The Achilles Tendon Apocalypse

This last year I have watched more NCAA gymnastics than I ever have. Not only is it more accessible, but for the first time in years, I was also not coaching at meets on the weekends. This gave me the opportunity to tune in to ESPN’s “Friday Night Heights”. Over the last few seasons, I’ve noticed the amount of Achilles tendon injuries in collegiate gymnastics seems to be exponentially rising. This past week, LSU had their third Achilles tear of the season, with Kai Rivers going down during podium training prior to Friday’s meet. This is Kai’s second Achilles tear in 3 years, and unfortunately, this situation is becoming increasingly common. Personally, feel a sense of urgency in addressing this matter, and that something needs to change- NOW. Today, I give you my thoughts on the matter, some suggestions on what I think can be done to mitigate the risk based on current information available, and where I think future research should be directed.

Why is it (seemingly) almost always the ‘power’ gymnasts?

A friend of mine asked me this a few weeks ago. As a person with an education in (and passion) for exercise science, I’ll be honest in saying I did not have an immediate answer. My head started spinning with a million ideas. While I am a firm believer there are multiple factors that contributes to an Achilles tear (which I will get into later), there is one thing that stood out in my informal research. Of the 15-20 videos of Achilles tears I watched, many athletes had inefficient punching and/or landing mechanics.

I started to research Achilles injuries last season when Olivia Gunter (Former LSU gymnast who tore her Achilles in April 2018 on a double arabian) posted her thoughts on Twitter regarding her injury. Gunter revealed in her days as a gymnast, she was one to punch and land flat-footed. In her words, she could “get away with it” because she was a “powerful athlete'”. My first thought in regards to this is that maybe if the gymnast is extremely powerful, they don’t really need to learn correct punching mechanics- ie, fully pushing off the toes to get height, using the entire foot, etc, because they don’t need perfect technique to get height on their tumbling. I also believe that landing positions in women’s gymnastics- the stick position of elite and lunge of DP/college, leave a lot to be desired in terms of functional landing techniques. I don’t think it’s a stretch to say that improper landing techniques often cause injury, and may also be contributing to progressive wear and tear on the Achilles tendon. However, more research needs to be done on the latter at this time. On a more positive note, with the rise of sport science in the gymnastics world in the last 5-10 years, safer landing techniques are increasingly being implemented, so I think we are well on our way to addressing this particular issue.

The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). Every time a gymnast punches, runs or jumps (basically anything that goes through the high toe motion), the calf muscles pulls up on the Achilles. Over time, repetitive use of any muscle/tendon can lead to an overuse injury, This is when the tendon does not have enough time/resources to recover, and begins to lose structural integrity. In my research, I found an article from 2004 that analyzed the Achilles tendon with repetitive use. This study found that the part of the Achilles tendon that inserts onto the calcaneal bone became what they called “stress shielded” with excess repetitive use. Essentially, the tendon had less forces being pulled up on it by the calves, as the body re-directed the forces away from the irritated area. The stress shielded part of the tendon was found to have atrophic changes- decrease in its size and tensile strength. Essentially, this article suggests that when the tendon is irritated, the body tries to protect it, but in doing so, it becomes under-utilized and therefore weaker. Incorrect use of the foot during punching could not only increase the rate at which irritation occurs in the tendon, but also lead to a quicker decline in strength as a result of the “stress shielding” effect. Add in a maximal effort, and then the weakened tendon is more susceptible to tearing.

Why do so many athletes tear their Achilles in competition?

Factors that are said to impose stress on the tendon during activity include the size of the tendon, speed of muscle contraction (in this case, the calf muscles) and amount of contraction. During a competition, the adrenaline caused by competing likely increases the speed of muscle contraction and the size of the contraction, as the gymnast often flips higher and faster. This is great for minimizing amplitude deductions, but can be a problem for a weaker tendon that may not be able to withstand this increased force. Gymnasts often describe adrenaline from competition as giving them a little extra “oomph”- they run a little faster, punch a little harder, etc. This greater force can then exceed the maximum force threshold of the tendon, resulting in a tear.

Why are there so many Achilles injuries in college?

If I’m being honest, I think this could be due to multiple things. The first being related to biomechanics, the maximal load a tendon can endure can decrease over time due to factors like high training volume and relatively inadequate rest. So while the tendon may be undergoing structural changes in the latter years of club gym, the cumulative effect may not be seen until college. I also think there may be a link to nutrition, the onset of puberty linked to hormonal changes, and growth related factors.

Nutrition? Hormones?

The female athlete triad, which I learned in approximately 10 classes during my undergraduate kinesiology degree, is described as a combination of three major things- disordered eating, amenorrhea (absence of menstruation) and osteoporosis (decreased bone density). Past studies related to the female athlete triad have concluded that these factors can lead to increased risk of injury and health problems later in life- including heart problems and infertility. It is no secret that gymnastics has had its issues with disordered eating, and will for the foreseeable future. Part of this directly results from comments from coaches or judges, or more indirectly from feeling the pressure to achieve perfection in all senses. Most obviously, even just the fact that one experiences puberty while wearing a leotard in public can be enough to struggle with body image. In regard to Achilles specific injuries, poor nutrition caused by disordered eating during childhood and puberty can lead to decreased tendon strength. A person requires the correct nutrition to lay down collagen, primarily produced before age 25, which is the primary component of tendons. If a person is under-eating, they do not have the resources to continue to lay down collagen and build the strength in their tendons.

The second aspect, hormones, is also linked to this female athlete triad. Under-eating and extreme exercise is associated with the delaying of puberty and growth, often leading to delayed onset of menstruation. In puberty, the increase in hormones contributes to the increase in both tendon strength and bone density during time of growth. For gymnasts whose puberty is delayed, this could potentially have negative effects. In the non-sporting world, there also appears to be an increased amount of diagnoses of women with hormonal imbalances or struggling with conception. Whether this be attributed to our environment, food quality or simply just increased awareness leading to more diagnoses, it is hard to pinpoint an exact cause. Regardless, hormones need to be more vigorously investigated in the science world, both the impacts they may have on fertility but also female physiology as a whole (including tendon strength).

So, what should we do?

I wish I could wave a magic wand and have this all fixed, but unfortunately, I can’t. The three practical suggestions I have for current coaches are as follows:

  1. Teach proper punching (and landing) techniques

Efficient landings and punching techniques that allow for maximal muscle recruitment and force dissipation/production will only benefit the athlete in all aspects of sport. For this, strength and conditioning coaches can be brought in, and SHIFT movement science is always a good website to further coach self-education. For reference, this is a post I made on proper landing techniques a few years ago.

2. Rest= a crucial part of any training program

Rest if important for all gymnasts regardless if they are injured or not (though it does become even more crucial during injury management). It is also important to note that while not all gymnasts experience pain in their calf/Achilles prior to tendon ruptures, many do. In order for a tendon to recover and maintain its strength, adequate rest must be provided.

3. Implement strategic conditioning

Along with correct technique, gymnasts need great levels of muscle strength to maximize force production and dissipation. One of the ways to do this is to train the glutes (this will also have the bonus of increasing power). This allows the gymnast to add more power to their gymnastics while relying less on the force production from the calves/quads.

Next steps: more research

Ultimately, the greatest need to determine what will be best in preventing these injuries is scientific research specifically related to Achilles Tendons tears in gymnasts. While the suggestions mentioned above will help, only further research will give us insight on how to most accurately prevent these types of injuries. In my opinion, areas of future research should at the very least include:

1. Tendon characteristics and relation to different phases of the menstrual cycle

2. The impact of different landing/punching mechanics on Achilles tendon structure/strength and the long term impact on tendon health

3. Disordered eating and its impact on tendon tensile strength

4. The world we live in today and how our body is affecting the female body’s physiology (specifically- tendon strength)

Risk mitigation strategies, attention to the latest research in sport, and simply a will to improve the training regimen and athlete safety are foundational principles to decreasing the number of Achilles tendon injuries.

At What Age Do (Should) Gymnasts Peak? A Controversial Topic

One thing I think COVID has brought for the better in the gymnastics community is an increased focus on change. Change at all levels, stemming from abuse stories, injury and scientific advancement. Having no competitions for a year, I personally was able to take the time to reflect on what is important to me, and what kind of coach I want to be. One thing that I spent lots of time thinking about was the peaking age of gymnasts. Having taken a kinesiology degree at the University of Calgary, I was able to learn a lot about different sports, their physiological needs and LTAD (long term athlete development) timeline. This got me thinking that perhaps we can adjust our gymnastics training system to reduce injury, increase longevity and alter the typical gymnast’s ‘peak’ age.

Background

Up until the 1970s, gymnasts on the Olympic stage were largely adult women. For example, Vera Caslavska was twenty-two when she won her first all-around gold medal at the 1964 Olympics, and twenty-six when she was able to repeat as Olympic all-around champion at the 1968 Games. Compare this to Olga Korbut, the darling gymnast who took the gymnastics world by storm at the 1972 Olympics at age 17, where she won three gold medals. Then, we had Nadia Comaneci, who got the first ever perfect 10 when she was just 14 at the 1976 Olympics in Montreal. Though it did not happen overnight, by the time Nadia won her medal in the 1970s, young gymnasts with pixie haircuts had taken over the sport. The trend of having younger athlete on teams stayed fairly consistent throughout the 1980s, 1990s and 2000s, though there are some exceptions. For example, Svetlana Khorkina competed at 3 Olympic Games in her career (1996, 2000 and 2004). However, it is important to note that she was the exception rather than the norm. Since the mid 2000s, we have seen an increasing amount of older gymnasts remain in the sport at the elite level, suggesting that perhaps the trend is beginning to reverse itself. There are increasing amounts of gymnasts reaching their peak abilities later in their careers- Simone Biles, Aly Raisman, Ksenia Afanaseyva, etc. At the JO level however, it still seems that there is this belief that gymnasts peak anywhere from ages 14-18. With the elite success we see from older gymnasts, we must then question as to why in our culture it is still largely engrained that girls must learn skills as fast as possible, before they hit puberty.

Is it a biological advantage to teach skills when they are smaller?

If you came here looking for a concrete answer, unfortunately I do not have one for you. Younger gymnasts are easier to spot, there is no doubt about it. However, I would argue that that requiring gymnasts be taught skills pre-puberty is flawed. The first issue: as we’ve seen with gymnasts who hit growth spurts, sometimes they CAN’T do skills after they’ve hit puberty. For example, a common bars skill I find to be more prevalent in junior or early years of senior competition are piked inbars (piked stalders). In some gymnasts, they may experience growth spurts in puberty in which their body composition changes, and is no longer suitable for these types of skills- whether that be because of limb length, hip/hamstring flexibility, etc. For a skill that put immense pressure on the back as the gymnast gets older and flexibility decreases, the decision is often made to opt for a different bars skill. I wonder what the point of focusing lots of time and energy on it in the younger years when it may not have a good trade-off value in terms of future use. I have lots of thoughts in terms of relying too much on flexibility and not working the end range strength enough to be able to complete skills in a post-pubertal body, but that is a lengthy discourse for a different time. While I do believe we need to equip gymnasts with a solid skill base that will serve them will in the future, I also believe that no time really is “wasted time” working on physical preparation and trying new skills, as long as gymnasts are physically and mentally ready. The pros and cons must then be weighed to see if there really is significant benefit in pushing for maximum acquirement of skills pre-puberty. After all, it’s basically like doing the skill in a whole different body anyways, so is it really necessary to teach them everything before age 12?

Wear and tear on the body

This is perhaps what I have a greater issue with in terms of kids training hours upon hours when they’re still in elementary school. As I’ve stated in previous articles, peak bone mineral density (BMD) doesn’t occur until well past puberty, and usually occurs in females in their early to mid twenties. Bone remodelling is rampant in females pre-puberty, reaching a peak remodelling rate from 11-14, and then reaching a plateau around age 16. This plateau indicates that the majority of bone content, size and mass has been attained, with slow remodelling occurring until peak BMD has been achieved. In girls ages 10-12, forearm fractures peak due the rapid remodelling rate of the skeletal structure, which lags behind height and weight changes that come with puberty. This study also suggests that bone size increases prior to BMD and BMC (bone mass content), which in layman’s terms means that the bone grows faster in size than in strength, and most likely contributes to an increase risk in fractures in early puberty. So what does this mean? Children’s bones are pliable- they easily move and therefore, are easier to break. This is because a child’s body grows in height and weight faster than their skeletal structure can keep up with. A child has open growth plates and their bones are constant remodelling, so putting excessive force on the joints in big tumbles such as full ins or double layouts is potentially too much for their bones to bear. Not only do they not have the skeletal structure necessary, but in this seven year longitudinal study, it was discovered that bone development precedes muscle development, further increasing the risk of fractures. Though these findings would make sense, it is important to note that muscle versus bone growth rate is controversial and needs more research before a more definite conclusion is reached. When we consider all the above factors, it should really be no surprise that we see so many fractures in gymnasts. I don’t think there is anything wrong with learning big skills on the tumble track at a relatively young age and doing trampoline work, but I do believe we must begin to stray away from the idea that young gymnasts need so many numbers and hours on hard surfaces, and that they must compete these skills pre-puberty.

The culture of NCAA recruiting

I believe that a huge reason we still deal with so many injuries in pre-teen and teen gymnasts is because of the pressures of college recruiting. Up until May 1st 2019, schools were able to speak with gymnasts and give unofficial visits. This resulted in gymnasts committing to schools in the EIGHT grade. Personally, I wanted to go to Harvard and go to law school in grade 8 ( a FAR cry from what I’m doing now). I find it young to pick a school you won’t attend for another 5-6 years, and I think it leads to a pressure to perform top skills to secure a scholarship spot early, before they are all gone.The new rules that came into effect in 2019 now make it so coaches are not able to contact gymnasts until June 15th of their sophomore year of high school. I hope as the years go on and future classes of top schools don’t have any prior verbal commits from previous years leading up to the rule change, that gymnasts and coaches will feel less pressure to bust out the top skills at early ages and follow a more gradual pacing timeline.

The effect of club gymnastics culture limiting adult participation in the sport

If you’ve been to any gym club during competitive training hours, you will most likely see the room dominated with younger girls, and then typically a group of older teenage athletes. What you don’t see (at least in Canada), are hardly any adults training.

I think a large reason that we push girls so young to compete such high-level skills, is because we see their path in club as being from the age they start at the gym, to 18. It is not the norm to train girls after age 18, unless they are elites and their Olympic year falls when they are 18/19. I remember going on Twitter this year, and there was controversy that girls whose collegiate teams opted to not compete this year went and competed at JO 10 regionals and nationals. Some complained that it “wasn’t fair”, because they were “taking spots away from girls who were trying to be recruited by colleges”. While I can understand the sentiment, gymnastics is a competitive sport. If a gymnast is able to compete at a level 10 level, why should she be restricted from attending JO Nationals just because she’s an adult?

On the other end of the spectrum, a personal friend of mine competed JO 6 last season in Canada after a decade of not competing. After playing around at open gym over the past few years, she wanted to be able to do competitive gymnastics again. In our province, there were currently NO adult meets (other than fun ones) and no adult competitive teams. Sadly, she was not met with enthusiasm by several members of the gymnastics community. I heard grumblings that she was “too old” and that it “wasn’t fair” that she was competing against girls 5-10 years younger than her.

Though only one person’s story, I think this anecdote is indicative of a greater cultural issue in women’s gymnastics. Once gymnasts turn 18, they are expected to move onto other things- college gymnastics, university, etc. Making the gym not inclusive to older athletes makes them not want to stick around- it makes them think that their time is done, that they’re too old, too broken, and that there’s no point to continue training if they aren’t elite. If we want to consider an older peaking age in gymnasts, we must also culturally shift from thinking the sport is only for little girls to a sport for grown women, and make it an inclusive environment for athletes of all ages.

Is it *physically* feasible to hit peak ability later in life?

Perhaps if we were more inclined to believe that women’s artistic gymnastics (WAG) is a sport that spans into adulthood, longevity would increase and we would begin to see older gymnasts hitting peak ability later in life. Trampoline and Tumbling seems to have made this work (see Rosie MacLennan who has been around for the better part of a decade and has two Olympic Gold medals), and while they are two different sports, I think we could learn a thing or two from the cultural mindset. I understand it is more feasible for trampoline and tumbling athletes to continue their careers into adulthood because the reduced training hours allows them to also be able to have a job, but this is EXACTLY the point I am trying to make. Is it possible for WAG to have older athletes training lower hours while still maintaining competitive routines? We won’t know until we try. I do believe that another issue that complicates artistic gymnastics is that the ultimate goal for many gymnasts is college gymnastics, which they go to at age 17/18. That being said, I do believe there is room to grow, even if simply leads to healthier gymnasts in their teens years, and not to older Olympians.

Proof that gymnastics can still be done at an older age, we are starting to see older athletes hit their peak ability well past their teen years. Becky Downie from Great Britain is a great example of this. She has been competing at the senior level since 2008, and did not win her first World Championships medal until 2015, a team bronze, at age 23. She did not win her first individual world medal, a silver on the bars, until 2019 at age 27.

Where do we go from here?

Evidently, even if it is not currently the norm, it IS possible to hit peak ability at older ages. More research needs to be done on biological effects of competing in gymnastics later in life, and the skill development timeline that would be most advantageous to prolonging the careers of athletes. The unfortunate reality of the situation, is that we will not have more athletes with increased longevity until the predominant gymnastics training system changes. In order to effect change, there will be mistakes made along the way, which I strongly believe is why sport takes time to see large scale change. I think that we are on the right track with an increased emphasis on strength and conditioning, along with athlete well-being emerging as more important priorities in gymnastics. Therefore, I do believe we CAN see the sport increasingly change and adapt, whether that leads to older athletes at the elite level or healthier athletes at the college level.

5 Exercises to Improve Active Flexibility and Mobility

Coming back to training in early February, I was inspired to focus on increasing my gymnasts’ mobility and active flexibility- both in their leaps/jumps and in passive stretches. A few years ago, we had a strength and conditioning coach come into our gym to talk about how strength is a crucial aspect in achieving active flexibility. Being strong enough at the end range of movements is key for achieving maximum range in skills such as back handsprings, jumps/leaps, etc. After testing out lots of different exercises and stretches, today I share a few of my favourite exercises that I have discovered over the years.

1. Superwoman Lifts

There are two types of superwoman lifts I like to use to achieve maximum shoulder mobility and flexibility in skills like handsprings, walkovers, etc. The first has the gymnast lying on their stomach, nose on the ground. Keeping the nose on the ground and elbows straight, they focus on lifting their palms off the ground as high as they can, holding at the top for a second, then slowly lowering back down to the ground. I used this recently before practicing Yurchenko vaults, and the girls were able to open their shoulders and block more effectively. I find that 10 repetitions of this exercise before performing skills is typically enough to see direct improvement.

Superwoman lifts:

Superwoman 4-point lifts:

The second variation of these lifts is the 4-point variation. In this, the gymnast lifts her palms off the ground, hitting 4 different points until her arms are by her sides. This is particularly important in improving overall shoulder mobility for the skills mentioned above, but also to keep the chest open and maintain/improve posture. I use this exercise more as a preventative measure in terms of keeping the shoulders moving well, and for developing mobility for overall shoulder health.

Exercise tips– keep nose to the floor, elbows straight, hold at the top of each lift for one second before lowering arms

2. Straddle Lifts

Perhaps the most difficult exercise I have listed, gymnasts begin on their elbows in froggy, next to a panel mat. One leg then extends onto the panel mat so that the gymnast is in half middle splits and half froggy. The gymnast then pulses the straight leg up and down, lightly tapping the mat. This works on strengthening the gymnast’s glutes and external hip rotation, which are crucial to improving active flexibility in skills such as straddle jumps. To make this exercise easier, have the gymnast bring her bent leg in so that it is directly underneath her. I start with 2 sets of 5 repetitions per side and increase accordingly as strength improves. Starting difficult exercises with low repetitions is crucial to maintain form and have them performed correctly.

Exercise tips– keep hips square and straight leg in line with hips

3. Isolated Leg Lifts

A common exercise used in gymnastics, I slightly modify it by having the gymnast place her arms down by her sides, palms facing the wall.

Front scale lifts:

For the front scale leg lifts, I have the gymnast start with her heel against the wall, shoulders down, ribs in, and hands down at her sides, palms facing the wall. This allows her to completely focus on her lower body. The exercise begins by the gymnast lifting her leg up as high and fast as she can, followed by a slow lower.

Exercise tips– keep hips square, engage lower core and hip to lift the leg, keep both legs straight

Arabesque lifts:

During arabesque lifts, I have the gymnast place her arms and chest on that well, as all too often girls will lean forward to kick their back leg high. For this exercise, I am less concerned about the height, and more focused on keeping the back hip stretched open with a straight leg, and strengthening the glute to lift the leg. In this exercise, the gymnast begins with hips square, and with the top of her foot pushing into the box, so that the back hip is extended and the leg is straight. She then puts her chest and arms on the wall (a wall “hug” I call it) to minimize upper body compensation in the kick. She then lifts her leg up and down, fast on the way up, with a slow lower. In order to make this exercise easier or harder, the box can be made lower or higher accordingly.

In both these exercises, it is important that the gymnast lifts quickly and lowers slowly. Going fast on the way up teaches those muscles that they need to be quick (necessary for jumps/leaps), and the slow lower strengthens the core/hip.

Exercise tips– maintain stretch through the back hip, keep hips square, minimize upper body movement

4. Hamstring Rolls

This exercise is the simplest on the list to teach. The gymnast begins in a half split stretch, with the bottom of her calf on the foam roller. From there, she puts both hands on her calf, applying pressure, and begins rolling her leg back and forth. To be effective, adequate weight must be placed on the calf for the hamstring to lengthen during the rolls. Please note that the roller does not need to move more than a few inches when going back and forth, even with flexible hamstrings. This exercise should be carefully supervised to ensure it is being done correctly to avoid excess strain on the hamstrings.

Exercise tips- keep hips square, keep rolls small, maintain adequate pressure on calf

5. Modified Runner’s Lunge with Slider

This is possibly my favourite exercise/stretch ever. I would even argue that it is somewhat magical! I do this all the time before jumps/leaps, and have seen improvement in overall split, stretching of the back hip, and maintaining a straight back leg in dynamic movements.

The key to doing this exercise is to engage the lower core. In the starting position, the gymnast is to engage her lower core, standing with hands on the hips and legs straight prior, with a slider underneath one foot. To initiate the exercise, the gymnast begins to push the slider back with the ball of her foot, while simultaneously bending into the front knee. She must keep the core engaged and the back leg straight, until arrival into a runner’s lunge. Once achieving maximum mobility, the gymnast drags the slider back in until she is back to her starting position.

This is an effective stretch, as stabilizing the core puts focus on stretching the hip flexor instead of the ligaments in the hip joint capsule. The use of the slider also causes active work of the muscles (glute, hips, etc) to reach the extended hip position. These same muscles are those that are used in achieving the split in dynamic movements such as jumps or leaps. We stretch the antagonist muscle (hip flexor) in the straight leg, while we strengthen the agonist muscles (hamstring/glutes), a concept used often in the world of strength and conditioning.

Exercise tips- keep lower core engaged, keep back leg straight, go slowly for maximum benefit

So there you go, five of my favourite exercises to improve mobility and flexibility. Let me know what you think of these exercises, and any ones not mentioned that you like to use in your home gym!

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A Controversial Topic: How Many Hours Should Female Gymnasts Train?

Something I’ve really thought about over the past few years is how many hours gymnasts should train. Or better yet, how many hours gymnasts should be in the gym, and what the time in the gym should look like.

The first time I remember actively thinking about this topic was in 2009. The new TV show Make It or Break It had just come out. Unfortunately at this point in my life, my family did not have cable. So, I would spend hours on the family computer looking up YouTube videos to see if I could locate any clips from the show. In the rabbit hole that is the YouTube suggested videos, I stumbled upon old US Nationals broadcasts. During one of the broadcasts, I remember it was mentioned that Nastia Liukin trained 30+ hours per week, while her teammate Shawn Johnson only trained around 20-25.

As I reflect back on this time it gets me thinking- both of these gymnasts took turns being the top 2 Americans between 2006 and 2008, with completely different training regimens. Nastia had a history of being more injury plagued, while Shawn remained relatively healthy through to the 2008 Beijing Olympics. This could be for a variety of different reasons but got me thinking- for most athletes, what is the optimal amount of training for developing high performing athletes, while also minimizing risk for acute and overuse injury?

Sport specialization: what the research says

Gymnastics is a sport that has historically seen gymnasts specialize at an early in their career due to the fact that so many hours of training are required at a young age. Training 16+ hours in the gym in primary or elementary school usually leaves little time for other sports or activities. Currently, the consensus in the sport science community is that early specialization is not ideal for two reasons: athlete burnout and injuries. Not only burnout and injury, but there are other repercussions for specializing in a sport young, especially gymnastics. This 2019 study found that gymnasts who specialized showed decrease manipulative skills over their peers who were involved in multiple sport programs. Manipulative skills include passing, throwing and catching objects. We all know that there is a running joke that gymnasts can flip on a 10cm wide beam but can’t throw a ball, but maybe this isn’t something to joke about? We have to wonder if maybe we are setting up children to be, to a degree, physically illiterate. This could have potential negative effects for their life such as eliminating the option to excel in gym class, or partake in activity as adults.

There is evidence that sport sampling (trying lots of different sports) at an early age is beneficial for kids. For example, this 2009 study found that children who experienced multiple sports at a young age instead of specializing were more likely to be active as adults, had lower levels of athletic injuries, and scored more favourably on outcome measures such as grade point averages . Seeing as overuse injuries are most commonly associated with repetitive motions, it is not a shock that experiencing a variety of movement patterns that different sports bring would decrease injury. Knowing this information, we must then answer this question: what is the goal for the kids we are coaching? This may, should, be different for evert child. However, it is important we consider that very few gymnasts will ever compete at the level 10 or elite level, and they certainly will NOT if they quit gymnastics by age 12. Instead of making them choose gymnastics over other sports at age 8, maybe we should make it so that doing other sports simultaneously is an option. Without a doubt, specializing in the later teen years is mandatory to compete at the elite level. But perhaps with peaking kids later, along with lowering the hours at the younger levels would have it so kids are a), less injured and b), more inclined to remain in the sport- which is what we want at the end of the day, isn’t it?

If sport specialization at at young age is bad why do we still do it?

Though the research states that sport specialization is not good in terms of injury and athlete burnout, lots of gymnastics coaches (previously, even myself) do believe that girls need to start the sport very young. While I agree that an early start in gymnastics is an asset, that doesn’t mean a seven year old needs to train 20 hours per week. In fact, I was watching NCAA this weekend and the commentator of the Auburn/LSU meet said that Auburn gymnast Piper Smith started gymnastics at age 10. One might argue that we don’t see lots of top level gymnasts who started gymnastics at a later age, and therefore you do need to start gymnastics early on. However, I would argue that this might be partially due to a cultural issue. I know plenty of gyms who will not accept older kids into their competitive programs if they are starting gymnastics later, or will put them into a different “stream” (ie: Xcel). It may be that lots of talented kids have gotten turned away for simply not meeting the “mold” of starting gymnastics at age 5. This is entirely speculation on my end but I think it would be interesting to investigate in the future.

Attention limits of children in relation to sport

The first thing we need to consider whilst planning training sessions that lots of us currently do not, (myself included, up until recently), is the attention span that a child has. According to Brain Balance Centers, children usually can focus well for 2-3 minutes per year of their age. For example, if we go with 3 minutes, this means that a ten year old can focus for a maximum of thirty minutes before needing to switch tasks. In most competitive gyms I know or have been to myself, practices for children 7 and up are around 4 hours long, with 45 minute-1 hour rotations.

Theoretically speaking then, a 10 year old child has enough focus for 30 minutes for a rotation. This means that our 45 minute-1 hour rotations are not nearly as beneficial as they potentially could be. My suggestion would be to do one of two things: firstly. adjust the schedule so that an event is scheduled twice in a practice- two, thirty minute chunks instead of an hour long rotation. The other option would be to shorten practices by a bit so that the entire time in the gym is more productive. This is the option I would lean towards, especially with younger kids. Why spend 20 hours a week training if only 12 of them are productive? In speaking of productivity I don’t mean eliminating the social aspect or just simply working in the gym the entire time. I am talking about eliminating the unfocused, half-effort turns, the wasted time in the latter half of the rotation because the girls are too tired to get on the bar to take another turn, etc. I believe just being in the gym for the amount of time the child can focus would not only maximize performance, but also give them time to do other activities if they so choose. There are some exceptions, but I do believe that in practice there can be lots of time wasted on an event simply because the kids hit their max attention span (not to mention fatigue threshold) around the thirty minute mark.

So- what should we be doing?

With the ever changing research that is coming out about sport (specifically, gymnastics), the overwhelming consensus is that more hours is not necessarily better. Why is it so hard of us to let go of this notion then? Because no coach or athlete wants to believe that they didn’t reach their goals because they didn’t put enough time or effort in, and to be honest, gymnastics is still one of the sports that requires the most hours in the gym- I will not argue with that. The question then becomes, what is the optimal amount of hours for girls to train that maximizes improvement and progress while also reducing the risk of injury?

As stated above, I think time on each event should be roughly limited to the age of the child times three. While that is simply the average of an attention span and not the upper limit, I think it would be a good rough guideline to follow. While this can be difficult as gymnastics is not separated by age, but rather by skill level, I think the smart choice would be to take roughly the average age of the group and use that as the multiplied number. Ie: you have a group of 7/8 year olds, you schedule around 30 minutes on an event (3×8= 24 and then a buffer five minutes to set up equipment/get going).

All things considered, the research in relation to how much we should train and what that should look like is lacking. The reality is, I don’t have an answer on how many hours per week different levels should train. In doing research for this article, I found lots of opinions on the matter but none that had any scientific backing. However, Dave Tilley from Shift Movement Science has begun researching how to quantify load in gymnastics, and I think this is the key to optimizing gymnastics training. Once we can quantify load (ie: how much stress 10 double backs or 10 back walkovers is on the body), it will be easier to decide how much and how often we should train on the events, how long we should spend on weightlifting/conditioning, how much accessory work we need, and how much rest we need between sessions.

Why implementing less training hours is complicated- NCAA

If you’ve been a member of the gymnastics community for long enough, you know that other than the Olympic Games, most gymnasts’ ultimate goal is to attain a college scholarship. With early recruiting still being a problem, we’ve seen girls as young as 13, predominantly top elites, verbally commit to the top schools. It is important to note however that per the NCAA website, new rules state that gymnasts are not to communicate with coaches until June 15th of their sophomore year. Hopefully this will help prevent early recruiting going forward. I do fully believe however, that most top programs have/will try to get around these rules, and that more steps will need to be taken by the NCAA to eliminate early recruiting going forward.

Even with the rule change, coaches have their eye on gymnasts very early on. This early recruiting causes a mad dash for gymnasts to get as many skills as possible, mostly in ages 11-14, for fear that if you leave it any later there won’t be a scholarship spots left. This leads to increased training hours and a push (whether that be from the coach, gymnast, parents or all three) to get new, high level skills that are desirable in collegiate gymnastics. In female gymnasts, their BMD is growing at it’s most rapid rate from ages 11-14 (we talked about this a little more in last week’s article which you can find here). During this age, gymnasts are therefore most susceptible to injury. It is hard to balance as a coach, because it is a delicate balance between helping the gymnast realize her dreams and keeping her healthy, and sometimes, it seems nearly possible do both.

It is also important to consider the greater picture when we think of hours and college gymnastics. By the time junior elites get to college, they are often injury plagued and either hardly compete or have to medically retire. For example, take Jazmyn Foberg, a senior on the Florida Gators gymnastics team- a 2014 US Junior National Champion, Jazzy was, and still is amazing, but injuries she brought with her to college from her elite career have left her only having competed a full college season in 2018.

In summary

At the end of the day, I think most of us are having young kids train too much. I have personally found in prior years where I have coached younger athletes (and even some older ones), that a four hour practice is too long in terms of both physical and mental fatigue, and that kids burnout when faced with high volumes of training at a young age. In line with research, I think we need to consider the effects of sport specialization, burnout and injuries when designing our training plans and schedules. Other factors that also need to be considered are time to fatigue, preventing injury and keeping the kids engaged while maintaining enough repetition to be successful in competition. Overall, training hours in gymnastics need to be more researched. Until we have a better idea of what load skills pose on the body, all we can do is remember that we are first and foremost coaching people, and that everything we do should be in their best interest at a personal level, followed by how it affects their gymnastics, not the other way around.

Working with the Cycle- Coaching Female Gymnasts Through Puberty

A few weeks ago I went in to see my massage therapist. As always, we chatted about a variety of things- then, the topic of periods came up. I currently struggle with an irregular cycle and ovarian cysts so needless to say, my cycle has been a mess since can I remember. She told me I might like this app called Flo that allows you to track your period and makes suggestions for you based on which phase of the cycle you are in. I downloaded it and immediately fell in love with it. One of the features that intrigued me was the one that suggested different types of exercise (HIIT, restorative yoga, etc.) for each phase of your cycle. This got me thinking- with the overwhelming amount of changes that puberty brings- hormonal changes, body changes, growth related pain/injuries, etc., maybe there are changes we can make in gymnastics training to better work with the gymnast’s body. Today I discuss the idea of exercise in relation to the female menstrual cycle, along with other aspects of puberty and how we can best support our athletes. 

A rundown of the cycle: the basics and what you need to know 

As noted by the popular app Clue, the menstrual cycle is composed of six general parts- menstruation, the follicular phase, the proliferative phase, ovulation, the luteal phase and the secretory phase. 

Menstruation: aka: the period- shedding of the uterine lining, estrogen and progesterone levels low. 

Follicular phase: time of the period between menstruation and ovulation- uterine lining slowly starts to build back up again and as this happens, estrogen production occurs.  

Ovulation: release of egg from ovary mid-cycle. Estrogen peaks just beforehand and drops right afterwards. 

Luteal phase: Time between ovulation and before start of menstruation. Progesterone is produced, peaks, then drops.  

Secretory phase: Uterine lining produces chemicals that will either help support an early pregnancy or will help prepare the lining to break down and shed if no pregnancy occurs.  

Image taken from helloclue.com

Then, you are back to the beginning.  

A cycle typically lasts 24-38 days (though cycle lengths can vary/be irregular, especially during puberty). Changes after the onset of menstruation can not only include changes in the body (hair, skin, weight, etc.), but also psychological impacts such as migraine headaches and decreased mental health.  

Om for the flow?  

There are few studies that examine exercise for distinct phases of the cycle and virtually none that include gymnastics. However, a few related to general exercise do exist. For example, this study examined the use of yoga and determining its effects on heart rate and blood pressure pre and post cycle. Historically, these parameters are higher in the pre-menstrual phase of the cycle and are correlated with increased levels of anxiety, depression, mood swings, irritability, etc. Yoga was found to decrease blood pressure and heart rate in both the pre and post menstrual phases of the cycle. In gymnastics specifically, my first thought is that use of yoga in training may increase performance, especially on an event like balance beam where controlled nerves and a positive mindset are so important. We all have those girls that hit 12/13 and start experiencing increased emotions due to puberty, and yoga may be a coping mechanism we can use to help regulate emotions and in turn improve performance. 

Cycle research in relation to sport is lacking 

When researching for this article, overall I was disappointed to find that there were very limited studies surrounding menstruation and exercise, and virtually none in relation to gymnastics. One 2020 study did say that that there was no performance change in relation to the cycle for distance covered in matches in female soccer players. While I have no doubt that athletes are capable of playing throughs aches and pains and are mentally tough, I wonder what research would say in terms of maximizing performance in sport. This study looked at current game performance and how it was affected, but I would be more interested in seeing studies done that investigate optimizing training to facilitate high performance. While we cannot control the days competitions occur, we can control when we introduce certain training techniques such as learning new skills, working on strength/conditioning and when we ease off. We periodize our schedules to account for off-season, pre-season, season, etc., so why can’t we partially periodize the training for bodies? You may think I am out to lunch on this (which is completely fair), but the female is so under researched in the science community (specifically in relation to sport) that I can only imagine what is left to discover. 

The female athlete triadwhat it is and what we can do to help  

This is something we’ve known about for quite a long time. While not directly relevant to physical programming, I thought it was important to include. If you’ve never heard of it before, the female athlete triad is a combination of disordered eating, osteoporosis and amenorrhea (loss of period). It is important to note that all three factors are related to each other, as disordered eating can lead to amenorrhea, which in turn is associated with osteoporosis. In a sport that has a history of all three of these factors, this is definitely something we need to keep in mind when coaching our athletes. Though we are making improvements, the journey to positive body image and healthy bodies is far from over. This is especially important for our sport as we deal with high impact loading and dangerous skills on a regular basis. A 2017 study suggested some effective treatment/prevention strategies in terms of the female athlete triad from a multidisciplinary team. Below are some roles and responsibilities I extracted from a table in the article that I think coaches need to be informed about.

Team MemberRole
Athlete– Abides by the guidelines established with other team members
– Communicates concerns (and successes) with team members
– Keeps lines of communication open
Family members (parents, siblings)– Support and encourage athlete
– Create a positive environment for the athlete
– Provide an environment for success (purchase healthy food choices, set a good example by making good food and exercise choices
Registered dietician/nutritionist– Educates the athlete regarding general health, good choices and sport-specific food choices (training and competition)
– Oversees restoration of positive energy balance (refuelling)
Physical therapist– Provides rehab guidelines for injury management (stress fractures, overuse injuries) and recovery
– Make exercise recommendations to promote bone acquisition
Psychologist/psychiatrist– Determines if there is an underlying diagnosis (anxiety, depression) that may be triggering
– Triad-related conditions, psychiatrist prescribes medication when necessary
– Provides support and management strategies for coping with the condition

While it is not our job as coaches to act as a nutritionist or psychologist, I think it is important to be informed of potential risks for developing the female athlete triad, and then being able to refer gymnasts and parents to the appropriate practitioner. Risks associated with the development of the female athlete triad include weight loss, difficulty concentrating and irregular or absence of periods. Catching potential problems early is key in protecting our athletes. 

Not scientific, but I think it is also important that we as coaches are careful to how we discuss appearance, and how we frame an athlete’s health in the gym. In the past, I have walked by and heard coaches discussing how so and so gained weight, or how someone else needs to lose five pounds. Sometimes, this has even been in the ear shot of the gymnasts. In my personal experience, 9/10 times these discussions occurred around an athlete who was in the midst of hitting puberty. While I understand that gymnastics is a strength to weight ratio-based sport, I think it is important we focus on our athlete’s happiness and health in the gym. You cannot control what they do at home, what they eat or what happens when nature takes control, but you can help them become strong and independent athletes with healthy mindsets and boundaries.  

Preventing stress fractures 

One of the main types of injuries seen in gymnastics are stress fractures. In a sport with high loading and high repetition, it is no wonder that we struggle with broken bones. My opinion stands that as coaches, we need to design our programs intelligently to effectively manage the load on our gymnasts’ bodies. In terms of preventing spinal stress fractures, we need to make sure we are teaching gymnasts to use their deep core muscles to keep the spine protected (you can find the information in last week’s article here). Along with muscular control, it is important to generally understand the changes bone undergoes through puberty. When speaking of bone, we refer to bone mineral density (BMD) as a measure of bone strength. According to Bone Mass Gain and Adolescence, bone remodelling rate is highest in girls from ages 11-14. In a sport where girls are learning double backs at age 10, we are teaching them skills that have astronomical force on their joints, when they haven’t even come close to hitting their peak BMD (females usually achieve 98% of their peak BMD by age 16). Keeping this in mind, it may be that we need to adjust our training plans in terms of teaching extremely difficult skills. Perhaps we should stick to drills, softer landings and longer periods of training a skill before we introduce it into competition. How many of the top level junior gymnasts competing double twisting double backs at age 12 make it to the senior elite ranks? Not many.  

In my research for this piece, I found in this article published in 2019 that discusses different injuries and their prevalence in gymnastics. One of the most common wrist injuries this paper named was a stress fracture of the scaphoid bone. The scaphoid bone is a tiny little bone in your wrist found near your thumb right above the radius bone. The mechanism for this injury is repetitive wrist extension (position the hand is in in a handstand) with compressive axial forces. The comment in the article I found most interesting was that this type of wrist injury is “particularly seen in gymnasts who have rapidly increased their level of training”. This is a serious injury that leaves a gymnast out 8-12 weeks in a cast with no weight bearing, so my thought is that the rapid increase in training is NOT worth it if you are then sidelined three months with an injury. While I am completely cognizant that gymnastic requires lots of hours of training, I think the evidence demonstrates that what we are currently doing is not working for us. Evidence of BMD and injuries further reinforces the idea that we need to pace our gymnasts better. Training them for longevity with an end goal in mind- may that be completing a gymnastics career relatively healthy or competing in college- is crucial in helping them achieve their goals.  

Final thoughts

Overall, I wrote this article to open a discussion about the best training practices through puberty. While I am no gymnastics expert by any means, my experiences coaching in the sport have taught me that the teenage years are crucial in developing a healthy athlete. Not only do we want to keep them physically healthy, but we also want to help them develop a positive mindset and high self-esteem. In the future I would like to see increased studies on female gymnasts, specifically in terms of quantifying load and effects of certain skills on pre-pubertal bones/joints.

Leave me a comment below and let me know what you think!

You can also follow me on Twitter @levelupmvmtsci.

Promoting Safety in Gymnastics: Landings

In watching NCAA gymnastics this weekend I was inspired to make my first blog post about landings. Seeing these top-level gymnasts land in a variety of ways- whether it be the legs almost completely straight, an arched back, knees turned in, etc.- made my biomechanics-oriented brain hurt. In fact, a 2007 study that looked at injuries in NCAA from 1988-2004 found that 70% of injuries that were sustained in competition occurred on landings during the floor exercise or dismounts. Coaching at the club level I have realized over the years that not everyone knows what a technically safe landing- which to an extent makes sense, since lots of club coaches are young up and comers with limited biomechanics knowledge. However, this past meet weekend reinforced to me that even at the top levels, athletes still do not know how (or do not care) to land correctly. Teaching our athletes to land correctly is one thing coaches can control in terms of injury prevention, whether it be to lessen the load on tendons and ligaments to prevent overuse injuries, or to minimize the risk of fluke injuries occurring.  Please note that today will be a focus on two foot landings primarily for dismounts, vaults and/or tumbling passes.

A Perfectly *Safe* Landing 

An ideal landing position requires that the force upon landing be dissipated throughout as much of the body as much as possible. This is where joint alignment comes in. In the sport of gymnastics, we develop asymmetries from an early age due to the extreme use of our dominant “side.” Due to this, gymnasts tend to favour one side over the other. According to The Asymmetry Of Lower Limb Load in Balance Beam Routines, strength asymmetry may increase risk for injury, as typically injuries occur only to one side, and rarely bi-laterally. It is important to note that more research is required in this field. There are also times when there is asymmetrical joint loading- whether that be when the feet are staggered, when someone is twisting into the ground and one-foot lands first, etc. Landing asymmetrically often makes one susceptible to injury as the body shifts and turns during landing because the impact is not evenly spread between the two sides, making it so one side is more protected than the other. A 2015 study found that the stress on tendons and ligaments is also high when the gymnast lands with straight legs, as the supportive connective tissue takes the hit instead of being absorbed by the muscles due to lack of activation time. Therefore, it is important that we especially focus on having both sides of the body ready for a high impact landing- this includes focusing on alignment as well as increasing the time the body has to absorb the force. 

The ideal stance in a landing is to have feet around shoulder width apart, which widens the base of support over which force is exerted. Knees should be in flexion (bent), tracking over the toes, along with the hips also being in flexion (the ‘I’m about to sit on the toilet position’).

Knee valgus- increases the risk of ACL tears

A widespread known fact in the scientific community is that girls are more likely to land with their knees turned in (we call this knee valgus in anatomy). This increases the risk for ACL tears and can also lead to knee pain, which is why it is important for the knees to be in line with the big toes. In a sport with a decent amount of achilles tears and ACL injuries, we must reflect that maybe poor landings are partly to blame for increasing the rate at which these injuries occur.

A good landing!

Along with foot position, research states that increased bend in the knees helps spread the force throughout the body, as in this position the glutes become activated and absorb most of the force, while stabilizing the knees. According to Forzahealth, dysfunction in glutes can lead to that dreaded knee valgus, so it is important that we focus on having them function correctly. When the gymnast sequentially lands in a pattern of ball of the foot, heel, ankles bends, knee bends, hip bends, this increases the time the body has to take the force. Utilizing this type of landing with proper glute activation protects the joints. Often we see “jolt” like landings when the gymnast lands locked legged. This is to the extreme of straight legs, but demonstrates that the body does not have time to activate the muscles in preparation to absorb the force, therefore leading to higher stress on the joints.

In relation to joints, it is also important that the gymnasts learn how to control their deep core muscles. Spoiler alert: all the crunches in the world do not develop these types of muscles. Instead, exercises need to be taught that encapsulate the whole core (back, superficial abs, deep abs) Using these types of exercises to develop deep core muscles protects the spine at a vertebral level. For some great exercises and more info on this check out this post from Shift Movement Science’s Dr. Dave Tilley. He is a super knowledgeable PT and gymnastics coach who I could not recommend enough!

The infamous back arch we see in NCAA gym to keep chest up on landing

Just watching NCAA this weekend I can’t tell you how many times I saw a gymnast land with her back arched. In this position, the deep core muscles that protected the spine are NOT ACTIVATED. Contrary to popular belief, it is possible that not all of stress fractures in gymnastics come from back bending as once was the original thought (though some definitely do- I will not argue that!). Instead, the thought is that if gymnasts do not activate their deep core muscles during landing, the vertebrae that make up the spine and the intervertebral discs take the blow. Per the Mayfield Brain and Spine website, repeated blows to the spine can lead to degradation of ligaments and/or intervertebral discs that keep the spine aligned. Upon repeated high impact, this is when we start to see stress fractures as the vertebrae’s primary protection is compromised.

Why implementing proper landings is complicated. 

The current code (speaking specifically of WAG) has it so that gymnasts are deducted for physiologically safe landings. As it currently stands in the 2017-2021 FIG code of points, current landing deductions that are potentially detrimental to the gymnast’s health include 0.1 for legs apart on landing, and 0.1-0.3 for body posture fault (which includes chest position). Knowing what we have learned- that hips should be in flexion for a safe landing, this makes it an automatic deduction to use a safe squat landing. Being a former judge and current coach, I can tell you that similar deductions exist in the JO code in terms of chest position. From my point of view, this is part of the problem. Especially at the higher levels where Olympic and world medals are at stake, gymnasts, (often perfectionists), and their coaches want to have the highest score possible. This often includes aiming for chest upright landings with feet together, to prevent landing deductions. If you’ve ever tried to do a squat landing with your chest upright you’ll notice this is impossible to do without compensating in some way, including decreased hip bend or arch through the low back. Then why do we construct our code to use these types of landings you may ask? Because historically, gymnastics is a sport based largely on aesthetics and less on function. Lots of our aesthetically pleasing positions such as a perfectly straight handstand line, or hollow body hold are not functional positions. The struggle then is to implement safety into the code while maintaining what makes the sport beautiful.

Where do we go from here? 

Generally, I think we need to start teaching athletes how to perform a basic squat and squat landing at a younger age. Seeing as gymnastics coaches are experts in gymnastics and not strength and conditioning, this might entail having a strength and conditioning coach come in once a week to work with the athletes and the coaches. Learning correct form and muscle activation will hopefully lead to better foundational movement, and therefore, better dissipation of force upon landing. I also do believe the code needs to be revised in terms of landing deductions at the club, college, and elite level. Furthermore, there needs to be a medical professional and strength and conditioning expert who understands gymnastics on the panel that revises the code of points. Having turned a blind eye at athlete for safety for so long, it is important that we strive to change the way we see gymnastics. In a sport where it was once thought that female gymnasts peaked at 16, I think it is important to realize that this may be the case because we were not training them for longevity, as is reflected in the types of landings most of us still use to this day. My hope is that we as coaches continue to educate ourselves on biomechanics, physiology, and strength and conditioning to help protect our athletes’ health for their gymnastics careers and beyond.