Gymnastics

Introduction

• Disciplines: acrobatic, artistic, gymnastics for all, parkour, rhythmic, tumbling, and trampoline ( Tables 90.1 to 90.5 )

  • Olympic disciplines: artistic, rhythmic, trampoline

  Table 90.1

  Acrobatic Gymnastics (Men and Women)

  Events	Levels
  Women’s pairs Men’s pairs Mixed pairs Women’s group Men’s group	Junior Olympic	Elite
  	Levels 1–10 Competitive levels: 2–10	Future Stars Junior Senior

  See https://usagym.org/ .

  Table 90.2

  Artistic Gymnastics

  Events	Women’s Programs
  Vault Uneven bars Beam Floor exercise	Xcel Program: Competitive Recreation Tract	Junior Olympic	Elite
  	5 Levels: Bronze–Diamond All levels competitive	Levels 1–10 Competitive levels: 2–10	Talent Opportunity Program (TOPS 7–10 years old) HOPES (10–12 years old pre-elite) Junior Pre-Elite Junior and Senior International

  Events	Men’s Programs
  Floor exercise Pommel horse Still rings Vault Parallel bars High bar	Xcel Program	Junior Olympic	Elite
  	3 Levels: Bronze–Gold All levels competitive	Levels I–X Competitive levels: IV–X	Future Stars Program Junior National Team Senior Elite Team

  Table 90.3

  Rhythmic Gymnastics (Women Only)

  Events	Programs
  Rope Hoop Ball Clubs Ribbon	Xcel Program	Junior Olympic	Elite
  	Levels A–D Competitive levels: A–D Individual and group competitions	Levels 1–8 Competitive levels: 3–8 Individual and group competitions	Future Stars Program Junior Senior Individual and group competitions

  Table 90.4

  Tumbling and Trampoline (Men and Women)

  Events	Levels
  Double minitrampoline Synchronized trampoline Trampoline Tumbling	Junior Olympic	Elite
  	Levels 1–10 Competitive levels: 1–10 First competitive level: 1 (except synchronized trampoline: level 10)	Junior Senior

  Table 90.5

  Gymnastics for All (Men and Women) and Parkour

  Programs
  Noncompetitive	Competitive	HUGS (Special Needs Program)	Parkour
  Exhibitions and Shows	Power Team: Levels 1–10 Acrobatics and Tumbling USA Gym for Life	Has both recreational and competitive options	Newest discipline Only international-level competitions

• Over 169,000 competitive gymnasts register yearly with USA Gymnastics, and up to 5 million recreational gymnasts in the United States.

  • USA Gymnastics current national governing board and oversees the majority of competitions within the United States.

    • New nationwide governing boards for competitive gymnastics are being founded and may change the landscape of gymnastics within the United States

• More than 70% are female artistic gymnasts

Epidemiology

• Injury rates: vary greatly depending on the level of the gymnast and hours spent training

  • 0.687–2.859 injuries per 1000 hours of training

  • 6.07–9.22 injuries per 1000 athletic exposures in collegiate athletes

  • 42.6–106.2 injuries/1000 registered gymnasts in Olympic-level gymnasts (artistic, rhythmic, trampoline)

• Higher incidence during dismounts and floor exercise in women and during vaulting in men

• Contributing factors:

  • Poor landing technique, including landing short

  • Landing with overly upright posture, decreased knee flexion, and relative joint stiffness

• Sprains most common, followed by strains

• The ankle/foot is the most commonly injured body part, except in nonelite male gymnasts and acrobatics (where it is the hand/wrist)

• Competition injury incidence approximately two times the practice incidence

• High incidence of growth plate injuries because of an immature skeletal system

• Injury risk factors:

  • Larger size

  • Rapid growth

  • Training for >15–20 hours/week

  • Life stress

• Gymnasts are both lower and upper extremity weight-bearing athletes; therefore, injuries incurred during gymnastics participation are comprehensive ( Table 90.6 ).

  Table 90.6

  Differential Diagnosis of Gymnastics Injuries

  Lower Extremity Injuries
  Foot	Base of the fifth metatarsal avulsion fracture Base of the fifth metatarsal apophysitis (Iselin’s disease) Calcaneal apophysitis Calcaneal fat pad contusion Calcaneal stress fracture Lisfranc injury Stress fractures: navicular and metatarsals Toe fractures Turf toe
  Ankle	Anterior and posterior ankle impingement Distal fibular Salter–Harris I fracture Ankle sprains: high, lateral, and medial Os trigonum fracture OCD of the talar dome Osteochondritis dissecans-talus Posterior tibialis tenosynovitis
  Knee	ACL tear MCL/LCL sprain/tear Meniscal injuries Osgood-Schlatter syndrome Osteochondritis dissecans of the MFC Patellofemoral syndrome Patellar subluxation/dislocation Sinding–Larsen–Johansson syndrome
  Hip	Acetabular labral tear Apophysitis Femoral acetabular impingement Femoral stress fracture Hip instability/hypermobility
  Upper Extremity Injuries
  Hand/Wrist	Fractures related to grip lock Ganglion cysts Gymnast wrist Rips Scaphoid fractures/stress fractures carpals Scaphoid impaction syndrome Scapholunate dissociation TFCC tears Ulnar impaction syndrome
  Elbow	Elbow dislocations Medial epicondyle apophysitis Medial epicondyle avulsion fractures Osteochondritis dissecans of the capitellum Ulnar collateral ligament injuries
  Shoulder	Proximal humeral epiphysitis (Little Leaguer’s shoulder) Impingement syndrome Labral tears Multidirectional instability Rotator cuff strain/tears Shoulder dislocations/subluxations
  Other
  Head	Concussions
  Cervical Spine	Cervical fractures Cervical strain
  Lumbar Spine	Discogenic back pain Facet syndrome Lumbar strain Mechanical lower back pain Sacroiliitis Scheuermann disease Spondylolisthesis Spondylolysis

  ACL, Anterior cruciate ligament; LCL, lateral collateral ligament; MCL, medial collateral ligament; MFC, medial femoral condyle; OCD, osteochondritis dissecans; TFCC, triangular fibrocartilage complex.

Common Injuries and Medical Problems