12 SPINELINE | JANUARY · FEBRUARY 2017 WWW.SPINELINE-DIGITAL.ORG
Ellen K. Casey, MD, Nicole
University of Pennsylvania Perelman
School of Medicine
How to Score a Perfect 10 in Caring
for Gymnasts with Low Back Pain
Increased international attention toward gymnastics is limited to every four years at the
Olympic Games. The total number of participants in gymnastics worldwide is considered
to be underestimated. The physical demands of gymnastic training, and its health-related
consequences are also likely under-reported. While only a select few American gymnasts
achieve international recognition, there are close to four million female and two million
male gymnasts in the United States. 1 Female gymnasts participate in four events: uneven
bars, balance beam, vault and floor exercise. Male gymnasts participate in six events:
parallel bars, high bar, rings, floor, vault and pommel horse. Though participation in these
different events creates some variability in the physiologic stresses and injuries experienced by male and female gymnasts, both genders are at risk for lumbar spine injuries.
The multiple repetitions of skills performed at extreme ranges of motion coupled with
the high training volume that often begins at a young age predispose gymnasts to lumbar
spine injuries. The aim of this article is to provide the spine physician with gymnastics-specific knowledge to incorporate into the evaluation and management of gymnasts with
low back pain (LBP).
Low Back Pain in Gymnasts
Gymnastics-related injuries are common—ranging from 0.5 to 22. 7 injuries per 1000 hours
of participation. 2-6 The most commonly injured body regions are the lower limb (30%-70%)
and the lumbar spine (40%-86%). 7, 8 Several factors play a role in the high prevalence of
lumbar spine pain and injury in gymnasts:
Biomechanical demands of the sport
Repetitive spinal loading in the sagittal plan— extension stresses the posterior elements and flexion can lead to elevated intradiscal pressure.
High-impact landings can lead to disc pathology.
Gymnasts generally have a large range of motion, but often lack adequate dynamic
stability, so they rely on passive structures (bones and ligaments) rather than dynamic stabilizers (core muscles) to stabilize their spine.
Elite gymnasts between the ages of 10 and 14 years practice an average of 5.04
hours/day and 5. 36 days/week. 9
Gymnasts may perform a hundred repetitions of a skill in a single practice, which
translates into thousands of repetitions over the course of one year.
There is no “off-season” for gymnastics and most programs do not employ any
periodization into gymnastics training; however, the major competition season
occurs in the winter and spring, so these tend to be peak times for injuries.
Young age of participants
80% of gymnasts are 18 years of age or younger1
Many gymnasts begin intense training as early as six years of age10