Gymnastics Injury Rate Rivals That of Contact Sports

ACEP News
May 2008

By Diana Mahoney
Elsevier Global Medical News

Young gymnasts are as prone to catastrophic injuries as young athletes who participate in more aggressive contact sports, according to the results of a large retrospective analysis.

Between 1990 and 2005, an estimated 425,900 children from 6 to 17 years of age were treated for gymnastics-related injuries in U.S. emergency departments, representing an average of 4.8 injuries per 1,000 gymnasts per year.

This annual injury rate is on par with those reported for sports such as hockey, soccer, and basketball, and warrants the establishment of a national database for gymnastics-related injuries with an eye toward the development of prevention strategies.

The investigators calculated national estimates of gymnastics-related injuries, as well as rates of the most frequently occurring types of injury, using sample weights provided by the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission.

Of the estimated 26,600 gymnastics-related injuries occurring annually during the study period, more than 82% occurred among female gymnasts, and the average age of the injured gymnasts was 11.5 years.

Over the 16-year period, the annual injury rate decreased by 25%, from 28,700 in 1990 to 21,500 in 2005, wrote Shubha Singh and colleagues of the Center for Injury Research and Policy, Columbus, Ohio (Pediatrics 2008 April [Epub doi:10.1542/peds.2007-0767]).

Overall, upper-extremity injuries accounted for 42% of the gymnastics-related ED visits, followed by injuries to the lower extremities (34%), head/neck (13%), and trunk (10%).

Girls were more likely than were boys to sustain upper-extremity injuries, while boys were more likely to sustain head/neck injuries, the authors reported.

Analysis of age-related patterns revealed that lower-extremity injuries and strains/sprains were the most prevalent type of injury in older gymnasts (12-17 years), while upper-extremity fractures/dislocations were most common in younger gymnasts (6-11 years).

"The high frequency of upper-extremity injuries in the 6- to 11-year age group could be attributable to improper training in correct falling procedures," the authors hypothesized.

"Gymnasts, unlike football or rugby players, are not taught to fall in a manner that diffuses the impact of the fall across as much of the body surface as possible; consequently, individuals have a tendency to stiffen up and brace themselves with their arms during a fall."

Most of the injuries occurred either at school (40%) or at a sports or recreation facility (39.7%). Approximately 20% of the injuries happened at home or on other public property, and these were significantly more common in the 6- to 11-year-old athletes, "which may reflect where the younger age group spends a great deal of active time," the authors wrote. In addition, "it is unlikely that children use competition or training mats to practice gymnastics at home; as a result, they are more likely to practice on hard, unsafe surfaces. These surfaces may increase the risk for injuries in this population."

Gymnastics is a demanding sport with a high potential for injury, particularly in settings in which appropriate supervision and safety measures are absent, according to the authors. "The prevention of gymnastics-related injuries depends on the establishment and universal enforcement of uniform rules and regulations for gymnasts, coaches, and spotters," they stressed.

Toward this end, "establishment of a national database for gymnastics-related injuries, including exposure data for direct calculation of injury rates, would permit better identification and monitoring of risk factors for gymnastics-related injuries and aid in the development, implementation, and evaluation of injury prevention strategies based on epidemiologic evidence."

The authors indicated that they had no financial relationships relevant to the study to disclose.

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