So You Want to Be a Gymnast? Not After This Article!

Zak Muggleton, Year 3 

Maybe you’ve seen it on social media? Maybe you’ve seen it whilst switching through channels when the Olympic are on every four years? Or maybe you’ve even seen it performed by street performers, watching them twist and turn as they fly above cement? Undeniably, gymnastics is an enthralling sport to watch, and, as you may know if you’ve taken part in the sport, it’s for the adrenaline junkie, bound to put a smile on your face! 

But there is a bleaker side to gymnastics. It is dangerous. Very dangerous. If it were not for the extensive conditioning that the gymnasts face for hours a week, and meticulous coaching, their bodies would simply not be able to cope with the strain put upon them. As a former gymnast, I recall how it took up a large majority of my childhood, and has had huge implications on my life nowadays. Unfortunately, I live with chronic back pain. This is due to coaches inadequately warming us up before starting to practice backbends and high-flying backflips. Nowadays, whilst in university, not being able to take part in gymnastics has a huge psychological impact on me. Especially since it was my entire life, doing it 40+ hours a week as a child. It was my identity. Therefore, I was interested to research the injuries that take place in elite gymnastics. I want to look at this topic not only from a medical perspective, but appreciating the psychological effect on the gymnasts, who have to say goodbye to everything they know from their childhoods. 

It is part of college culture in America to have gymnastics teams that compete in competitions, a bit like supporting your university football team. This is of huge benefit to those gymnasts that have achieved level 10 (the highest level you can achieve before you qualify for elite) as they get a full scholarship to their chosen college, and get to continue the sport they love. Reiterating again that many gymnasts grow up with the sport, therefore making it such a major part of their lives, continuing it into college. Live injury updates, including their college team, name, timeline of injury and detail of injury, are put onto College Gym News to update fans and to keep the records current (College Gym News, 2022). This has been used in this article to try and establish the most common types of injuries, but this is by no means a big enough study to conclusively state which injury is the most common, as fact. At the time of research, there were 90 recorded injuries. Of theses, there were 10 ACL (anterior cruciate ligament) tears, 16 Achilles’ tendon tears (the ligament connecting the gastrocnemius and the calcaneus, known as the heel), 15 boots (defined as any foot or ankle injury requiring a boot to be worn), 7 knee injuries (not an ACL injury), 8 crutches, 5 retirements (injuries so severe that it requires a gymnast to leave the sport), 5 unknown and 1 arm in a cast, occurring due to a Colles’ fracture (a distal radius fracture). 

It could be concluded that the limbs are most likely to be affected by gymnastics injuries, with lower limb injuries coming out on top. This sample is a demonstration that it is unlikely for gymnastics to cause a fatality/injury to one’s trunk. However, the most dangerous injuries are to the head and neck, causing potentially death or disability, but all precautions are taken to prevent this. Safety equipment is always used and difficulty of skills is slowly progressed to prevent someone being unable to complete the skill safely. As there is no reference to head injuries within this list, these precautions could be the reason for that. 

Overlin et al conducted a study that has updated the world on artistic gymnastic injuries, and as you can see by figure 1, there is a list of common gymnastic injuries by location (Overlin et al, 2011). Here are descriptions of some of the conditions: 

• Lisfranc injury (injury of foot with one or more metatarsal bones displaced from tarsus, torn Lisfranc ligaments with widened space between metatarsal bone) [Wikipedia, 2022]
• Os trigonum fracture (Fracture of accessory bone at the posterolateral aspect of the talus) [Royal Orthopaedic hospital, 2022]
• Distal fibula physeal fracture (Fracture of the fibula near the talus bone) [Royal Children’s Hospital Melbourne, 2022]
• OCD (osteochondral defect) of the talar dome (injures cartilage and underlying bone of the talus in the joint) [Zanon et al, 2014]
• Posterior tibial tenosynovitis (inflammation of the covering around the tendon, the tibialis posterior tendon) [Whitney K, 2021]
• Osgood-Schlatter disease (pain and swelling below the knee, at the tibial tuberosity) [Johns Hopkins Medicine, 2022] 
• Gymnast’s Wrist (distal radial epiphysis – overgrowth injury of the growth plate of the radius – it can lead to premature closure of the radial growth plate causing the radius to be shorter than the ulna) [Children’s Hospital of Chicago, 2022]
• TFCC tear (connects the ulnar and radius distally) [Handcare, 2018]
• Grip lock fracture (fracture of distal radius and ulna, when finger and wrist come into contact, and occurs when the grip attaches to the bar upon rotation, it requires up to one year recovery) [Tabila E, 2007]
• Medial Epicondyle Apophysitis (pitcher’s elbow – medial epicondyle inflammation around a growth point, leading to an inability to perform certain actions without pain) [Columbia, 2022]
• Rotator cuff impingement (muscles between the bursa and the humerus that gets stuck between the acromion and the humerus) [Webmd, 2020]
• Labral tears (injury to tissue holing the ball and sockets together, sharp catching like pain in the shoulder) [OrthoNorCal, 2020]
• Spondylosis (term used to describe degenerative conditions of the spine) [DeWitt, 2016]
• Spondylolisthesis (vertebra slips out of position) [NHS, 2022]
• Facet syndrome (arthritis-like condition of the spine that can be a significant source of back and neck pain. It is caused by degenerative changes to the joints between the spine bones. The cartilage inside the facet joint can break down and become inflamed, triggering pain signals in nearby nerve endings) [Mayfield, 2022]
• Scheuermann disease ( some spine grow in a triangle rather than a cylinder causing varying speeds of growth during growth spurt) [McAfee, 2015]
• Discogenic back pain (a form of low back pain, caused by chemically or mechanically damaged intervertebral discs) [Physiopedia, 2022]
• Sacroiliitis ( an inflammation of one or both of your sacroiliac joints) [Mayo Clinic, 2021]
• Turf toe (sprain to main joint of the big toe by hyperextension) [webmd, 2022]

In your future practice, if you ever have a gymnast coming into your GP, you could, theoretically, look back over this list! As you can seen, a large number of ailments affect gymnasts. But it’s not only just damage to their bodies as adults in the sport; it is evident that a lot of gymnasts hurt themselves in the process of developing whilst learning gymnastics. I only feel lucky I didn’t experience more of these injuries!

References

College Gym News., Injury Updates., 2022., [Online]., Available at:  Injury Updates – College Gym News (Accessed: 20/07/22) 

Overlin, A. Chima, B. Erickson, S., Update on Artistic Gymnastics., 2011., [Online]., Available at:  Update on Artistic Gymnastics : Current Sports Medicine Reports (lww.com) (Accessed: 24/11/22) 

Wikipedia., 2022., Lisfranc Injury., [Online]. Available at : https://en.wikipedia.org/wiki/Lisfranc_injury#:~:text=A%20Lisfranc%20injury%2C%20also%20known,are%20displaced%20from%20the%20tarsus (Accessed: 24/11/22) 

WebMD., Turf Toe: Symptoms, Causes and Treatments., 2022., [Online]., Available at: https://www.webmd.com/fitness-exercise/turf-toe-symptoms-causes-and-treatments (Accessed: 24/11/22)

Royal Orthopaedic hospital., Posterior Impingement Surgery (os trigonum)., 2022., [Online]., Available at:  file (roh.nhs.uk) (Accessed: 24/11/22)

Royal Children’s Hospital Mebourne., Distal tibia and-or fibula physeal fractures – Emergency Department., 2022., [Online]., Available at:  https://www.rch.org.au/clinicalguide/guideline_index/fractures/ankle_emergency/#:~:text=Distal%20tibial%20physeal%20fractures%20are,transitional%20fractures%20can%20also%20occur (Accessed: 24/11/22)

Zanon G, Di Vico G, Marullo M., Osteochrondritis Dissecans of the Talus., 2014., [Online]., Available at:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295677/ (Accessed: 24/11/22)

Whitney K., Tibialis Posterior Tendinosis and Tibialis Posterior Tenosynovitis., 2021., [Online]., Available at:  https://www.msdmanuals.com/en-gb/home/bone,-joint,-and-muscle-disorders/foot-problems/tibialis-posterior-tendinosis-and-tibialis-posterior-tenosynovitis#:~:text=Tibialis%20posterior%20tenosynovitis%20is%20inflammation,are%20felt%20around%20the%20ankle (Accessed: 24/11/22)

Johns Hopkins., Osgood-Schlatters Disease., 2021., [Online]., Available at:  https://www.hopkinsmedicine.org/health/conditions-and-diseases/osgoodschlatter-disease#:~:text=Osgood%2DSchlatter%20disease%20is%20a%20condition%20that%20causes%20pain%20and,which%20stretches%20over%20the%20kneecap (Accessed: 24/11/22)

Children’s Hospital of Chicago., Gymnast’s Wrist (Distal Radial Epiphysitis)., 2022., [Online]., Available at:  https://www.luriechildrens.org/en/specialties-conditions/gymnast-wrist-distal-radial-epiphysitis/ (Accessed: 24/11/22)

The Hand Society., TFCC Tear: Causes and Symptoms., 2018., [Online]., Available at:  TFCC Tear: Causes and Symptoms | The Hand Society (assh.org) (Accessed: 24/11/22)

Tabila E. Grip Lock: A unique Mechanism of Injury in Gymnastics. 2007., [Online]., Available at:  [Online at Human Kinetics Journals] (Accessed: 24/11/22)

Columbia University., Medial Epicondyle Apophysitis / Little League Elbow (Pediatric)., [Online]., Available at:  Medial Epicondyle Apophysitis / Little League Elbow (Pediatric) | ColumbiaDoctors – New York (Accessed: 24/11/22)

WebMd., Rotator Cuff Impingement., 2020., [Online]., Available at:  https://www.webmd.com/pain-management/rotator-cuff-impingement#:~:text=A%20rotator%20cuff%20impingement%20is,move%20and%20lift%20your%20arms (Accessed: 24/11/22)

OrthoNorCal., Labral Tears of the Shoulder., 2020., [Online]., Available at:  https://www.orthonorcal.com/labral-tears-of-the-shoulder-orthopedic-specialists-los-gatos-morgan-hill.html (Accessed: 24/11/22) 

DeWitt., Spondylosis: What It Actually Means., 2016., [Online]., Available at:  Spondylosis: What It Actually Means (spine-health.com) (Accessed: 24/11/22)

NHS., Spondylolisthesis., 2022., [Online]., Available at:  Spondylolisthesis – NHS (www.nhs.uk) (Accessed: 24/11/22)

Orlando M., Facet Joint Syndrome/ Arthritis., 2018., [Online]., Available at:  Facet Joint Syndrome, Facet arthropathy Mayfield Brain & Spine Cincinnati, Ohio (mayfieldclinic.com) (Accessed: 24/11/22)

McAfee P., Scheuermann’s Disease of the Thoracic and Lumbar Spine., 2015., [Online]., Available at:  Scheuermann’s Disease of the Thoracic and Lumbar Spine (spine-health.com) (Accessed: 24/11/22)

Physiopedia., Lumbar Discogenic Pain., 2022., [Online]., Available at:  https://www.physio-pedia.com/Lumbar_Discogenic_Pain#:~:text=Discogenic%20pain%20is%20a%20form,in%20deterioration%20due%20to%20ageing (Accessed: 24/11/22)

Mayoclinic., Sacroilitis., 2021., [Online]., Available at:  https://www.mayoclinic.org/diseases-conditions/sacroiliitis/symptoms-causes/syc-20350747 (Accessed: 24/11/22)