Performance, Physique, Injury and Training

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Word count: 3224

Gymnastics:

Performance, Physique, Injury and Training.

PETER BALE and JACQUELINE D. GOODWAY

University of Brighton, Eastbourne, England;

and Michigan State University, East Lansing, MI

Gymnastics is a sport in which over 30 million people participate in over 80 countries. These participants are either artistic (Olympic) gymnasts, sports acrobats or rhythmic gymnasts. Sport acrobatics and rhythmic gymnastics are two smaller components of competitive gymnastics. Only females participate in rhythmic gymnastics (approximately 1000 in the USA) and many more women than men participate in artistic gymnastics and sports acrobatics. In female artistic gymnastics there is competition on the vault, uneven bars, balance beam, and floor exercise whereas in men's artistic gymnastics there is competition on the vault, high bar, parallel bars, rings, pommel horse and floor. Men have greater upper body strength than women, thus men's gymnastics emphasizes explosive strength and power, especially in the upper body, while women gymnasts show greater flexibility and artistry than men. However, both sports require an immense amount of power and strength.

The Federation of International Gymnastics (FIG), the international governing body for the standardization of competitive gymnasts, review and update their code of judging every four years. Hence, performance demands on gymnasts are continually changing to meet the new code requirements. Thus, children begin gymnastics training at younger and younger ages, as it takes about 6-10 years for a gymnast to pass through the ranks to the elite level. In many countries children may start training from as young as five years of age (1). However, for every gymnastic competitor at the elite level there are many more recreational gymnasts.

In the United States of America gymnastics takes the form of recreational, club, high school, and college competitive gymnastics. The United States Gymnastics Federation (USGF), now called USA Gymnastics, governs the age-group competitive program consisting of compulsory and optional exercises. For women's gymnastics, level 4 through level 10, then elite is the normal competitive progression. A total of 44,305 (USA Gymnastics, 1993) girls and woman compete at all levels of gymnastics competition, with the highest number of girls (19,182) competing at level 5, 4,084 at level 9, and only 767 girls and woman competing at the elite level.

The men's gymnastics program in the USA is much smaller than the women's. A total of 9,097 men compete and the men's competitive program starts at level 7, goes through to level 1 and then elite, which is the highest competitive level. Most of the of boys and men (3,605) compete at level 6. The majority of children and young adults participating in gymnastics across the United States are young females. Thus, much of the literature regarding gymnastic performance, physique, injury and diet has focused on women's gymnastics. This review reflects the bias toward female participants.

Physique And Performance

In general elite gymnasts tend to be lower in stature, have low body fat (2,3) and have mesomorphic-ectomorhphic physiques (2,3,7) which are more flexible than the average male or female of a similar age (2,3,12). Research (12) also found that endurance (number of leg lifts) was a significant discriminator of high verses low level gymnasts. The mean score for leg lifts of the low non-elite group of female gymnasts was 5.93 (SD 3.73) compared with 13.2 (SD 38) for the high achievers (12). The authors of this work are, however, cautious in the interpretation of their results because, as in many similar studies, there was only a small number of subjects in their study (N=66).

In the 1970's, Novak and his colleagues (15) considered that gymnastic performance was most dependent upon agility, flexibility, coordination, rhythm and timing as well as specific gymnastic skills. This view still holds. Aerobic capacity does not seem to play a significant role in elite performance. Research (15) has reported a value of 42.5 ml kg-1 min-1 for aerobic capacity of elite gymnasts indicating a moderate capacity relative to other athletes. Male gymnasts we have tested in our laboratory have yielded a VO2 max in the 50's. However, like their female counterparts, male gymnasts have a high anaerobic capacity, their major source of energy during performance. Other research (4) has suggested that the extra muscle on the chests, particularly of male gymnasts, impinges upon a compliant thorax so reducing the gymnast's expiratory reserve volume and vital capacity. Nevertheless, this decrease in lung efficiency does not appear to be a limiting factor in their performance as aerobic endurance is not an important component of gymnastics.

Bale and Goodway (3), in their review of performance variables associated with the competitive gymnast, commented that male gymnasts generally reach their peak of performance in their early twenties, whereas female gymnasts tend to reach their peak in their mid-to-late teens. Moreover, female gymnasts are typically younger, lighter and shorter than gymnasts of two decades ago, with this more slender physique reflective of the biomechanical advantage gained while performing high risk acrobatic skills common to contemporary gymnastics. Accordingly, the physique most advantageous to perform these tricks has resulted in a propensity to the prepubertal female physique. Thus, women's artistic gymnastics has become a sport involving extensive hours of training by young children who are potentially at greater risk of injury.

GYMNASTIC INJURY

Injury Definition.

Before reviewing the literature on gymnastics injury the reader must be cautioned in making direct comparisons between studies. The literature reflects a diverse range of operational definitions of injury such as: any incident that causes modification of training; pain; need for medical treatment; and time away from gymnastics training. Such definitions can dramatically effect the sensitivity of the data collected on gymnastic injury and thus discretion should be used in inter-study comparison.

Injury Rate.

The injury rate in gymnastics is considered as high as injury rates in contact sports such as football. This rate varies according to the level of performance and participation. Relatively high injury rates ranging between 0.55 and 5.6 per participant per year were found in college and competitive club programs (7,8,10,11,12,16). Lower injury rates ranging between 0.22 and 0.33 per year per participant were found in high school and club-level gymnasts (8) and non-competitive gymnasts had much lower injury rates ranging between 0.04 (13) to 0.7 per 100 participants per year (16). Thus the highest rates of injury are at the elite level of gymnastic performance. Correspondingly a study of injuries to United Kingdom female gymnasts found that injury occurred in one-in-eight elite gymnasts as compared to one-in-850 recreational gymnasts (9).

Location of injury.

Injuries can be classified into upper extremity, lower extremity, spine, and head injuries. Injury data from training in private clubs identified the high incidence of lower extremity injuries which accounted for 50-60% of all injuries (7,8,11). Injuries in college and high school gymnasts reported comparable injury data to that attained in club gymnastics (8,10,20,21). At high level club competition, lower extremity injuries were even higher (78%) relative to upper extremity (11%) injury (14). Thus injuries as a result of competition supports the trend of lower extremity injury occurring in training. Interestingly data reported by Sands and his colleagues (20) found similar trends and in addition reported that the right side of the body was injured more frequently than the left side of the body.

Types of Injuries.

Injuries in gymnastics have also been divided into acute injuries resulting from a single episode of trauma and chronic injuries arising from repetitive micro-trauma causing long term injury without any known incident or origin. Acute injuries have been reported as accounting from between 57% (10,22) and 83% (21) of all gymnastics injury. Acute injuries have been attributed to factors such as intense practice, high skill level, inadequate matting, the absence of a spotter, and dismounting. Events such as the uneven bars, floor, and vault were also associated with a high incidence of acute injuries (16).

Chronic injury in child athletes has been associated with intensive and often inappropriate training practices at a young age when the body is prepubertal. Injuries to the upper extremity dominate the literature, with the anatomical structure of upper extremity joints considered a contributory factor in the predominance of injury. Little literature has been able to define exactly what is an appropriate amount of training, and how much is too much.

Site of Injury.

The predominate site of gymnastic injuries in the lower extremity are to the knee and ankle. Women were more at risk of knee injury than male gymnasts (23) because of the Q-angle at the knee of women who have wide hips. The incidence of knee injury ranged between 9% and 20% (7,11,23) and both acute and chronic injuries were documented. Ankle injuries such as sprains are common in gymnastics, the incidence of which ranged from 14% to 22% (11,21).

In the upper extremity, injuries are predominantly at the wrist, shoulder and elbow. Much of the literature on the wrist was of the case study type describing overuse injury. A long history of gymnastics participation, intensive training, the fulcral arm in vaulting, and soft matting were factors associated with such injuries to both male and female gymnasts.

The anatomical structure of the shoulder joint creates a joint that is very mobile and hence predisposed to injury, especially injury to muscle and tendons. The nature of events such as rings and high bar stress the shoulder joint unduly and thus may account for this greater incidence of injury.

The elbow joint has a low incidence of injury. Both acute injury associated with the presence/absence of spotters, thickness of mats, and falls on outreached arms; and chronic injuries associated with repetitive trauma from prolonged training to a joint that is not anatomically efficient in bearing weight, have been reported in the literature.

Competitive gymnastics has frequently been associated with spinal injury. Injury to the spine typically results from either a single episode of trauma such as falling from the apparatus, or the repetitious micro-trauma of protracted gymnastic training. However, the incidence of such traumatic injury is minimal and it is chronic injury that is the major type of spinal injury in women's gymnastics. Imbalance between muscle groups (e.g. weak abdominals), poor flexibility, training error, extensive training, poor physical preparation, training during the growth spurt, and skills involving vast degrees of hyper-extension or hyper-flexion have all been contributors to injury of the spine. Spondylolysis and spondylolisthesis are common spinal injuries and gymnasts have reported four times (11%) the frequency of spondylolysis as might be expected in the female Caucasian population.

Type Of Tissue Injury.

Gymnastics injury has also been classified into types of tissue injury, including: sprain (joint); fracture; dislocation; contusion; and strain (muscular). The incidence of sprains ranged from 12% in a competition (14) to 59% in female collegiate gymnasts (23). The incidence of strains was less than for sprains, with the incidence of dislocations the least common type of injury (7,11,14). Contusions were a fairly common injury (34%) in female competitive gymnasts (13) with fractures being less common ranging between 3% for non-competitive gymnasts (13) and 31% for female competitive gymnasts (8,11,16).

Etiology of Injury.

Goodway (9) in her study of United Kingdom gymnasts stated that the majority of injuries occur in training while learning individual skills, particularly on landings. Studies of gymnasts in the USA have supported this statement (8,10, 13,16).

The number of hours of training was a potential indicator of injury (9,10). For example, a higher incidence of injury was associated with a greater duration and frequency of training, with gymnasts and clubs that train for more than 20 hours per week having greater incidence of injury than those training less (9,10,16).

Research has shown that competition makes up only 0.4% of gymnastics activity time (8) and though there were less injuries in competition relative to training, competitive injuries still accounted for a disproportionate 5% of total injury. The literature overwhelmingly concluded that competitive gymnasts were at greater risk of injury than non-competitive gymnasts, even when the greater amount of time in the gymnasium was accounted for. However, interestingly research has indicated that higher level competitors have lower injury rates than lesser level competitors (9,12).

There is still little detail on the types of gymnastics skills which cause injury. Tumbling, swinging and running respectively have been reported as responsible for most injuries (20). Missed skills also involve a large risk of injury (11).

The incidence of injury during the performance of skills that are spotted by the coach is very equivocal. Weiker (22) reported that 78% of all injuries that occurred were without the presence of a spotter. However, Pettrone and Ricciardelli (16) contradicted this evidence stating that the majority of injuries in their study occurred with the presence of a spotter.

The apparatus associated with the highest incidence of injury was typically the floor exercise (8,11,13,16,20). The beam and vault often had the lowest incidence of injury.

NUTRITION

Dieting to reduce body fat and improve shape and agility is often part of a well designed training program in women's artistic gymnastics, a sport in which form and appearance are important. Concern arises when these more aesthetic demands of the sport push many female gymnasts towards dietary habits which result in a negative energy balance. Research has suggested (5,17) that athletes in sports which emphasize leanness (including women's gymnastics) are preoccupied with weight to such an extent that they had tendencies towards eating disorders such as anorexia nervosa and bulimia. Such dieting can only result in a decrease in gymnastic performance and increased risk of injury with a general decrease in overall health, causing malnutrition, dehydration, hypoglycemia and, unless corrected even death. Important role models such as parents and coaches must be sensitive to the pressure the gymnast has towards maintaining exceptional slimness and give sensible advice on nutrition.

Though male gymnasts usually have a balanced diet, many eat meals high in protein (6) with the view that the increased protein content is required for the formation of lean tissue. Some male gymnasts also take protein supplements with the mistaken view that even higher protein will result in even greater muscle mass and therefore greater muscle strength and power. However concern has been raised at the possible detrimental effects of excessive protein intake, particularly to kidney function.

Talent Selection And Training

By measurement of anthropometric, biomechanical, physiological and psychological variables attempts have been made to predict gymnastics talent in children (1,12,18,19). The major problems are the questionable validity, reliability and objectivity of tests of gymnastic talent believed to underlie success, and the ability to separate the influence of growth and maturation from the effects of age and training (12).

Indeed there is a diverse amount of literature on issues related to talent selection, training and skill development in gymnastics. It is not possible within the scope of this review to discuss the pertinent literature. However, this literature may be grouped into four main areas: biomechanical analysis of individual skills; psychological skills training; skill analysis and technique; and training programs and training systems. The 1985 scientific congress at the Montreal World Championships produced a trilogy of books on identifying, training and developing gymnastic talent (19). Other journals that commonly discuss training issues include "Technique" a USGF Gymnastics publication, 'International Gymnast' and research published by the United States Elite Gymnastics Coaching Association.

References

1. Bajin, B. Identification program for Canadian female gymnastics. In: World Identification Systems For Gymnastics Talent, B. Petiot, J.H. Salmela, & T.B. Hoshizaki (Eds.). Sport Psyche Editions: Montreal, Canada, 1987, pp. 34-44.

2. Bale, P. and Goodway, J. The anthropometric and performance

variables of elite and recreational female gymnasts. N.

Zealand J Sports Med. 63-66, 1987.

3. Bale, P. and J. Goodway. Performance variables associated

with the competitive gymnast. Sports Med. 10,3:139-145,

1990.

4. Bartlett, H.L., M.J. Maricem, And E.R. Buskirk. Body composition and expiratory reserve volume in female gymnasts and runners. Med.Sci. Sports Exerc. 16,3: 31-315, 1984.

5. Borgen, J.S. And C.B. Corbin. Eating disorders among female athletes. Physician Sportsmed. 15,2: 89-95, 1987.

6. Brotherhood, J.R. Nutrition and sports performance. Sports Med. 1: 350-389, 1984.

7. Caine, D., B. Cochrane, C. Caine, And E. Zemper. An epidemiological investigation of injuries affecting young competitive female gymnasts.AmerJ. Sports Med. 17: 811-820, 1989.

8. Garrick, J.G., and R.K. Requa Epidemiology of women's

gymnastics injuries. AmerJ. Sports Med. 8: 261-264, 1980.

9. Goodway, J.D. Gymnastic injuries within the United Kingdom.

M.Phil Thesis, Brighton Polytechnic, England. 1989.

10. Hudash Wadley, G. and J.P. Albright. Women's intercollegiate gymnastics. Injury patterns and "permanent" medical disability. Amer.J. Sports Med. 21: 314-320.

11. Lindner, K.J. And D.J. Caine. Injury patterns of female competitive club gymnasts. Can.J. Sport Sci.. 15: 254-261, 1990.

12. Lindner, K.J. And D.J. Caine. Physical and performance differences between female gymnasts competing at high and low levels. J. Hum. Movement Studies. 23: 1-15, 1992.

13. Lowry, C.B. And B.F. Leveau. A retrospective study of gymnastics injuries to competitors and noncompetitors in private clubs. Am.J.Sports Med. 10: 237-239.

14. Martin, R.K., C.E. Yesalis, D. Fuster And J.P. Albright. Sports injuries in the 1985 Junior Olympics. An

epidemiologic analysis. Am.J.Sports Med. 15,6: 603-608, 1987.

15. Novak, L.P., W.A. Woodward, C. Bestit, And H. Mellerowicz. Working capacity, body composition and anthropometry of Olympic female athletes. J Sports Med. Phys. Fitness. 17: 275-284, 1977.