Low Back Pain in Gymnasts

Over the past 12 months, low back pain has been a common complaint in WA gymnasts. The scary fact, which we have found here at Loftus Physiotherapy & Rehabilitation, is many gymnasts continue to train unnecessarily. Low back pain is preventable and can be managed. It should never be one of those ‘aches’ or ‘pains’ that an elite junior athlete should put up with. Every gymnast we take care of here at Loftus trains more than an AFL player, but spends far less time focusing on the ‘sore’, ‘tight’, or ‘weak’ area/s of their body.
Physiotherapy in Perth for Gymnasts and Dancers
The common factors we see that put the lower back (lumbar spine) at risk in our gymnasts include:
1. Inadequate stability for the amount of flexibility‐ the routines, skills, and postures that gymnasts perform often enforces a high degree of flexibility at the lumbar spine. To perform these safely a gymnast must have adequate core strength (much more than the average AFL player).
2. Repetitive loading ‐ gymnasts are always transmitting great forces through the body during training and performance. Many of the landings involve an arching of the back at the lumbar region of the spine.
3. Full range tasks – the majority of gymnasts I have seen perform the pike/tuck (maximal flexion) and arch (maximal extension) movements do them really well, but it provides a gigantic challenge for the lumbar spine when performed slightly off perfect.
4. Accidents – at every gymnastics competition we see some great falls and crashes. But thankfully acute injuries to the spine are uncommon during competition! Clearly due to the great coaching they receive here in WA on how to fall safely.
The common injuries of concern:
1. Facet joint irritation – between every two vertebrae of the spine, there are two facet (zygapophyseal) joints. When an injury occurs to the facet joint, the pain is usually localized over the area. Irritation to the facet joint is inflammatory in nature and often associated with poor control in arched positions and overuse/excess loading in extended positions. Treatment usually includes hands on mobilization whilst starting a tailored rehabilitation program.
2. Stress fractures – an overload injury where the bone cannot cope with the constant stress placed upon it. This type of injury presents similarly to facet joint irritation, pain with arching and high impact skills. The difference is this problem has a slow progressive worsening, starting out as a ‘niggle’ and ending up as a severe pain with movement.
Following diagnosis of a stress fracture appropriate rehabilitation is essential, as consequences of impaired fracture healing include the development of bony defects and even slipping of the vertebral position (spondylolysthesis) if bony defects are severe. Common in cricketers (fast bowlers) and ballet dancers.
3. Disc injury – this type of injury is more common in middle‐aged adults (parents of gymnasts may be at higher risk!). The intervertebral disc gets placed under significant pressures during the high impact landing and degree of flexibility required for certain tasks. A disc injury usually involves more pain with lumbar flexion activities such as piked skills. In very nasty cases there may be pain with coughing and sneezing, in addition to referred pain in the buttock or leg.
Rehabilitation for disc injuries requires a tailored core stability program for gymnasts, before a closely guided return to gymnastic skills and routines.
After only focusing on low back pain so far, I would like to highlight that compared with other athletes and people of the same age; gymnasts do have much better core strength, control and flexibility. And following discussions with a few of the parents of gymnasts, it is evident they excel at another sport, for these reasons above.
In summary, with the support of recent research, there needs to be emphasis placed on core stability continuously as a gymnast matures. Core stability is necessary to successfully control movement during advanced routines and skills.
With the combination of sufficient strength and graduated training loads; low back pain can be a problem of the past in gymnastics and the end result will be improved individual performances.

Reference:
Harringe M, Nordgren J, Arvidsson I, Werner S (2007) Low back pain in young female gymnasts and the effect of specific segmental muscle control exercises of the lumbar spine: a prospective controlled intervention study. Knee Surgery, Sports Traumatology, & Arthroscopy 15(10): 1264‐71