Back Injuries and Gymnastics

Gymnastics is a sport that requires a high degree of discipline and rigorous training. As a result of this, a majority of injuries involve spinal or backbone trauma, particularly among adolescents. Gymnasts can take precautions to offset the risk of damage to their lower backs.

Spine Anatomy and Bone Growth

The spine is composed of bony segments called vertebra, and inter-vertebral disks between each segment filled with a gelatinous substance called the nucleus pulposus. Together with the vertebrae, they allow for flexible upper body movement, at the same time protecting the spinal cord within.

There are growth plates at the ends of children’s bones called physes. These plates mark the place of growth during childhood and adolescence. As the child ages, the physes begin to calcify and the bones cease to grow. For males, skeletal maturity peaks at age 18, and for females at 16 ½.

The Birth of an Injury

Back injuries in adolescent athletes stem from repetitive stressful body movements, like bending and twisting that can cause trauma to the spinal column. The risk of lower back injury peaks especially during vigorous training where the body becomes too fatigued to allow for proper protection to the back. Employing incorrect movement techniques, having weak abdominals and poor leg stamina are some of the causes of injuries.

The bones of the lower back or the lumbar vertebrae in a developing adolescent are more susceptible to injury. Strenuous sports activities strain the ligaments and muscles surrounding the spine. As these do not grow at the same rate that bones do, the pressure placed on these ligaments and muscles puts undue stress on the spine.
Difficult sports-related moves like somersault landings are the cause of a majority of spinal injuries. A gymnast dismounting badly on a hard surface, or a diver landing flat in water are accidents that more often than not, lead to spinal trauma.

Identifying The Injury

Spondylolysis and spondylolisthesis – Spondylolysis is a term used for a lateral fracture of the pars interarticularis, a thin segment of vertebral bone. Spondylolisthesis occurs when both sides of the pars interarticularis are fractured and the injured segment of the vertebra moves forward to rub against the next segment. Vertebral fractures stem from undue stress placed on the vertebrae. Constant lower back hyperextension, as with back bends performed by gymnasts are the leading causes of these fractures.

Herniated disks - lumbar disks are composed of tough elastic-tissue fibres which surround a soft gel-like centre. Recurring trauma to the back is the prevailing reason for herniated disks in adolescents. The lumbar segments become misaligned, causing the gel-like nucleus pulposus to bulge outward. This puts pressure on the surrounding nerves of the spinal cord, causing debilitating pain. Commonly referred to as “slipped vertebral apophysis” or “slipped disk”, it is a condition resulting from lifting heavy weights, or from tough training involved in gymnastics.

Disc degeneration

The long term effects of gymnastics can result in disc degeneration or as it is also known as degenerative disc disease as it refers to a syndrome in which a compromised disc causes low back pain. Lumbar degenerative disc disease usually starts with a torsional (twisting) injury to the lower back, such as when a person rotates to put something on a shelf or swing a golf club. However, the pain is also frequently caused by simple wear and tear on the spine

The above MRI scan shows disc degneration in the circled areas.

Fractures – The vertebrae is particularly vulnerable to sports-related injuries. A forceful jolt may fracture sections of the spine. In the same manner, an gymnast tailbone, the physes and sacrum, is also susceptible to fractures. Incurring blows to the back, or taking a hard fall, is the major cause of spinal fractures.

Scheuermann’s disease – The cause of this injury is yet unknown. It involves two vertebra segments taking on an aberrant wedge-like shape, causing a distended outward curve of the upper back.

Scoliosis

Scoliosis is an abnormal curvature of the spine to one side. In those who have the condition, the spine bends either to the left or to the right. The bend can occur at any point along the spine, from the top to the bottom. The curvature can also vary from a slight to severe. However, the chest area (thoracic scoliosis) and the lower part of the back (lumbar scoliosis) are the most common regions to be affected.

In a survey of 100 girls, aged 11-15, having been trained actively in rhythmic gymnastics at least for a period of 5 years, we found a fivefold higher incidence of adolescent idiopathic scoliosis (AIS). These data were compared to the results from a screening of 4800 students of the same age, carried out in Sofia by the same examining team in 1996.

The X-ray above shows Scoliosis of the spine.

Manifestations of Back Injuries

Spinal trauma is a serious injury requiring immediate medical treatment. Apart from the pain that coincides with performing any activity, some of the signs of a spinal injury include pain at night time, hindered mobility of the lower back, or pain running down the leg.

Medical Treatment for Back Injuries

As soon as a back injury is suspected, the adolescent gymnast must cease all activity relating to the gymnastics, and consult with a doctor. If proven necessary, an orthopaedic specialist may conduct a subsequent examination to determine the extent of the injury. Medication for pain relief may be dispensed, and a supportive back brace worn to effect treatment. Physical therapy also plays a role in the management of back injuries.

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The Elasticated Back Brace offers compression and support without restricting movement. The two-way elasticated stretch fabric has been specifically designed to provide relief to injuries such as lower back pain, lumbago and rheumatic conditions.

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This support can be used during a range of sporting activities including gymnastics and can be used at home or work.

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A Physical Therapist oversees rehabilitative exercises to strengthen the back, and enable the athlete to regain the necessary conditioning relative to returning to the sport.

However, before performing any sports-related activity, medical assessment needs to be made to determine physical fitness. If required, the adolescent athlete may have to start out with low-intensity activities before incrementally progressing to more strenuous movements.

Parents of the adolescent athlete should be mindful of possible reoccurrence of back injury, and to seek medical treatment as repeatedly as necessary.

Other Treatment Options

Emu Gel

This gel, blended with Black pepper and Eucalyptus Essential Oil, is excellent for relieving muscular aches such as back pain.

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Averting and Avoiding Injury

Constant awareness of the danger posed by improper or excessive training is a factor in preventing spinal injuries. Towards this end, coaches can shorten practice sessions to establish a physically safer sports environment for gymnasts. Gymnasts and their coaches should be cognizant of proper training techniques to enable them to supervise training activities.

Spinal injuries in adolescents present a grave problem in all sports and especially gymnastics. Effecting immediate diagnosis and medical treatment can go a long way in enabling a gymnast to commence training.