Gymnastic injuries

Pediatric and Adolescent Shoulder Instability

PURPOSE OF REVIEW

Traumatic and atraumatic shoulder instability is common in pediatric and adolescent patients. It is well-established that young patients with anterior shoulder dislocation are at high risk of recurrent instability. This review assesses the current literature pertaining to management of both anterior instability and MDI in the pediatric and adolescent populations.

RECENT FINDINGS

Current research suggests that pediatric and adolescent patients with shoulder instability have excellent outcomes following arthroscopic Bankart repair; however, higher rates of recurrent instability requiring revision surgical management have been identified in patients with more than one dislocation episode pre-operatively, those with Hill-Sachs lesions and those under age 16. The addition of the remplissage procedure to an arthroscopic Bankart repair may be useful in preventing recurrent instability for patients with large Hill-Sachs lesions. Open procedures with bony glenoid augmentation may be indicated in patients with significant glenoid bone loss, or those who have failed primary surgical management, with promising outcomes reported following the Latarjet coracoid process transfer procedure in the adolescent population. Pediatric and adolescent patients with hyperlaxity, and those participating in swimming or gymnastics are more likely to have multidirectional instability (MDI). Non-surgical management with physical therapy is the mainstay of treatment for MDI with positive outcomes reported overall. In young patients with MDI who continue to have symptoms of instability and pain that effects daily activities or sports despite an adequate and appropriate course of rehabilitation, surgical management with capsulorrhaphy may be considered, with promising outcomes reported for both open and arthroscopic techniques. Attentive selection of timing and surgical procedure for pediatric and adolescent patients with anterior shoulder instability may help to prevent recurrent instability following shoulder stabilization. Although most pediatric and adolescent patients with MDI do well following non-surgical management alone, those that fail conservative management have good outcomes following arthroscopic or open capsulorrhaphy.

A Systematic Review of Dynamic, Kinematic, and Muscle Activity during Gymnastic Still Rings Elements

Still rings are a unique gymnastics apparatus allowing for a combination of dynamic and static elements in a specific technique. This review aimed to compile the dynamic, kinematic, and EMG characteristics of swing, dismount, handstand, strength, and hold elements on still rings. This systematic review was conducted in concordance with PRISMA in PubMed, EBSCOhost, Scopus, and Web of Science databases. In total, 37 studies were included, describing the strength and hold elements, the kip and swing elements, swing through or to handstand, and dismounts. The current evidence suggests that the execution of gymnastics elements on still rings and training drills requires a high training load. Specific preconditioning exercises could be used to train for the Swallow, iron cross, and support scale. Negative impacts of load during hold elements can be reduced by special support devices such as the Herdos or support belts. Another aspect is improving strength prerequisites by exercises such as bench presses, barbell exercises, and support belts, where the main focus should be on muscular coordination similar to the other considerable elements. Electromyography is an appropriate tool for the investigation of muscular coordination and force platforms for assessing a sufficient strength level to successfully perform elements on still rings.

The use of inertial measurement units to quantify forearm loading and symmetry during gymnastics vault training sessions

The upper limbs are important in gymnastics vaulting, as the success of the flight phase is dependent on a quick and forceful push-off from the vault. This places the upper limbs under stress, which has been associated with pain and injury. This study aimed to quantify forearm segmental loading and symmetry when performing foundation to advanced-level vaulting skills during training. Twelve advanced-level artistic gymnasts (female, n = 6; male, n = 6) wore bilaterally forearm-mounted inertial measurement units while completing their vaulting sessions. The peak resultant acceleration for the leading and non-leading forearms during contact were calculated. Female gymnasts performed variations of Yurchenko vaults, while male gymnasts performed Handspring and Tsukahara vaults. Descriptive statistics (median and inter-quartile range), symmetry index scores, and total session impact load (measure of cumulative loading) were calculated between the lead and non-lead forearms. High asymmetrical loading was identified for some Yurchenko, Handspring, and Tsukahara vaults, with large variations identified between gymnasts. Some gymnasts experienced greater loading at their lead forearm, while others experienced greater loading at their non-lead forearm. Results indicate that limb loading patterns in advanced gymnastics are highly individualised, indicating that individual analysis is needed to identify gymnasts (or limbs) at an increased risk for overuse injury.

Screening Tools as a Predictor of Injury in Gymnastics: Systematic Literature Review

Background

Gymnastics requires a high level of physical ability and technical skill which utilises short sets of athleticism and artistry to perform complex and intense movements which can overload musculoskeletal tissues and result in acute injuries which can develop into chronic injuries. The aim of this systematic literature review was to investigate which screening tools predict injury in gymnasts and encompasses all genres, levels and ages.

Methods

An electronic search of seven databases from their inception until March 2021 was conducted. The databases were the Allied and Complementary Medicine Database, CINAHL, eBook Collection (EBSCOhost), MEDLINE, Cochrane Database of Systematic Reviews, SPORTDiscus and PEDro (the Physiotherapy Evidence Base). A combination of the following search terms was used: (1) Gymnastics AND injury AND Screening, (2) Screening AND Gymnastics and (3) Musculoskeletal AND Screening AND Gymnastics. These terms were searched in all text, abstract, title and subject terms. Studies were assessed using a 20-point scoring tool.

Results

The mean methodological quality score was 13.1 points (range 10–17 points). Range of motion, anthropometric and postural measurements, hypermobility, clinical diagnostic tests, movement screening tools, muscle strength, power and endurance were reported in the included studies. Some evidence existed for screening measurement of height and mass as taller and heavier gymnasts might be more susceptible to injury; however, the different methodologies utilised and lack of acknowledgment of confounding variables limit the clinical relevance of these findings.

Conclusions

Height and mass should be recorded during the screening process. A lack of heterogeneity in study methodology prevented a meta-analysis. Studies were limited by a lack of prospective injury design, poor injury definition, self-reporting of injury and only 2 studies reported reliability of screening tools. Further research is required to determine the role of injury screening in gymnastics.

Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42020218339.

The Injured Shoulder in High-Level Male Gymnasts, Part 1: Epidemiology and Pathoanatomy of Surgically Treated Lesions

BACKGROUND

Weightbearing and traction-suspension movements with the upper limbs put considerable demands upon the shoulder region of high-level gymnasts. The diagnosis of instability in these gymnasts may be difficult because voluntary inferior shoulder subluxation is part of their training and is needed to perform some acrobatic figures.

PURPOSE

To (1) assess the epidemiology of shoulder lesions requiring surgery, (2) describe the types of injuries and assess which maneuvers and equipment put the gymnast most at risk, and (3) present a pathoanatomic classification of the injured shoulder in high-level male gymnasts.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Over a 20-year period (1994-2014), 26 high-level male gymnasts (30 shoulders; mean age, 22 years; range, 16-33 years) were referred to our surgical center for shoulder pain or instability. Four gymnasts underwent surgery on both shoulders. All shoulders were evaluated clinically, radiologically, and arthroscopically. An independent observer evaluated the circumstances in which these lesions occurred, including the apparatus used and the maneuvers performed.

RESULTS

The mean duration of symptoms before surgery was 8 months (range, 6-24 months). Eighteen injured shoulders (60%) had chronic overuse injuries. In 27 shoulders (90%), the mechanism of injury was traction of the arm in forced flexion-rotation while using suspension equipment with locked hands on the bars or the rings. In the remaining 3 shoulders, the traumatic position was one of an isometric muscle contraction against gravity, sustained while performing strength-and-hold positions on the rings. Based on the main presenting symptoms (pain and/or instability) and main anatomic lesions found during arthroscopy, the injured gymnasts' shoulders were classified into 2 categories: painful shoulders (n = 13) with no clinical, radiological, or arthroscopic findings of instability (mainly superior cuff and biceps anchor lesions) and unstable shoulders (n = 17) with isolated inferior capsule labral tears or mixed lesions (tendinous and capsulolabral). Some gymnasts with inferior labral tears had no recall of having suffered a dislocation or subluxation.

CONCLUSION

The majority of injuries requiring surgery in this population occurred during traction in forced flexion-rotation using suspension equipment. Injured shoulders were classified as either painful or unstable shoulders.

ANALYSIS AND COMPARISON OF TRAINING LOAD BETWEEN TWO GROUPS OF WOMEN’S ARTISTIC GYMNASTS RELATED TO THE PERCEPTION OF EFFORT AND THE RATING OF THE PERCEIVED EFFORT SESSION

The aim of this study was to assess the internal training load in female artisticgymnastics through subjective perception of effort (PSE) by calculating the sRPE variableand different associated variables. Ten gymnasts participated (age: 14.4 ± 2.9 years; height:1.5 ± 0.1 m; mass: 43.3 ± 12.2 kg) and were divided into two groups according to theircompetitive level and weekly training volume: High Level Gymnasts (HLG) and MediumLevel Gymnasts (MLG). The PSE of each gymnast was recorded daily for four weeks after theend of each training block. The HLG group recorded a significantly higher RPE and sRPEvalue in the specific physical preparation (SST) and in the parallel technical training (UB)contents (p < 0.05) compared to MLG. Statistically significant differences were also obtainedfrom the registered mean values of RPE and sRPE when comparing training content.Furthermore, a direct relationship between volume and workload was observed. Finally, thevariables associated with injury risk control provided relevant information to determine thatthe HLG group had a higher risk of injury than the MLG group. Therefore, the sRPE hasbeen a useful tool to assess the internal training load in women's artistic gymnastics. Suchinformation may help quantify the load in this sport in the future.

A systematic review of injuries in gymnastics

OBJECTIVES

To identify all studies of gymnastics injuries and assess injury rates, types, locations, and causes.

METHODS

Seven electronic and two grey literature databases were searched. Two reviewers independently assessed titles/abstracts, abstracted data, and calculated average rates weighted by study size.

RESULTS

One study (n = 963) of three Olympic games (2008,2012,2016) provided injury rates for females of 86.4/1000gymnasts and males 79.9. For 29 databases one study of males (n = 64) provided a rate of 8.8 injuries/1000hours/AE (AE = athletic-exposure) and three of females varied rates (8.5, 9.4, and 91). Three studies for males (n = 153) provided a weighted average rate of 1.4 injuries/1000hours/training, and for females six studies (n = 476) 1.5 injuries. Four studies of males (n = 286) provided a weighted average of 678 injuries/1000gymnasts per year and eight studies of females (n = 1,764) a rate of 306. Of 19 surveys, eight provided rates for females (n = 1,463) of 596 injuries/gymnast per year and two for males (n = 40) a rate of 1,036. In the Olympics injuries were preponderately lower limb (63%) then trunk (23%) and upper limb (14%); injury type was sprains (35%) followed by tendinopathy/arthritis/impingements (17%), contusions (10%), and fractures (7%). Five database studies provided injury location data for 274 males: averages weighted by study size were upper extremity 42.8%, lower extremity 33.6%, torso/spine 11.8%, and head/neck 4.9% and 12 studies with 843 females provided average rates for lower extremity 51%, upper extremity 30.8%, torso/spine 13% and head/neck 0.8%. Official gymnastics organizations' websites provide no readily available data about injury rates or methods of prevention.

CONCLUSIONS

Studies need to collect comprehensive data for injury rates by training/competitions, gender, age, injury location/type/cause. Studies could assess whether trainers and physiotherapists monitoring gymnasts closely for injury risk would reduce injuries. Studies including randomized controlled trials (RCTs) of interventions in training, videotaping and performance feedback to reduce injury rates would be helpful.

Injury epidemiology and risk factors in competitive artistic gymnasts: a systematic review

Background

Artistic gymnastics is reported to have some of the highest injury rates in sports, which limits participation and often involves considerable medical expenses.

Purpose

To critically appraise the epidemiological literature on injury patterns and risk factors in competitive artistic gymnastics.

Study design

Systematic review.

Methods

Six databases were searched for articles that investigated injuries in competitive artistic gymnasts. Injury incidence, prevalence and risk factor data were extracted, alongside information on injury location, type, severity, nature and mechanism of injury. Quality and level of evidence were assessed using a modified Downs and Black quality index checklist and the Oxford Centre for Evidence-based Medicine guidelines.

Results

The search identified 894 articles, with 22 eligible for inclusion. Descriptive analysis showed that injury incidence and prevalence varied from 0.3 to 3.6 injuries per gymnast (female=0.3–3.6, male=0.7) and 2.0–2.3 (female=2.0–2.3, male=2.0), respectively. Male gymnasts sustained mostly upper limb injuries, while female gymnast reported lower limb injuries. Floor was associated with the greatest number of injuries for both male and female gymnasts. Higher competitive level and exposure to competition were risk factors for gymnastics injury: age, body mass, body size, training duration and life stress were significant associated factors.

Conclusion

Injury incidence and prevalence results are substantial among artistic gymnasts of all competitive levels. Gymnasts who train at highly competitive levels and are exposed to competition environments are a greater risk of injury. Future researchers should implement consistent reporting methods.

A systematic review of shoulder injury prevalence, proportion, rate, type, onset, severity, mechanism and risk factors in female artistic gymnasts

OBJECTIVES

Systematically review shoulder injury prevalence, proportion, rate, type, onset, severity, mechanism, risk factors in female artistic gymnasts.

METHODS

PubMed, Web of Science, Scopus, Cochrane Library were searched on 7/01/2017. Original studies reporting data for female artistic gymnasts only, of any age or level were included. Quality assessment was undertaken using Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

Fifteen observational studies were included. Thirteen were poor/fair quality. Shoulder injury prevalence (0%-86.9%) was higher in international (29.2%) versus national (20%) gymnasts. As a proportion of all injuries, shoulder injuries made up 4.2%-7.5%. Rates (0.35-5.7/1000 athlete exposures) were greater during practice (5.0/1000) than competition (2.4/1000). Multidirectional instability (33.8%, 37.7%) and musculotendinous injury (26.6%-90.9%) were the most common injury. In four studies 66.2%-100% of total shoulder injuries were acute onset. Most (59.3%) shoulder injuries were minor, 7.4% required surgery and 80% caused symptoms post-retirement. Asymmetric bars were the most frequent mechanism of shoulder injury. One study reported excessive shoulder stretching, hyperlaxity and instability as significant (p < 0.001) potential risk factors.

CONCLUSIONS

Shoulder injuries are a problem among female artistic gymnasts. Interventional studies reporting age and competition level-specific data may guide prevention strategy implementation.

Extensor Tendon Impingement in a Gymnast

Wrist injuries in the gymnast are due to the transformation of the upper extremity into a weight bearing entity. Gymnast wrist pain presents a difficult diagnostic and therapeutic challenge. Here, we present a new case of extensor tendon impingement in an elite gymnast. To our knowledge, there is no similar report in the literature.

[The gymnastics shoulder]

BACKGROUND

Adult gymnasts show a high prevalence of various shoulder pathologies. Due to the specific equipment used in gymnastics and the high training schedule with weekly training times up to 32 h, the shoulders of gymnasts are mostly subjected to symmetrical bilateral weight bearing. This is in contrast to overhead throwing, racket and martial arts sport forms in which the load is mainly located on the dominant side.

CAUSES OF INJURY

Structural lesions of the shoulder and shoulder girdle in male gymnasts can arise due to high repetitive support and swing forces during exercises on the six specific types of apparatus and particularly the rings.

INJURY PATTERNS

These lesions particularly affect the biceps tendon anchor, the long head of the biceps tendon and the tendon of the supraspinatus muscle. Because possible pathologies can increasingly occur even in younger gymnasts, awareness of the treating physician and also the trainer should be increased.

THERAPY

Early initiation of intensive conservative treatment and arthroscopic interventions in cases of failure of non-operative management are relevant for satisfying results. Modern arthroscopic reconstructive techniques are available for treating structural lesions.

CONCLUSION

Nevertheless, in almost 30 % of the patients the occurrence of shoulder pain or the necessity for surgical interventions will prevent them from achieving the national or international level of competition. This underlines the necessity for development of prevention programs.

Pediatric and adolescent shoulder instability

Instability of the shoulder is a common issue faced by sports medicine providers caring for pediatric and adolescent patients. A thorough history and physical examination can help distinguish traumatic instability from multidirectional or voluntary instability. A systematic understanding of the relevant imaging characteristics and individual patient disease and goals can help guide initial treatment. Given the high risk of recurrent instability, young, active patients who seek to return to competitive contact sports should consider arthroscopic stabilization after a first-time instability event. MDI should be treated initially with conservative rehabilitation. Patients who fail extensive conservative treatment may benefit from surgical stabilization. Arthroscopic techniques may now approach the results found from traditional open capsular shift procedures. Future studies should be designed to examine the outcomes in solely pediatric and adolescent populations after both conservative and operative treatment of shoulder instability.

Heart rate variability reflects training load and psychophysiological status in young elite gymnasts

In gymnastics, monitoring of the training load and assessment of the psychophysiological status of elite athletes is important for training planning and to avoid overtraining, consequently reducing the risk of injures. The aim of this study was to examine whether heart rate variability (HRV) is a valuable tool to determine training load and psychophysiological status in young elite gymnasts. Six young male elite gymnasts took part in a 10-week observational study. During this period, beat-to-beat heart rate intervals were measured every training day in weeks 1, 3, 5, 7, and 9. Balance, agility, upper limb maximal strength, lower limb explosive, and elastic power were monitored during weeks 2, 4, 6, 8, and 10. Training load of each training session of all 10 weeks was assessed by session rating of perceived exertion (RPE) and psychophysiological status by Foster's index. Morning supine HRV (HF% and LF%/HF%) correlated with the training load of the previous day (r = 0.232, r = -0.279, p < 0.05 ). Morning supine to sitting HRV difference (mean R wave to R wave interval (RR), mean heart rate, HF%, SD1) correlated with session RPE of the previous day (r = -0.320, r = 0.301, p < 0.01; r = 0.265, r = -0.270, p < 0.05) but not with Foster's index. Training day/reference day HRV difference (mean RR, SD1) showed the best correlations with session RPE of the previous day (r = -0.384, r = -0.332, p < 0.01) and Foster's index (r = -0.227, r = -0.260, p < 0.05). In conclusion, HRV, and in particular training day/reference day mean RR difference or SD1 difference, could be useful in monitoring training load and psychophysiological status in young male elite gymnasts.

Specific injuries induced by the practice of trampoline, tumbling and acrobatic gymnastics

PURPOSE

The recreational and competitive practice of acrobatic sports, that is, trampoline, tumbling and acrobatic gymnastics (ACRO), is growing rapidly around the world. Many studies described the injuries affecting young artistic gymnasts, but only few concerned acrobatic sports.

METHODS

During a 5-year period, 357 traumatic events were collected in young acrobats practicing trampoline, tumbling or ACRO. Accident characteristics, level of expertise and training, injury location (upper limb, spine and lower limb), type of tissue injured (bone, cartilage, muscle, ligament and tendon) and provoking factors (intrinsic/behavioural and extrinsic) were investigated.

RESULTS

Acrobats of national and international levels were mostly injured. Injuries occurring in acrobatic sports concerned predominantly the lower limbs and concerned in this body part mainly damages to ligaments. Forearm and knee injuries were preferentially related to trampoline. Ankle injuries were preferentially related to tumbling. Wrist injuries were preferentially related to ACRO. Upper limb bone damage and upper limb tendon damage were preferentially related to trampoline and ACRO, respectively. Intrinsic/behavioural factors were the main injury determinant in the three acrobatic sports.

CONCLUSIONS

The main injuries in acrobatic sports (i.e. lower limbs) are similar to those observed in artistic gymnastics. Specific injuries may result from falls and incomplete and/or erroneous figure's landing and may also depend to the type of the landing surface.

LEVEL OF EVIDENCE

II.

Modifying landing mat material properties may decrease peak contact forces but increase forefoot forces in gymnastics landings

This study investigated how changes in the material properties of a landing mat could minimise ground reaction forces (GRF) and internal loading on a gymnast during landing. A multi-layer model of a gymnastics competition landing mat and a subject-specific seven-link wobbling mass model of a gymnast were developed to address this aim. Landing mat properties (stiffness and damping) were optimised using a Simplex algorithm to minimise GRF and internal loading. The optimisation of the landing mat parameters was characterised by minimal changes to the mat's stiffness (<0.5%) but increased damping (272%) compared to the competition landing mat. Changes to the landing mat resulted in reduced peak vertical and horizontal GRF and reduced bone bending moments in the shank and thigh compared to a matching simulation. Peak bone bending moments within the thigh and shank were reduced by 6% from 321.5 Nm to 302.5Nm and GRF by 12% from 8626 N to 7552 N when compared to a matching simulation. The reduction in these forces may help to reduce the risk of bone fracture injury associated with a single landing and reduce the risk of a chronic injury such as a stress fracture.

Gymnastics injuries and imaging in children

Injuries of children participating in gymnastics are seen less often than in more popular sports. Patterns of injury are predictable based upon sex, age and level of intensity of training and competition. More injuries are seen in girls than in boys, and the great majority of early adolescents who compete have wrist pain. Some otherwise quiescent congenital spine anomalies may be uncovered by the stress of gymnastics maneuvers and present with low back pain. In addition to diagnosis of injuries, imaging can be used to guide analgesic and anti-inflammatory therapy in some injured athletes. Parents whose children wish to participate in gymnastics should understand that fewer injuries occur in the child enjoying recreational gymnastics than in competing gymnasts. More gymnastics injuries are found in very competitive athletes training at higher levels.

Reducing ground reaction forces in gymnastics' landings may increase internal loading

The aim of this study was to use a subject-specific seven-link wobbling mass model of a gymnast, and a multi-layer model of a landing mat, to determine landing strategies that minimise ground reaction forces (GRF) and internal forces. Subject-specific strength parameters were determined that defined the maximum voluntary torque/angle/angular velocity relationship at each joint. These relationships were used to produce subject-specific 'lumped' linear muscle models for each joint. Muscle activation histories were optimised using a Simplex algorithm to minimise GRF or bone bending moments for forward and backward rotating vault landings. Optimising the landing strategy to minimise each of the GRF reduced the peak vertical and horizontal GRF by 9% for the backward rotating vault and by 8% and 48% for the forward rotating vault, compared to a matching simulation. However, most internal loading measures (bone bending moments, joint reaction forces and muscle forces) increased compared to the matching simulation. Optimising the landing strategy to minimise the peak bone bending moments resulted in reduced internal loading measures, and in most cases reduced GRF. Bone bending moments were reduced by 27% during the forward rotating vault and by 2% during the backward rotating vault landings when compared to the matching simulations. It is possible for a gymnast to modify their landing strategy in order to minimise internal forces and lower GRF. However, using a reduction in GRF, due to a change in landing strategy, as a basis for a reduction in injury potential in vaulting movements may not be appropriate since internal loading can increase.

Lesões desportivas na ginástica artística: estudo a partir de morbidade referida

INTRODUÇÃO: Os níveis de exigência biomecânica devidos ao alto grau de dificuldade na realização de gestos fazem da ginástica artística (GA) uma modalidade com elevado risco de lesões. Assim, é necessário que os aspectos a elas relacionados sejam controlados. OBJETIVO: Analisar a ocorrência de lesões na Ginástica Artística, associando-as a fatores de risco específicos da modalidade e do atleta, a partir de inquérito de morbidade referida. MÉTODOS: Foram entrevistados 54 ginastas, recrutados ao acaso, classificados segundo o nível competitivo em duas categorias: regional e nacional. Utilizou-se o inquérito de morbidade referida (IMR) com a finalidade de reunir dados sobre a natureza da lesão, região corporal e aparelho ginástico. Os dados foram organizados e apresentados sob a forma de distribuição de freqüências e as variáveis, analisadas segundo nível de associação a partir do teste de Goodman para contrastes entre populações multinomiais, considerando significante o valor P < 0,05. RESULTADOS: Presença de lesão durante a temporada foi relatada por 39 (71,70%) atletas, sendo 22 (56,41%) mulheres e 17 (43,59%) homens. Nas categorias regional masculino e feminino e nacional feminino, a maior ocorrência de lesões foi de origem articular, correspondendo a 55,56%, 50% e 45,45% do total, respectivamente. Para o sexo feminino nacional, os membros inferiores foram os mais referidos (68,18%) e, em ambas as categorias, as lesões ocorreram nos aparelhos de saltos (79,41%), enquanto que no sexo masculino nacional o maior número de agravos foi verificado nos aparelhos de apoio e suspensão (72%). CONCLUSÕES: Há elevada freqüência de lesões, acometendo principalmente articulações e membros inferiores, sendo os aparelhos de saltos os mais referidos quanto à ocorrência de acometimentos. Foi observado também que, quanto maiores as exigências de desempenho técnico, maior a freqüência de lesões.

Programas e campanhas de promoção da atividade física

O incentivo à prática regular da atividade física vem sendo apontado como importante ação na área da saúde pública, o que vem ensejando iniciativas de larga abrangência populacional, na forma de programas e campanhas em prol de estilos de vida ativos. Neste artigo, fazemos reflexões sobre o processo de adesão à prática regular de atividades físicas e sobre as ações costumeiramente adotadas nesse sentido em programas de promoção da atividade física (especialmente Agita São Paulo e Programa de Educação e Saúde através do Exercício Físico e do Esporte). Identificamos que os objetivos, estratégias e avaliações dos programas enfocam o aumento do nível de atividade física da população e a ampliação de seus conhecimentos sobre os benefícios da atividade física. Tendo em vista a complexidade da adesão à prática de atividades físicas, apontamos a necessidade de se ampliar o número de variáveis sobre as quais devem repousar as ações e a avaliação dos programas. A nosso ver, além do quantitativo de pessoas fisicamente ativas, é preciso considerar variáveis como oferta, acessibilidade e qualidade de espaços para traduzir melhor o desempenho das ações adotadas, tornando mais consistentes a elaboração e a avaliação desses programas de promoção da atividade física de larga abrangência populacional.

Impact Modeling of Gymnastic Back-Handsprings and Dive-Rolls in Children

This study was to determine estimates of the stiffness and damping properties of the wrist and shoulder in children by examining wrist impacts on the outstretched hand in selected gymnastic activities. The influence of age, mass, and wrist and torso impact velocity on the stiffness and damping properties were also examined. Fourteen young gymnasts (ages 8 to 15 yrs) were videotaped while performing back-handspring trials or dive-rolls. Kinematic and ground reaction analysis provided input for computer simulation of the body as a rheological model with appropriate stiffness and damping. A significant positive linear relationship was obtained between wrist damping in dive rolls and age, mass, and wrist and torso impact velocity, while shoulder damping in the back-handsprings had a significant positive linear relationship with body mass. This new information on stiffness and damping at the shoulder and the wrist in children enables realistic mathematical modeling of children's physical responses to hand impact in falls. This is significant because modeling studies can now be used as an alternative to epidemiological studies to evaluate measures aimed at reducing injuries in gymnastics and other activities involving impact to the upper extremity.

Fear of injury in gymnastics: Self-efficacy and psychological strategies to keep on tumbling

The aim of this study was to examine female gymnasts' fear of injury, their sources of self-efficacy and the psychological strategies used to overcome their fears. The participants were 10 female gymnasts aged 12 - 17 years. They had all taken part in competitive gymnastics and had experienced some type of injury during their careers. Individual interviews were conducted using a structured interview guide. Data were analysed using an inductive content analysis. The results indicated that gymnasts were most fearful of injuries because of the difficulty in returning from an injury and being unable to participate in practices and competitions while injured. Gymnasts described aspects of their past performance experience, such as success, consistency and communication with significant others, as important sources of self-efficacy. Some examples of psychological strategies used to overcome their fear of injury were mental preparation (e.g. imagery, relaxation), just "going for a skill" and the coaches' influence.

Effect of a prophylactic brace on wrist and ulnocarpal joint biomechanics in a cadaveric model

BACKGROUND

Wrist pain from repetitive dorsiflexion and compression during pommel horse exercises is common among male gymnasts.

PURPOSE

To determine the biomechanical effects of a prophylactic wrist brace on the wrist and ulnocarpal joints during mechanical loading in a cadaveric model.

HYPOTHESIS

The lateral wedge of the palmar pad of the brace will compensate for positive ulnar variance, distributing contact forces more evenly across the radioulnar carpal joint.

STUDY DESIGN

Controlled laboratory study.

METHODS

Six male and six female fixed cadaveric forearm-wrist specimens were subjected to a 32.13-kg compressive load applied through the long axis of the pronated forearm with a dorsiflexed wrist in contact with a support surface. Wrist joint dorsiflexion angle and ulnocarpal joint intraarticular peak pressure were assessed under three brace conditions: Ezy ProBrace with and without palmar pad and a nonbraced control.

RESULTS

Wrist joint dorsiflexion angle was significantly reduced by the Ezy ProBrace with and without the palmar pad. However, ulnocarpal joint intraarticular peak pressure was reduced only by the brace with pad.

CONCLUSION

Prevention of pathologic wrist changes requires intervention in pressure attenuation, which was achieved with the Ezy ProBrace with palmar pad.

CLINICAL RELEVANCE

This brace may decrease the cumulative effects of repetitive stress of pommel horse exercise training.

On-the-field evaluation of an athlete with a head or neck injury

Head and cervical spine sports-related injuries are intimately associated. The on-field evaluation and management of the athlete with these injuries is of paramount importance to stabilize the athlete and prevent further injury. Clinicians need to be aware of the differential diagnoses and consider each possibility based on the mechanism of injury. Although recognition of head and cervical spine injuries has resulted in significant reductions of catastrophic neurological injuries, especially in the cervical spine, further advances to decrease the incidence and long-term sequelae of head and neck injuries are needed. The first step is education of the athlete and the individuals involved in the care of that athlete.

Occurrence of acute lower limb injuries in artistic gymnasts in relation to event and exercise phase

OBJECTIVES

To record the incidence of lower limb injuries (acute and overuse syndromes) in Greek artistic gymnasts in relation to the event and exercise phase.

METHODS

A total of 162 gymnasts (83 male and 79 female athletes) participating in the Greek artistic gymnastic championships were observed weekly for the 1999-2000 season.

RESULTS

Ninety three (61.6%) acute injuries and 58 (38.4%) overuse syndromes were recorded. The most common anatomical location was the ankle (69 cases, 45.7%), followed by the knee (40 cases, 26.5%). The rate of mild injuries was 26.6% (25 cases), that of moderate injuries was 44% (41 cases), and that of major injuries was 29% (27 cases). The incidence of injury to the ankle and knee was significantly higher in the floor exercise, especially during the landing phase, than in the other events.

CONCLUSIONS

By its nature, gymnastics predisposes to acute injuries, but up to 75% are mild or moderate. Special attention should be paid to the floor exercise, especially the landing phase.

Premenarchal athletic injury to the breast bud as the cause for asymmetry: prevention and treatment

Some variation in breast size is normal and is common in most women. When this variation becomes large and appreciable asymmetry develops--greater than a one-cup size difference--the asymmetry often disrupts the patient's life. The etiology of most breast asymmetries is unknown; however, current theories on causes include endocrine, iatrogenic, and traumatic injury. The Tulane University Plastic Surgery Service recently evaluated two cases of breast asymmetries that developed after traumatic injury to the breast bud while the body was under increased physical stress. Both girls sustained injuries at approximately 10 to 11 years old (Tanner Stages I-II) while participating in gymnastics.

[Influence of age and physical activity on isokinetic characteristics of hamstring and quadriceps muscles of young gymnasts and soccer players]

OBJECTIVE

The aim of this work is the assessment of age and sport influences on the isokinetic knee muscle characteristics.

SUBJECTS AND METHOD

Subjects performed a bilateral knee flexion/extension test on an isokinetic device at 60 and 180 degrees.s(-1) speed in concentric mode. The three parameters studied in this work were the Peak Torque, Average Power and hamstring/quadriceps ratio. Thirty-eight soccer players (16,6 +/- 1.4 years old) and 22 gymnasts (18 +/- 2.8 years old) were tested. The population was separated into three groups : 15 years old, 17 years old, 20 years old.

RESULTS

The isokinetic values of soccer players were significantly higher (p < 0.0001) than those of the the gymnasts. The isokinetic values of the oldest soccer players were significantly higher (0.005 < p < 0.05) for hamstrings than those of the younger soccer players. The isokinetic values of the oldest gymnasts were significantly higher (0.005 < p < 0.05) for the quadriceps than those of the younger gymnasts. There were no significant differences between dominant and non dominant limbs in soccer players.

CONCLUSION

In the present study, the muscular maturation improves the absolute strength of the older sportsmen in comparison to the younger. Soccer favor most the absolute strength of the inferior member in comparison to the gymnastics.

Balancing the risk of injury to gymnasts: how effective are the counter measures?

BACKGROUND

To minimise injury risk and maximise gymnastics performance, coaches, parents, and health professionals working with young gymnasts need to understand and practise safe gymnastics.

AIMS

To (a) identify the various injury counter measures specific to gymnastics, (b) critically review the literature describing each injury prevention measure, and (c) assess, using available risk factor and injury data, the weight of evidence to support each of these counter measures. Specific recommendations for further research and implementation strategies to prevent injury and improve safety are also given.

METHODS

The relevant literature was identified through the use of Medline (1966 to May 1998) and SPORT Discus (1975 to May 1998) searches, hand searching of journals and reference lists, and discussions with key Australian gymnastics organisations.

RESULTS

The key gymnastics injury counter measures identified in this review include coaching (physical preparation, education, spotting, and performance technique), equipment, and the health support system (medical screening, treatment, and rehabilitation). Categorisation of the type of evidence for the effectiveness of each of these counter measures in preventing injury showed that most of it is based on informal opinion/anecdotal evidence, uncontrolled data based studies, and several prospective epidemiological studies. There is no evidence from formally controlled trials or specific evaluation studies of counter measures for gymnastics.

CONCLUSIONS

Although gymnastics is a sport associated with young participants and frequent high volume, high impact training, there is a paucity of information on injury risk factors and the effectiveness of injury practices. Further controlled trials are needed to examine the extent to which injury prevention counter measures can prevent or reduce the occurrence of injury and re-injury. Particular attention should be devoted to improving training facilities, the design and testing of apparatus and personal equipment used by gymnasts, and coaching and the role of spotting in preventing injury.

Head and neck injuries in young athletes

Careful study of the pathophysiology and epidemiology of sports-related spine injuries brings to light many common features. The incidence increases as the sport becomes increasingly violent and aggressive. Poor conditioning and lack of knowledge of the proper techniques of the sport put the athlete at significant risk for head and spine injury. Improper helmet fit and the use of the head as an offensive weapon also are common features of injury. Although recognition of these features has resulted in a dramatic reduction in catastrophic neurological injury, the athlete remains at risk for less severe head and spine injury, and concussion remains at epidemic proportions at high school, university, and professional levels. It is hoped that careful recognition of the signs of concussion and knowledge of return-to-play criteria will prevent catastrophic complications from minor head injuries, although the long-term effects of multiple concussions on cognition may be problematic.

Epidemiology of injury in elite and subelite female gymnasts: a comparison of retrospective and prospective findings

OBJECTIVES

An 18 month prospective injury survey was conducted on 64 Australian elite and subelite female gymnasts. The aims were to determine the rate of injury, anatomical location, and types of injury incurred by female competitive gymnasts, and to compare the findings with data collected retrospectively from the same sample of gymnasts.

METHODS

The gymnasts recorded (weekly) in an injury record booklet the number of hours trained and information on any injuries suffered over that week.

RESULTS

The sample reported 349 injuries, a rate of 5.45 per person (6.29 for the elite and 4.95 for subelite gymnasts) over the 18 month survey. Injuries to the ankle and foot (31.2%) were the most commonly reported, followed by the lower back (14.9%). The most prevalent type of injury were sprains (29.7%), followed by strains (23.2%), and growth plate injuries (12.3%). The elite gymnasts reported that, for each injury, they missed fewer training sessions (p = 0.01), but modified more sessions (p = 0.0001) than their subelite counterparts. Further, the elite gymnasts spent 21.0% of the year training at less than full capacity because of injury. Although a significantly higher number of injuries were recorded in the prospective study (p = 0.0004), no differences were found between the distribution of injury by anatomical location or type between the two methods of data collection.

CONCLUSIONS

The findings have important implications in terms of training procedures and periodic screening of gymnasts.

Foot and ankle problems in the young athlete

In the U.S., greater than half of boys and one quarter of girls in the 8- to 16-yr-old age range are engaged in some type of competitive, scholastic, organized sport during the school year. Children and adolescents are becoming more involved in sports at earlier ages and with higher levels of intensity. Foot and ankle problems, in particular, are the second most common musculoskeletal problem facing primary care physicians in children under 10 yr of age next to acute injury. This report focuses on foot and ankle problems, trauma, and overuse in the young athletic population. Guidelines are given for both conservative and surgical management. Specific problems addressed include pes planus, tarsal coalition, adolescent bunion, os trigonum, accessory navicular, physeal fractures, sprains, peroneal tendon subluxation, metatarsal fractures, sesamoid fractures, turf toe, stress fractures, tendonitis, osteochondritis dissecans, ankle impingement, bursitis, Haglund's deformity, sesamoiditis, plantar fasciitis, apophysitis, osteochondroses, cuboid syndrome, and reflex sympathetic dystrophy. An extensive review of the literature is performed and presented in combination with the extensive experience of a well-established sports medicine clinic at the Boston Children's Hospital.

Does the menstrual cycle and use of oral contraceptives influence the risk of low back pain? A prospective study among female soccer players

Female sex hormones have been suggested to affect the risk of low back pain. One reason is the fact that back pain is a very common symptom during pregnancy. It also seems to be a more common problem among female than male athletes, e.g. in soccer. Although there are few scientific data supporting a relationship between female sex hormones, use of oral contraceptives and low back pain, many doctors and physiotherapists advise women with low back pain to avoid oral contraceptives. The aim of this study was to evaluate whether low back pain fluctuated during the menstrual cycle and differed between women using and not using oral contraceptives. A questionnaire was sent to 12 female soccer teams; 261 players answered and 50 players (28 with back pain and 22 controls) fulfilled the prospective study. At baseline the players underwent a thorough clinical examination and then filled in a diary concerning menstrual data, back pain, training and matches during one season. A total of 296 menstrual cycles was analysed. No difference in prevalence or severity of back pain was seen between the different phases of the menstrual cycle or between users and non-users of oral contraceptives. Our data do not support the hypothesis that low back pain is influenced by hormonal fluctuations during the menstrual cycle or by use of oral contraceptives.

Low back pain and other overuse injuries in a group of Japanese triathletes

OBJECTIVE

To document the incidence of low back pain and other overuse injuries in a group of triathletes, and to investigate any associations with various physical and triathlon related factors.

METHODS

By means of a questionnaire, the physical characteristics, training habits, and the incidences of overuse injuries of 92 Japanese triathletes (70 males, 22 females) were documented. Student's t and chi 2 tests were used to determine the significance of any associations with injury incidence, as well as differences between subjects experiencing or not experiencing low back pain in the previous year.

RESULTS

Low back pain was experienced by 32% of subjects in the previous year. The majority (54%) of low back pain episodes lasted under seven days, suggesting mainly soft tissue involvement, and 19% lasted over three months, suggesting involvement of the intervertebral discs. Weekly trunk flexor muscle training frequency was significantly greater (P = 0.035) for the low back pain subjects. Close to significant differences for average weekly cycling time, trunk flexor muscle training time, and low intensity aerobic training, as well near significant associations for weight training and average weekly triathlon training load, were also found. No other factors were significantly associated with low back pain. Low back injuries accounted for 28% of all injuries. Only the knee was a more common single site of injury (33%).

CONCLUSIONS

The three most common injuries suffered by the triathletes were of the knee, back and shoulder. The low back pain suffered by many triathletes could be of a potentially serious nature. It is suggested that cycling is a major risk factor for low back pain in triathletes.

Oral, maxillofacial and general injuries in gymnasts

It is estimated that between 4 and 18 per cent of all sports injuries involve the maxillofacial region. Among the various sporting activities, gymnastics has been rated as a high-injury risk discipline. The aim of this study was to document the extent and type of oral, maxillofacial and general injuries among gymnasts. The majority of injuries occurred during training and the severity of the injury was strongly associated with the skill level of the gymnast; in other words, advanced level gymnasts suffered more serious injuries, e.g. concussion and direct orofacial injuries. However, 7 per cent had experienced damage to the 'hard' tissues of the mouth during the past 12 months. No gymnast interviewed wore a mouth guard and their knowledge of dental first aid was poor. The study highlights the clear need for a structured health promotion initiative, aimed at those participating in and coaching gymnastics.

Physique as a risk factor for ulnar variance in elite female gymnasts

The aims of this study were: 1) to determine ulnar variance variability of elite, female gymnasts; 2) to evaluate the relationship between ulnar variance and physique, maturity status, and training characteristics of these gymnasts. All 156 skeletally immature female gymnasts were participants at the World Championships Artistic Gymnastics, Rotterdam, The Netherlands, in 1987. Chronological ages varied between 13.1 and 20.6 yr (mean = 15.9 +/- 1.3 yr). A large set of anthropometric dimensions was taken and somatotype was determined by the Heath-Carter technique. Skeletal age was assessed by the Tanner-Whitehouse II method. Menarcheal status and training data were collected by questionnaire. Ulnar variance was determined according to Hafner et al. Gymnasts differ significantly from reference girls with respect to physique and maturational status: gymnasts were smaller and delayed in skeletal maturity with about 1.5 yr. For those who had attained menarche, mean age at menarche was 15.1 +/- 1.3 yr. Ulnar variance shows a normal distribution in the gymnasts, ranging from -10.5 mm to +5.9 mm, which is somewhat more positive, i.e., an ulnar overgrowth, than reference wrists. The relationship between ulnar variance and somatic and maturational features suggests that female gymnasts who are more mature and have a physique characterized as relatively tall with a high lean body mass are at greater risk for developing a positive ulnar variance. No relationship between ulnar variance and training characteristics was evident. It is concluded that the observed positive ulnar variance in this sample of elite female gymnasts is less pronounced than originally stated in most "case reports."

Grip lock injuries to the forearm in male gymnasts

We performed an epidemiologic survey to estimate the number of grip lock injuries occurring among male high school and college gymnasts. These injuries occur when dowel grips used by the gymnast become locked on the bar as the gymnast's momentum carries him through the skill being performed. We also questioned injured gymnasts to obtain details of their injuries. Thirty-eight high school coaches reported 17 injuries and 32 college coaches reported 21 injuries for a 10-year period; 36% of the coaches responding reported at least one such injury in their program. Of the 23 injured gymnasts who returned detailed questionnaires, 20 had sustained fractures and 9 required surgery. The distal forearm or wrist were the areas injured most often. Fourteen gymnasts had residual pain, seven had functional limitations, and eight had limited motion in the wrist. Fifteen of the 23 athletes were using a cubital (hyperpronated) grip at the time of injury and 19 were using dowel grips. Among the reasons cited for the injury, 18 gymnasts thought that their grips were either too large, worn, or stretched; 8 said the grips slid up their wrists, and 7 cited technical errors.

Injury incidence and cause in elite gymnasts

This report describes the incidence, localization, and cause of injuries in Swedish male and female elite gymnasts during 18 active months (three seasons). Thirty-one elite gymnast clubs with all together 437 gymnasts were included in the study, which consisted of a written questionnaire reporting morphometric facts as well as data concerning the injury. There were in total 82 injury reports. The injury incidence was 6.25 per 100 elite gymnasts and season. A majority of the injuries occurred in the lower extremities. The right leg was injured more often than the left. Most of the severe injuries occurred during mounting and dismounting which advocates the need for preventive measures in association with these particular events. Male gymnasts were more prone to sustain severer injuries such as dislocations and fractures. Severe injuries affected the upper extremity in 83%, and the right side was injured more often than the left.