Other skills typically require extreme levels of hyperextension, and commonly hyperlordosis. This position places an emphasis on scapular protraction and thoracic hyper-kyphosis, in combination with anterior pelvic tilt ( Fig. For proper execution of skills, certain spinal positioning is stressed and developed from a young age, one example among many being the "hollow" position. Some trials have shown reaction forces of 6.5 to 9.2 times body weight during the downward ring swing ( 3). Contrarily, "hanging" events, such as the uneven bars, horizontal bar and rings, place a traction force. More evident is the amount of force generated at the Achilles tendon during a back take-off, which has been measured at 16 times body weight ( 3).īody positions for different skills and landing require a varied amount of hyperflexion, hyperextension, or vertical stability of the spine. During the take-off for a backward somersault skill, vertical forces through the foot have been measured at 3.4 to 5.6 times the body weight of the gymnast. The amount of force generated will vary with the skill performed, the body part analyzed, and the technique and skill level of the gymnast. Biomechanical analyses of gymnastics have been performed and provide evidence of the forces generated during the participation of this sport ( 3). During take-off from the ground, rebounding, and landing required for floor, vault, and dismounts, a large amount of force is translated along the axial spine ( 17,18). There are many different body positions required in the sport of gymnastics that are relevant to back injury. Many factors make this difficult: rule changes occur every 4 yr, new skills are developed, there are multiple different events, and the dynamic activity and body positioning is unique, unlike any other sport. A basic understanding of these, however, is important to understand the mechanism of injury in these athletes and their return to sport. The sport of gymnastics rises in popularity every 4 yrs during the Olympic games, and for most who watch the sport, a thorough understanding of the events, skills, equipment, and biomechanics of gymnastics is rare. With this recognition, also noted is a significant difference in the underlying pathology in adolescents with back pain compared with an adult population ( 9,15,32). Recently, more attention has been brought to the high prevalence of back pain in children, more common than previously thought, with multiple studies showing back pain in 18%-70% of adolescents studied ( 24,42,49). These visits result in medical costs amounting to billions of dollars annually ( 8,10). Although not overall the highest in prevalence, the occurrence of back injury and pain in both women's and men's gymnastics is significantly high due to the unique physical challenges inherent in gymnastics ( 4,12,16,17,28,36,46,47).īack pain has long been recognized as a major reason for doctor visits in the general population and is the most common type of pain reported by adults. Exposure data show that injury rates are greatest during competition and for both women and men are highest during participation on the floor exercise event ( 4). Overall, an extensive and detailed review of the literature by Caine and Nassar reveals that lower extremity injuries, in particular ankle ligament sprains and internal knee derangements, are most common in women's gymnastics, while upper extremity wrist and shoulder injuries are most common for men. Injury rates in gymnastics have been well documented in multiple epidemiologic studies and literature reviews ( 4,12,13,17,20,28,36,39). As a result, gymnasts present a unique diagnostic and treatment challenge to the medical practitioner. The casual observer will note that the sport of gymnastics requires a level of flexibility, conditioning, and complete body recruitment that is matched infrequently by other sports.
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