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Gymnastics and Cheerleading

Denise, age 17, came to me complaining of constant back pain. When I looked at an x-ray and saw how chewed up her back was, at first I thought she had cancer. Then I looked more closely and saw that she had multiple, small fractures all along her spine. I asked Denise about her athletic history, and she told me she was a gymnast. The constant arching of her back during gymnastics maneuvers had cracked the bones in her back. Her injuries were so severe that she was forced to stop all gymnastics permanently.

      Gymnasts suffer a multitude of injuries and have the highest injury rate of all athletes, including football players. Cheerleaders perform many of the same activities and therefore suffer similar injuries. Both sports require strength, balance, timing, and extreme flexibility.


Above all else, a gymnast must be flexible. It is your innate flexibility, not your size, that determines whether you can make it as a gymnast. You can stretch your muscles and tendons to make them longer, but the looseness of your joints is genetically determined. If you flex your joints too far, you incur an injury. All but the most flexible or "loose-jointed" athletes drop out of gymnastics because they can't compete.

      Many adult women gymnasts are tiny because their growth has been stunted. Rigorous training at an early age prevents them from menstruating because they don't have enough body fat to reach normal estrogen levels. This prevents the normal growth spurt.

      As for women who go into gymnastics with a normal menstrual cycle, the heavy exercise may cause them to have spotty periods, or their periods may stop altogether. If they ease up their exercise intensity, their periods usually become normal again and they continue to develop sexually. But they may never make up lost growth because the growth centers in their long bones close sooner than they should. That's partly the reason well-known gymnasts such as Cathy Rigby and Olga Korbut are tiny even as adults.

      I believe that the pressure of competition contributes to a high injury rate among gymnasts. Gymnastics is set up for early competitions rather than exhibitions. I suspect that the urge to compete pushes young children to try moves they are not yet ready for. They usually try them out in practice, which is where 95 percent of gymnastics injuries occur. Some gymnasts may be slightly injured but are afraid to say so for fear of missing a competition, and they injure themselves even more. This early, hard push to compete also leads to a high dropout rate.


Gymnasts are likely to pull or tear muscles anywhere in the body due to the stresses of sudden, violent manuevers. The standard treatment applies: Rest the muscle and ice it down intermittently for a few days, and then start an early stretching program to relengthen the muscle.

      You need to stretch six to eight times a day during rehabilitation. Stretch the muscle until you feel uncomfortable, and then stop. When you can painlessly stretch the injured muscle as far as you can the one on the opposite side of the body, you are ready for action again.

      Gymnasts have a problem with stretching. Their joints are so loose that it's almost impossible for them to stretch an injured muscle fully. The muscle may stretch only as far as the joint allows it to, not as far it needs to stretch to recover from an injury.

      A gymnast may tear a muscle severely enough to require surgery, although this is rare. This may happen to a quadriceps muscle in the thigh. Scar tissue that builds up in a weak area in the muscle may need to be removed.


A fall from a height that snaps the head back can cause a whiplash injury. A gymnast sustaining such a fall may dislocate or fracture a cervical vertebra in the neck.

      This is a grave injury and should be treated only by emergency medical personnel. If you hit your head hard on the floor and your neck snaps back, do not move until an ambulance arrives and an expert can stabilize your neck. Continued medical care under the direction of a physician will be necessary.


Gymnastics, with its emphasis on speed combined with intricate movements, is characterized by a high incidence of shoulder injuries. In no other sport is an athlete so suddenly forced to support his or her entire body weight on the shoulders. For this reason, gymnasts suffer severe rotator cuff muscle injuries.

      Stretched or torn rotator cuff muscles lead to tendinitis in the shoulder. You can control the pain and inflammation with rest and anti-inflammatory agents. But treatment requires a special exercise program to restrengthen these muscles, which hold the joint together.

      Doing a handstand on the uneven bars after decelerating from a high speed places tremendous stress on the shoulders. The shoulder can rotate 360°, but it is not designed to do so while supporting the entire body weight. Continually overstressing the shoulder can partially dislocate it by weakening the rotator cuff muscles, which loosens the joint.

      The tremendous rotational stress of activity on the rings and bars may completely dislocate a shoulder. In this case, the shoulder is completely out of joint, and a doctor must put it back in place. Rehabilitation is necessary to restore strength to the shoulder muscles and prevent another dislocation. If a dislocation recurs, surgery to tighten the joint may be necessary.


Although stories abound of gymnasts who are crippled by low-back pain by the time they reach their late 20s, this may not be due to their training. Anyone with hypermobile joints is prone to develop back problems. Because of the tremendous torque gymnasts exert on their backs, they commonly suffer injuries all the way up the spine to the skull.

      A gymnast who falls to the floor on her back can fracture one or more of the wings of the vertebrae. Or a gymnast may fracture the part that connects the front and rear portions of the vertebra, an injury called spondylolysis.

      Sometimes the front part of the vertebra slips forward with activity in those who already have spondylolysis. This condition, called spondylolisthesis, leaves the spine unstable. If rest and back-strengthening exercises fail to correct the problem, the vertebra may need to be fused surgically and the gymnast, unfortunately, will have to give up gymnastics.

      Landing on your behind from the height of the rings or uneven bars can compress the vertebrae so much that they fracture. You may even chip off a piece of vertebra. This is known as wedging.

      Arching the back violently, particularly on dismounting, can cause this injury to the rear rather than the front part of the vertebra. Arching flexes and extends the spine so much that the vertebrae bang into each other. Most gymnastics schools now discourage arching on landing to avoid this severely painful injury.

      Stress fractures of the spine and pelvis are rare, but they can disable a gymnast for up to two years. These are weight-bearing joints, so they heal slowly. If you have persistent pain in your back or pelvic area, have a doctor perform a bone scan to check for a stress fracture.


It hurts me just to look at a gymnast whack into the bottom bar of the uneven bars. Swinging into this bar can cause bruises or blood clots in the front of the pelvis. If you get such bruises, ice them intermittently until they disappear and stay off the uneven bars until you are completely pain-free. Rest is particularly important because repeated episodes of bleeding can cause many serious complications, including calcification of muscles and impaired function of internal organs.


If the elbow gives way while you are doing a handstand, either on the floor, rings, or bars, you can sprain the ligaments on the inside of the elbow. A mild sprain simply requires rest. A more severe sprain may require you to wear a splint for several weeks. After the healing begins, you should strengthen the elbow with an exercise program. The best exercises are the Arm Curl and Reverse Arm Curl described in Chapter 6.

      This injury often is confused with tennis elbow, which is an inflammation of the muscles of the wrist where they attach to the elbow. A gymnast develops tennis elbow when a sudden stress on the wrist stretches it up and back, causing pain on the inside of the elbow. Stressing the wrist forward can cause pain on the outside of the elbow. The correct treatment for tennis elbow is the program of range-of-motion and strengthening exercises in Chapter 8.

      Hitting the mat on your arms with the elbows locked can hyperextend the elbow, that is, force it to extend farther than it is designed to go. If this happens, rest and ice the elbow, and then do strengthening exercises until the elbow has healed.

      Gymnasts also develop a form of pitcher's elbow. Two of the bones in the elbow joint (radius and ulna) bang into each other, causing a dead area in the elbow. The dead bone may chip off, and the chips may float inside the elbow, causing pain and clicking in the joint.

      A fracture of the olecranon process in the back of the elbow can also cause bone chips. If these floating chips get caught in the joint, the elbow can lock. You will need to have the chips removed surgically, but you can return to action as soon as you recover from the surgery.


Gymnasts commonly sprain wrists from applying force to the wrist in tumbling routines such as cartwheels. As with any sprain, the proper treatment is RICE, followed by the strengthening exercises in Chapter 9. If you get a severe sprain, you must have it x-rayed, just as you would a severe ankle sprain. The wrist has many small bones with many ligaments that can sprain or tear.

      Tumbling is an activity that suddenly places the entire body weight on the wrists. This can lead to tendinitis in the wrist and elbow. Weight lifters may lift their own body weight and golfers may apply tremendous torque to the wrists, but only gymnasts combine the two movements.

      Painful wrist motion may be due to a ganglion, which is a cyst in the tendon sheath on the back or front of the wrist. The ganglion forms as a result of trauma to the wrist tendon. A ganglion usually responds to a cortisone injection, but it may need to be removed surgically.

      Landing on an outstretched hand can also break a tiny wrist bone at the base of the thumb. A fracture of this navicular bone causes pain and tenderness in the wrist behind the thumb and makes it difficult to extend the wrist backward.

      This is a difficult injury to diagnose because the break in the bone may not show up on an x-ray until several weeks after the injury. If your doctor suspects you may have fractured this bone, make sure he or she orders a second x-ray a few weeks after the first one.

      Healing is especially difficult for this injury due to poor blood supply to that area of the wrist. The bone usually knits in two months but may take as long as six to eight months. If it does not heal, surgery to fuse the parts together will be necessary if you wish to continue your gymnastics career.


Knee injuries are not common but can occur if the gymnast comes down with the knee hyperextended when tumbling or dismounting. Although the most common injury is an anterior cruciate ligament (ACL) tear, a gymnast may tear other ligaments, as well as cartilage.


Because gymnastics is basically a running sport, it can lead to running-related injuries such as shin splints and runner's knee. These injuries are due to problems with the foot striking the floor. Gymnasts usually feel the pain in their shins or knees when running to vault over the horse or during floor exercises.

      Since gymnasts compete barefoot (vaulters may wear a flat shoe), it is difficult to correct any foot strike problems. I suggest that the gymnast wear an arch or shoe insert in a vaulting shoe or very light sneaker during practice to relieve the pressure of daily pounding on the legs.


Ankle sprains and even fractures are common among gymnasts, who often land off-balance or on the edge of the mat. All but the mildest ankle injuries should be examined by a physician and x-rayed. A sprained ankle can be treated by RICE, range-of-motion exercises, and then strengthening exercises. A broken ankle will need to be casted for 6 to 12 weeks, and then restrengthened with the same exercise program used for a sprained ankle.


The repeated trauma of landing hard from dismounts off the balance beam, vault, rings, and uneven and parallel bars can cause stress fractures of the long bones of the foot. An off-balance landing may also cause toes or other bones to break.


The selection process for cheerleaders is not as rigorous as that for gymnasts. Cheerleaders tend to have tighter joints, and they may not work on their flexibility or warm up adequately. Consequently, cheerleaders suffer more pulled muscles, inflamed tendons, and sprained ligaments than gymnasts.

      In addition, cheerleading is a burst-type sport. There are long downtimes while the game goes on. If you don't keep warm during inactive periods, you risk pulling a muscle. Cheerleaders at football games in cold weather have to keep their bodies warm and their muscles loose.


In general, cheerleaders suffer injuries similar to those of gymnasts. They have a higher incidence of hip and groin injuries due to performing splits, often from a height. If you have a foot imbalance, such as a pronating foot, the trademark stamping of the foot on a hardwood basketball floor can cause severe shin splints or stress fractures of the leg. You can correct this by taking anti-inflammatory agents to relieve the initial pain and then by wearing an arch support or orthotic in your sneaker.

      Modern cheerleading, with its gymnastics-like routines, is a high-risk sport. A fall from the top of a pyramid or a missed catch after being thrown by another cheerleader can lead to a traumatic head injury or a broken neck. Cheerleaders have died from falling from the upper part of a pyramid, and there is a movement to ban pyramiding below the college level.

How to Improve Your Routines

Both gymnasts and cheerleaders should concentrate on strength training to improve their performance and prevent injuries. For gymnasts, strength and balance are the major factors in competition. Cheerleaders especially need to increase their strength, particularly in their upper bodies. If the bottom person in a pyramid doesn't have a strong back, the whole pyramid can collapse, causing injuries to many.

      Most gymnasts and cheerleaders start training at a young age. Girls age 11 and up can lift weights to increase their strength without bulking up their muscles. As long as a girl has normal levels of estrogen circulating in her blood, her muscles will become stronger but still look the same.

      At the college level, most cheerleaders are also gymnasts who are good athletes. At the high school level, however, the strength and flexibility training required of gymnasts does not carry over to cheerleaders. Cheerleaders need to consider themselves athletes and condition themselves as gymnasts do. They have to train like any other competitive athlete: lift weights, stretch their muscles, and condition their bodies.

      To prevent muscle pulls, both gymnasts and cheerleaders need to work on flexibility and warmup, particularly between bursts of activity. Warmup means what it says: keep your body temperature up.

      Then they need to do a total body-stretching program. Usually gymnasts are so flexible that they only need minimal stretching after warming up. Cheerleaders probably need a prolonged stretching period so that they can maintain their flexibility during inactive periods.

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