The Most Common Gymnastics Injuries: What to look for, and when to seek treatment

Gymnastics is a tough sport and aches and pains often come with the territory, but how do you know when it’s something that can be treated with icing and ibuprofen, or when it’s time to take your child to see a doctor? Many gymnasts are used to training through discomfort and may even have a higher threshold for pain than most people, so they don’t always speak up as soon as something hurts. Parents and gymnasts may worry about missing training or missing out on a big meet and put off seeking treatment out of fear of being sidelined, but ignoring an injury is likely to lead to a longer recovery time.

When is it time to see a doctor?

“For a chronic injury I recommend seeking treatment if the pain has gone on for longer than five days in a row, or if the gymnast has experienced the pain every other day for more than two weeks,” says Dr. Elspeth Hart, DScPAS, PA-C, MPAS, ATC, LAT.

The founder of the nonprofit, Gymnastics Medicine: Education and Research, Dr. Hart runs a Boston-area clinic treating gymnastics injuries with the goal of getting athletes back to their sport.

“The sooner you seek treatment, the better,” says Dr. Hart. “The hardest thing is when a gymnast comes in with something like three to six months of back pain. Usually, it will take at least that long to be able to return to the sport.” 

Pay attention when your child begins complaining of pain and check back in to see if it is continuing. Things like stretching, massage, or physical therapy all may be part of the recovery process, but only after you have gotten a medical diagnosis.

How long will recovery take?

Recovery time depends entirely on the diagnosis. Minor injuries may only require a few days or a few weeks of modified training, while a serious chronic injury requiring surgery could take up to twelve to eighteen months to fully heal. No gymnast ever wants to miss out on training, but with the proper diagnosis and treatment Dr. Hart finds that most kids are able to get back into the gym.

“Most kids do recover from their injuries. Ninety percent of the time kids are able to get back to gymnastics,” she says.

However, Dr. Hart warns that it’s important to follow the treatment and recovery plan and not rush back into training too soon, which can lead to a ripple effect of further injuries.

“The biggest thing we see is that gymnasts want to compete and perform. They don’t want to miss training, so they sometimes try to go back too soon. Rehab is an important piece. It takes time to build back up. For example, I tell gymnasts that three weeks in a boot equals three weeks to get back to regular training,” Dr. Hart says.

The best plan is for your gymnast to wait to return to training until he or she is fully cleared, continue with any PT that has been prescribed, and back off if pain returns.

What are the most common gymnastics injuries?

According to Dr. Hart, research shows that the most common gymnastics injury is an ankle sprain, while the second most common is knee internal derangement (either a meniscus or ACL tear), however, these aren’t the injuries she sees most often among the gymnasts who come to her for treatment. Below are the top three most common injuries Dr. Hart sees in gymnasts:

Back Pain

Low back pain is the number one complaint among gymnasts because the sport requires repetitive hyperextension and twisting of the spine. It’s also the symptom that seems to scare parents the most. Facebook groups and gymnastics forums are full of questions from parents seeking advice about their child’s back pain, often looking for reassurance that back pain may be nothing serious. The key is seeking a medical diagnosis as soon as possible. The doctor will perform a physical exam and may order imaging. X-rays sometimes detect a spinal fracture, but often an MRI or a CT scan is required. In cases where there is no sign of a fracture your doctor may prescribe physical therapy, massage, or a brief period of rest. If your child does have a spinal fracture, it does not necessarily mean the end of gymnastics.

Spondylolysis is a stress fracture or defect in a vertebra, while Spondylolisthesis is the slipping of all or part of one vertebra forward on another vertebra. Treatment for both typically includes a period of rest and may include the use of a back brace. Surgery is sometimes needed for patients with spondylolisthesis with severe or high-grade slippage or more than fifty percent displacement. Physical therapy is usually required to help prevent further injuries to the spine. With proper treatment most gymnasts are able to return to the sport.

Gymnast Wrist

Gymnast wrist can occur when athletes with open growth plates perform weight bearing or pounding exercises on their hands, which leads to injury and inflammation of the radial growth plate. Gymnasts may have tenderness on their wrists at the site of the growth plate, decreased motion, and pain when bearing weight on their hands. Typically, gymnast wrist is diagnosed with a physical exam, x-rays, and possibly an MRI. Treatment depends on the severity of the case. Some gymnasts may recover after rest, immobilization in a brace or cast, and physical therapy, but more severe cases may require surgery.

Osteochondritis Dissecans of the elbow

Often referred to as OCD, this joint condition occurs from repetitive impact that leads to a lack of blood flow to the bone and cartilage. In gymnasts Osteochondritis Dissecansis most commonly found in the elbow. Symptoms include swelling at the elbow, tenderness at the elbow with rest or movement, loss of motion in the elbow, and gymnasts may experience the feeling that the elbow is locking or catching. Non-surgical treatment typically requires bracing, physical therapy, and somewhere between three to nine months of rest. Surgical treatment is needed if the condition is unstable and will not heal on its own. According to Dr. Hart, surgery for OCD of the elbow often requires surgery with up to a year to a year and a half to fully recover.

Summary

If your child is experiencing chronic pain, the best bet is to seek treatment as quickly as possible so that they can get on the road to recovery and return to the sport they love.

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Tell us about your athlete's struggle with injuries.​

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Where should I start... will be up all night if I start listing out all 3 of my dd's injuries. Guess you'll all have to find out tomorrow when I'm a little less tired:)

Reply 4 Likes

Broken elbow
Sprained ankle
Broken Ankle
Tweaked back
Gymnast wrist

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My daughter has been really lucky (knock on wood :D).She hasn't had any overuse or chronic injuries and her only acute injuries have been to her ankle which she has had multiple breaks and sprains on.

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  • Numerous sprains
  • Numerous broken toes and other bones in foot
  • Stress fractures in back
  • More back issues 2 years later
  • A few bone bruises
  • Achilles/tendon issue (possibly career ending for vault and floor)

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Broken wrist when she first started competing then was really healthy until L7 when she had at least 1 ankle sprain per year through L10. a serious knee injury in L10. The sprains didn't completely take her out. She could still train bars but was out of vt/tumbling/beam for at least a month each

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Nice article. I especially like Dr Hart's point about taking time to build back up - There is some really interesting information/data out there about injuries and how they relate to breaks in consistent training load. Injuries are most likely to occur in a certain timeframe after a return from injury/break/lower intensity.

Reply 3 Likes

My daughters most unique injury was she dislocated her finger it was her middle finger fully dislocated so it looked like a 7 (ugh) she popped it back in herself (yikes) then when and told her coach it did this and then pulled it sideways and put it back in place again (according to her coach my dd says she didnt do that lol) we were very lucky she didnt break it when she put it back in place. Her knuckle is still bigger than the other one.

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Let's go chronologically:

1) Broken arm - broke and displaced ulna and radius. Casted and braced for 12 weeks.
2) Bone bruise - foot - Boot for 2 weeks, then they let her choose whether she wanted to run around on it. She did. It hurt. Covid shut everything down, lucky for her, because over a month in, it wasn't improving until she fully rested it.
3) Ankles - So. Many. Ankle. Issues. Rolled, sprained, who knows. Turns out, she's hypermobile everywhere except her wrists. Ortho sent her to PT to strengthen ankles, but said realistically only surgery to tighten ligaments is going to stop it from happening. Her gym doesn't do hard landings except during comp season (and usually only during comp week), and she HATES landing on mats or into the pit, and we have an ongoing fight about why she's trying to destroy her ankles
4) Wrists - Like 40 degree mobility in her wrists! Less in one of them! Checked and re-checked, no gymnast wrist, 3 months of OT fixed the wrist pain (which was literally, they don't bend back far enough to flatten on the ground without hurting). She won't do OT at home.
5) Back - Hurt her back doing back walkovers on beam. A month of no impact until she was cleared for everything after checking her in every possible way for a stress fracture. We've removed all back bends and walkovers.

I'm still paying the bills off on the arm but the months of PT and OT for ankles/wrists really wore down on my soul

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She has had a concussion that took her out for a couple of months in the middle of getting ready for first year L9, was just getting going then covid hit. Once the gym was open, she started training L10, but the gym did not compete in 2021. She then broke her ankle. Two surgeries later with weekly PT she is still not released fully and may now need another surgery, but we are waiting for an MRI approval. If she does need another surgery, it is a small one with minimal recovery, like a week or so just for the incision to heal. She is so close to fully training again, yet so far. She has been busting her butt weight training and has gotten so strong I hope she has an opportunity to get it all together for next year. It has been a difficult time to say the least pretty much since Covid shut everything down in 2020. Her next competition is hopefully 2023 so it will have been 3 seasons since her last competition. I am praying every day that she gets her shot at competing again.

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I was surprised to learn just how serious OCD of the elbow is. I always think of back issues as the worst thing for a gymnast, but OCD of the elbow is no joke. That is a long recovery time!

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1. Broken toes
2. severs
3. Overextended knee
4. Sprained upper back
5. Sprained finger

The severs and broken toes happened simultaneously and the toes actually happened doing BHS outside the gym. That was the injury that she was out the longest for. The back happened after a nasty fall on bars and put her out about three weeks and then she slowly eased back in.

We have been extremely fortunate to so far (knock on wood) not deal with overuse or overtraining injuries. I think this is in part due to the gym’s strong emphasis on conditioning and strength training.

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I'll go from head to toe between all 3 of my gymnasts - I can't remember exactly who had which injury!

  • Hair: DD got her hair caught in equipment had to have a chop:)
  • Forehead - Multiple headaches watching meets (me)

Ok seriously now

  • Broken nose
  • tooth knocked out
  • one shoulder fracture
  • multiple rips, one which got infected and needed antibiotics
  • elbow stress fracture
  • fractured wrist
  • broken little finger
  • Fractured ankle
  • Multiple tweaked ankles, sprains etc.
  • Broken toe (DD claimed 3 years later she had broken it, we have no source)

No overuse injuries that I'm aware of.

This looks like a recipe! Method: enjoy it while it lasts.

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We are in the midst of treating spondylolithesis and spondylitis in my daughter. She is 13, level 7 training level 8. She has never had an acute injury to her back. In fact, her back never really hurt, but her right hip was hurting pretty consistently for 3 months before we got an xray done. During COVID she grew 5 inches (4'4 to 4'9) and was dealing with Severs pretty badly. I thought her hip pain was just another growing pain. We went to PT and she was stretching. Nothing was helping. Finally in December of 2021 we got Xrays done. It showed the break between L4 and L5 and slippage. It wasn't until January of 2022 that we were able to get in for the MRI and arthrogram of her hip. Her hip was fine, but the slippage showed impingement of her nerves and we were sent to a pediatric orthopedic surgeon. The good news is that her slippage, which is between L5 and S1, is only a 1 (a 1+ maybe they said) and no surgery until a 4. The break between L4 and L5 will never heal, it is too wide a gap. It was probably a stress fracture that pulled apart because she is hyperflexible in her back. She has seen 2 surgeons now at 2 localish Children's Hospitals because it was her back and I wanted the very best advice. Both said she could continue gymnastics, but listen to her body. She needs to limit back walkovers, but she can tumble, she twist, and she needs to continue PT and keep her core strong (which isn't a problem for gymnasts as we know). We are making the decision to only do bars and floor for now as she does the most arching on beam (back walkover series) and vault (yurchenko timer). She is going to try to switch to Tsuk over the summer so she can do vault and do BHS BHS series on beam or switch to XCEL diamond and maybe add in her side aerial (still have to learn the code of points to see if that is possible). She is also going to change gyms. We are at a very small gym currently. They do not have a pit bar or a tumble trak so all skills are learned over a competition surface. She is doing all landings and new tumbling on the floor with mats rather than over a pit. The new gym will have all these things to limit impact on her back during some training. She wants to stay in the sport so we are doing what we can to prolong her involvement. Any suggestions on levels (8 or Diamond) would be appreciated.

Reply Like

I'll go from head to toe between all 3 of my gymnasts - I can't remember exactly who had which injury!

  • Hair: DD got her hair caught in equipment had to have a chop:)
  • Forehead - Multiple headaches watching meets (me)

Ok seriously now

  • Broken nose
  • tooth knocked out
  • one shoulder fracture
  • multiple rips, one which got infected and needed antibiotics
  • elbow stress fracture
  • fractured wrist
  • broken little finger
  • Fractured ankle
  • Multiple tweaked ankles, sprains etc.
  • Broken toe (DD claimed 3 years later she had broken it, we have no source)

No overuse injuries that I'm aware of.

This looks like a recipe! Method: enjoy it while it lasts.

Ooh, I didn't include the knocked out baby teeth in my daughter's injury. She was 8, split the beam on a leap and knocked out her front upper teeth. One was loose and ready to fall out, the other was not. And when she caught the beam, she dug her thumb nail into her chin. Boy did she bleed between the teeth and the chin.

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Perfect 10: College Gymnastics