Gymnastics is a great sport to develop strength and flexibility, coordination, agility and discipline. Most kids experience some gymnastics either at school or as a recreational sport at indoor sports centres. A smaller number of kids go on to train for competitions, often competing for the first time at as young as 7 or 8. Competitive gymnastics requires extreme flexibility, strength at end of range, core control, and proprioception. It also demands large training hours of 15-30 hours/week. These high demands coupled with the fact that gymnasts are mostly children or adolescents means they are more susceptible to certain injuries. Below is a summary of some common injuries in gymnastics and recommendations for treatment and prevention. Lower back pain – low back pain is very common in gymnastics. There are several diagnoses that can be the cause of low back pain in gymnasts including facet irritation, sacroiliac joint problems, stress reaction/fracture or spondylolysis. The arched posture of typical gymnasts pre-disposes them to low back pain. Landing in this arched position or landing short with twisting movements can jam up the joints in the low back. The great flexibility of the gymnasts low back can also be a problem if they do not have adequate core strength to be stable in these extreme positions. Physiotherapy is crucial to determine diagnosis as this will affect whether the gymnast needs to rest from training and how long it will take to get better. It is important for gymnasts, coaches and parents to remember that low back pain in gymnastics can be treated. It is not something that should have to be ‘put up with’ and in fact ignoring low back pain can lead to more serious problems both now and later in life. Ankle sprains –ankle sprains often occur in gymnastics particularly in tumbling or landing from jumps and leaps that requiring twisting. Ankle sprains are usually a ligament injury but more severe ones can result in fracture. Under-rotating/landing short on tumbling or vaulting can also cause ankle pain as the shin bone and ankle bone jam against one another. Initial RICE is important. Physio can determine whether XRAY is required, help speed up the healing process and give specific exercises to prevent the injury recurring. Tape may also be useful when returning to gymnastics as theses injuries commonly recur. Knee Pain – the knee is most commonly injured when landing dismounts and can involve damage to the ligaments or cartilage. Knee pain that comes on gradually is also common and may be related to growth (Oscgood schlatters) or due to the knee cap not tracking correctly (patellafemoral pain). Assessment is important to determine the exact diagnosis as with some knee injuries you may be able to continue training, others may require a short period of relative rest while more serious ligament or cartilage damage may require surgery. Shin splints – Shin splints is an umbrella term used for shin pain, it can actually be a variety of different diagnoses. These include stress fracture, medial tibial traction periostitis and compartment syndrome. Shin pain is caused by repetitive high impact loading. Muscle tightness around the calf and shin and poor foot biomechanics can also contribute. Shin pain needs to be assessed to rule out stress fracture and generally requires a period of rest coupled with physiotherapy treatment to correct muscle tightness. Wrist pain – wrist pain is common in gymnastics due to the repetitive high impact weight bearing particularly with tumbling. Any wrist pain that comes on suddenly particularly due to a fall needs to be assessed to check for a fracture. Wrist pain that comes and goes or develops gradually can be caused by the bones in the wrist jamming against one another when the hand is bent backwards such as in a handstand. Using braces or taping to give the wrist some support and prevent it from bending all the way back can be useful. Preventing and treating injury in gymnastics is a team effort. Coaches need to be aware of techniques that predispose to injury and correct their gymnasts accordingly. Parents need to monitor their child’s symptoms and ensure they are getting adequate rest and nutrition. The gymnast themselves needs to be aware of the difference between fatigue pain and injury, something which can be very difficult in children, particularly when they may have done the sport virtually their whole life. The physio needs to understand the requirements of the sport as well as the gymnasts themselves who are often very motivated and have a high pain tolerance. Finding a physio who specialises in sports or used to be a gymnast themselves will be even more beneficial. Prevention is better than a cure. Regular screening of all competitive gymnasts is important to detect and correct technique faults, pathology, poor biomechanics and muscle imbalances that may predispose to injury. Overall it needs to be emphasized the assessment and diagnosis by a professional is paramount. Many gymnasts do not report pain. This may be because they do not consider the pain to be an injury, the do not want to have to stop training or they do not want to tell their parents or coach. However early diagnosis and treatment can prevent many more serious problems and enable a much quicker return to painfree training and competition. Physiotherapy assessment is the best first step then if needed the Physio will refer the gymnast on to a sports doctor or for scans such as an XRAY.