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To examine the relationship between Achilles-tendon (AT) and patellar-tendon (PT) structure, clinical-examination and tendon pain in young gymnasts; and, to explore the associations between these factors and age, maturation, and training-load. Two hundred and seventy-four female gymnasts (aged 12.1±1.9 yrs) were assessed for anthropometric measures, pubertal-stage, and training-load. They had clinical-tests (pain-on-palpation for AT and pain-on-palpation and Royal-London Hospital-Test for PT), were asked about tendon-pain during-loading and were assessed for tendon-structure. Gymnasts with positive clinical-tests (with and without pain during-loading) presented a significantly higher prevalence of disorganized AT and PT compared to gymnasts with negative clinical-tests (with and without pain during-loading) (p<0.05). A significant pubertyXpositive clinical-test interaction was found for disorganized PT structure, whereby a disorganized structure was more prevalent among post-pubertal gymnasts with positive clinical-tests compared to pre-pubertal participants with negative clinical-tests (F(1, 263)=9.436, p=0.002). In gymnasts with positive clinical-tests, significant correlations were found between disorganized AT and PT structures and age, and training-load (p<0.05). An increased prevalence of disorganized tendon structure (regardless of pain during-loading) was seen in participants with positive clinical-tests. This disorganized tendon-structure was found to be significantly related to increased age, post-pubertal stage, and higher training hours in gymnasts with positive clinical-tests. [ABSTRACT FROM AUTHOR]

Background: Anconeus compartment syndrome is a rarely reported compartment syndrome in the anconeus muscle compartment of the forearm. It has anatomic and pathophysiological associations with posterolateral rotatory instability (PLRI) of the elbow. Purpose: To present the history, management, and outcomes of 4 patients with anconeus compartment syndrome. Secondary aims were to (1) establish normative anconeus pressures and (2) measure the volume of this compartment with and without PLRI in cadavers. Study Design: Case series; Level of evidence, 4. Methods: Four patients with clinical signs of anconeus compartment syndrome (2 gymnasts, 1 swimmer, and 1 footballer/weightlifter) were identified over a 3-year period (2015-2017 inclusive). Patient history, sporting activity, physical examination, anconeus compartment pressures, and treatment outcomes were recorded. Manometry of the anconeus compartment in 2 healthy male controls was performed to establish normative compartment pressures. Anconeus volumetric anatomy and the effect of creating PLRI on compartment volume was investigated in 4 cadaveric elbows. Results: All 4 patients had microtraumatic PLRI, and 2 patients had anconeus hypertrophy. Anconeus compartment pressures at rest and at 2-minutes postexercise were median 28.0 and 67.5 mm Hg, respectively, in the patients and mean 16.5 and 18 mm Hg, respectively, in the controls. Simultaneous fasciotomy and PLRI reconstructive procedures were performed in 2 patients, with outcomes showing full return to competition. Fasciotomy alone was performed in 2 patients to allow return to competition, with both requiring later reconstruction to address PLRI. Cadaver dissection revealed that the anconeus compartment was extremely small and that creation of PLRI reduced the direct volume of the compartment and increased the distance between the anconeus origin and insertion. Conclusion: Our case series demonstrated that anconeus compartment syndrome can occur in upper limb-dominant athletes in the presence of PLRI and anconeus hypertrophy. Pain is relieved by fasciotomy, but definitive treatment of the underlying instability prevents further symptomatology. [ABSTRACT FROM AUTHOR]

Background: There is a large population of young athletes who participate in gymnastics, and the prevention of injury in junior athletes is considered important. However, few studies have prospectively investigated the relationship between physical factors and the occurrence of injury. Purpose: To investigate the physical characteristics that are factors in the injury occurrence in elementary and junior high school gymnasts. Study Design: Prospective observational study. Methods: A total of 36 healthy young gymnasts (at national competition level) were enrolled in the study. Once a week for 23 weeks, injuries were prospectively investigated using self-report questionnaires under the supervision of a research staff. Joint range of motion (hip, ankle, shoulder, and wrist), tightness (Thomas test, Ely test, straight leg raise [SLR], triceps surae, combined abduction test [CAT], horizontal flexion test [HFT]), and muscle elasticity (multifidus) were assessed to compare differences in physical function between injured and non-injured participants. Results: Injuries occurred most commonly in the wrist (42.1%), lower back (30.2%), and foot (9.5%) among males, whereas heel (22.2%), knee (16.0%), and lower back (12.8%) were the most common injury sites among females. Wrist injuries in male athletes showed decreased shoulder joint range of motion, and lower back injuries showed decreased hip and shoulder joint range of motion. Lower back injuries in female athletes showed decreased hip extension mobility. Heel and knee joint injuries in females also showed increased range of motion and decreased tightness. Conclusions: The results of this study indicate that the factors related to flexibility differ according to injury location. Further studies are required to clarify the physical factors that influence injury occurrence by examining the effects of the gymnasts' muscle strength, age, individual factors, and left–right differences. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the effect of skill modifications on head motion experienced during women's artistic gymnastics skills. Nine gymnasts (four beginner and five advanced) completed three trials of up to 24 skill progressions, each consisting of a skill and two progressive safety modifications. Gymnasts were instrumented with mouthpiece sensors embedded with an accelerometer and gyroscope collecting motion data at 200, 300, and 500 Hz during each skill performance. Peak-to-peak linear and rotational kinematics during contact phases and peak rotational kinematics during non-contact phases were computed. A mixed-effects model was used to compare differences in modification status nested within skill categories. Timer skills (i.e. drills that simulate performance of a gymnastics skill) resulted in the highest median ΔLA and ΔRA of all skill categories, and 132 skill performances exceeded 10 g ΔLA during a contact phase. Modifications were associated with significant reductions in head kinematics during contact phases of timers, floor skills, bar releases, and vault skills. Gymnasts can be exposed to direct and indirect head accelerations at magnitudes consistent with other youth contact sports, and common safety modifications may be effective at reducing head motion during contact and non-contact phases of gymnastics skills. [ABSTRACT FROM AUTHOR]

Background: To provide epidemiological data for minor and moderate-to-serious injury claims for gym and fitness related injuries amongst those aged 16–64 in New Zealand, to inform the development of an injury prevention program. Methods: Retrospective analytical review of gym and fitness related injury entitlement minor and moderate- to-serious Accident Compensation Corporation (ACC) claims from 1 July 2011 to 30 June 2020. Data were analysed by cause of injury, geographical region, sex, age, body site and injury type. Qualitative analysis of free text describing the activity causing the injury was conducted. Results: Over the ten-year period, 16–64 year olds made 345,254 injury claims, costing ACC NZ$241,298,275 in treatment charges. Soft tissue injuries were the most prevalent making up 96% (331,343) of all claims and 88% (NZ$213,049,197) of the total charges. Strenuous movement with lifting (n = 154,467, 47%), strenuous movement without lifting (n = 84,469, 25%), impact/contact with object (n = 39,610, 12%) and impact/contact with ground (n = 25,351, 8%) were the top four mechanisms resulting in injury, accounting for 92% of soft tissue injuries. Males and females aged 21 to 30 years old were most frequently injured. The four most injured body sites (lower back/spine, shoulder, knee, neck/back of head) accounted for 63% of injuries in females, and 65% in males. Conclusions: The most common cause of injury from gym and fitness activity claims in 16–64 year olds in New Zealand was lifting/carrying/strain resulting in lower back/spine and shoulder (including clavicle/blade) soft tissue injuries. Soft tissue injuries accounted for 96% of the total claims. Males and females aged 21 to 30 years old were most frequently injured age group. Key points: • The most common cause of injury from gym and fitness activities amongst those aged 16–64 was lifting/carrying/strain resulting in lower back/spine and shoulder soft tissue injuries. • Of all injuries, 96% were soft tissue injuries. • Males and females aged 21 to 30 years old were most frequently injured. [ABSTRACT FROM AUTHOR]

Background: The prevalence of wrist pain among gymnasts ranges from 46% to 79%. To alleviate wrist pain, gymnasts wear wrist guards/supports (WG/S). Purpose: To investigate the effect of WG/S on the wrist joint through joint moment, angles, total joint range of motion (ROM) arc, and ground-reaction force (GRF). Study Design: Controlled laboratory study. Methods: A cross-sectional study design was used to investigate 23 female gymnasts (mean ± SD: age, 12.3 ± 1.5 years; height, 143.4 ± 7.6 cm; mass, 37.7 ± 6.6 kg; body mass index, 18.6 ± 2.9) who performed back handsprings (analyzed by first half [phase 1] and second half [phase 2]) with the following 3 conditions: no WG/S, Skids/Ultimate Wrist Supports (S/UWS), and Tiger Paws (TP). Wrist joint moments, angles, total ROM arc, and GRF were examined by the 3 conditions using analysis of variance with Bonferroni correction and effect size (Cohen d). Results: For mean wrist flexion moment, both S/UWS and TP showed significantly higher values than the no-WG/S condition in landing phase 1 (S/UWS: P =.001, d = 1.30; TP: P =.019, d = 0.87). In angle comparisons in landing phase 1, no WG/S showed greater mean wrist extension angles compared with S/UWS (P =.046; d = 0.80), but no significant differences with TP (P =.096; d = 0.65). Also, in landing phase 1, total ROM arc of the right wrist was greater in the no-WG/S condition compared with S/UWS (P =.018; d = 0.88), but there were no differences with TP (P =.400; d = 0.52). Conclusion: These data show an increased wrist flexion moment using S/UWS and TP compared with the no-WG/S condition in landing phase 1 of back handsprings. Also, increased wrist extension angles and total arc ROM of the right wrist were found in the no-WG/S condition compared with S/UWS, but not with TP in landing phase 1. S/UWS may be helpful to reduce wrist joint angles, specifically wrist extension in landing phase 1, but both S/UWS and TP caused higher wrist flexion joint moment in landing phase 1. There were no differences found in GFG among the three variables. Clinical Relevance: In the first half of the back handspring, wrist guards can limit wrist extension joint angles and total arc ROM; however, an increased wrist flexion moment was found when wrist guards were worn, which may potentially lead to an increased risk of injury. Injury history, especially overuse signs/symptoms, and previous surgery on the wrist joint need to be well considered before the application or use of wrist guards. Also, the amount of time/exposure wearing wrist guards should be carefully controlled in young female gymnasts. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objectives: To compare gymnastics-related injuries between former collegiate gymnasts who did and did not report components of the female athlete triad (Triad) during college, including disordered eating or menstrual irregularity. We hypothesized that athletes reporting these 2 triad symptoms would have higher rates of time loss injury and injuries requiring surgery. Design: Retrospective case–control. Setting: Online survey. Patients: Four hundred seventy former collegiate gymnasts. Interventions: Athletes completed online survey distributed through social media. Main Outcome Measures: Participants were grouped based on self-reported menstrual irregularity and disordered eating during college. We compared time loss injuries, injuries resulting in surgery, and injury locations between the groups using χ2 analyses. Results: Seventy percent (n = 328) of participants in this study reported a time loss college injury without surgery, and 42% (n = 199) reported an injury during college that required surgical treatment. A significantly greater proportion of gymnasts with only disordered eating reported a time loss gymnastics injury (without surgery) compared with those who reported only menstrual irregularity during college (79% vs 64%; P =0.03). A significantly greater proportion of the disordered eating–only group reported a spine injury compared with the menstrual irregularity–only group (P = 0.007) and the group who reported neither menstrual irregularity nor disordered eating (P = 0.006). Conclusions: College gymnasts who experienced disordered eating were more likely to experience a nonsurgical time loss injury while in college, as well as spine injury compared with those with menstrual irregularity. Sports medicine providers should be aware of the association between injuries and individual components of Triad in gymnasts beyond bone stress injuries. [ABSTRACT FROM AUTHOR]

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Objective: We aimed to investigate the effect and safety of extracorporeal shock wave therapy (ESWT) on ischial apophysitis (IA) in young high-level gymnasts. We hypothesized that ESWT would be safe and effective in alleviating pain. Design: Retrospective case series. Setting: Funabashi Orthopedic Hospital. Patients: The subjects were 18 high-level gymnasts (mean age of 13 years) with a chief complain of chronic buttock pain diagnosed with IA. Interventions: Ten patients received only physiotherapy (PT), whereas 8 received both PT and ESWT to the ischial tuberosity. The basic protocol for ESWT was to use an energy dose of 0.20 mJ/mm2 or less with 3000 shots per session at 4-week intervals. Main Outcome Measures: We investigated whether PT and ESWT relieved the pain and allowed the patient to return fully to gymnastics. Based on radiographs at the last observation, we examined whether early closure of the apophyseal line of the ischium and around hip joint on the affected side occurred. Results: In the PT group, pain was relieved in 2 of 10 patients. In the ESWT group, pain was relieved and full return to gymnastics was possible in all 8 patients. None of the patients showed early closure of the apophyseal line. Conclusions: Extracorporeal shock wave therapy can be a safe and effective treatment option for IA in young high-level gymnasts. [ABSTRACT FROM AUTHOR]

The sport of gymnastics is undergoing a global examination of its culture and the relationship between the gymnast, coach and environment is a central focus. The aim of this review is to explore biomechanics and motor control research in skill development and technique selection in artistic gymnastics with a focus on the underlying concepts and scientific principles that allow performance enhancement, skill development and injury risk reduction. The current review examines peer reviewed papers from 2000 onwards, with a focus on contemporary approaches in the field of gymnastics research, and highlights several key directions for future gymnastics research. Based on our review and the integration of the models of Newell (1986) and Irwin et al. (2005), we recommend that future gymnastics research should embrace at the very least a multidisciplinary approach and aim for an interdisciplinary paradigm. [ABSTRACT FROM AUTHOR]

Background: Gymnastics requires intense year-round upper and lower extremity strength training typically starting from an early age. As such, the injury patterns observed in these athletes may be unique. Purpose: To characterize the types of injuries and provide return-to-sport data in male and female collegiate gymnasts. Study Design: Descriptive epidemiology study. Methods: A conference-specific injury database was utilized to perform a retrospective review of injuries for male and female National Collegiate Athletic Association (NCAA) Division I gymnasts within the Pacific Coast Conference between 2017 and 2020 (N = 673 gymnasts). Injuries were stratified by anatomic location, sex, time missed, and injury diagnoses. Relative risk (RR) was used to compare results between sexes. Results: Of the 673 gymnasts, 183 (27.2%) experienced 1093 injuries during the study period. Injuries were sustained in 35 of 145 male athletes (24.1%) as compared with 148 of 528 female athletes (28.0%; RR, 0.86 [95% CI, 0.63-1.19]; P =.390). Approximately 66.1% (723/1093) of injuries occurred in a practice setting, compared with 84 of 1093 injuries (7.7%) occurring during competition. Overall, 417 of 1093 injuries (38.2%) resulted in no missed time. Shoulder injuries and elbow/arm injuries were significantly more common in male versus female athletes (RR, 1.99 [95% CI, 1.32-3.01], P =.001; and RR, 2.08 [95% CI, 1.05-4.13], P =.036, respectively). In total, 23 concussions affected 21 of 673 athletes (3.1%); 6 concussions (26.1%) resulted in the inability to return to sport during the same season. Conclusion: For the majority of musculoskeletal injuries, the gymnasts were able to return to sport during the same season. Male athletes were more likely to experience shoulder and elbow/arm injuries, likely because of sex-specific events. Concussions occurred in 3.1% of the gymnasts, highlighting the need for vigilant monitoring. This analysis of the incidence and outcomes of injuries observed in NCAA Division I gymnasts may guide injury prevention protocols as well as provide important prognostic information. [ABSTRACT FROM AUTHOR]

Gymnastics has a history of high injury incidence rates. However, little is known about the injury pathology in young gymnasts. The purpose of this study was to fill gaps in the literature by providing insight into the injury pathology in gymnasts aged 6 to 17 years. This study was retrospective in design, where injury data were collected using a Qualtrics questionnaire and distributed via social media. The findings revealed that the most common injury site was the lower limb (60.5%), in particular, the ankle/foot (49%) and knee (27%). Overuse injuries and sprains were most prevalent among the lower limb (25% and 18.4%, respectively), and gymnasts seemed to have a tendency to train through injury with modifications to training. In conclusion, lower limb joint sprain and overuse injuries accounted for the majority of injuries in youth gymnasts. These injuries were more frequently reported in girls in the years associated with peak height velocity and beyond. [ABSTRACT FROM AUTHOR]

Background: Although anterior apophyseal abnormalities of the vertebrae and spondylolytic spondylolisthesis (SS) are prevalent in gymnasts during growth spurts, no studies have examined the relationship between apophyseal abnormalities and SS. Hypothesis: A significant relationship will exist between anterior apophyseal abnormalities and SS in young gymnasts. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 306 gymnasts (123 male, 183 female; age range, 6-28 years) with >2 weeks of back pain were enrolled in this study. Apophyseal abnormalities were evaluated using radiography. In the primary analysis, multiple logistic regression analysis was performed to assess the odds ratio (OR) for multivariate factors (age, body mass index, sex, skeletal maturity, competitive level, and presence of spondylolysis or SS) influencing the incidence of apophyseal abnormalities. In the secondary analysis, 90 of the 306 gymnasts were followed up radiographically for a minimum of 2 years, and factors contributing to the worsening of apophyseal abnormalities were identified. Results: In the primary analysis, the chi-square test revealed a relationship between anterior ring apophyseal abnormalities and SS at the L5-S1 segment (OR, 7.6). Multiple logistic regression analysis demonstrated that the presence of SS at L5-S1 (OR, 9.5) and competitive level (international: OR, 6.7; national: OR, 4.5) correlated with the incidence of apophyseal abnormalities. The secondary analysis identified the presence of SS at L5-S1 (OR, 5.9) as a significant factor contributing to the worsening of apophyseal abnormalities. Conclusion: The presence of SS was a factor affecting the incidence and prognosis of anterior apophyseal abnormalities. [ABSTRACT FROM AUTHOR]

Objective: Following sports injury, a timely and accurate diagnosis is important, so as to initiate appropriate care as soon as possible. This is perhaps even more paramount in pediatric athletic trauma, particularly during the pre-puberty through adolescent years of rapid skeletal growth. This paper presents the diagnosis and management of osteochondritis dissecans in its third most common location, the elbow, a presentation of which chiropractors should be aware, including the importance of timely diagnosis and appropriate treatment. Clinical features: A 9-year-old elite gymnast presented at a chiropractic clinic with elbow pain and restricted range of motion after a fall during training. Following multidisciplinary involvement, the diagnosis was eventually made as osteochondritis dissecans. Intervention and outcomes: The patient underwent successful arthroscopic surgery in order to remove the osteochondral fragment, followed by a specific regimen of rehabilitation exercises, which helped to enhance and accelerate optimal healing for her return to athletic activity. Summary: This case reminds the practicing chiropractor of the valuable role he/she can play in a multidisciplinary management of pediatric sports trauma, particularly in diagnosis and post-surgical care. A literature review presents a synopsis of the reported clinical presentations, diagnostic assessment and therapeutic options for capitellar osteochondritis dissecans. [ABSTRACT FROM AUTHOR]

Inconsistencies between sexes in the landing criteria provided by the international gymnastics governing body (FIG) may predispose female gymnasts to lower extremity injury. This study aimed to investigate lower extremity biomechanics when performing the male and female landing strategy. Seven collegiate, female gymnasts (age: 20.5 ± 1.2 years, height: 1.64 ± 0.06 m, mass: 60.4 ± 10.2 kg) performed drop landings using the prescribed women's and men's landing strategy. Kinematic and kinetic data from 10 trials of each landing strategy were collected. Differences between landing strategy at individual and group level for key injury risk variables of the lower limb were explored. Group differences (p ≤.05) were reported in the sagittal range of motion (ROM) at the knees and hips, with the men's landing strategy eliciting a larger ROM decelerating the body upon impact. Large inter and intra-individual variation was apparent with different movement responses shown across individuals and demonstrating degeneracy as gymnasts satisfied the overall landing objective. These results indicate an individually favoured landing strategy to fulfil the informational constraints and hence supporting the use of a single-subject design. The current study emphasises the potential injury risk associated with the different informational constraints placed on females' landing strategy by the FIG, whilst recognising the individual gymnasts' task response. Highlights An increase in the range of motion at the knee and hip may support the recommendation of the men's landing style. Gymnasts appear to utilise individual landing strategies to complete the landing objective, supporting the use of a single-subject design. [ABSTRACT FROM AUTHOR]

Background: Lumbar disk degeneration (LDD) occurs frequently in athletes. Researchers have found that LDD occurs mainly in the lower disks (L4/L5 and L5/S1) in the general and athletic populations. However, a retrospective study showed a high prevalence of LDD in the upper lumbar disks (L1/L2), especially in elite gymnasts. Purpose: To investigate the effect of competition level on the prevalence and incidence of LDD in the upper lumbar disks (L1/L2). Study Design: Cross-sectional study; Level of evidence, 3; and cohort study; Level of evidence, 2. Methods: We conducted 2 studies to evaluate the effect of competition level on the prevalence and incidence of LDD in Japanese collegiate gymnasts. In study 1, a cross-sectional study of 298 collegiate gymnasts was conducted between 2011 and 2015. Competition levels were categorized as regional, national, and international, and T2-weighted magnetic resonance imaging (MRI) was used to evaluate LDD. Chi-square testing was applied to assess differences in the prevalence of LDD and spinal levels among the 3 competition levels. In study 2–-a prospective cohort study–-LDD progression and its related risk factors were investigated in 51 collegiate gymnasts. Baseline lumbar MRI scans and measurements of physical function (generalized joint laxity and finger-floor distance test) were performed in March 2014. Follow-up lumbar MRI scans were obtained 2 years later, in February 2016. Logistic regression analyses were performed to investigate the relationship between competition level and LDD progression. Results: In study 1, the prevalence of at least 1 degenerated disk in the regional, national, and international groups was 44.2% (19/43), 44.7% (98/219), and 52.8% (19/36), respectively (P =.655). The prevalence of LDD at L1/L2 in the international group was significantly higher than that in the other 2 groups (P =.018). In study 2, the presence of LDD at L1/L2 was associated significantly with international-level competition (adjusted odds ratio, 47.8; 95% CI, 2.75-830.50). Conclusion: In Japanese collegiate gymnasts, competing at the international level was found to be a risk factor for LDD at L1/L2. [ABSTRACT FROM AUTHOR]

Introduction Avulsion fracture of the ischial tuberosity is uncommon. Patients typically present with symptoms consistent with hamstring strain. The purpose of this case report is to describe an avulsion fracture of the ischial tuberosity and subsequent recovery in an athlete with an endocrine disorder. Case Description A 15-year-old United States of America Gymnastics level 9 gymnast presented with right hamstring pain after regular practice. She had been diagnosed with isolated growth hormone deficiency at age 4 and was treated with growth hormone replacement therapy until age 14. Six months before presentation, she experienced the insidious onset of dull, aching pain in her right hamstring, near the junction of the thigh and buttocks, that was believed to be the result of a chronic hamstring strain. The pain increased gradually over a year and was relieved with rest, massage, and dry needling. Two days before presentation, she felt a "snap" and pain while performing a switch leap during regular practice. She had sharp localized pain in the proximal hamstring with walking and sitting. She was diagnosed with a minimally displaced avulsion fracture of the ischial tuberosity. Outcome With nonoperative treatment, the fracture healed at three months, which is longer than the expected six weeks. Although return to sports is expected three months after this injury, it did not occur until six months in this patient. She was unable to participate in competitive level 9 gymnastics until 12 months after injury. Discussion This case highlights that delayed recovery can occur after avulsion fracture of the ischial tuberosity in adolescent athletes with a history of growth hormone deficiency and treatment using growth hormone. Level of Evidence 5 [ABSTRACT FROM AUTHOR]

Purpose: Elbow osteochondritis dissecans (OCD) is well-studied in throwing athletes; however, there are limited data regarding gymnasts with capitellar OCD lesions. We aimed to determine the overall rate of return to competition following surgical treatment of capitellar OCD lesions and to determine the relationship, if any, between arthroscopic grade of lesion and ability to return to competition., Methods: A medical chart Current Procedural Terminology query from 2000 to 2016 yielded data on 55 competitive adolescent gymnasts who were treated surgically for elbow OCD lesions in a total of 69 elbows. Retrospective chart review was used to collect data on preoperative and postoperative symptoms and surgical treatment. Patients were contacted to complete questionnaires (Modified Andrews Elbow Scoring System, Disabilities of the Arm, Shoulder, and Hand) on return to sport. Current elbow function and follow-up data were available for 40 of 69 elbows., Results: Average age at time of surgery was 12.1 years with 18 of 55 (33%) of patients competing at a pre-elite level of gymnastics (level 9 or 10 of 10) before surgery. Nine out of 31 gymansts (29%) underwent bilateral surgery for OCD lesions. Average OCD lesion size was 10 mm. Thirty-one of 40 elbows (78%) were treated with debridement back to a stable cartilage rim with microfracture, and nine of 40 elbows (22%) were treated with debridement alone. Thirty-six of 40 patients (90% returned to competitive gymnastics with all returning patients competing at or above the same level after surgery. Among the patients who were followed up, 29 of 30 patients (97%) reported some difficulty with specific events on return to competition., Conclusions: The rate of return to sport for gymnasts at 90% is similar to that observed in other sports. This study suggests that elbow OCD lesions are not career-ending injuries for adolescent gymnasts; however, gymnasts should not expect a fully asymptomatic return to all events in a sport., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Despite increasing participation rates in youth gymnastics, the majority of epidemiologic literature focuses on older elite athletes or stratifies athletes by level of competition. Hypothesis: The authors hypothesized that sex- and age-based patterns in youth gymnastics–related injuries exist, which are otherwise overlooked in an unstratified population. Study Design: Descriptive epidemiology study. Methods: Publicly available injury data from the National Electronic Injury Surveillance System were collected on pediatric gymnastics injuries presenting to emergency departments in the United States. Participation data from the National Sporting Goods Association were used to calculate national injury incidence rates in 7- to 11-year-olds (childhood) and 12- to 17-year-olds (adolescence) from January 1, 2012, to December 31, 2018. Z tests were conducted for the comparison of injury rates between girls and boys within each age group and for overall injury rate across age groups. Results: Girls participated in gymnastics at a frequency 6.5 times that of boys in childhood and 13.5 times that of boys in adolescence. An estimated 72,542 youth gymnastics–related injuries were reported in US emergency departments each year. A large proportion (61.3%) occurred in childhood, with female predominance in both age groups. Overall, there was no difference in weighted annual injury rate (injuries per 100,000 athlete-days per year) by age group (6.9 [childhood] vs 8.8 [adolescence]; P =.19) or sex (7.4 [girls] vs 8.1 [boys]; P =.65). In adolescence, boys were more likely than girls to experience injury (16.47 vs 8.2; P =.003). Wrist and lower arm fractures were more common in childhood than adolescence (1.07 vs 0.43; P =.002) and specifically in girls (childhood vs adolescence, 1.06 vs 0.37; P =.001). Ankle injuries and concussions were more common in adolescence vs childhood (P =.01 and.0002). Conclusion: Upper extremity injuries predominated among childhood gymnasts, particularly girls. In adolescence, girls and boys experienced increases in concussions and foot and ankle injuries. Although representing a lower overall number of training gymnasts as compared with girls, adolescent boys experience a higher rate of injuries overall. [ABSTRACT FROM AUTHOR]

Mental blocks, phenomena in which athletes lose the ability to perform previously automatic skills, are well known but poorly understood. Study 1 was designed to assess mental blocks in gymnastics and determine if such blocks are distinct from related conditions, such as slumps, choking, and fear of injury. Mental blocks were reported to have unique characteristics and to affect backward moving skills. Study 2 was a qualitative analysis of the experiences of 5 gymnasts currently experiencing mental blocks on backward moving skills. Such block is called flikikammo and was described as cycling on and off, spreading to other events and skills, affecting visualization, and worsening when performance of the affected skills was forced by coaches. The findings are the first to detail the experience of gymnasts currently experiencing the condition. Additional research may help identify ways to alleviate and/or prevent flikikammo. [ABSTRACT FROM AUTHOR]

The aim of this research was to summarize the relevant literature on wrist injuries in gymnasts and to determine the prevalence of injuries based on a systematic review of previous research. In sports gymnastics, the upper extremities are the bearers of the whole body, which leads to consequences such as wrist injuries. The types of injuries are different, depending on its excessive use. The combination of a period of rapid growth and intensive training creates the conditions for gymnasts to be more prone to injuries, especially wrist injuries. Electronic search of papers was performed in databases: KoBSON, PubMed and Google Academic, and the studies were published in the period from 2010 to 2020, while a descriptive method was used to analyse the obtained data. Based on the database search, 14 studies met the criteria. Subjects who participated in questionnaires and experiments and different types of corrective treatment, sought to prevent further progression of the injury, and most subjects made major progress in suppressing or completely regressing their wrist injury. Raising awareness of the existence of this injury is of great importance in sport gymnastics, so early detection and prevention of injury is crucial.

Background: Gymnastics is a unique sport that places significant loads across the growing elbow, resulting in unique overuse injuries, some of which are poorly described in the current literature. Purpose: To provide a comprehensive review of the unique overuse elbow injuries seen in youth gymnasts and to provide an up-to-date synthesis of the available literature and clinical expertise guiding treatment decisions in this population. Study Design: Narrative review. Methods: A review of the PubMed database was performed to include all studies describing elbow biomechanics during gymnastics, clinical entities of the elbow in gymnasts, and outcomes of operative and/or nonoperative treatment of elbow pathology in gymnasts. Results: Participation in gymnastics among youth athletes is high, being the sixth most common sport in children. Early specialization is the norm in this sport, and gymnastics also has the highest number of participation hours of all youth sports. As a result, unique overuse elbow injuries are common, primarily on the lateral side of the elbow. Beyond common diagnoses of radiocapitellar plica and osteochondritis dissecans of the capitellum, we describe a pathology unique to gymnasts involving stress fracture of the radial head. Additionally, we synthesized our clinical experience and expertise in gymnastics to provide a sport-specific rehabilitation program that can be used by providers treating surgical and nonsurgical conditions of the elbow and wishing to provide detailed activity instructions to their athletes. Conclusion: Overuse injuries of the elbow are common in gymnastics and include osteochondritis dissecans of the capitellum, radiocapitellar plica syndrome, and newly described radial head stress fractures. A thorough understanding of the psychological, cultural, and biomechanical aspects of gymnastics are necessary to care for these athletes. [ABSTRACT FROM AUTHOR]

There is currently limited research exploring the relationship between growth, training load and injury in gymnasts. Twenty-one national level, trampoline gymnasts recorded training load and injury for 8-weeks. Percentage of predicted adult height (%PAH) was calculated using the Khamis–Roche method and used to define growth spurt status. Training load was calculated using the session rate of perceived exertion and analysed as differential loads and as a 7-day exponentially weighted moving average (EWMA7day). There was a significant non-linear association between %PAH and the probability of injury when adjusting for either training load metric (differential load, P = 0.015; EWMA7day; P = 0.008), with the highest injury risk estimated at ~90% PAH (circa growth spurt). The probability of injury significantly increased with increases in EWMA7day training load (RR: 1.88 95% CI: 1.21– 2.91, P = 0.005) but not with differential load. No significant interaction between %PAH, training load and the probability of injury were observed. Data suggest that competitive trampoline gymnasts are at an increased risk of injury during the adolescent growth spurt or with higher weekly training loads. Coaches should be educated and encouraged to identify periods of rapid growth and monitor training load, to reduce the risk of injury. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology and patterns of gymnastics-related Head & Neck trauma injuries using the NEISS database from 2001 to 2020., Study Design and Setting: Cross-sectional analysis of a national database., Methods: Gymnastics-related ED visits between 2001 and 2020 were queried from the NEISS database. Bivariate chi-squared analyses were used to compare injury demographics, location, type, and disposition. Fracture location was identified using the narrative description of each case and were divided into subtypes for further analysis., Results: 1455 gymnastics-related head and neck traumatic injuries were identified. The majority were in females (65.8%). The most common presenting age group was pediatric (≤18 years) (92.7%), and the largest racial group was Caucasian (51.5%). Of all location subtypes, facial injuries were the most common presenting injury type overall (45.2%). Regarding injury types, lacerations were most common (36.8%), followed by dental injury (30.7%) and fractures (21.2%). The most common location of head and neck fractures was the nose (45.8%), followed by cervical spine (16.7%) and orbit (13.3%). The majority (95.7%) of gymnastics-related head and neck traumatic injuries presenting to the ED were treated and discharged., Conclusion: This study characterizes gymnastics-related head and neck injuries which is a topic that is under-studied. The findings from this study are helpful for gymnasts and those who care for them including providers, coaches and guardians, and this data may help inform future guidelines for treatment and injury prevention., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The hindfoot region is commonly injured in gymnasts, and musculoskeletal ultrasound can be used to identify structural abnormalities in this region. Although prior studies have shown that sonographic abnormalities may not correlate with symptomatic pathology, the presence of asymptomatic sonographic abnormalities of the hindfoot in Division I collegiate gymnasts has not been evaluated., Objective: To identify and describe commonly seen asymptomatic sonographic abnormalities of the hindfoot region in Division I collegiate gymnasts., Design: Cross-sectional study., Setting: Tertiary care academic medical center., Participants: 39 Division I NCAA men's and women's collegiate gymnasts without current hindfoot pain or history of hindfoot injury., Interventions: Diagnostic musculoskeletal ultrasound of the hindfoot region., Main Outcome Measures: Sonographic appearance of the hindfoot region, specifically the plantar fascia, plantar fad pad, and Achilles tendon., Results: A total of 37 of 39 gymnasts included in the study were found to have at least one asymptomatic sonographic abnormality of the hindfoot region. A total of 28.2% of athletes were found to have sonographic abnormalities within the Achilles tendon, with Doppler flow being the most common finding, and 35.8% of athletes were found to have a Haglund's deformity. However, only 7% of athletes with a Haglund's deformity demonstrated abnormal sonographic findings within the tendon. Sonographic abnormalities of the plantar fascia and plantar fat pad were seen in 30.7% and 69.2% of athletes, respectively., Conclusions: Asymptomatic sonographic abnormalities of the hindfoot region are common in collegiate gymnasts. Clinicians should use clinical judgment when interpreting these findings as they may not represent symptomatic pathology., (© 2023 The Authors. PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.)

Objective: To categorize injury types and occurrence among athletes participating in the Special Olympics (SO). Design: Retrospective cross-sectional cohort study. Setting: 2018 SO USA Games. Participants: Athletes participating in 14 sports at the 2018 SO USA Games (n = 2251). Independent Variables: Individual and team sports. Main Outcome Measures: Percentage of athletes injured per individual sport, percentage of injury type by sport, rate of injuries per 1000 exposures, and number of injuries per game in team sports. Results: In individual sports, the percentage of athletes injured ranged from 38.5% in gymnastics to 12.9% in golf. Musculoskeletal (MSK) injuries occurred in 53.3% of gymnastics injuries and 58.6% of tennis injuries. For stand-up paddleboard, most injuries were non-MSK (66.7%). The highest rate of MSK injuries occurred in gymnastics (25.6/1000 exposures), whereas the highest rates of non-MSK injuries (95.2/1000 exposures) and minor injuries (47.6/1000 exposures) were among stand-up paddleboard athletes. In team sports, the highest number of injuries per game occurred in softball (1.9 per game). Conclusions: A high percentage of injuries occurred at the 2018 SO USA Games. The high rate of non-MSK injuries is unique to the SO and should be considered when planning medical coverage for future events. [ABSTRACT FROM AUTHOR]

Background: Gymnastics requires a high level of physical ability and technical skill which utilises short sets of athleticism and artistry to perform complex and intense movements which can overload musculoskeletal tissues and result in acute injuries which can develop into chronic injuries. The aim of this systematic literature review was to investigate which screening tools predict injury in gymnasts and encompasses all genres, levels and ages. Methods: An electronic search of seven databases from their inception until March 2021 was conducted. The databases were the Allied and Complementary Medicine Database, CINAHL, eBook Collection (EBSCOhost), MEDLINE, Cochrane Database of Systematic Reviews, SPORTDiscus and PEDro (the Physiotherapy Evidence Base). A combination of the following search terms was used: (1) Gymnastics AND injury AND Screening, (2) Screening AND Gymnastics and (3) Musculoskeletal AND Screening AND Gymnastics. These terms were searched in all text, abstract, title and subject terms. Studies were assessed using a 20-point scoring tool. Results: The mean methodological quality score was 13.1 points (range 10–17 points). Range of motion, anthropometric and postural measurements, hypermobility, clinical diagnostic tests, movement screening tools, muscle strength, power and endurance were reported in the included studies. Some evidence existed for screening measurement of height and mass as taller and heavier gymnasts might be more susceptible to injury; however, the different methodologies utilised and lack of acknowledgment of confounding variables limit the clinical relevance of these findings. Conclusions: Height and mass should be recorded during the screening process. A lack of heterogeneity in study methodology prevented a meta-analysis. Studies were limited by a lack of prospective injury design, poor injury definition, self-reporting of injury and only 2 studies reported reliability of screening tools. Further research is required to determine the role of injury screening in gymnastics. Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42020218339. [ABSTRACT FROM AUTHOR]

Background: The results of surgical treatment of shoulder injuries in high-level male gymnasts have not yet been documented. Purpose: To evaluate the functional and subjective results after surgical treatment of shoulder injuries in high-level gymnasts and the possibilities to return to sport at the same level. Study Design: Case series; Level of evidence, 4. Methods: Over a 20-year period (1994-2014), 23 high-level male gymnasts (26 shoulders) underwent surgery by a single experienced shoulder surgeon. At the time of surgery, 7 gymnasts competed at the international level, 12 at the national elite level, and 4 at the regional level. According to symptoms and anatomic lesions, the shoulders were classified into 2 groups: painful shoulders (n = 11) and unstable shoulders (n = 15). Fifteen capsulolabral repairs, 10 cuff debridements, 1 cuff repair, 4 SLAP (superior labral anterior and posterior) repairs, and 8 suprapectoral biceps tenodesis were performed. Twelve shoulders (46%) had >1 procedure performed. Outcomes assessment was performed by an independent observer at a mean of 5 years (range, 2-15 years) postoperatively. In addition, patients completed the Subjective Shoulder Value (range, 0%-100%). Results: After shoulder surgery, 21 (91%) of the 23 gymnasts returned to competitive gymnastics, and 20 gymnasts (87%) regained their preinjury level of sport. All international-level gymnasts returned to their preinjury level of sport. Three athletes (13%) underwent revision surgery, and 1 athlete (4%) ended his career without returning to competition. The postoperative period before resumption of competitive gymnastics was 9 ± 3.5 months (mean ± SD). Of the 15 gymnasts treated for shoulder instability with arthroscopic stabilization, 12 were able to return to their previous level of sport. All 8 gymnasts who had arthroscopic biceps tenodesis were able to return to their previous level of sport, as opposed to only 2 of 4 gymnasts treated with SLAP repair. The gymnastics-specific Subjective Shoulder Value score was 80% ± 11%. Conclusion: Most gymnasts who required surgical treatment for a shoulder injury were able to return to competition at their previous level, although there was a considerable postoperative recovery period. Current arthroscopic reconstruction techniques were effective for treating structural lesions and allowing return to high-level gymnastics. [ABSTRACT FROM AUTHOR]

Background: Weightbearing and traction-suspension movements with the upper limbs put considerable demands upon the shoulder region of high-level gymnasts. The diagnosis of instability in these gymnasts may be difficult because voluntary inferior shoulder subluxation is part of their training and is needed to perform some acrobatic figures. Purpose: To (1) assess the epidemiology of shoulder lesions requiring surgery, (2) describe the types of injuries and assess which maneuvers and equipment put the gymnast most at risk, and (3) present a pathoanatomic classification of the injured shoulder in high-level male gymnasts. Study Design: Case series; Level of evidence, 4. Methods: Over a 20-year period (1994-2014), 26 high-level male gymnasts (30 shoulders; mean age, 22 years; range, 16-33 years) were referred to our surgical center for shoulder pain or instability. Four gymnasts underwent surgery on both shoulders. All shoulders were evaluated clinically, radiologically, and arthroscopically. An independent observer evaluated the circumstances in which these lesions occurred, including the apparatus used and the maneuvers performed. Results: The mean duration of symptoms before surgery was 8 months (range, 6-24 months). Eighteen injured shoulders (60%) had chronic overuse injuries. In 27 shoulders (90%), the mechanism of injury was traction of the arm in forced flexion-rotation while using suspension equipment with locked hands on the bars or the rings. In the remaining 3 shoulders, the traumatic position was one of an isometric muscle contraction against gravity, sustained while performing strength-and-hold positions on the rings. Based on the main presenting symptoms (pain and/or instability) and main anatomic lesions found during arthroscopy, the injured gymnasts' shoulders were classified into 2 categories: painful shoulders (n = 13) with no clinical, radiological, or arthroscopic findings of instability (mainly superior cuff and biceps anchor lesions) and unstable shoulders (n = 17) with isolated inferior capsule labral tears or mixed lesions (tendinous and capsulolabral). Some gymnasts with inferior labral tears had no recall of having suffered a dislocation or subluxation. Conclusion: The majority of injuries requiring surgery in this population occurred during traction in forced flexion-rotation using suspension equipment. Injured shoulders were classified as either painful or unstable shoulders. [ABSTRACT FROM AUTHOR]

Background: Over 1,500 collegiate gymnasts compete each year. Injury rates among these athletes are high, yet little is known about their long-term health outcomes. Hypothesis/Purpose: The purpose of our study was to describe health-related outcomes of former collegiate gymnasts and to evaluate how early sport specialization, concussion history, and disordered eating (DE) influence current health. We hypothesized that gymnasts who specialize early would report more injuries and would have worse physical health currently; that gymnasts who sustained concussions will be more likely to seek mental health treatment during their sport careers; and that gymnasts with DE would report more injuries. Methods: 473 former female collegiate gymnasts completed a survey (Table 1) that was distributed through social media. Participants were grouped according to early (<14 years) or late (> or equal to 14 years) specialization, whether they sustained a concussion during gymnastics participation, and whether they reported a history of DE or not. We determined the number of participants who had time-loss injuries, menstrual dysfunction, reasons for retirement from sport, functional outcome measures, and whether participants had sought mental health care during college. Results: The median age of gymnastics specialization was 8 years [interquartile range=6-11 years]. A significantly greater proportion of early specializers sustained injuries requiring surgery (60% vs. 44%; p=0.02), however, the proportion of time-loss injuries sustained during college, reasons for retirement, and current pain and physical function scores did not significantly differ between the early and late specializers (Table 2). Forty-two percent of participants sustained a concussion. Those with a concussion were more likely to have sought mental health treatment during college (32% vs. 23%; p=0.03), and to have a diagnosis of anxiety disorder (16% vs. 9%; p=0.01) than those with no concussion history (Table 3). Thirty-four percent reported DE during college. Those in the DE group had an increased risk of osteoporosis during college (4% vs 0%; p=0.003), secondary amenorrhea (16% vs 9%; p=0.02), and had an increased risk of time-loss injury (78% vs 65%; p=0.004) (Table 4). In addition, they had worse PROMIS pain (11.5 vs 10.2; p=0.007) and physical function scores (12.2 vs 11; p=0.01) after college. Conclusion: It is important for clinicians, coaches, and gymnasts to be aware of the risks of early specialization, concussions, and DE, all of which are common in former collegiate gymnasts. Counseling regarding these risks and prevention strategies for these health problems should be a focus of further research. [ABSTRACT FROM AUTHOR]

Women's gymnastics athletes in the National Collegiate Athletic Association (NCAA) constitute a unique population of NCAA athletes given the nature and dynamics of the sport. Routine examination of women's gymnastics injuries is important for identifying the evolving burden of injuries in this sport. Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014–2015 through 2018–2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios were used to examine differential injury rates. The overall injury rate was 8.00 per 1000 athlete-exposures; injury incidence was greater in competitions than in practices (injury rate ratio = 1.84; 95% CI = 1.48, 2.29), though practice injury rates increased during 2015–2016 through 2018–2019. Most injuries were classified as strains (16.5%), sprains (16.4%), and inflammatory conditions (12.3%), with overuse injuries prevalent among practice injuries (22.5%). Concussions (8.4%) were the most commonly reported specific injury. The increasing trend in practice injury incidence is noteworthy although competition injury rates were higher overall. Findings also suggest that the etiologies of overuse injuries and inflammatory conditions as well as the biomechanical aspects of concussions warrant further attention. [ABSTRACT FROM AUTHOR]

Background: Foot and ankle injuries comprise a significant proportion of all injuries sustained by National Collegiate Athletic Association (NCAA) athletes. In particular, sports that combine jumping and rapid changes in direction are associated with increased lower extremity injuries. Purpose: To describe the epidemiology of foot and ankle injuries in men's and women's jumping sports, including NCAA men's and women's basketball, women's volleyball, and women's gymnastics, during the 2009-2010 through 2013-2014 seasons. Study Design: Descriptive epidemiology study. Methods: Injury-surveillance data were obtained from the NCAA Injury Surveillance Program for the 2009-2010 through 2013-2014 seasons. Injuries were examined by mechanism, activity during injury, and participation restriction time. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios, and risk ratios with 95% CIs were calculated. Reported sex differences were calculated for men's and women's basketball. All 95% CIs not containing 1.0 were considered statistically significant. Results: A total of 1136 players sustained foot and ankle injuries (483 male and 653 female) over 612,680 AEs. These injuries resulted in a combined rate of 1.85 per 1000 AEs (95% CI, 1.75-1.97). Ankle sprains were the most common injury (63.7%), with lateral ligamentous complex injuries making up 77.1% of all ankle sprains. The most common foot injury varied based on sport and sex. Ankle injury rates were higher in male versus female basketball players (injury rate ratio, 1.33 [95% CI, 1.13-1.57]), but foot injury rates did not differ. Among basketball and volleyball players, player contact during jumping was the most common injury mechanism. Female gymnasts had higher overuse injury rates than other athletes (0.49/1000 AEs [95% CI, 0.30-0.74]; P < .002). Overall, female basketball players were 1.81 times more likely to sustain an overuse injury than male basketball players (95% CI, 1.02-3.20; P ¼ .02). Conclusion: The most common foot and ankle injury sustained in collegiate jumping sports was a lateral ligamentous complex ankle sprain. Injury-prevention programs focusing on ankle flexibility, strength, and proprioception may help to alleviate the injury burden and lessen severity. Improving the anticipation of contact during jumping and landing may reduce injury rates and increase player safety. The increased prevalence of overuse injuries in female collegiate athletes competing in jumping sports necessitates further investigation to reduce injury rates through prevention and training programs. [ABSTRACT FROM AUTHOR]

The article presents the discussion on gymnasts in both retrospective and prospective injury surveillance studies. Topics include training culture and repression of female gymnasts making headlines and given rise to considerations in gymnastic federations worldwide; and Olympic Games in artistic gymnastics chosing to line up in suits with long legs for dissociatign themselves from sexualization.

Aims of this study were to investigate if changes in elbow and wrist joints loading and biomechanical characteristics of performance existed as a function of (a) different hand placement and (b) fundamental skills development in female gymnastics. Ten female gymnasts performed 54 successful trials of round-off skills (cartwheel [18], round-off [18], round-off to back handspring [18]), with three different hand positions (parallel, T-shape and reverse). Kinematic and kinetic data were collected for each trial. A two-way repeated measures ANOVA was used to analyse the injury risk factors. Findings of the current study showed that an increase in RO skill difficulty level significantly influences the mechanical load on the upper extremities. With the increase in mechanical load on the upper extremities during the reverse and parallel hand positions, this study suggests that that T-shape hand position should be used as the primary technique for the young female. Differences in vertical velocity from touchdown to take-off between the three hand positions for the RO and RO-BH suggested that the reverse position was less effective for young female gymnasts. The findings of the current study demonstrated no clear performance benefits between hand position selection.

Background: The mechanism of injury and the conservative rehabilitation of the ulnar collateral ligament of the elbow (UCL) are well studied and reported in overhead athletes, while research on gymnastic athletes is sparse. Evidence suggests exercise as the mainstay in UCL injury rehabilitation. With this report, we aimed to provide a complete rehabilitation protocol following a partial UCL tear of an acrobatic athlete, where exercise and adjunct treatments, such as manual therapy, were used in a progressive staged rehabilitation., Case Description: A 16-year-old female acrobatic athlete was diagnosed with partial tear of the anterior band of UCL. The rehabilitation included progressive exercise loading in conjunction with manual therapy for 10 sessions in 8 weeks. Pain, UCL special tests, the Disabilities of Arm, Shoulder and Hand Score Questionnaire (DASH), and the Upper Limb Functional Index (ULFI) were assessed and administered at baseline and at 3, 6, 10 weeks, and 3 months., Results: Improvement in all outcome measures was noted at the 3-month follow-up indicating a substantial reduction in pain and disability, and an increase in stability of the elbow joint. Return to training was achieved at 8 weeks from the initial visit, while return to sport at the pre-injury level was achieved at 3 months., Conclusion: Progressive exercise loading along with the addition of manual therapy is an effective intervention for the rehabilitation and return to sport following a partial UCL tear. A progressive staged rehabilitation guideline for acrobatic athletes with UCL injuries has been provided to be used and guide clinical practice., Level of Evidence: Level IV., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Reportedly, 17.2% of collegiate female gymnasts experience Achilles tendon ruptures (ATRs). Cumulative microtraumas resulting in chronic tendinopathy/tendinitis may contribute to this high injury risk. We hypothesized that the risk of ATRs in female collegiate gymnasts increases with years of competitive gymnastics, that non-steroidal anti-inflammatory drug (NSAID) use is associated with less ATRs, and that the risk is larger during competition than training., Methods: Female gymnasts from 78 USA collegiate teams completed a survey assessing the prevalence of ATRs, NSAID use, age at which competitive gymnastics started and age at which ATR occurred, and whether ATRs occurred during training or competition., Results: Twenty-one of 103 gymnasts (20.4%, 95% CI: 13.6% to 29.4%) experienced ATRs. Eighteen of 21 ruptures (85.7%, 95% CI: 61.3% to 95.8%) occurred after more than ten years of competitive gymnastics (mean: 14.0±2.6 years, 95% CI: 12.8 to 15.2 years). ATRs occurred 0.08±0.01 (95% CI: 0.06 to 0.11) times per 1000 hours at training versus 1.85±0.11 (95% CI: 1.60 to 2.10) times per 1000 hours at competition (P<0.05). Prevalence of NSAID use was 27.6% (95% CI: 18.6% to 39.0%) in gymnasts without ATR but only 5.5% (95% CI: 0.6% to 35.5%, P=0.09) in gymnasts with ATR. Multiple regression analysis demonstrated a negative association between NSAID use and incidence of ATRs (P<0.05)., Conclusions: Female collegiate gymnasts are at high risk for ATRs, especially after more than ten years of competitive gymnastics and during competition.

Introduction: Gymnastics consists of several different disciplines, whereof TeamGym is one. TeamGym is a young discipline with sparse research. The aim of the study is to investigate the injury characteristics in Swedish elite gymnasts competing in TeamGym including training load and other physical and psychological factors associated with injury., Methods and Analysis: The Swedish TeamGym Injury Cohort is a longitudinal prospective cohort study for 52 weeks that includes the junior (15-17 years) and senior (≥18 years) Swedish female and male national teams in TeamGym. A baseline questionnaire will be sent out in an online application (SmartaBase) regarding demographics, previous injuries, gymnastics-related factors, for example, time at elite level and psychosocial factors such as stress, athletic identity, coping skills, personality traits and coach-athlete relation. A weekly questionnaire will be sent out in SmartaBase every Sunday and will monitor injuries using the Oslo Sports Trauma Research Centre Overuse Questionnaire, gymnastics-related factors, for example, landing surfaces, stress, recovery and training load. A test battery for the lower extremity will be performed. Data for ankle dorsiflexion, hop tests and ankle plantarflexion strength/endurance will be collected., Ethics and Dissemination: This project was approved by the Swedish Ethical Review Authority (2023-06653-01) and is performed according to the Declaration of Helsinki. The results will be published in peer-reviewed journals, scientific conferences and shared with the Swedish Gymnastics Federation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This was a clinical trial of prospective cohort. Wrist pain in gymnasts is a global phenomenon. Compression forces acting on wrists while performing gymnastics is a predisposing factor in the development of wrist pain and consequential injury of the distal radial physis in skeletally immature gymnasts. One approach to mitigate these forces is wrist bracing; however, studies on the efficacy of wrist braces to reduce wrist pain experienced by gymnasts are limited. The purpose of this study was to investigate the efficacy of an innovative design of a wrist brace to decrease gymnasts' wrist pain while performing gymnastics. A wrist brace was designed and trialled over 3 weeks by 48 male gymnasts (aged 8-22 years, levels 4-7) with wrist pain. Wrist pain was recorded on a visual analog scale of 1 to 10 before and after trial. Data analysis was performed using SPSS-22 (IBM Inc). Paired t -tests were performed to compare variables before and after trial, with effect size analyses used to quantify the relative magnitude of any differences. Paired t -tests indicated the gymnasts reported significantly reduced pain (P =.002; 53.5%) while wearing the braces for training on the pommel, floor, and parallel bars. The overall large effect size value was practically significant (d = 0.902). For any wrist brace to be effective, it needs to be implemented when the gymnast experiences wrist pain before an injury occurs. This would minimize the development of pain-provoked adaptive movement patterns that perpetuate dysfunction. The brace with the volar gel pad is recommended to be worn as an adjunct to current strategies in management of gymnasts' wrist pain or as an injury prevention device in skeletally immature gymnasts. • This study validated the efficacy of the new design of wrist brace. • Gymnast's hyperextended wrists are subject to torsional stresses. • Chronic wrist pain may progress to physis injury. • Dissipation of compression loads decrease experience of wrist pain. [ABSTRACT FROM AUTHOR]

The article describes the grip lock wrist injuries that are common in gymnasts. It is reported that this injury targets gymnasts who compete on the high or uneven bars and is caused by the friction between their dowel grips and the bar. The author suggests that grip lock injuries can lead to fractures of the distal radius and ulna bones if untreated. The author also suggests that using high quality grips is the best means to prevent grip lock injuries.

This article reports on wrist pain in gymnasts. The author details the various stresses associated with gymnastics and the pressure it puts on an athlete's wrist. Reasons include the fact that gymnasts spend large amounts of time on their hands, particularly those at higher competitive levels. Additionally, the wrists of gymnasts are repeatedly exposed to various combinations of compressive, torsional, and tensile stresses.

This article reports on the impact of stretching on sports injury risks and performance. The author details the significance of stretching and the misconceptions associated with the practice in regards to preventing injuries. Additionally, various case studies and tables are presented in order to give the reader a better understanding of the benefits of stretching. Control group statistics are offered.