Gymnastics and Low Back Pain

By Phil Cossens – Diploma Sports Physiotherapy

Unfortunately, low back pain is an all too common complaint in gymnasts. Even more concerning is the fact that many gymnasts train with low back pain unnecessarily. It is important to note that low back pain is preventable, can be managed appropriately, and should not be regarded as something you just have to ‘put up with’. In fact, ignoring niggling pains can often lead to more serious injury.

Although the causes are numerous, there are several factors in the sport of gymnastics that mean the lumbar spine is at risk:

• Flexibility without adequate stability: Gymnasts often perform skills and postures that utilise great flexibility of the lumbar spine. To perform such skills safely, a gymnast requires core strength that is well above that of many other athletes.
• Repetitive impact/loading: Impact/loading is most evident during floor tumbling, where great forces are transmitted through the body repetitively. It is my experience that forward tumbling can be of particular concern if handspring or layout skills land in an arched position.
• Combination of movement from maximal flexion (pike/tuck) to maximal extension (arch): Large range movements provide a unique challenge for the lumbar spine.
• Falls & crashes: People outside the sport may be surprised to hear that there are relatively few acute injuries to the spine due to falls. I suspect that this is due to good aerial awareness, a learned ability to fall safely, and of course, good coaching.

Some common injuries of concern

• Facet joint irritation: Each level of the spine has two facet joints between adjacent vertebrae. The facet joints are located at the back of the vertebral column, just to the left and right of the midline. Pain at the facet joint is usually well localised and hurts right over where the injury is. Facet joint irritation is inflammatory in nature, and is often associated with poor control in arched positions and overuse/excess loading in extended positions. Treatment may involve hands-on mobilisation of the painful segment while initiating an appropriate rehabilitation program.
• Stress fractures: As suggested in the name, stress fractures are an overload injury, where the bone is unable to withstand the stresses placed upon it over time. Stress fractures present similarly to facet joint irritation, painful usually with arching and high impact skills. Problems are often progressive, beginning as a slight niggle eventually leading to debilitating severe pain. Beginning as a ‘stress reaction’, the bone is unable to withstand the cumulative stress placed upon it, and this weakness may progress until a fracture occurs. Once a stress fracture has occurred, appropriate rehabilitation is essential, as consequences of impaired fracture healing include the development of bony defects (soft areas in the bone) and even slipping of the vertebral position (spondylolysthesis) if bony defects are severe. This condition is also seen in other athletes such as cricket fast bowlers and ballet dancers.
• Disc injury: Although more common in middle aged adults (perhaps the parents are more susceptible than the gymnasts!), the intervertebral disc does get placed under significant pressures with the levels of impact and mobility it is required to withstand. Disc injuries may be more painful with lumbar flexion activities such as piked skills, but can be aggravated with movements in all directions. In nasty cases, disc injuries can be painful with a cough or sneeze, and may create referred pain into the buttock or leg. Rehabilitation for disc injuries requires a strong core stability program, and as with any significant rehab program, closely guided return to gymnastics skills.

Although the focus of this article has been to discuss the various problems associated with low back injuries in gymnasts, I would like to emphasise that overall, gymnasts maintain better core strength, control and flexibility than most people their age, even when compared to other athletes. Perhaps this is why gymnasts are often so successful when they transfer to compete in other sports.

To conclude, I wish to place emphasis on core stability. When sufficient core stability is gained to successfully control movement during advanced skills, low back pain can be a thing of the past in gymnastics. When sufficient strength is combined with appropriate, graduated training loads, every gymnast is able to maintain their health and therefore maximise performance each day.