The high complexity of skills and maneuvers required in gymnastics, coupled with the long hours of training performed on different equipment, can make a gymnast considerably prone to injuries of the lower extremity.
These injuries can significantly alter a gymnast’s overall quality of life by increasing the risk of developing early degenerative musculoskeletal disorders in addition to having a direct impact on performance.
As outlined by Elizabeth Bradshaw in her study on the use of biomechanical approaches in identifying and quantifying injury mechanisms and risk factors in women’s artistic gymnastics, the four stages of injury prevention include – identification of the magnitude of the injury problem; identification of the causes and mechanisms of injury; development and implementation of injury prevention strategies; and assessment of the effectiveness of the injury prevention measures.
While considering the multifactorial nature of injuries in gymnastics, a thorough evaluation of both internal (age, body composition, health, foot structure etc.) and external (training technique, environment, protective equipment, etc.) risk factors is necessary to adopt a broader approach for treating and preventing overuse injuries.
Professor Patria Hume, from the Auckland University of Technology in New Zealand, described a key factor for minimising occurrences of long-term overuse injuries in gymnasts as appropriate loading of biological structures to guarantee tissue strength adaptation and strengthening.
The author advocates a reduction in biomechanical loading especially during landings because of the high magnitude of impact load acting on the lower limbs; the use of functional movement screening, biomechanically instrumented equipment or instrumentation on the gymnast for monitoring incorrect biomechanics have been proposed as different means of achieving this.
Spinal injuries, specifically injuries to the lower back, are common in gymnasts because of the increased compression and extension of the spine. If elevated levels of stress to the spine continue for a significant period of time, stress fractures and excessive vertebra displacement can eventually occur.
Hume further describes high loading forces resulting from dismount and tumbling landings as placing enormous stress on the spine and lower extremities especially when combined with improper technique and coordination.
The development of stronger core muscles is essential in this regard to prevent the gymnast from adopting compensatory methods such as using the lumbar spine as a pivot point which can increase the compressive forces acting on the vertebrae.
According to a study conducted to describe the epidemiology of women’s gymnastics injuries occurring within the NCAA competition level during the 2009-2010 through 2013-2014 academic years, the knee had the largest proportion of severe injuries, particularly tears to the anterior cruciate ligament.
One of the most important aspects of preventative strategies should be measures for screening alignment of the gymnast’s musculoskeletal system considering the role of lower extremity dynamic misalignment in many of the injuries of the lower extremity.
This should include an assessment of the gymnast’s foot structure in order to identify any abnormal movements such as hyperpronation that could facilitate postural misalignment and increase the predisposition of the individual to spinal or ACL injuries.
An orthotic intervention in the form of MASS4D® customised foot orthotics helps support the foot in its optimal posture; this reduces the stress placed on the lower limbs allowing for maximum functionality of all joints in the foot.
As part of an active rehabilitation programme, this would help in facilitating a speedy recovery for an injured gymnast while providing protection from recurrences by addressing any underlying biomechanical problems.
The ability of MASS4D® bespoke foot orthotics to support the structure of the foot in its optimally functional position allows for efficient proprioceptive input, effective lower limb muscle spindle firing and optimal full body structure. This promotes healthy postural alignment while enforcing normal functioning of the foot.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.