Factors Associated With Achilles Tendon Rupture in Women’s Collegiate Gymnastics

Background: Achilles injury risk in women’s collegiate gymnastics is 10-fold higher than in all other collegiate sports. This study aims to identify risk factors for Achilles tendon ruptures in collegiate female gymnasts. Hypothesis: Gymnasts with Achilles tendon ruptures will be more likely to report early gymnastics specialization, elite-level training before college, and performance of high-difficulty skills on floor and vault. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Anonymous surveys were distributed to current and former collegiate female gymnasts, aged 18 to 30 years, via coaches, athletic trainers, Twitter, and ResearchMatch. Information about Achilles tendon ruptures, gymnastics-related injuries, sport specialization, event/skills participation, and medication use were collected. Results: A total of 581 gymnasts were included. One hundred gymnasts (17.2%; 95% CI: 14.1%-20.3%) reported Achilles tendon ruptures during collegiate training or competition. Most ruptures (91%) occurred on floor exercise; 85.7% of these occurred during back tumbling-take-off. Compared with gymnasts without ruptures during college, a greater percentage of gymnasts with ruptures competed at a Division I program, trained elite, competed difficult vaults and floor passes before and during college, competed in all 4 events during college, identified as Black/African American, and used retinoid medications. Conclusion: Achilles tendon ruptures are more common in women’s collegiate gymnastics than other sports. Competing at the elite level, performing difficult floor and vault skills, and competing in all 4 events may increase the risk for an Achilles tendon rupture. Potential nontraining risk factors include retinoid exposure and Black/African American race. Future studies regarding the mechanisms of Achilles tendon ruptures in female collegiate gymnasts are warranted. Clinical Relevance: Collegiate gymnasts who compete at the elite level, perform high levels of difficulty on floor and vault, and compete in all 4 events may be at increased risk for Achilles tendon ruptures.

TIME LOSS INJURIES AMONG FORMER COLLEGIATE GYMNASTS: THE INFLUENCE OF FEMALE ATHLETE TRIAD SYMPTOMS

Background: Female college gymnasts have one of the highest injury rates in the NCAA and are at risk for female athlete triad syndrome. While female athlete triad syndrome leads to bone stress injuries, little research has been done on specific injury location and type. Purpose: Our objective was to compare injuries sustained during gymnastics between former collegiate gymnasts who did and did not report experiencing symptoms of Female Athlete Triad Syndrome during college, including disordered eating (DE) or menstrual irregularity (MI). Methods: 465 former collegiate gymnasts completed an online survey distributed via social media. Participants were grouped based on mensural irregularity and whether they had a history of DE/ED of not. We compared injury outcomes (time-loss injuries and injuries resulting in surgery) and injury locations between groups using Chi-square analyses. Results: A significantly greater proportion of those who reported MI during college reported a time-loss wrist/hand and injury during gymnastics compared to eumenorrheic gymnasts (Table 1). A significantly greater proportion of those who reported MI during college sustained an injury that required surgery relative to those who reported regular periods during college (52% vs 65%, p=0.009). Specifically, they reported a greater proportion of hip/pelvis (2% vs. 7%, p=0.02) and leg/ankle/foot surgeries (23% vs. 33%, p=0.009). A significantly greater proportion of the group who reported DE during college reported a time-loss gymnastics injury during college that did not require surgery or retirement, relative to those who did not report DE (78% vs 66%, p= 0.005) (Table 2). Specifically, they reported a greater proportion of spine (25% vs. 14%, p=0.002), hip/pelvis (8% vs. 2%, p=0.001), and leg/ankle/foot injuries (53% vs. 41%, p=0.01). There was a significantly greater proportion of gymnasts who reported DE during college who sustained a hip/pelvis (7% vs. 3%, p=0.04) and leg/ankle/foot injury (34% vs. 23%, p=0.02) requiring surgery compared to those who did not report DE during college. onclusion: College gymnasts who experienced triad symptoms were more likely to experience a time-loss injury, or have an injury requiring surgery. Clinicians and providers should be aware of the association between injuries and DE and MI in gymnasts. Early intervention for athletes with triad symptoms should be undertaken to decrease the risk of musculoskeletal injury.

HEALTH OUTCOMES AMONG FORMER FEMALE COLLEGIATE GYMNASTS: THE INFLUENCE OF SPORT SPECIALIZATION, CONCUSSION, AND DISORDERED EATING

Background: Over 1,500 collegiate gymnasts compete each year. Injury rates among these athletes are high, yet little is known about their long-term health outcomes. Hypothesis/Purpose: The purpose of our study was to describe health-related outcomes of former collegiate gymnasts and to evaluate how early sport specialization, concussion history, and disordered eating (DE) influence current health. We hypothesized that gymnasts who specialize early would report more injuries and would have worse physical health currently; that gymnasts who sustained concussions will be more likely to seek mental health treatment during their sport careers; and that gymnasts with DE would report more injuries. Methods: 473 former female collegiate gymnasts completed a survey (Table 1) that was distributed through social media. Participants were grouped according to early (<14 years) or late (> or equal to 14 years) specialization, whether they sustained a concussion during gymnastics participation, and whether they reported a history of DE or not. We determined the number of participants who had time-loss injuries, menstrual dysfunction, reasons for retirement from sport, functional outcome measures, and whether participants had sought mental health care during college. Results: The median age of gymnastics specialization was 8 years [interquartile range=6-11 years]. A significantly greater proportion of early specializers sustained injuries requiring surgery (60% vs. 44%; p=0.02), however, the proportion of time-loss injuries sustained during college, reasons for retirement, and current pain and physical function scores did not significantly differ between the early and late specializers (Table 2). Forty-two percent of participants sustained a concussion. Those with a concussion were more likely to have sought mental health treatment during college (32% vs. 23%; p=0.03), and to have a diagnosis of anxiety disorder (16% vs. 9%; p=0.01) than those with no concussion history (Table 3). Thirty-four percent reported DE during college. Those in the DE group had an increased risk of osteoporosis during college (4% vs 0%; p=0.003), secondary amenorrhea (16% vs 9%; p=0.02), and had an increased risk of time-loss injury (78% vs 65%; p=0.004) (Table 4). In addition, they had worse PROMIS pain (11.5 vs 10.2; p=0.007) and physical function scores (12.2 vs 11; p=0.01) after college. Conclusion: It is important for clinicians, coaches, and gymnasts to be aware of the risks of early specialization, concussions, and DE, all of which are common in former collegiate gymnasts. Counseling regarding these risks and prevention strategies for these health problems should be a focus of further research. [Table: see text][Table: see text][Table: see text][Table: see text]

Preseason Upper Extremity Range of Motion and Strength in Relation to In-Season Injuries in NCAA Division I Gymnasts

Background: Gymnastics is a demanding sport that places unique forces on the upper extremity. The repetitive nature of the sport and the high-impact forces involved may predispose the gymnast to overuse injuries. Risk factors for injuries in gymnastics are not well understood. Purpose/Hypothesis: The purpose of this study was to ascertain whether preseason upper extremity range of motion (ROM) and strength differ between National Collegiate Athletic Association (NCAA) Division I collegiate gymnasts who sustain an in-season upper extremity injury and those who do not. We hypothesized that gymnasts who sustain an upper extremity injury would demonstrate reduced ROM and strength compared with noninjured gymnasts. Study Design: Cohort study; Level of evidence, 3. Methods: Over 4 seasons, from 2014 to 2018, a total of 15 female NCAA Division I collegiate gymnasts underwent preseason upper extremity ROM (shoulder: flexion, internal and external rotation; elbow: extension; wrist: extension) and strength (shoulder: internal and external rotation, and middle and lower trapezius) testing. Overuse upper extremity injuries were tracked in each subsequent season. Gymnasts were dichotomized into injured and noninjured groups, and a 2 × 2 analysis of variance was used to measure differences in preseason measures between the groups as well as within arms (injured vs noninjured arm for the injured group; dominant vs nondominant arm for the noninjured group). Results: A total of 12 overuse upper extremity injuries (10 shoulders; 2 wrist/forearm) occurred during 31 gymnast-seasons. There were no significant interactions for preseason ROM and strength measurements between groups (injured vs noninjured) or within arms (injured and noninjured arm for the injured group; dominant and nondominant arm for the noninjured group; P = .07). Conclusion: Preseason upper extremity ROM and strength were not different between gymnasts who sustained an in-season upper extremity overuse injury and those who did not. It is possible that ROM and strength measures used to screen other overhead athletes may not capture the unique features and requirements of gymnastics. Further, it may be challenging to discern differences in clinical measures of ROM and strength in gymnastics populations owing to the bilateral nature of the sport.

Stress Distribution Patterns Across the Shoulder Joint in Gymnasts: A Computed Tomography Osteoabsorptiometry Study

Background: The distribution pattern of subchondral bone density is an indicator of stress distribution over a joint surface under long-term physiologic loading. The biomechanical characteristics of the articular surfaces of the shoulder joint in gymnasts can be determined by measuring this distribution pattern. Purpose: To evaluate the distribution of subchondral bone density across the shoulder joint in male collegiate gymnasts and to determine the effects of gymnastic activities on its articular surfaces under long-term loading conditions using computed tomography osteoabsorptiometry (CTOAM). Study Design: Descriptive laboratory study. Methods: CT image data were obtained from both shoulders of 12 asymptomatic male collegiate gymnasts (gymnast group; mean age, 19.4 years; range, 18-22 years) and 10 male collegiate volunteers (control group; mean age, 20.2 years; range, 18-22 years). The distribution pattern of subchondral bone density across the articular surfaces of each shoulder joint was assessed by CTOAM. Quantitative analysis was performed of the locations and percentages of high-density areas on the articular surface. Results: Stress distribution patterns over the articular surfaces differed between the gymnasts and the controls. In the gymnasts, high-density areas were detected on the posterosuperior articular surface of the humeral head and the anterosuperior and/or posterosuperior articular surface of the glenoid. Mean bone density was greater in the gymnasts than in the controls ( P < .0001). Conclusion: Stress distribution over the articular surfaces of the shoulder joint was affected by gymnastic activities. Stress was concentrated over the superior part of the glenohumeral joint in male collegiate gymnasts. Clinical Relevance: The present findings suggest that gymnastic activities increase stress to the articular surfaces of the superior glenohumeral joint. This supports the notion that mechanical conditions play a crucial role in the origin of disorders particular to gymnastic activities.

Being Mindful of Perfectionism and Performance among Collegiate Gymnasts: A Person-Centered Approach

Little research has integrated mindfulness and perfectionism, particularly within sports wherein athletes are judged on performance to a standard of perfection. The current study had two primary aims: (a) to explore profiles of mindfulness and perfectionism among intercollegiate gymnasts through a person-centered approach and (b) to analyze differences in objective performance across the resulting profiles. The analytic sample consisted of 244 NCAA gymnasts who completed self-report measures of mindfulness and perfectionism. Competitive performance records (i.e., national qualifying scores) were then gathered for participating gymnasts. Cluster analyses revealed a three-cluster solution; however, significant performance differences were not observed across the three profiles due to lower than desired power. Small to moderate effect size estimates provided some evidence that perfectionism may be adaptive to gymnastics performance. Elite-level athletes were represented across three distinct profiles, suggesting that more than one profile of characteristics may be adaptive for reaching high levels of performance.

Mindfulness with Collegiate Gymnasts: Effects on Flow, Stress and Overall Mindfulness Levels

The physical and psychological demands of sports can place an athlete under a variety of stressors. Subsequently, the way in which athletes deal with such stressors can positively or negatively affect their performance. Flow is defined as a type of experience where one is completely engaged in an activity and optimally functioning. Recently, an increase in mindfulness and acceptance based approaches have been utilized as a means to augment negative emotions in sport and many have suggested a link between mindfulness and flow. Thus, if mindfulness can positively influence flow, perhaps performance can also be positively affected. There has also been a need to determine optimal intervention lengths to successfully teach mindfulness practices within sports teams. The purpose of the current study was to examine the effects of a mindfulness training program on mindfulness scores, dispositional flow scores, and perceived stress scores within a population of Division I female collegiate gymnasts. Results from a repeated measures ANOVA indicated that athletes who participated in the mindfulness training demonstrated a statistically significant difference in the dispositional flow dimensions of loss of self-consciousness and the autotelic experience. These results suggest that mindfulness may influence factors associated with athletic performance.