Stretching the Spines of Gymnasts: A Review

Effect of Eutony, Holistic Gymnastics and Pilates on hamstring flexibility and back pain in pre-adolescent girls: Randomized clinical trial

OBJECTIVE

This study aimed to evaluate the effects of Eutony, Holistic Gymnastics, and Pilates on hamstring flexibility and back pain in pre-adolescent girls.

METHODS

This randomized prospective quantitative clinical trial compared the effects of Eutony, Holistic Gymnastics, and Pilates on hamstring flexibility and back pain. The sample consisted of 80 pre-adolescent girls aged 10-13 years and divided into three groups: Eutony, with 26 girls; Holistic Gymnastics, 27 girls; and Pilates, 27 girls. The participants underwent ten 1-h weekly interventions. Hamstring flexibility was evaluated using fingertip-to-floor, sit-and-reach, and hip angle tests; back pain was evaluated using the Body Posture Evaluation Instrument questionnaire and the way they carried their backpack by the Layout for Assessing Dynamic Posture. Descriptive statistical analysis, analysis of variance, and Kruskal-Wallis test were performed at a 5 % significance level (p < 0.05).

RESULTS

The three body practices increased hamstring flexibility in all fingertip-to-floor (7.77 cm), hip angle (5.58°), and sit-and-reach evaluations (9.07 cm). Before the intervention, 66.25 % of participants complained of back pain. After the intervention, only 37.50 % continued with the complaint. Moreover, 25 % of pre-adolescent girls started to carry their school backpack correctly.

CONCLUSION

Eutony, Holistic Gymnastics, and Pilates increased hamstring flexibility, reduced back pain complaints, and incentivized the girls to carry the school backpack correctly.

REGISTRY OF CLINICAL TRIALS

Brazilian Registry of Clinical Trials ReBEC (RBR-25w6kk).

Anorexic Readiness Syndrome in Elite Female Acrobatic Gymnasts-International Study

Anorexic Readiness Syndrome (ARS) is a concept used in research for the early detection of disordered eating (DE). It is a set of indicators located primarily within the cognitive and behavioral sphere of an individual's functioning. The aim of this study was to examine whether among the elite acrobats there are girls showing a high level of anorexic tendency, and if so, what behaviors and attitudes are the most common. In addition, an attempt to determine what sport-related factors or other non-sport variables may increase the risk of ARS was conducted. The study group was made up of 133 acrobatic gymnasts aged 10-19, representing six countries that participated in the Acro World Cup competition held in Poland. The study procedures included surveys (personal questionnaire and the Eating Attitudes Questionnaire), anthropometric measurements such as weight, height, waist circumference (WC) and determination of the Body Mass Index (BMI), fat percentage (Fat%), and waist to height ratio (WHtR). A high level of ARS was found in 9.8% of acrobats. This group most often declared attitudes and behaviors indicative of anorexic tendencies. A strong relationship with the level of ARS was noted in the following: the use of fasting and diets (p ≤ 0.001; V = 0.54), limiting of fats and carbohydrates (p ≤ 0.001; V = 0.60), feeling angry after eating too much (p ≤ 0.001; V = 0.55), knowing the caloric value of many food products (p ≤ 0.001; V = 0.59), and the desire to improve the appearance of one's body (p ≤ 0.001; V = 0.52). The role played in the acrobatic partnership and the region of residence were considered as the sport-related risk factors. Among non-sport factors, the strongest predictor of ARS was the age of gymnasts (β = 0.516; p ≤ 0.001).

Is There a "Window of Opportunity" for Flexibility Development in Youth? A Systematic Review with Meta-analysis

BACKGROUND

Flexibility is an important component of physical fitness for competitive and recreational athletes. It is generally suggested that flexibility training should start from childhood (6-11 years of age) to optimize joint range of motion (ROM) increases; however, evidence is limited and inconsistent.

OBJECTIVE

To examine whether there is a difference in the effect of stretching training on flexibility during childhood (6-11 years of age) and adolescence (12-18 years of age).

DESIGN

Systematic review and meta-analysis.

METHODS

We searched PubMed Central, Web of Science, Scopus, Embase, and SPORTDiscus, to conduct this systematic review. Randomized controlled trials and non-randomized controlled trials were eligible. No language and date of publication restrictions were applied. Risk of bias was assessed using Cochrane RoB2 and ROBINS-I tools. Meta-analyses were conducted via an inverse variance random-effects model. GRADE analysis was used to assess the methodological quality of the studies.

RESULTS

From the 2713 records retrieved 28 studies were included in the meta-analysis (n = 1936 participants). Risk of bias was low in 56.9% of all criteria. Confidence in cumulative evidence was moderate. We found that stretching was effective in increasing ROM in both children (SMD = 1.09; 95% CI = 0.77-1.41; Z = 6.65; p < 0.001; I² = 79%) and adolescents (SMD = 0.90; 95% CI = 0.70-1.10; Z = 8.88; p < 0.001; I² = 81%), with no differences between children and adolescents in ROM improvements (p = 0.32; I² = 0%). However, when stretching volume load was considered, children exhibited greater increases in ROM with higher than lower stretching volumes (SMD = 1.21; 95% CI = 0.82-1.60; Z = 6.09; p < 0.001; I² = 82% and SMD = 0.62; 95% CI = 0.29-0.95; Z = 3.65; p < 0.001; I² = 0%, respectively; subgroup difference: p = 0.02; I² = 80.5%), while adolescents responded equally to higher and lower stretching volume loads (SMD = 0.90; 95% CI = 0.47-1.33; Z = 4.08; p < 0.001; I² = 83%, and SMD = 0.90; 95% CI = 0.69-1.12; Z = 8.18; p < 0.001; I² = 79%, respectively; subgroup difference: p = 0.98; I² = 0%).

CONCLUSIONS

Systematic stretching training increases ROM during both childhood and adolescence. However, larger ROM gains may be induced in childhood than in adolescence when higher stretching volume loads are applied, while adolescents respond equally to high and low stretching volume loads.

REGISTRATION

INPLASY, registration number: INPLASY202190032; https://inplasy.com/inplasy-2021-9-0032/.

Prevalence of muscle imbalance and its potential influence on injury among female acrobatic dancers

Objective

The purpose of this study was to determine the prevalence of muscle imbalance among young adolescent acrobats (n=15) and if there was a potential link to injury.

Methods

Isokinetic strength of the lower extremity, isometric strength of the trunk, and flexibility of both the trunk and lower extremity were assessed. Pearson correlation (r) and χ² correlation tests were performed on all explanatory variables.

Results

Significant correlations were found between isokinetic peak torque of the quadriceps and hamstrings (p=0.000) and the plantar flexors and dorsiflexors (p=0.000) on both sides, along with plantar flexor dominance (p=0.000). Non-significant findings were seen when identifying dominance between the quadriceps and hamstrings (p=0.933) as well as when correlating peak torque and flexibility of the lower extremity (right hamstrings: p=0.668, left hamstrings: p=0.338, right quadriceps: p=0.171, left quadriceps: p=0.707, right plantar flexors: p=0.282, left plantar flexors: p=0.382, right dorsiflexors: p=0.297 and left dorsiflexors: p=0.393).

Conclusion

Acrobats demonstrated noticeably high ranges of flexibility, and the most common injury site was found to be the ankle. However, these mentioned injuries were not all due to acrobatic participation. The limited sample size warrants extensive research with a larger sample size to further verify or dispute the results found in this study. Muscle imbalances found within this population could increase the risk of injury.

Whole-Body Vibration Effects on Flexibility in Artistic Gymnastics—A Systematic Review

It is well documented that whole body-vibration training has effects on muscle strength and flexibility, blood circulation, decreases pain perception and strengthens bone and tendon. Although whole body-vibration has benefits in athletes’ flexibility, we are not sure what its actual effects are in artistic gymnastics (since they already have stunning flexibility). Hence, the aim of this study was to analyse the studies on whole-body vibration in artistic gymnastics and to present the effects on flexibility. The search and analysis were carried out in accordance with PRISMA guidelines. The databases search (PubMed, Scopus, Google Scholar, Cochrane Library, ProQuest, EBSCOhost and Science Direct) yielded 18,057 potential studies. By the given inclusion criteria (studies from 2005 to 2022; full-text published in English; the study included male and female gymnasts as samples, and that participants were tested for evaluation of flexibility by whole-body vibration method), a total of 9 full-text studies were included, with a total of 210 participants, both male and female. As far as the measured flexibility tests conducted, front split, sit and reach and bridge were evaluated, while obtained results were 9.1–39.1%, 2.79–6.7%, 6.43–7.45%, respectively. All studies have conducted same vibration frequency (30 Hz) with same amplitude of displacements (2 mm), except for the one study who did not show the information of implemented amplitude. After analysing the obtained results, it can be concluded that the usage of whole-body vibration platform shows flexibility improvements in artistic gymnasts, both male and female. In addition, a combination of whole-body vibration and traditional static stretching may enhance the flexibility in artistic gymnasts. However, these results should be taken with caution. Since this review did not reveal the optimal vibrational protocol, it is necessary to invest time during the implementation of various vibrational experimental protocols, so future research is required.

Acute and long-term effects of two different static stretching training protocols on range of motion and vertical jump in preadolescent athletes

This study examined the acute and long-term effects of two static stretching protocols of equal duration, performed either as a single stretch or multiple shorter duration repetitions on hip hyperextension range of motion (ROM) and single leg countermovement jump height (CMJ). Thirty female gymnasts were randomly assigned to stretching (SG) or control groups (CG). The SG performed two different protocols of static stretching, three times per week for 9 weeks. One leg performed repeated stretching (3 × 30 s with 30 s rest) while the other leg performed a single stretch (90 s). The CG continued regular training. ROM and CMJ were measured pre- and 2 min post-stretching on weeks 0, 3, 6, 9, and 3 weeks into detraining. CMJ height increased over time irrespective of group (main effect time, p = 0.001), with no statistical difference between groups (main effect group, p = 0.272). Three-way ANOVA showed that, CMJ height after stretching was not affected by either stretching protocol at any time point (p = 0.503 to 0.996). Both stretching protocols equally increased ROM on weeks 6 (10.9 ± 13.4%, p < 0.001, d = 0.42), and 9 (21.5 ± 13.4%, p < 0.001, d = 0.78), and this increase was maintained during detraining (17.0 ± 15.0%, p < 0.001, d = 0.68). No increase in ROM was observed in the CG (p > 0.874). Static stretching of long duration applied either as single or multiple bouts of equal duration, results in similar acute and long-term improvements in ROM. Furthermore, both stretching protocols do not acutely affect subsequent CMJ performance, and this effect is not influenced by the large increase in ROM and CMJ overtime.

Measurable Thoracic Motion Remains at 1 Year Following Anterior Vertebral Body Tethering, with Sagittal Motion Greater Than Coronal Motion

BACKGROUND

Anterior vertebral body tethering is an alternative to fusion surgery for the treatment of adolescent idiopathic scoliosis (AIS) that is purported to preserve spinal motion. There is limited information regarding the measurable motion that is maintained over the instrumented levels following thoracic anterior vertebral body tethering surgery in humans. The purpose of the present study was to assess radiographic spinal motion 1 year after anterior vertebral body tethering.

METHODS

As part of a prospective U.S. Food and Drug Administration investigational device exemption study, 32 patients were treated with thoracic anterior vertebral body tethering. At 1 year postoperatively, patients were evaluated with standing flexion-extension and side-bending radiographs in a microdose biplanar slot scanning imaging system. The angle subtended by the screws at the upper instrumented vertebra (UIV) and lower instrumented vertebra (LIV) was measured on left and right-bending radiographs to evaluate the coronal arc of motion and was compared with preoperative values over the same levels. At 1 year postoperatively, the sagittal Cobb angle was measured over the instrumented levels on flexion and extension radiographs.

RESULTS

Side-bending radiographs revealed that the mean angle subtended by the screws changed from 15° ± 8° on left-bending radiographs to 8° ± 6° on right-bending radiographs. The mean coronal arc of motion on bending was 7° ± 6°, with 20 (62.5%) of 32 patients having a coronal arc of motion of >5°. The mean preoperative coronal arc of motion over the instrumented segments was 30° ± 9°. On flexion-extension lateral radiographs made at 1 year postoperatively, the mean kyphotic angle over the instrumented segments was 33° ± 13° in flexion and 11° ± 14° in extension, for a mean postoperative arc of motion of 21° ± 12° between flexion and extension radiographs.

CONCLUSIONS

At 1 year following thoracic anterior vertebral body tethering for the treatment of AIS, the thoracic spine showed a measurable range of coronal and sagittal plane motion over the instrumented levels without evidence of complete autofusion. Motion in the coronal plane decreased by 77% following anterior vertebral body tethering. These findings provide proof of concept that sagittal spinal motion is preserved after thoracic anterior vertebral body tethering, although the functional importance remains to be determined.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Intersection of surgical injuries and pain interference among former female collegiate gymnasts

BACKGROUND

Gymnastics is a competitive sport with numerous health benefits. However, few data exist that examine the lasting effects of injuries in retired gymnasts.

OBJECTIVE

To examine pain interference among former collegiate gymnasts. Specifically, we focused on the relationship between gymnastics-related injuries sustained during middle/high school or college that required surgery and former collegiate gymnasts' current pain. We hypothesized that injuries requiring surgery would be associated with increased pain and reduced function after retirement.

DESIGN

Cross-sectional survey.

SETTING

An online questionnaire was distributed to former female collegiate gymnasts via social media.

PARTICIPANTS

A total of 447 former female collegiate gymnasts completed the survey and were grouped according to whether they indicated an injury during their middle/high school or collegiate gymnastics career that required surgery.

MAIN OUTCOME MEASURES

The association between current pain interference (Patient-Reported Outcomes Measurement Information System [PROMIS] scale) and injuries in middle/high school or college that resulted in surgery. Pain interference elements included current enjoyment of life, ability to concentrate, participation in day-to-day activities, enjoyment of recreational activities, ability to perform errands, and ability to socialize with others.

RESULTS

Those who reported an injury that resulted in surgery (n = 260; mean current age ± SD = 32.8 ± 9.5 years) were younger than those who did not at the time of survey completion (n = 187; current age: 37.0 ± 11.0 years) and reported beginning gymnastics at an earlier age (4.4 ± 2.0 years vs. 5.1 ± 2.5 years; p = .001). There were no statistically significant differences between the groups on any PROMIS questions. In secondary analyses, we found a small but significant association between beginning gymnastics at an earlier age and the odds of requiring surgery (odds ratio = 1.11, 95% confidence interval [CI] = 1.02-1.21; p = .02).

CONCLUSIONS

Most retired gymnasts reported a gymnastics-related injury that required surgery. Gymnasts who start gymnastics at a younger age were more likely to sustain an injury that required surgery, but surgery was not associated with higher levels of pain interference.

Comparison between gymnasts and non-gymnasts in isometric strength of the lower limbs

Muscle asymmetries in gymnasts are common and can lead to injury. We aimed to determine differences in hip, knee, and ankle strength between female gymnasts and non-gymnasts, and secondly, to determine the effect of strength training intervention. Fifteen gymnasts (aged 11.19 ± 1.89 years) and 15 non-gymnasts (aged 10.92 ± 1.96 years) performed unilateral isometric maximal voluntary contractions of the hip (extensor, flexor, abductor, adductor, internal and external rotator), knee and ankle flexors and extensors on a dynamometer. Inter-limb asymmetries (ILAs) were compared across strength outcomes (MVC torque) and groups. ILAs was calculated based on the strength measurements. The gymnasts were retested after 8 weeks, during which the participants performed 5 weeks of regular training and 3 weeks of targeted strength training intervention. We found significant differences between groups in most observed hip strength parameters, but not in knee and ankle strength. The intervention did not significantly affect any parameter of ILAs. Gymnasts and non-gymnasts differ in hip strength parameters. A longer intervention program may decrease ILA parameters.

Injuries and illnesses among competitive Norwegian rhythmic gymnasts during preseason: a prospective cohort study of prevalence, incidence and risk factors

Objectives

Rhythmic gymnastics is an Olympic sport that demands high training volume from early age. We investigated the extent of, and risk factors for, injuries among competitive Norwegian rhythmic gymnasts.

Methods

One hundred and seven of 133 (80.5%) female rhythmic gymnasts (mean age: 14.5 years (SD 1.6), mean body mass index: 18.9 (SD 2.2)) participated. All gymnasts completed a baseline questionnaire and the ‘Triad-Specific Self-Report Questionnaire’. Injuries, illnesses and training hours were recorded prospectively for 15 weeks during preseason using the ‘Oslo Sports Trauma Research Center Questionnaire on Health Problems’ (OSTRC-H2).

Results

Response rate to OSTRC-H2 was 97%. Mean overuse and acute injury prevalence were 37% (95% CI: 36% to 39%) and 5% (95% CI: 4% to 6%), respectively. Incidence was 4.2 overuse injuries (95% CI: 3.6 to 4.9) and 1.0 acute injuries (95% CI: 0.5 to 1.6) per gymnast per year. Overuse injuries in knees, lower back and hip/groin represented the greatest burdens. Previous injury increased the odds of injury (OR 30.38, (95% CI: 5.04 to 183.25)), while increased age (OR 0.61 per year, (95% CI: 0.39 to 0.97)) and presence of menarche (OR: 0.20, (95% CI: 0.06 to 0.71)) reduced the odds of all injuries and substantial injuries, respectively.

Conclusions

Overuse injuries were common among Norwegian rhythmic gymnasts. Younger gymnasts had higher all-injury risk. Gymnasts who were not menstruating had higher substantial injury risk. Injury prevention interventions should start at an early age and focus on preventing knee, lower back and hip/groin injuries.

Gastrocnemius Medialis Architectural Properties in Flexibility Trained and Not Trained Child Female Athletes: A Pilot Study

Gastrocnemius medialis (GM) architecture and ankle angle were compared between flexibility trained (n = 10) and not trained (n = 6) female athletes, aged 8–10 years. Ankle angle, fascicle length, pennation angle and muscle thickness were measured at the mid-belly and the distal part of GM, at rest and at the end of one min of static stretching. Flexibility trained (FT) and not trained athletes (FNT) had similar fascicle length at the medial (4.19 ± 0.37 vs. 4.24 ± 0.54 cm, respectively, p = 0.841) and the distal part of GM (4.25 ± 0.35 vs. 4.18 ± 0.65 cm, respectively, p = 0.780), similar pennation angles, and muscle thickness (p > 0.216), and larger ankle angle at rest (120.9 ± 4.2 vs. 110.9 ± 5.8°, respectively, p = 0.001). During stretching, FT displayed greater fascicle elongation compared to FNT at the medial (+1.67 ± 0.37 vs. +1.28 ± 0.22 cm, respectively, p = 0.048) and the distal part (+1.84 ± 0.67 vs. +0.97 ± 0.97 cm, respectively, p = 0.013), larger change in joint angle and muscle tendon junction displacement (MTJ) (p < 0.001). Muscle thickness was similar in both groups (p > 0.053). Ankle dorsiflexion angle significantly correlated with fascicle elongation at the distal part of GM (r = −0.638, p < 0.01) and MTJ displacement (r = −0.610, p < 0.05). Collectively, FT had greater fascicle elongation at the medial and distal part of GM and greater MTJ displacement during stretching than FNT of similar age.

Correlation between hypermobility score and injury rate in artistic gymnastics

BACKGROUND

Generalized joint hypermobility (GJH) is suggested as a contributing factor for injuries in young athletes and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of joint and soft tissue injuries during sports activities. The aim of this study was to determine the correlation between the hypermobility score (using the Beighton`s modification of the Carter-Wilkinson criteria of hypermobility) in gymnasts and injury rate, during the period of one year.

METHODS

This study observed 24 artistic gymnasts (11-26 years old), members of Qatar National Team in artistic gymnastics. We examined the Beighton joint hypermobility screen and a seasonal injury survey. The gymnasts characteristics (age, gender) and gymnastics characteristics (training per day and number of years in training artistic gymnastics) and their relations to injury rate were also included.

RESULTS

The most common injury was the lower back pain injury, followed by knee, shoulder, hip and ankle injuries. We found strong correlation of number of years gymnastics training and injury rate (P<0.001). There is no significant correlation in the numbers of training hours during one week and hypermobility score to numbers of injuries (P>0.05).

CONCLUSIONS

According to this study there is no correlation between GJH and injury rate in artistic gymnasts in Qatar. Total training period in gymnastics have greater contribution in injury rate.

THE FUNCTIONAL MOVEMENT SCREEN (FMS™) IN ELITE YOUNG SOCCER PLAYERS BETWEEN 14 AND 20 YEARS: COMPOSITE SCORE, INDIVIDUAL-TEST SCORES AND ASYMMETRIES

BACKGROUND

The Functional Movement Screen (FMS™) is a widely used seven-test battery used by practitioners working in sport medicine. The FMS™ composite score (sum of seven tests) in soccer athletes from different competitive levels has been well explored in literature, but the specific movement deficits presented by young high competitive level players remains unclear.

PURPOSE

The aim of the present study was to provide a detailed description of the performance of elite young soccer players (age 14-20 years) on the FMS™ testing battery.

STUDY DESIGN

Cross-sectional observational study.

METHODS

One-hundred and three young soccer players (14-20 years) from a premier league club were assessed by two experienced raters using the FMS™ testing battery. FMS™ composite score, individual-test scores and asymmetries were considered for analysis, and comparisons between age categories were performed.

RESULTS

FMS™ composite scores ranged from 9 to 16 points (median=13 points). 82% of the athletes had a composite score ≤14 points, and 91% were classified into the "Fail" group (score 0 or 1 in at least one test). Almost half of athletes (48%) had poor performance (i.e., individual score < 2) in "deep squat" test. Most of athletes in the younger categories (under-15 and under-16) had poor performance in the "trunk stability push-up" test (70%) and in the "rotary stability" test (74%). Asymmetry in at least one of five unilateral FMS™ tests was found in 65% of athletes.

CONCLUSION

High-performance young soccer players have important functional deficits, especially in tasks involving deep squat and trunk stability, as well as high prevalence of asymmetry between right and left body side.

LEVEL OF EVIDENCE

3a.

Flexibility training in preadolescent female athletes: Acute and long-term effects of intermittent and continuous static stretching

This study compared the acute and long-term effects of intermittent and continuous static stretching training on straight leg raise range of motion (ROM). Seventy-seven preadolescent female gymnasts were divided into a stretching (n = 57), and a control group (n = 20). The stretching group performed static stretching of the hip extensors of both legs, three times per week for 15 weeks. One leg performed intermittent (3 × 30 s with 30 s rest) while the other leg performed continuous stretching (90 s). ROM pre- and post-stretching was measured at baseline, on weeks 3, 6, 9, 12, 15 and after 2 weeks of detraining. ROM was increased during both intermittent and continuous stretching training, but remained unchanged in the control group. Intermittent stretching conferred a larger improvement in ROM compared to both continuous stretching and control from week 3, until the end of training, and following detraining (p = 0.045 to 0.001 and d = 0.80 to 1.41). During detraining, ROM after the intermittent protocol decreased (p = 0.001), while it was maintained after the continuous protocol (p = 0.36). Acute increases in ROM following the intermittent stretching were also larger than in the continuous (p = 0.038). Intermittent stretching was more effective than continuous, for both long-term and acute ROM enhancement in preadolescent female athletes.