The decision to obtain diagnostic testing in a gymnast with
LBP depends on the severity of pain, degree of functional limitation and findings on physical examination. A comprehensive
discussion about the utility of imaging in this population is
beyond the scope of this article. However, it is worth noting
that there is a high prevalence of abnormal findings in spine
imaging in asymptomatic gymnasts. 23, 26
Management of the Gymnast with Low Back Pain
The treating physician should determine a gymnast’s participation status at each visit as no participation, modified
participation or full participation. If the recommendation is
modified participation, then specific parameters should be set
for training volume, type of skills performed and appropriate
landings (Table 4). These recommendations should be communicated to the athlete, family, coach and athletic trainer
Low back pain is common in gymnasts, but should not be
considered normal, particularly given the high incidence of
spondylolysis in this group. The management strategy for a
gymnast with LBP will vary based on the underlying etiology.
However, activity modification, education and an individualized rehabilitation plan are key tenants of care. Like all athletes, gymnasts want to return to the sport they love, and it is
our experience that compliance and outcomes improve when
the treating physician understands the demands of their sport
and what it will take to return to full participation.
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1A 1B 1C
2A 2B 2C
Figure 2. Overhead mobility test: 2A adequate shoulder motion and arm control, 2B inadequate shoulder motion, often due to tight anterior shoulder
girdle muscles and poor scapular control and 2C compensatory spinal extension to achieve the motion.
Figure 1. Bridge test: 1A symmetric motion from all regions, 1B decreased hip extension and 1C decreased shoulder and thoracic spine motion.