymnastics. This condition may become more severe, resulting in spondylolisthesis, where one segment of the spinal column slips forward on another. The treatment for these injuries include a period of rest and physical therapy to strengthen the core and resolve any poor movement patterns contributing to the injury.

A majority of gymnasts will experience wrist pain at some point in their career, affecting up to 79% of those in the sport. In gymnastics, the repetitive loads of tumbling, swinging and weight-bearing on the hands may lead to overuse injury or stress fracture. Distal radial physeal stress syndrome (commonly known as Gymnast’s wrist) is a stress injury affecting the growth plate at the end of the radius (forearm) bone. In children, the growth plate is made of cartilage which is softer and more vulnerable to injury compared with mature bone. This condition can ultimately cause chronic pain, loss of motion, and eventual inability to weight-bear or perform impact skills onto the hand. It is important to have wrist pain evaluated by a sports medicine doctor, especially if pain persists despite rest and basic care.

Many gymnastics skills require weight-bearing and loading onto the arms. Over time this repetitive stress can result in cartilage damage at the elbow joint, called osteochondritis dissecans (OCD). The cartilage sits over top the bone much like asphalt sits over a roadbed. The cartilage may crack but not become displaced or the damaged piece may break free much like a pothole breaking loose from asphalt. In other sports, this condition is more commonly seen at the knee or ankle joints. However, because of the unique demands of the sport, the gymnast will predominantly see this injury at the elbow and therefore, should be cautious of elbow pain that does not improve with rest.

The Female Athlete Triad is a medical condition that includes one or more of the following: 

  1. Low energy availability with or without disordered eating
  2. Menstrual dysfunction
  3. Low bone mineral density

The Triad is most commonly seen in physically active girls and women who participate in aesthetically-pleasing sports such as ballet, gymnastics, figure skating, and diving. Other sports that value a thin, lean body type such as rowing or distance running are also at a higher risk. This condition may range from mild to severe, with the most serious complications involving clinical eating disorders, abnormal or absent periods, and osteoporosis. In addition, the Triad is linked to decreased performance in the athlete’s chosen sport and increased risk of stress fractures. A multi-faceted treatment plan may be necessary for this condition and Cincinnati Children’s is well-equipped to handle all aspects of recovery. Our Sports Medicine physicians have a gymnastics-specific approach concerning the activity level, nutritional concerns, and psychological factors of the gymnast. 

Tips for Parents and Coaches

Local gymnast does the splits.

Coaches: You are on the front lines with the athletes and can play a big role in the area of injury prevention. Overuse injuries to the growth plates are more common when the athlete is growing at their fastest rate, approximately age 11 (girls) and age 13 (boys). For a female gymnast, the 9-13 year old window is often a time to move up in levels and progress skills in the gym. This means increased hours in the gym, increased training intensity, and advanced routines that are inherently more demanding on the body. Keep a close watch on any gymnasts exhibiting pain during this timeframe because they are more susceptible to both acute and chronic injury, especially growth-related injury. 

Parents: Check to see if your child’s school or sports club has access to an athletic trainer. Athletic trainers (ATs) are highly qualified, multi-skilled health care professionals who collaborate with physicians to provide preventative services, emergency care, clinical diagnosis, therapeutic intervention, and rehabilitation of injuries and medical conditions. Schools and clubs with an athletic trainer report that their student athletes sustain fewer injuries (both acute and recurring) than those without athletic trainers. Having athletic trainers on staff also improves the rate of early detection of dehydration, head injuries, and other sports-related health issues.