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PubMed2003

Onset of puberty, menstrual frequency, and body fat in elite rhythmic gymnasts compared with normal controls.

OBJECTIVES: To assess the prevalence of delayed menarche and abnormal menstrual patterns, as well as the association of menstrual status with physical training in elite rhythmic gymnasts from Greece and Canada. METHODS: Fifteen Greek (mean (SEM) age 14.5 (0.2) years) and 30 Canadian (mean (SEM) age 14.7 (0.4) years) rhythmic gymnasts were surveyed for age at menarche, menstrual frequency, and training profile, and measured for height, weight, and percentage body fat (%BF). Seventy eight healthy adolescents served as country specific non-active controls: 38 Greek non-athletes (mean (SEM) age 14.5 (0.1) years) and 40 Canadian non-athletes (mean (SEM) 14.2 (0.1) years). RESULTS: Of the Greek gymnasts, 79% had not yet menstruated compared with 34% of the Canadian gymnasts. Menarche was significantly (p<0.01) delayed in the rhythmic gymnasts (composite mean 13.8 (0.3) years, n = 45) compared with the controls (composite mean 12.5 (0.1) years, n = 78). There was no significant difference between Greek and Canadian gymnasts for the age at menarche (14.2 (0.3) v 13.6 (1.2) years respectively). Menstrual irregularities were reported in 78% (61% oligomenorrhoeic and 17% amenorrhoeic) of the menarcheal athletes. Menarcheal gymnasts were found to be significantly (p<0.05) taller and heavier, with a higher %BF and a lower training frequency and training duration (p<0.05) than the premenarcheal gymnasts. Overall, the mean %BF of the gymnasts was significantly lower (p<0.05) than that of the control subjects. The Canadian controls exhibited a significantly (p<0.05) greater %BF than the Greek controls of the same age. CONCLUSION: Delayed menarche, menstrual irregularities, and low body fat are common in elite rhythmic gymnasts. Premenarcheal gymnasts train more often and for longer, and have a lower body mass index and less body fat, than menarcheal gymnasts. Prospective studies are needed to explore further these and other factors associated with delayed menarche and menstrual irregularities in female athletes.

Adolescent↗
PubMed2004

Alterations in serum growth hormone (GH)/GH dependent ternary complex components (IGF-I, IGFBP-3, ALS, IGF-I/IGFBP-3 molar ratio) and the influence of these alterations on growth pattern in female rhythmic gymnasts.

BACKGROUND AND AIM: Normal growth in children is regulated to a great extent through the actions of the GH/IGF-I axis, a system consisting of GH and its mediators (ternary complex) that modulate growth in many tissues. The ternary complex (IGF-I/IGFBP-3/ALS) provides an acute regulatory mechanism in which IGF-I may be mobilized from the circulating reservoir of 150 kDa complexes to the tissues. Acute exercise is known to be a stimulus for GH secretion. The beneficial effects of scheduled exercise on body composition are also well established. However, the impact of strenuous exercise on the pubertal development of child athletes is still not well understood. The first goal of this study was to assess the acute effects of high intensity exercise training on GH-dependent ternary complex components in female rhythmic gymnasts compared to age-matched healthy female controls with normal physical activity. The second goal was to explore the influence of these exercise-induced changes on skeletal and pubertal growth in the same group prospectively over a period of 4 years. SUBJECTS AND METHODS: Seventeen female rhythmic gymnasts, aged 11.4 +/- 0.9 years, who had 10 h per week intense exercise for at least 4 months volunteered to participate in this study. Anthropometric measurement of height (Height SDS for chronological age [HtSDS(CA)], parentally adjusted height, predicted adult height), bone age and weight (BMI) were made using standard techniques in gymnasts and controls (aged 12.5 +/- 3.0 years, n = 12). Gymnasts were followed up to 4 years to observe growth velocity and pubertal progression. In order to determine the acute impact of exercise on levels of GH and GH-dependent ternary complex component (IGF-I, IGFBP-3, ALS, IGF-I/IGFBP-3 molar ratio), blood samples were obtained from gymnasts after a routine 2-h high-intensity training program and then after a 2-day rest period. These results were compared with age-matched controls with no scheduled sports activity. RESULTS: Despite the significant increment in serum GH and GH-dependent components immediately following the exercise, serum GH/IGF-I levels showed a significant decrement (p < 0.01) after a 2-day rest in gymnasts, to a nadir as low as those of the control subjects' baseline levels (p < 0.01). There was no difference in anthropometric characteristics of gymnasts and controls except BMI; gymnasts were leaner than controls. During a 4-year follow up, there were no differences between the gymnasts and controls in regard to skeletal growth and reaching their predicted height. However, in gymnasts there was a delay in pubertal tempo but not in growth. CONCLUSION: Intense exercise induces an acute rise in GH levels, but this acute elevation rapidly normalizes after a 2-day rest in female rhythmic gymnasts. These fluctuations in serum GH and GH-dependent ternary complex components had no reflection on the skeletal growth patterns in gymnasts over the 4-year follow up but there was a delay in their pubertal progression.

Adolescent↗
PubMed2002

Wrist pain in young gymnasts: frequency and effects upon training over 1 year.

OBJECTIVE: To determine the frequency and characteristics of wrist pain in young, nonelite gymnasts over a 1-year training period, and to describe the effects of chronic wrist upon gymnastics training. DESIGN: Prospective cohort study. SETTING: Los Angeles-based gymnastics club. PARTICIPANTS: Forty-seven nonelite female and male gymnasts between 5 and 16 years of age. ASSESSMENTS: Each subject completed an interview-based questionnaire and received a physical exam at the study onset and at the end of 1 year of training. The questionnaire detailed training habits and elicited a history and description of wrist pain. MAIN OUTCOME MEASURES: The frequency of wrist pain and several measures of training were reported at the study onset and at 1 year. Gymnasts with wrist pain were compared with those who were pain-free. MAIN RESULTS: Wrist pain was reported by 57% (27 of 47) of subjects at the study onset. Eighty-nine percent (24 of 27) reported wrist pain both at the study onset and 1 year later. Nineteen gymnasts (40%) were pain-free at each collection. The floor exercise, the pommel horse, and the balance beam were most frequently associated with wrist pain symptoms. Multivariate analysis revealed that adolescent gymnasts between 10 and 14 years of age were significantly more likely to report wrist pain at each survey than those who were either above or below this age range (p = 0.03). Forty-two percent of subjects with wrist pain at each survey reported that the symptoms interfered with training. Only five gymnasts with wrist pain were seen by physicians. Training intensity increased in gymnasts with and without wrist pain. The relative increase within each group was statistically significant among pain-free gymnasts (p = 0.003), but was not for those with wrist pain (p = 0.08). CONCLUSIONS: Wrist pain among young, nonelite gymnasts is common, and appears to persist with continued training in the vast majority of those who report symptoms. Adolescent gymnasts between 10 and 14 years of age training at this level are significantly more likely to have wrist pain. Wrist pain appears to have a negative effect upon training, based upon both self-report and training intensity measures; however, more study is needed with respect to this issue.

Adolescent↗
PubMed1995

Gymnasts exhibit higher bone mass than runners despite similar prevalence of amenorrhea and oligomenorrhea.

Female athletes exhibit a higher prevalence of exercise-associated amenorrhea and oligomenorrhea compared with nonathletic women, and both conditions are related to reduced bone mineral density (BMD), particularly at the spine. This study investigated bone mass and oligomenorrhea and amenorrhea in two groups of competitive female athletes with different skeletal loading patterns: gymnasts and runners. Bone mineral density (g/cm2) of the femoral neck, lumbar spine (L2-4), and whole body was assessed by dual energy X-ray absorptiometry (QDR-1000/W, Hologic Inc., Waltham, MA) in collegiate gymnasts (n = 21) and runners (n = 20), and nonathletic college women (n = 19). The runners and gymnasts had similar values for percent body fat (14.7 +/- 2.2% and 15.6 +/- 2.9%, respectively), which were lower (p < 0.001) than controls (22.3 +/- 3.0%). Lean body mass (LBM) did not differ among the groups, but when adjusted for body surface area, gymnasts had a higher LBM/height2 (p = 0.0001) compared with runners and controls. Muscle strength was significantly greater (p < 0.05) in gymnasts for quadriceps, biceps, and hip adductor force, compared with runners and controls. Gymnasts had a significantly later menarche age (16.2 +/- 1.7 years) compared with runners (14.4 +/- 1.7 years) and controls (13.0 +/- 1.2 years). The prevalence of oligo- and amenorrhea was 47% for gymnasts (6 amenorrheic, 4 oligomenorrheic), 30% for runners (3 amenorrheic, 3 oligomenorrheic), and 0% for controls. Furthermore, athletic groups had similar menstrual histories given the higher proportion of gymnasts who had experienced primary amenorrhea. When evaluated since menarche, however, runners had somewhat longer histories due to an earlier age at menarche and slightly older ages. Dietary calcium intake did not differ among groups, although mean values were below the RDA of 1200 mg/day. By athletic group, BMD at any site did not differ among women with amenorrhea versus oligomenorrhea versus eumenorrhea, although there was a trend for the regularly menstruating athletes in both groups to have slightly higher values. Lumbar spine BMD was lower (p = 0.0001) in runners (0.98 +/- 0.11 g/cm2) compared with both gymnasts and controls (1.17 +/- 0.13 and 1.11 +/- 0.11 g/cm2, respectively). Femoral neck BMD differed among all groups (p = 0.0001): gymnasts = 1.09 +/- 0.12 g/cm2 > controls = 0.97 +/- 0.10 g/cm2 > runners = 0.88 +/- 0.11 g/cm2. Whole body BMD was lower (p < 0.01) in runners (1.04 +/- 0.06 g/cm2) compared with gymnasts and controls (1.11 +/- 0.08 and 1.09 +/- 0.06 g/cm2, respectively).(ABSTRACT TRUNCATED AT 400 WORDS)

Absorptiometry, Photon↗
PubMed2000

Control of locomotion in expert gymnasts in the absence of vision.

The main aim of this study was to determine how gymnasts are affected by the removal of vision when executing simple moves. A secondary aim was to establish whether crucial sensory cues exist for blindfolded gymnasts. Eight expert gymnasts were asked to maintain a straight displacement during three types of blindfolded locomotion: walking, steering a wheelchair and verbally ordering a second person pushing their wheelchair. In the first two conditions, active displacement made proprioceptive cues available to update the body trajectory. In the last condition, however, proprioceptive cues were greatly reduced, since the gymnasts displaced passively. The performance of the gymnasts was compared to that of eight experts in other non-gymnastic sports (control group). The results showed that the participants veered in all conditions. However, except in the verbal condition, the gymnasts departed less from linearity than the controls. We conclude that: (1) even for a simple motor task, gymnasts' performance is altered by eliminating vision; (2) compared with other sportsmen and women, gymnasts are better able to deal with the absence of vision when proprioceptive cues are available. These findings suggest two possible explanations: (1) gymnasts are more able to 'pick up' crucial information and (2) a gymnast's proprioceptive system is more sensitive.

Adolescent↗
PubMed1999

The contribution of anthropometric characteristics to performance scores in elite female gymnasts.

BACKGROUND: Aims of this study were: a) to identify anthropometric variables correlated with gymnastic performance, and b) to predict performance scores from a combination of anthropometric dimensions. METHODS EXPERIMENTAL DESIGN: correlational analysis and a stepwise multiple regression were used. SETTING: Subjects were participants at the 24th World Championships Artistic Gymnastics, Rotterdam, The Netherlands, in 1987. PARTICIPANTS: A total of 168 female gymnasts (mean age: 16.5 +/- 1.8 years) were investigated. Each gymnast participated in all events. MEASURES: An extensive battery of anthropometric dimensions was taken on each athlete. The somatotype was estimated. Skeletal maturation of the hand-wrist was assessed. Competition scores for the four individual gymnastic events (balance beam, floor exercise, vault, uneven bars) and a composite score for each gymnast were the dependent variables. RESULTS: Moderately high, significant correlations (p < 0.01) were observed between skinfolds and endomorphy, and gymnastics performance scores, r varying from -0.38 to -0.60, for biceps skinfold and the score on balance beam, and for endomorphy and the total score, respectively. The correlations suggest that gymnasts with more subcutaneous fat and higher endomorphy have lower performance scores. About 32% to 45% of the variance in gymnastic performance scores could be explained by anthropometric dimensions and/or derived variables, but endomorphy and chronological age are the most important predictors. CONCLUSIONS: There is a relatively strong relationship between several anthropometric variables and gymnastic performance in a sample of elite female gymnasts, but the associations are not sufficiently high to predict performance scores on an individual basis.

Adolescent↗
PubMed1998

[Effect of high performance sports on puberty development of female and male gymnasts].

High impact training may influence the pubertal development of athletes. The effects of high intensity training on pubertal development of female and male elite gymnasts are presented. 22 female and 18 male elite gymnasts were enlisted in this study. Prepubertal and pubertal stages were determined and hormonal levels regarding the hypophyseal, gonadal and adrenal axes were measured. The LH/FSH ratio necessary for the advancement of full pubertal maturation was assessed at 13.9 amd 13.0 years in female and male gymnasts, respectively. Female gymnasts demonstrated, on average, a delayed bone age of 1.7 years compared to their chronological age, whereas both bone and chronological age were identical in male gymnasts. There were no significant pubertal increase of estrogen levels in female gymnasts during their peripubertal development indicating a low amount of fat mass in female elite gymnasts. Intensive physical training of elite female gymnasts combined with inadequate nutritional intake markedly affect pubertal development. These peripubertal effects are not observable in male gymnasts due to different training regimes in male and female elite gymnast. Regular monitoring of female gymnast during their vulnerable growth phase is necessary to minimize life-long physiological and psychological side effects of high impact training.

Adolescent↗
PubMed1998

Cardiovascular stress and lactate formation during gymnastic routines.

BACKGROUND: Carried out to investigate cardiovascular and metabolic response during various gymnastic routines [Pommel Horse (PH), Roman Ring (RR), Parallel Bar (PB), Horizontal Bar (HB) and Floor Exercise (FE)]. METHODS EXPERIMENTAL DESIGN: comparative and randomized. SETTING: General purpose, applicable on gymnastics training. Participants. Five male volunteers drawn from students attending sports coaching course in gymnastics at NIB, Patiala. A mixed population from all over India who had competitive experience of 6 to 10 years. INTERVENTIONS: no interventions. MEASURES: presence of heart rate overshooting, high lactate levels and individual characteristics of the gymnastics routines. RESULTS: In all the routines peak HR was much lower than maximum heart rate (HRmax) of the gymnasts. Mean HR was lowest in first set and highest in the final (3rd set) on all the apparatuses. Highest mean HR was recorded in HB followed by FE, RR, PB and PH respectively. After both first and third sets blood lactic acid (La) was highest in FE followed by RR, PB, HB and PH. La levels following the first set were 7.11, 6.77, 6.23, 5.97 and 5.18 mM/l, respectively. Third set values were 10.54, 10.16, 8.95, 8.74 and 8.04 mM/l. CONCLUSIONS: (a) Cardiovascular load in various gymnastic routines is considerably less than maximal running; (b) HR overshoot is common at the end of all the men's gymnastic routines; training evaluation or performance evaluation in gymnastics through heart rate should consider this fact to avoid any misinterpretation; (c) PH is physiologically least demanding among the five while FE and RR are most stressful; (d) repetition of gymnastic exercise routines with short rest pause may lead the gymnast to reach nearer to his lactate tolerance; (e) gymnastics activity is dominated by anaerobic metabolism.

Adult↗
PubMed2006

Lumbar spine MRI in the elite-level female gymnast with low back pain.

OBJECTIVE: Previous studies have shown increased degenerative disk changes and spine injuries in the competitive female gymnast. However, it has also been shown that many of these findings are found in asymptomatic athletic people of the same age. Previous magnetic resonance imaging (MRI) studies evaluating the gymnastic spine have not made a distinction between symptomatic and asymptomatic athletes. Our hypothesis is that MRI will demonstrate the same types of abnormalities in both the symptomatic and asymptomatic gymnasts. DESIGN: Olympic-level female gymnasts received prospectively an MRI exam of the lumbar spine. Each of the gymnasts underwent a physical exam by a sports medicine physician just prior to the MRI for documentation of low back pain. Each MRI exam was evaluated for anterior apophyseal ring avulsion injury, compression deformity of the vertebral body, spondylolysis, spondylolisthesis, degenerative disease, focal disk protrusion/extrusion, muscle strain, epidural mass, and bone-marrow edema. PATIENTS: Nineteen Olympic-level female gymnasts (age 12-20 years) were evaluated prospectively in this study. All of these gymnasts were evaluated while attending a specific training camp. RESULTS: Anterior ring apophyseal injuries (9/19) and degenerative disk disease (12/19) were common. Spondylolysis (3/19) and spondylolisthesis (3/19) were found. Focal bone-marrow edema was found in both L3 pedicles in one gymnast. History and physical exam revealed four gymnasts with current low back pain at the time of imaging. There were findings confined to those athletes with current low back pain: spondylolisthesis, spondylolysis, bilateral pedicle bone-marrow edema, and muscle strain. CONCLUSIONS: Our initial hypothesis was not confirmed, in that there were findings that were confined to the symptomatic group of elite-level female gymnasts.

Adolescent↗
PubMed2006

Artistic versus rhythmic gymnastics: effects on bone and muscle mass in young girls.

We compared 35 prepubertal girls, 9 artistic gymnasts and 13 rhythmic gymnasts with 13 nonphysically active controls to study the effect of gymnastics on bone and muscle mass. Lean mass, bone mineral content and areal density were measured by dual energy X-ray absorptiometry, and physical fitness was also assessed. The artistic gymnasts showed a delay in pubertal development compared to the other groups (p<0.05). The artistic gymnasts had a 16 and 17 % higher aerobic power and anaerobic capacity, while the rhythmic group had a 14 % higher anaerobic capacity than the controls, respectively (all p<0.05). The artistic gymnasts had higher lean mass (p<0.05) in the whole body and the extremities than both the rhythmic gymnasts and the controls. Body fat mass was 87.5 and 61.5 % higher in the controls than in the artistic and the rhythmic gymnasts (p<0.05). The upper extremity BMD was higher (p<0.05) in the artistic group compared to the other groups. Lean mass strongly correlated with bone mineral content (r=0.84, p<0.001), and multiple regression analysis showed that total lean mass explained 64 % of the variability in whole body bone mineral content, but only 20 % in whole body bone mineral density. Therefore, recreational artistic gymnastic participation is associated with delayed pubertal development, enhanced physical fitness, muscle mass, and bone density in prepubertal girls, eliciting a higher osteogenic stimulus than rhythmic gymnastic.

Anthropometry↗
PubMed2000

Short stature in competitive prepubertal and early pubertal male gymnasts: the result of selection bias or intense training?

OBJECTIVES: To determine whether high-volume, high-impact physical training in prepubertal and early pubertal male gymnasts is associated with reduced statural and segmental growth and reduced serum insulin-like growth factor-I (IGF-I) and increased cortisol (C) levels. STUDY DESIGN: Height, sitting height, leg length, and segmental lengths (humerus, radius, femur, and tibia) and breadths (biacromial and bi-iliac), diet, serum IGF-I, testosterone, and C were measured in competitive male gymnasts and normoactive children (Tanner stage < or = 2) every 3 to 4 months over an 18-month period. RESULTS: At baseline, gymnasts (n = 31) were 0.7 years older than members of the control group (P <.05, n = 50) but were no different in terms of biologic maturity. Age-adjusted z scores showed that the gymnasts were shorter than members of the control group (-0.5 +/- 0.2 SD, P <.05) because of reduced leg length (-0.8 +/- 0.2 SD, P <.001) but not sitting height. Segmental lengths and bi-iliac breadth age-adjusted z scores were also reduced in the gymnasts (P ranging <.05 to <.001). No difference was detected for serum IGF-I or C. After 18 months of follow-up, no differences were found for rates of change in height, sitting height or leg length, segmental lengths, IGF-I, or C between those gymnasts and control subjects who remained prepubertal and early pubertal (gymnasts n = 18; control group n = 35). However, the magnitudes of baseline differences in anthropometric measures (z scores) persisted throughout the study. CONCLUSION: Short stature in these competitive male gymnasts was due to a reduced leg length but not sitting height. The lack of a difference in growth rates, IGF-I, and diet over the 18-month period indicates that the short stature reported in male gymnasts is due to selection bias rather than gymnastics training.

Adolescent↗
PubMed2002

Bone density in female elite gymnasts: impact of muscle strength and sex hormones.

PURPOSE: The aim of this study was to investigate BMD in Danish female elite gymnasts and the relationships to maximal muscle strength, sex hormone concentrations, and menstrual status. METHODS: Six artistic gymnasts, five rhythmic gymnasts, and six controls aged 15-20 yr served as subjects. BMD (g x cm(-2)) of lumbar spine, proximal femur, distal radius, and whole body were measured by dual-energy x-ray absorptiometry (DXA) scanning. Maximal muscle strength (Nm) was measured in isokinetic trunk extension, trunk flexion, and knee extension. Serum concentrations of estrogen and progesterone in follicular and luteal phases were evaluated. RESULTS: Three out of six artistic gymnasts had amenorrhea, and two artistic and one rhythmic gymnast experienced oligomenorrhea. BMD in artistic gymnasts was greater than controls (24-45%, P < 0.05) in all sites except whole body. BMD in rhythmic gymnasts was greater than controls (4-26%, P < 0.05) in all sites except distal radius. In gymnasts, BMD correlated to both maximal muscle strength (0.60 < r < 0.85, P < 0.05) and serum progesterone (0.65 < r < 0.75, P < 0.05). CONCLUSION: In spite of oligomenorrhea or amenorrhea, it is possible for female gymnasts to maintain a high BMD in both the axial (L2-L4) and appendicular skeleton. The correlations between BMD and maximal muscle strength and progesterone concentration in gymnasts may indicate that within the same athletic group, progesterone concentration has a permissive role in bone formation, thus affecting the positive impact of muscle strength.

Adaptation, Physiological↗
PubMed2002

Upper-limb bone mineral density of female collegiate gymnasts versus controls.

PURPOSE: We examined bilateral bone mineral density (BMD) in the arms of female college gymnasts to assess the relative contribution of high-impact loading forces versus daily activities on bone plasticity. METHODS: Twenty-five female collegiate gymnasts and 25 controls were studied. BMD of the lumbar spine, proximal femur, and whole body were assessed via dual energy x-ray absorptiometry. Upper-limb BMD was determined by custom analyses of the whole-body scans to examine arms individually. RESULTS: BMD of gymnasts was significantly (P < 0.0001) greater than controls at all sites. Whole-body BMD was 8% higher in gymnasts (1.270 +/- 0.078 vs 1.175 +/- 0.073 g x cm(-2)), with 18-19% differences in the lumbar spine (1.427 +/- 0.144 vs 1.212 +/- 0.106 g x cm(-2), right proximal femur (1.298 +/- 0.101 vs 1.100 +/- 0.129 g x cm(-2)), and left proximal femur (1.293 +/- 0.111 vs 1.104 +/- 0.133 g x cm(-2)). Arm BMD was 17% greater in gymnasts, with higher values in both dominant (1.013 + 0.067 vs 0.875 + 0.066 g x cm(-2)) and nondominant (1.002 + 0.060 vs 0.849 + 0.062 g x cm(-2)) arms. Intragroup comparisons revealed a significantly (P < 0.0001) greater BMD in the dominant arm of the controls but no side-to-side difference in the arms of the gymnasts. CONCLUSIONS: Upper-limb BMD followed use patterns in both gymnasts and controls, demonstrating that the forces imposed on the arms with gymnastics training enhanced BMD and resulted in no bilateral differences. These findings illustrate the association between gymnastics training and increased BMD throughout the body, suggesting that the high BMD values observed in gymnasts are due primarily to the activity itself rather than selection bias.

Absorptiometry, Photon↗
PubMed1997

Does repetitive physical loading inhibit radial growth in female gymnasts?

OBJECTIVE: Stress-related injuries to the distal radius have been noted in female gymnasts with potential for resultant premature closure and abnormal growth at this site. The purpose of this study was comprehensively to review and critically to appraise the available literature to examine the evidence related to this question: does repetitive physical loading inhibit growth of the radius in female gymnasts? DATA SOURCES: MEDLINE and SPORT Discuss were searched from 1975 to the present by using "gymnast" in combination with injury, growth plate, epiphyseal, and ulnar variance. Additional references were retrieved from the bibliographies of the retrieved articles. STUDY SELECTION: All descriptive and analytic studies that included data related to stress-related injuries affecting the distal radius of competitive female gymnasts were included. Conclusions regarding the effects of gymnastics training on radial growth of female gymnasts were limited to data from case reports, clinical series, cross-sectional studies, and descriptive cohort studies. Data from relevant experimental animal studies also were included. DATA EXTRACTION AND SYNTHESIS: In reviewing the literature, particular attention was paid to the relative strengths of the different study designs. From these data, information associated with growth inhibition at the distal radius was examined. MAIN RESULTS: The descriptive research reviewed included clinical, cross-sectional, and cohort studies that establish the existence of stress-related injuries affecting one or more constituent parts of the epiphyseal-physeal-metaphyseal (EPM) complex of the distal radius, symptomatic ulna-radial-length difference (URLD), and distal radius physeal arrest among female gymnasts. Five cross-sectional studies showed radiographic abnormalities consistent with distal radius physeal-stress reaction in 10-85% of gymnasts studied. Two cross-sectional studies indicated "abnormal" positive URLD in 8-20% of wrists radiographed. Four cross-sectional studies showed significant correlations between training intensity and URLD, suggesting a dose-response relation. Three cross-sectional studies indicate greater URLD in gymnasts compared with nongymnasts. Radiographic evidence of distal radius physeal arrest involving physically immature female gymnasts is presented in four studies (two clinical series, one cross-sectional, and one descriptive cohort). In animal studies, prolonged physical training has also been shown to inhibit or stop growth in weight-bearing long bones. However, there were no rigorous studies (i.e., randomized control trials or analytic cohorts) examining the question. CONCLUSION: The results of this critical review of the scientific literature support the plausibility of stress-related distal radius physeal arrest with secondary URLD. However, the strength of evidence is inadequate to be conclusive.

Adolescent↗
PubMed2001

Does gymnastics training inhibit growth of females?

OBJECTIVE: The increasingly dominant performance of smaller-sized female gymnasts and increased magnitude of training beginning at an early age have prompted public and medical concerns, especially from an auxological perspective. The objective of this review is to determine if gymnastics training inhibits growth of females. DATA SOURCES: An extensive research of MedLine (PubMed interface) along with cross-referencing was conducted using the Text and MeSH words "gymnastics" in combination with "growth," "maturation," "body height," "body weight," and "growth plate." Our analysis is limited to English articles only. STUDY SELECTION: All published studies that included data related to the research questions were included. MAIN RESULTS: Although data from three historical cohort studies indicate that female gymnasts are short even before they begin training, clinical reports and cohort studies do suggest that some female gymnasts experience attenuated growth during training followed by catch-up growth during periods of reduced training or retirement. There is conflicting evidence whether the "catch-up" is complete. There were no studies reporting prevalence or incidence of inadequate growth. Three cohort studies provide evidence of reduced growth but training was not partitioned from other confounding factors in the gymnastics environment. Although there is a paucity of studies examining the link of dietary practices with diminished growth in female gymnasts, a review of related dietary literature indicates the potential for insufficient energy and nutrient intake among female gymnasts. CONCLUSIONS: Elite level or heavily involved female gymnasts may experience attenuated growth during their years of training and competition followed by catch-up growth during reduced training schedules or the months following retirement. However, a cause-effect relation between gymnastics training and inadequate growth of females has not been demonstrated.

Adolescent↗
PubMed2005

Gymnastics injuries.

OBJECTIVE: The purpose of this chapter is to review the distribution and determinants of injury rates as reported in the pediatric gymnastics injury literature, and to suggest measures for the prevention of injury and directions for further research. DATA SOURCES: An extensive search of Pubmed was conducted using the Text and MeSH words "gymnastics" and "injury" and limited to the pediatric population (0-18 years). The review focused on studies using denominator-based designs and on those published in the English language. Additional references were obtained from hand searches of the reference lists. Unpublished injury data from the USA Gymnastics National Women's Artistic Gymnastics Championships during 2002-04 were also analyzed. MAIN RESULTS: Comparison of study results was compromised due to the diversity of study populations, variability of injury definition across studies, and changes in rules and equipment across years. Notwithstanding, this review of the literature reveals a reasonably consistent picture of pediatric gymnastics injuries. The incidence and severity of injuries is relatively high, particularly among advanced level female gymnasts. Body parts particularly affected by injury vary by gender and include the ankle, knee, wrist, elbow, lower back, and shoulder. Ankle sprains are a particular concern. Overuse and nonspecific pain conditions, particularly the wrist and low back, occur frequently among advanced-level female gymnasts. Factors associated with an increased injury risk among female gymnasts include greater body size and body fat, periods of rapid growth, and increased life stress. CONCLUSIONS: Above all, this overview of the gymnastics injury literature underscores the need to establish large-scale injury surveillance systems designed to provide current and reliable data on injury trends in both boys and girls gymnastics, and to be used as a basis for analyzing injury risk factors and identifying dependable injury preventive measures.

Adolescent↗
PubMed1999

Water-gymnastics reduced the intensity of back/low back pain in pregnant women.

OBJECTIVE: To investigate if water-gymnastics during pregnancy may reduce the intensity of back/low back pain and the number of days on sick-leave. METHODS: A prospective, randomized study. One hundred and twenty-nine women were randomized to participate in water-gymnastics once a week during the second half of pregnancy and 129 were randomized to a control group. The women in both groups filled in questionnaires in gestational weeks 18, 34 and within the first postpartum week. Every day from week 18 to labor they assessed the intensity of back/low back pain. RESULTS: Back pain intensity increased during pregnancy. No excess risk for the pregnancy associated with water-gymnastics was observed. The women participating in water-gymnastics recorded a lower intensity of back/low back pain. The total number of days on sick-leave because of back/low back pain was 982 in the water-gymnastics group (124 women) compared with 1484 in the control group (120 women). After weeks 32 33, seven women in the water-gymnastics group compared with 17 in the control group were on sickleave because of back/ low back pain (p=0.031). CONCLUSIONS: Intensity of back/low back pain increased with advancing pregnancy. There was no excess risk for urinary or vaginal infections associated with water-gymnastics. Water-gymnastics during the second half of pregnancy significantly reduced the intensity of back/ low back pain. Water-gymnastics decreased the number of women on sick-leave because of back/low back pain. Water-gymnastics during pregnancy can be recommended as a method to relieve back pain and may reduce the need for sick-leave.

Absenteeism↗
PubMed2003

Differences in bone density, body composition, physical activity, and diet between child gymnasts and untrained children 7-8 years of age.

Strategies that enhance the acquisition of bone mass may be protective against osteoporosis. BMD was compared in 20 artistic gymnasts (10 boys; 10 girls) and 20 untrained children ages 7-8 years. Higher regional values of BMD were observed in female gymnasts than untrained girls. If retained to adulthood, this higher BMD may protect skeletal integrity in later life. Strategies that enhance the acquisition of bone mass in children may assist with the prevention of osteoporosis. This study explored the effects of regular high-impact and weight-bearing activity before the age of 7 years on total and regional bone mineral density (BMD). Twenty artistic gymnasts (10 boys and 10 girls) and 20 untrained children, 7-8 years of age, were recruited. The untrained children were matched to gymnasts by sex, height, weight, and age. Female gymnasts trained 8-10 h per week and had trained regularly for 3-4 years. Male gymnasts trained 4-6 h per week and had trained for 1-2 years. Measurements of bone mineral density were made using DXA for total body BMD (TBBMD); lumbar spine, both areal (aSBMD) and volumetric (vSBMD); total spine; pelvis; arms; and legs. Significant mean differences (8-10%) in aSBMD, vSBMD, arm BMD, and TBBMD were observed between female gymnasts and untrained girls (p < 0.05: aSBMD, vSBMD, and TBBMD body mass (BM); p < 0.01: arm BMD). A nonsignificant trend toward a higher TBBMD/BM and arm BMD was observed in male gymnasts compared with untrained boys. Trends toward a higher BMD within the pelvis, legs, and total spine were also observed in gymnasts. There were no differences in total and regional BMD between untrained boys and untrained girls. The results suggest that gymnastics training before the age of 7 years enhances the acquisition of bone mass at selected skeletal sites. The magnitude of this enhancement seems to be linked to the cumulative volume of such training. If retained during adolescence and young adulthood, a surfeit of bone acquired through high-impact and weight-bearing activity in early childhood may protect skeletal integrity in later life.

Body Composition↗