1. Gymnastics Single Sport / Multi Sport A sports medicine challenge Julie Sparrow MSc MCSP Grad Dip Phys National Lead Physiotherapist British Gymnastics

2. Artistic Gymnastics Men Floor Pommel Rings Vault Parallel bars High bar Women Vault Bars Beam Floor

3. Core components of all gymnastics skill Body positions (in all swing and flight elements) –Open – trunk extension –Closed – trunk flexed – “dish” –Straight Hand stand Splits – “side” and “box” “Bridge”

4. Core components continued Support - weight taken by hands or feet Swing* – in which the body travels about a fixed point Flight – with or without directional change Balance Rebound

5. Rhythmic gymnastics Women only Use of small apparatus –Ball –Ribbon –Hoop –Club –rope

6. Rhythmic Gymnastics Flexibility Co-ordination Flight Expression Elegance Dance

7. ‘Hypermobile’ Tall and slender Balance on large base of support

8. Making of a gymnast Many will start working on gymnastic related skill elements by the age of 6 Naturally self selecting based on skill confidence and courage Women peak in the mid to late teens Men peak in late teens into early 20’s

9. The influence of the growing skeleton Growth plate injury –Compression – load bearing in support –Shear – rotational stress –Traction – take off landing and swing. Trauma –Ligamentous –Bony

11. Epiphyseal (Salter Harris) fracture

12. Avulsion fracture

13. Buckle (Torus) fracture of the proximal radius

14. Plastic Bending fracture

15. The At Risk Spine

17. Source of back pain Bone stress reaction – pars stress # - end plate # Spondylolysthesis Ligamentous stress Annular stress and loss of disc integrity Zygapophyseal stress Muscle strain

18. Shoulder and upper quadrant

19. Impingement –Labral –Rotator cuff Tendon rupture –Rotator cuff –Biceps –Pectoralis major

20. Elbow wrist and hand

21. Clinical problems at the wrist Physeal stress Physeal arrest Scaphoid impaction Scaphoid stress # Ulnar impaction Avascular necrosis of the capitate Carpal chondromalacia Dorsal impingement/capsulitis Tears of the triangular fibro cartilage Carpal instability Distal radio ulnar instability

22. AnteriorPosterior

23. Forearm Pommel arm –Compartment like syndrome of the forearm

24. Injury potential in the lower limb Take off Landing Rebound

25. Soft tissue Achilles tendon Anterior knee pain syndromes Muscle trauma

26. Bony Injury Traction apophysisitis Bone bruising Osteochondritis dissecans Chondral defect

27. Bone bruise of the femoral condyle

28. Chondral defect of the talus

29. Summary Gymnastics is a potentially a high risk sport The growing body is at risk of injury if progression is not judiciously managed Gymnastics can provide positive benefits for motor skills and bone health