Which sport has the highest incidence of back injuries? If you answered football, hockey or basketball you guessed wrong. Spinal pathology occurs among male and female gymnasts, from children at the earliest competitive level to experienced adolescent and young adult gymnasts at the highest competitive level. Each year more than 80,000 gymnasts at all levels require medical attention. A great number of these injuries are to the back including sprains, strains, and spinal trauma such as herniated discs and fractures. In addition, gymnasts commonly experience injuries to the upper extremities (wrist, hand, elbow, clavicle, etc.) and lower extremities (knees, ankles, hips, tailbone, etc.).
The term gymnastics encompasses seven competitive categories: men’s artistic, women’s artistic, rhythmic, acrobatic, group, trampoline and tumbling. The incidence of injury is highest in the men’s and women’s artistic categories. Both of these groups use various apparatus as part of their competitive routines. The women compete on the balance beam, uneven bars, vault and floor exercise. The men’s competition includes the horizontal (high) bar, parallel bars, still rings, vault, pommel horse, and floor exercise. The etiology of gymnastic spinal injury can include: exaggerated bending, arching and twisting of the spine; the jolt of tumbling routines in the floor exercise; rigorous, repetitive apparatus training; and, falls from the apparatus. In addition, it should be noted that the uneven bars, parallel bars, horizontal bar and rings place an exaggerated traction force on the gymnast.
The two predominant types of spinal injury are strains of the spinal muscles and spondylolysis. Also occurring to a lesser extent is spondylolisthesis. Both spondylolysis and spondylolisthesis are usually manifested at the 5th lumbar vertebra (L5), and to a lesser extent at the 4th lumbar vertebra (L4). Spondylolysis is a medical term for a lateral fracture of is a thin segment of vertebral bone (the pars interarticularis). Spondylolisthesis is the term used to describe the forward slippage of all or part of one vertebra onto an adjacent vertebra. The slippage is thought to be the result of the gymnast’s performance of repetitive hyperextension movement, such as an apparatus dismount. Spondylolysis and spondylolisthesis can occur at the same time, however, spondylolysis is not necessarily a precursor of spondylolisthesis. Another back injury gymnasts experience is Scheuermann’s disease (adolescent kyphosis) which involves two vertebra segments being forced into aberrant wedge-like shape. This causes a distended outward curve of the upper back.
The long term result of the various insults to the bones and muscles of a gymnast’s spine is pain running down the leg, limited mobility and chronic low back pain. “Herniated discs and disc degeneration also occur but to surprisingly lesser extent.” This is thought to be due to the gymnast’s intense conditioning, muscle strength and flexibility. Fortunately muscle sprain and ligament strain can be treated with rest and physical therapy. When pain persists, it is recommended that the gymnast be evaluated by a neurosurgeon or an orthopaedic surgeon. It is also fortunate that catastrophic injury to the athlete is a relatively rare occurrence.”
The prevention of injury is of paramount importance. Parents and coaches should insist that all safety precautions are taken, especially in non-competitive situations (practice) where the bulk of injuries occur. This includes ensuring that spotters are in attendance, the apparatus is in good working order, the athlete uses the appropriate safety gear (hand grips, braces, pads, etc.), and there is a de-emphasis on “working through the pain.”
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