Gymnastics




Introduction





  • Types: acrobatic, artistic, rhythmic, tumbling, and trampoline ( Tables 90.1 to 90.4 )



    TABLE 90.1

    ACROBATIC GYMNASTICS (MEN AND WOMEN)
























    Events Levels
    Women’s pairs Junior Olympic Elite
    Men’s pairs Levels 1–10 Junior
    Mixed pairs Competitive levels: 4–10 Senior
    Women’s group First competitive level: 4
    Men’s group



    TABLE 90.2

    ARTISTIC GYMNASTICS
















    Women Men
    Events Vault
    Uneven parallel bars
    Balance beam
    Floor exercise
    Floor exercise
    Pommel horse
    Still rings
    Vault
    Parallel bars
    High bar
    Levels Junior Olympic Program
    Levels 1–10
    Competitive levels 2–10
    First competitive level: 2
    Elite Program
    Talent Opportunity Program (TOPS)
    HOPES (10–12-year-old pre-elite)
    Junior Pre-Elite
    Junior and Senior International
    Junior Olympic Program
    Levels I–X
    Competitive levels: IV–X
    First competitive level: IV
    Elite Program
    Future Stars Program
    Junior National Team
    Senior Elite Team


    TABLE 90.3

    RHYTHMIC GYMNASTICS (WOMEN ONLY)

























    Events Levels
    Rope Junior Olympic Elite
    Hoop Levels 1–8 Junior
    Ball Competitive levels: 5–8 Senior
    Clubs
    Ribbon
    First competitive level: 5 Individual and group competitions
    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



  • Over 97,000 competitive gymnasts register yearly with USA Gymnastics, and up to 5 million recreational gymnasts in the United States.



  • >70% 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




  • Higher incidence during dismounts and floor exercise



  • 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 men and acrobatics (where it is the hand/wrist)



  • The incidence of injury during competition approximately two times the practice incidence.



  • Higher incidence of growth plate injuries owing to 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 (see Table 90.5 ).



    TABLE 90.5

    DIFFERENTIAL DIAGNOSIS OF GYMNASTICS INJURIES








































    Lower Extremity Injuries
    Foot Calcaneal Apophysitis
    Calcaneal Fat Pad Contusion
    Calcaneal Stress Fracture
    Lisfranc Injury
    Stress Fractures: Navicular and Metatarsals
    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 Dessicans-Talus
    Posterior Tibialis Tenosynovitis
    Knee ACL Tear
    MCL/LCL Sprain/Tear
    Meniscal Injuries
    Osgood–Schlatter Syndrome
    Osteochondritis Dessicans of the MFC
    Patellofemoral Syndrome
    Patellar Subluxation/Dislocation
    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
    Scaphoid Impaction Syndrome
    TFCC Tears
    Elbow Elbow Dislocations
    Medial Epicondyle Apophysitis
    Medial Epicondyle Avulsion Fractures
    Osteochondritis Dessicans of the Capitellum
    Ulnar Collateral Ligament Injuries
    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
    Sacroilitis
    Scheuermann Disease
    Spondylolisthesis
    Spondylolysis





Common Injuries and Medical Problems


Mild Traumatic Brain Injury (MTBI)





  • Mechanism of injury: Hitting the head on the mat/floor or apparatus during a fall or dismount



  • Incidence: A study found a 30% lifelong occurrence



  • Return to play: Several activities are aerial in nature; hence, the graduated return protocol will have to be modified to meet the demands of the gymnast while maintaining their safety until the athlete has been fully cleared.



Cervical Spine Fracture, Subluxation, and Dislocation





  • Mechanism of injury: Complex aerial and acrobatic nature of gymnastics places athletes at a risk of catastrophic neck injuries. Cervical spine fractures, subluxations, and dislocations can occur through various mechanisms:




    • Landing head first in a loose foam pit, on a trampoline, or on a mat



    • Failure to complete rotation or over-rotating on aerial or salto maneuver.



    • Landing on the upper back with the neck in a hyperflexed position



    • Landing on the chin or chest with the neck in a hyperextended position




  • Specific consideration to standard evaluation and treatment:




    • Pediatric cervical spine collar availability



    • Loose foam pit injuries:




      • Foam blocks that fill the pit are easily disturbed, and the athlete is typically buried in the blocks.



      • Avoid jumping into pit to help an injured athlete because the disruption of foam blocks could worsen the injury and make it more difficult to remove the athlete.



      • Considering the difficulty of removing a gymnast with a cervical spine injury from a loose foam pit, physicians, trainers, coaches, and local paramedics should practice emergency removal as part of an emergency action plan.



      • Gently placing a mat into the pit and then using this as a means to reach the athlete is one method to minimize disturbing the foam blocks.





Shoulder Injuries


Anterior Dislocation, Labral Tears, and Multidirectional Instability


See Chapter 49 : Shoulder Injuries.


Rotator Cuff Syndrome, Impingement, and Tears





  • More common in male gymnasts



  • Rings, high bar, and parallel bars all put substantially increased stress on the shoulder.



Elbow Injuries


Dislocation





  • Upper extremity weight-bearing activities can be gradually introduced, once a gymnast has full range of motion (ROM) and strength in the upper extremity and is pain free.



Ulnar Collateral Ligament (UCL) Sprain





  • Mechanism of injury: Valgus stress to the medial aspect of the elbow causes traction injury to the UCL; may occur acutely due to a fall on an outstretched hand or chronically due to repetitive upper extremity weight bearing.



  • History: Valgus mechanism; may be acute or chronic



  • Physical examination: Findings typical of UCL injuries; evaluate for an increased carrying angle and elbow hyperextension bilaterally, which may be a risk factor for this type of injury



  • Imaging: Radiographs: Check for medial epidondylar apophyseal avulsion fracture or chronic changes consistent with medial epicondylar apophysitis. Magnetic resonance imaging (MRI) arthrogram may be needed to determine the degree of ligamentous tear.



  • Treatment: Surgery is reserved for complete rupture of UCL with resultant chronic instability.



  • Complications: Chronic instability, ulnar neuritis



Capitellar Osteochondritis Dissecans (OCD)





  • Mechanism of injury: Repetitive weight bearing causes valgus stress with medial elbow tension and lateral radiocapitellar joint compression.



  • History: Gradual onset, elbow pain with weight-bearing activities; pain relieved by rest; decreased elbow extension; in more advanced cases, mechanical symptoms of catching and locking noted



  • Physical examination: Tenderness to palpation over radiocapitellar joint; effusion may be present; ROM, particularly extension, may be decreased.



  • Imaging: Radiographs: If positive will show a radiolucency or fragmentation within the capitellum, with irregular ossification and crater next to articular surface; MRI arthrogram helps determine integrity of articular cartilage, or if radiographs are negative and there is a high clinical suspicion.



  • Classification and treatment of OCD lesions ( Fig. 90.1 ) :




    • Type I: No displacement of lesion or fracture of the articular cartilage




      • Treatment: Conservative; no upper extremity weight-bearing or strengthening activities until radiographs show evidence of healing and pain resolves completely; consider splint if pain not relieved by discontinuing upper extremity weight-bearing activities or to improve compliance




    • Type II: Evidence of fracture of articular cartilage or partial displacement of lesion




      • Treatment: Controversial; ranges from conservative to surgical intervention




    • Type III: Complete detachment of lesion with resulting loose body




      • Treatment: Typically, surgical



Jul 19, 2019 | Posted by in SPORT MEDICINE | Comments Off on Gymnastics
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