Sport-Specific Biomechanics of Spinal Injuries in Aesthetic Athletes (Dancers, Gymnasts, and Figure Skaters)

Muscle Strength and Joint Range of Motion of the Spine and Lower Extremities in Female Prepubertal Elite Rhythmic and Artistic Gymnasts

The purpose of this study was to investigate and compare the passive joint range of motion (PROM) and muscle strength in prepubertal rhythmic gymnasts (RGs), artistic gymnasts (AGs), and a control group (CG) of the same age. A total of 54 prepubertal girls were divided into three groups: 18 RGs (age 11.14 ± 0.7, height 142.6 ± 5.81, and body mass 31.2 ± 3.63); 18 AGs (age 11.27 ± 0.99, height 139.6 ± 5.85, and body mass 31.7 ± 3.21), and 18 school girls who are defined as CG (age 10.55 ± 0.42, height 145.33 ± 6.95, and body mass 42.1 ± 8.21) participated in the study. All athletes were elites and participated in national competitions. The CG participated only in their school physical education program. Isokinetic peak torques were measured using an isokinetic dynamometer (Cybex II) at 60, 180, and 300°·sec-1. Body mass index was greater in the CG compared to RGs and AGs (p < 0.001). PROM in cervical extension in RG was significantly higher compared to the AG and CG (p < 0.001). The athlete groups, RG and AG, showed significantly greater PROM in knee flexion (p < 0.001), hip flexion (p < 0.001), and hip abduction (p < 0.05) compared to CG. PROM in hip flexion was different between the left and right leg in RGs. The relative muscle strength of the quadriceps in the RG and AG was significantly greater compared to CG (p < 0.001 and p < 0.01 respectively). Gymnastics training in prepubertal ages can improve neuromuscular function and increase the relative muscle strength. Therefore, it is essential to note that when evaluating children within the developmental ages, especially those involved in sports, the type of muscle strength to be assessed should be specified.

Which typical floor movements of men's artistic gymnastics result in the most extreme lumbar lordosis and ground reaction forces?

Back pain is prevalent among gymnast populations and extreme flexion or extension of the lumbar spine along with high ground reaction forces (GRFs) are known to increase intervertebral stress. The aim of this study was to determine which postures and dynamic conditions among common floor movements provide the greatest risk of injury in men's artistic gymnastics (MAG). For this purpose, lumbar spine curvatures, obtained through a full-body subject-specific kinematic model fed by motion capture data, and GRFs on feet and hands were compared between typical floor movements of MAG (pike jump, round off back handspring, front handspring, forward and backward tucked somersaults) performed by six adolescent gymnasts. The round off back handspring and the pike jump resulted respectively in the largest lumbar extension and flexion, and the forward tucked somersault take-off in the highest GRF. At ground impacts, the largest lumbar flexion was during the backward tucked somersault landing and only the back handspring hands ground contact phase led to lumbar extension. Such identification of high-risk conditions should enable better back pain management in gymnastics through more tailored training adaptations, particularly in case of pathologies or musculoskeletal specificities.

Sport specialization of female figure skaters: cumulative effects on low back injuries

Objective: 1) to determine the proportion of sport specialization among female figure skaters, 2) to compare proportion of low back injuries between specialized female figure skaters and non-specialized female figure skaters, and 3) to identify an independent risk factor(s) for low back injuries in female figure skaters.Methods: A cross-sectional questionnaire study was used. Young female figure skaters were asked questions related to sport specialization and any history of low back injuries. The primary outcome variables were status of sport specialization, weekly training hours, and low back injury. Descriptive statistics, t-test, chi-square analyses, and binary logistic regressions were used.Results: Responses from 132 female figure skaters (mean age: 16.3 ± 2.7 years, age range: 8-22 years) were analyzed. Sixty-two percent (82/132) of figure skaters were specialized. Specialized female figure skaters spent more time in training (11.3 ± 6.5 hours/week) than non-specialized skaters (7.6 ± 4.9 hours/week, p = 0.001). No statistical differences were found in proportion of low back injury history between specialized (25.6%) and non-specialized female figure skaters (24.0%, p = 0.836). Chronological age was also identified as an independent risk factor for low back injuries in female figure skaters (aOR: 1.24, 95%CI: 1.00, 1.54, p = 0.048).Conclusions: The majority of female figure skaters in this cohort were specialized. An association between chronological age and low back injuries, found in the current study, may be a result of cumulative effects of participating in figure skating over time.

Injury patterns in synchronized skating: a growing and evolving sport

BACKGROUND

Data about injuries among synchronized skating athletes are lacking while physical demands in this sport discipline continue to grow. No injury data among junior synchronized skaters exist. The purpose of this study was to investigate the frequency and pattern of injuries in junior and senior synchronized skaters.

METHODS

In this descriptive epidemiology study anonymous questionnaires were distributed to synchronized junior and senior skaters. 708 synchronized skaters (393 juniors and 315 seniors) completed the questionnaire. Male skaters were excluded from analysis.

RESULTS

Spinal conditions were reported by 148 (37.7%) juniors compared to 149 (47.3%) of senior skaters with statistically significant cumulative incidence (P=0.01); 23% of juniors and 30.2% of senior skaters reported problems with more than one spinal region; 64.4% juniors and 72.1% senior skaters reported at least one non-spinal injury during their synchronized skating career. There were 380 unique injuries reported by junior skaters and 363 by senior skaters. Lower extremity injuries were the most common injuries in both groups of skaters, followed by upper extremity, head and trunk injuries. From all the anatomical regions mentioned, there was only statistically significant difference between the groups in the occurrence of head injuries with senior skaters having 1.9 greater odds ratio to have head injury.

CONCLUSIONS

This study presents new data on the current injury pattern seen in synchronized skating since the inclusion of new skills. The number of head injuries and spinal conditions show statistically significant cumulative incidence in senior compared to junior skaters.

Epidemiology of Figure Skating Injuries: A Review of the Literature

Context:

As the popularity and technical demands of figure skating increase, so will the number of athletes presenting with sport-related problems.

Evidence Acquisition:

Searches were performed across PubMed from 1980 to 2017. The keywords searched were skating, skaters, incidence, and injuries. The search was limited to English-language articles and human participants. Relevant articles were cross-referenced.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

Previous studies suggest an increase in incidence of figure skating injuries from 1982 to 2003. When combining all disciplines of figure skating, there is a similar proportion of acute and overuse injuries. Within disciplines, overuse injuries appear to be more common in singles skating, while acute injuries are more common in pairs skating, ice dancing, and synchronized skating. Lower extremity injuries are more common than upper extremity injuries in all disciplines, and pairs skating accounts for the majority of upper extremity injuries. Ankle sprains are the most common skating injury, and patellar tendinitis is the most common overuse injury across all disciplines. Stress fractures are the most common overuse injury in female singles skaters.

Conclusion:

The predominance of overuse injuries in singles disciplines reflects their increasing technical difficulty, with more difficult jumps and longer training hours. Partner disciplines are more likely to involve acute injuries and upper extremity injuries due to high-risk throws and lifts. Emphasis should be placed on properly fitting skating boots, intrinsic foot and ankle strengthening, and lower extremity flexibility, which may prevent many of the common lower extremity and back injuries in figure skating.

Occupational Health and the Arts

OBJECTIVE

Work in the visual arts, performing arts, and writing can involve exposures to occupational hazards, including hazardous materials, equipment, and conditions, but few art workplaces have strong occupational health resources. Literature searches were conducted for articles that illustrate these concerns.

METHODS

Medical databases were searched for art-related health articles. Other sources were also reviewed, including, unindexed art-health publications, and popular press articles.

RESULTS

Information was located that described some exposed populations, art-related hazards, and resulting disorders. Anecdotal reports were used when more complete data were not available.

CONCLUSIONS

Health hazards in the arts are significant. Occupational health professionals are familiar with most of these concerns and understand their treatment and prevention. The occupational health approach can reduce the health hazards encountered by at-risk art workers. Additional research would benefit these efforts. Resources for further information are available.

Postural adjustments in young ballet dancers compared to age matched controls

OBJECTIVES

The purpose of the study was to use photogrammetry to evaluate the posture of ballet practitioners compared to an age-matched control group.

DESIGN

One hundred and eleven 7- to 24-year-old female volunteers were evaluated and were divided into two groups: the ballet practising group (n = 52) and the control group (n = 59), divided into three subgroups according to age and years of ballet experience.

RESULTS

Dancers with 1-3 years experience compared to controls of the same age shows alterations in External Rotation Angle (P < 0.05). Dancers 4-9 years experience show alterations in Lumbar Lordosis, Pelvis Tilt Angle and Navicular Angle Right and Left (P < 0.05). Dancers with over 9 years experience show alterations in External Rotation and Navicular Angle Left (P < 0.05).

CONCLUSIONS

Research shows there are differences between dancers and controls. In the groups 1-3 years and over 9 years of experience, the External Rotation Angle is greater. In the group 4-9 years of experience the Lumbar Lordosis Angle is greater and Pelvis Tilt, Navicular Angle Left and Right are smaller. In more than 9 years of ballet experience, the Navicular Angle Left is smaller.

The effect of exercise training on lower trunk muscle morphology

BACKGROUND

Skeletal muscle plays an important role in maintaining the stability of the lumbar region. However, there is conflicting evidence regarding the effects of exercise on trunk muscle morphology.

OBJECTIVE

To systematically review the literature on the effects of exercise training on lower trunk muscle morphology to determine the comparative effectiveness of different exercise interventions.

DATA SOURCE AND STUDY SELECTION

A systematic search strategy was conducted in the following databases: PubMed, SportDiscus, CINAHL, the Cochrane Library and PEDro. We included full, peer-reviewed, prospective longitudinal studies, including randomized controlled trials and single-group designs, such as pre- to post-intervention and crossover studies, reporting on the effect of exercise training on trunk muscle morphology.

STUDY APPRAISAL AND SYNTHESIS

Study quality was assessed with the Cochrane risk-of-bias tool. We classified each exercise intervention into four categories, based on the primary exercise approach: motor control, machine-based resistance, non-machine-based resistance or cardiovascular. Treatment effects were estimated using within-group standardized mean differences (SMDs).

RESULTS

The systematic search identified 1,911 studies; of which 29 met our selection criteria: motor control (n = 12), machine-based resistance (n = 10), non-machine-based resistance (n = 5) and cardiovascular (n = 2). Fourteen studies (48 %) reported an increase in trunk muscle size following exercise training. Among positive trials, the largest effects were reported by studies testing combined motor control and non-machine-based resistance exercise (SMD [95 % CI] = 0.66 [0.06 to 1.27] to 3.39 [2.80 to 3.98]) and machine-based resistance exercise programmes (SMD [95 % CI] = 0.52 [0.01 to 1.03] to 1.79 [0.87 to 2.72]). Most studies investigating the effects of non-machine-based resistance exercise reported no change in trunk muscle morphology, with one study reporting a medium effect on trunk muscle size (SMD [95 % CI] = 0.60 [0.03 to 1.16]). Cardiovascular exercise interventions demonstrated no effect on trunk muscle morphology (SMD [95 % CI] = -0.16 [-1.14 to 0.81] to 0.09 [-0.83 to 1.01]).

LIMITATIONS

We excluded studies published in languages other than English, and therefore it is possible that the results of relevant studies are not represented in this review. There was large clinical heterogeneity between the included studies, which prevented data synthesis. Among the studies included in this review, common sources of potential bias were random sequence generation, allocation concealment and blinding. Finally, the details of the exercise parameters were poorly reported in most studies.

CONCLUSION

Approximately half of the included studies reported an increase in lower trunk muscle size following participation in an exercise programme. Among positive trials, studies involving motor control exercises combined with non-machine-based resistance exercise, as well as machine-based resistance exercises, demonstrated medium to large effects on trunk muscle size. Most studies examining the effect of non-machine-based resistance exercise and all studies investigating cardiovascular exercise reported no effect on trunk muscle morphology. However, these results should be interpreted with caution because of the substantial risk of bias and suboptimal reporting of exercise details in the included studies. Additional research, using methods ensuring a low risk of bias, are required to further elucidate the effects of exercise on trunk muscle morphology.

Interspinous ligament calcification in a collegiate gymnast

A 21-year-old collegiate gymnast presented with midline pain at the thoracolumbar junction upon back extension and a "gritty" sensation at that level. Ultrasound revealed an area of hyperechogenicity, representing a calcification, within the interspinous ligament at the area of maximal tenderness at the T12-L1 level. Under ultrasound guidance, multiple fenestrations were made into the calcification and a mixture of lidocaine and triamcinolone was injected. The patient experienced immediate improvement in her symptoms, and resolution occurred during the subsequent 6 weeks; she was able to make a gradual return to gymnastics. Interspinous ligament calcification in a young athlete has not been previously reported.