Balancing the risk of injury to gymnasts: how effective are the counter measures?

Background-To minimise injury risk and maximise gymnastics performance, coa ches, parents, and health professionals working with young gymnasts need to understand and practise safe gymnastics. Aims-To (a) identify the various injury counter measures specific to gymnas tics, (b) critically review the literature describing each injury preventio n measure, and (c) assess, using available risk factor and injury data, the weight of evidence to support each of these counter measures. Specific rec ommendations for further research and implementation strategies to prevent injury and improve safety are also given. Methods-The relevant Literature was identified through the use of Medline ( 1966 to Ii-lay 1998) and SPORT Discus (1975 to May 1998) searches, hand sea rching of journals and reference Lists, and discussions with key Australian gymnastics organisations. Results-The key gymnastics injury counter measures identified in this revie w include coaching (physical preparation, education, spotting, and performa nce technique), equipment, and the health support system (medical screening , treatment, and rehabilitation). Categorisation of the type of evidence fo r the effectiveness of each of these counter measures in preventing injury showed that most of it is based on informal opinion/anecdotal evidence, unc ontrolled data based studies, and several prospective epidemiological studi es. There is no evidence from formally controlled trials or specific evalua tion studies of counter measures for gymnastics. Conclusions-Although gymnastics is a sport associated with young participan ts and frequent high volume, high impact training, there is a paucity of in formation on injury risk factors and the effectiveness of injury practices. Further controlled trials are needed to examine the extent to which injury prevention counter measures can prevent or reduce the occurrence of injury and re-injury. Particular attention should be devoted to improving trainin g facilities, the design and testing of apparatus and personal equipment us ed by gymnasts, and coaching and the role of spotting in preventing injury.