There isn't as much research on injuries in rhythmic gymnastics as there is in other sports, but it is safe to say that feet and spinal injuries are highly prominent in the discipline. According to Skadefri, an evidence-based resource site that provides information on common sports injuries, injury risk factors, and specific injury prevention exercises the most common injuries in rhythmic gymnastics are ankle sprain, patellofemoral pain syndrome, medial tibial stress syndrome and back pain. These are all very common injuries that athletes and active people suffer. What's interesting about gymnastics however is the alarmingly high number of overuse injuries and the cause of these. Research shows that the main cause of injuries is psychological rather than physical, having more to do with behaviors, cultural values and unwritten norms influence gymnasts’ attitude towards pain .
Gymnasts have a high pain tolerance and train with some degree of discomfort on a daily basis, often failing to recognise the difference between pain from fatigue and pain from overuse, resulting in chronic overuse injuries.
-APA Sports Physiotherapist Kate Roberts
This week we bring a detailed report on injuries in the sport, the reason for these and how to prevent them. Let us know in the comments if you suffer from any injury. If you are a coach, please let us know what kind of injuries are more prominent among you gymnasts.
Spine injuries
According to an article published by the Australian Physiotherapy Association, some of the most common injuries of a rhythmic gymnast affect the lumbar spine, with incidence reports ranging from 10 to 37% of all injuries. One study from the USA found that 86% of RG participants reported lower back pain. A recent New Zealand study found that 50% of injuries are classified as acute and 50% as overuse or chronic. They found that injuries to the spine are more commonly chronic or overuse injuries, and statistics are therefore underestimated as gymnasts frequently fail to report chronic pain as an injury.
What is an overuse injury?
An overuse injury is a term used to describe an injury that occurs from tissue damage resulting from repetitive demand over a period of time rather than an acute injury such as a shoulder dislocation or an ankle sprain. Experts sometimes describe it as ‘the repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place’.
The repeated extreme hyperflexion and hyperextension required for RG is associated with most of the lumbar spine disorders seen.
Common Causes for Injuries
Here are some of the most common reasons for injuries in RG, according to the Australian Physiotherapy Association's report.
The female athlete triad
The female athlete triad involves three components: disordered eating, dysmenorrhoea and osteoporosis. It has been reported in up to 78% of female rhythmic gymnasts. It is desired that elite rhythmic gymnasts have 5–10% body fat and one study found that they tend to consume only 80% of daily energy requirements. Dysmenorrhoea is associated with an increased risk of injury, decreases in performance and in well-being.
The female athlete triad is not exclusive to rhythmic gymnastics. Every female athlete is at risk, regardless of their body build or sport. Consequences of these clinical conditions aren't always reversible, so prevention, early diagnosis, and intervention are vital for the safety and performance of any gymnast. Experts suggest that all active females should be assessed for components of the triad in order to treat it in time.
Sport Asymmetry
RG has been shown to be a very asymmetric sport, with skills practiced and performed on the stronger side with far greater repetition than the weaker side. Gymnasts also tend to focus on stretching their more flexible side, and this leads to significant muscle imbalances and overloading of the spine. To achieve perfection and reproducibility of their performance, skills must be practiced over and over again which puts the gymnast, and particularly their spine, at risk of overuse injuries.
Psychological
RG is a hard sport. With time, gymnasts develop a high pain tolerance and learn to train with some degree of discomfort on a daily basis, which in the long run can make them fail to recognize the difference between pain from fatigue and pain from overuse, resulting in chronic overuse injuries.
A study made in St Mary’s University and University of Portsmouth, shows that from a psychological point of view, behaviours of impression management were constantly used by gymnasts, with the aim of showing their coaches their dedication and passion, as well as for fear of being scolded or judged weak, causing gymnasts to overwork certain muscle groups. Other psycho-social factors influencing the overuse injury process can be linked to the social environment and to the organizational culture surrounding the athletes and their coaches. Here are some of the testimonies the researchers heard from gymnasts about pain and overuse injuries:
“Because if you go you give the impression of putting more effort into it…if you train despite the pain, it looks like you are putting more effort…”
“If you are always telling the coach that you have pain here and there, it might end up being…well…it makes you lose some credibility, and so I try to avoid it.”
“Well, not really being afraid of making them angry…but maybe if one has got knee pain and then maybe she starts feeling pain somewhere else too, then you are afraid they’ll think you don’t want to train"
Forcing Turnout
Turnout is desired in rhythmic gymnastics; 180 degrees of turnout and 60–70 degrees of hip external rotation is required to safely achieve this. Adequate hip turnout is required to achieve the strength and balance desired as well as for aesthetic reasons as it creates a better line in body work such as attitudes, arabesques, penches, etc...The problem is that some gymnasts force their turnout by placing the feet at 180 degrees on the floor and screwing the knees to achieve rotation, causing a number of back injuries and imbalances.
Injury Prevention Tips
Research shows that attitudes towards body awareness and injury prevention need to change. The good news is, that our views on pain management are easier to change than the anatomy of our body! Here are some tips to keep in mind when coaching or training RG:
Mental toughness behaviours have to change and respect our anatomical needs.
Poor communication between gymnasts and coaches causes misunderstandings. It's important to teach gymnasts what "good pain" and "bad pain" is. Coaches need to teach boundaries when it comes to determination and hard work.
It is therefore wise not to stretch to improve flexibility on the day of competition and to stretch at the end of training rather than at the beginning.
Prior to puberty, it is better to work on agility and skills and, as pre-pubescent muscles have a greater proportion of Type II fibres than Type I fibres, to focus on slow, controlled low load movements.
Injury prevention is better than treatment and correction of technique faults is paramount to treatment.
Exercises must be as specific as possible so it helps to have some knowledge of skills and bodywork.
Periodic screening to monitor weight, uncover pathology and detect any musculoskeletal imbalances will allow rhythmic gymnasts to correct technique issues to prevent injuries
Fitness training for 30 minutes twice a week at a HR of 70–80% MHR has been found to improve pain management, decrease the risk of injury and increase well-being in dancers and gymnasts.
Progressive exercises and approaches are used in other sports such as artistic gymnastics that are not as based on repetition as RG is. Although apparatus work such as Apparatus Difficulties, Risks and basics are repetition based, more progressive techniques teach correct body positioning, preventing overuse injuries.
Avoiding exercising turnout from the foot, and working it from the hips will make our training safer and more effective.
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