Numerous common, which shows that gymnasts have injuries

Numerous studies have been made to determine how
artistic gymnastics can affect how the female body develops in physiological areas–
such as bone and ligament development, injury, and sleeping habits.  This paper will observe aspects of artistic
gymnastics that can either harm or benefit the female body.  To fully understand how artistic gymnastics
affects the female body, one needs to look closer at each individual aspect of
the body.  The effect that artistic
gymnastics has on bone development will be discussed in relationship to how the
radius and the ulna are developed and remain developed into adulthood.  In the study, the radius and the ulna both
appeared to have a much higher bone density and bone mass in former gymnasts,
which is a positive impact for the body because it can reduce the risk of bone
breakages and bone diseases.  Bone
fractures will also be discussed, specifically stress and overuse fractures
that are caused by gymnastics.  Stress fractures in
Olympic gymnasts are common, which shows that gymnasts have injuries that
commonly occur in the sport, and overuse injuries are causing young gymnasts to
experience fractures that are not typically associated with gymnastics.  The effect of artistic
gymnastics on ligaments and tendons will be discussed by studies on the
anterior cruciate and the Achilles tendon. The anterior cruciate ligament is
commonly injured in many sports, and can be a devastating knee injury if torn.
When torn, the only option to treat an anterior cruciate is surgery and this
can put an end to many athletic careers as well as cause chronic issues as the
person ages. The Achilles tendon is some more vital connective tissue that can
be easily injured, especially in artistic gymnastics. About 69% of artistic
gymnasts complain or have occurrences of Achilles tendinopathy, compared
to 66% of sedentary peoples.  This is a
much more drastic increase than it may appear because 69% of gymnasts is a much
higher chance of a gymnast developing Achilles tendinopathy than an average
person (Notarnicola, 2014).  Achilles
tendinopathy is a condition that results in swelling, pain, and stiffness of
the Achilles tendon.  This condition is
thought to be caused by repeated small injuries to the Achilles tendon, and
these injuries are often considered to be incredibly insignificant at the time
of injury but can later result in painful conditions.  Injuries are incredibly common in gymnastics,
and to demonstrate this point, spinal cord and ankle injuries will be discussed.
The reason to why the spine will be discussed is because it is an important
part of the body that can greatly affect how a person lives their life.  As an older study, there may be some
information that has since been disproven, but basic concepts have remained the
same since the study was performed.  The
ankle will be discussed because it is an incredibly common body part that is
injured in gymnastics.  Sleep has also
been found to be affected by gymnastics and the amount of training a gymnast
participates in.  The final topic that
will be discussed is basic physiological effects of gymnastics, such as the
stereotypical short stature and delayed puberty.  These topics will be discussed in greater
depth to demonstrate how artistic gymnastics affects the female body, because it
is important that gymnasts are aware of the benefits and risks of gymnastics so
that they can determine if the benefits outweigh the risks themselves.In an article by G. Ducher (2009) regarding
the skeletal benefits of having done gymnastics at a highly competitive level
versus not having done more than two hours of physical activity a week during
childhood, the bone strength in the radius and the ulna of former gymnasts
compared to non-athletes was observed.  The study took retired artistic gymnasts that
had reduced the amount of physical activity they did in the three or more years
prior to the study to two hours or less of physical activity a week, and compared
their bone strength to the bone strength of non-gymnast subjects.  The bone strength of each individual was
calculated through a peripheral quantitative computed tomography (pQCT) test.  The study had each participant fill out a
questionnaire to determine if there were other factors that had taken place
that may change the outcome of the experiment, asking questions such as if
amenorrhoea (primary or secondary) had occurred for the subject, which could
influence how the bone developed other than the effects of exercise.  Amenorrhea is the delayed start of the
menstrual cycle, which is common in gymnasts and other female athletes that
have a very low percentage of body fat.  The
results of the test showed that at the site that was 4% of forearm length, the
skeletal benefits of the retired gymnasts were 1.9 times greater at the radius
than the ulna for bone mineral content (Ducher, 2009).  The average bone size of the gymnasts was
much larger at the distal radius than the distal ulna at this 4% site as well,
but at the site that is 66% of forearm length, the ulna appeared to have
thicker cortices, 1.8 times greater bone mineral content, 2.2 times greater
cortical cross-sectional area, and 3.7 times greater cortical thickness (Ducher,
2009). This study is of importance because it proves that gymnasts, although
retired, have a stronger bone than the non-gymnast.  The reason this has so much significance in
the effect of gymnastics to the development of a bone would be that it
demonstrates the need for physical exercise at a young age.  The non-gymnasts did a maximum of two hours
of physical activity per week when they were children, and this study shows
that the more exercise that occurs at an early age, the stronger the bones will
be, even if the person does not do large amounts of exercise after quitting their
sport.  The focus of this study was to
demonstrate that the bones of a person that frequently did large amounts of physical
activity as a young person are stronger than the bones of those that exercised
less frequently.  The stronger a bone is,
especially as a person gets older, the less a risk one has of seriously
injuring themselves.  Weak bones can also
cause osteoporosis, a serious disease that can cause bones to break easily
without any serious accident occurring. Osteoporosis affects 1 in 3 women over
the age of fifty, and being a gymnast can reduce the chances of getting this
disease (International Osteoporosis Foundation, 2017). Gymnastics
can increase the likelihood of a person fracturing a bone, even though it
strengthens bones.  In a study done by
Daichi Hayashi, the amount of stress fractures amongst Olympic athletes in the
2016 Olympics was analysed. It was concluded that 12% of stress fractures
reported during the Olympics was from artistic gymnasts (Hayashi, 2017).  A separate study was performed by Robert
Westermann, and the study that he and his team performed was to observe male
and female gymnasts at an institution that participates in the National
Collegiate Athletic Association (NCAA). 
Westermann found that the injury incidence amongst the female gymnasts
was 9.37 per 1000 athlete-exposures, whereas male gymnasts only had an 8.78 per
1000 incidence rate (Westermann, 2015).  Women
are reportedly more predisposed to having stress fractures than men.  Although gymnastics is thought to improve the
bone strength, stress fractures still can occur due to the amount of pressure
and force that is put on the bones of a gymnast.  The study by Hayashi was performed to show
the importance of MRI imaging to the diagnosis of stress reactions before it
can procure into a stress fracture, which, for gymnasts, can be especially important;
even one stress fracture—if painful enough— can cause an ample loss of practice
time, which in turn could lead to a more serious injury.  Another study on fractures was performed by
Jaron Santelli, who observed fractures in proximal radial heads of three young
gymnasts. Fractures in the proximal radial head are not common amongst
gymnasts, and none of these gymnasts had a previous injury that would cause
this fracture. Santelli determined that “these injuries are believed to be
chronic in nature and related to overuse” (Santelli, 2017).  Overuse injuries can be prevented by limiting
the amount of time that one body part or section spends being used and
attempting to evenly use all the body when possible.  A separate study that was performed by Holly
J. Benjamin shows that wrist injuries are another common injury in gymnastics
that is caused by overuse.  Benjamin
discusses general suggestions to prevent overuse injuries, saying that “general guidelines for overuse injury prevention including
limiting excessive loading of the wrist, maintaining wrist joint flexibility,
an emphasis on proper technique, and incorporating wrist and general core
strengthening” (Benjamin, 2017, p.322). 
Following these suggestions have been found to help reduce the chances of
developing overuse injuries, and to be beneficial in preventing reoccurrence of
these injuries.Artistic gymnastics greatly affects ligaments
and how they develop pre- and post- menarche, as demonstrated by a study
performed by Kim (2014).  Menarcheal age
is the age in which a female starts menstruating.  In this study, the effect that the menarcheal
age has on the biomechanics of the lower limbs during a single-legged drop
landing in artistic gymnastics was observed.  This is essentially how a knee is able to move
during a specific type of landing and how likely it is for a gymnast that has
reached menarcheal age to injure themselves while preforming this landing.  Knee injuries are extremely common amongst
gymnasts, making up about 34% of total gymnastics injuries.  Many of these knee injuries, such as meniscus
tears, are because of improper landings or a landing being too harsh for the knee
to handle, and it was found that as a gymnast passes the menarcheal age, the
knee cannot bend as much as it had previously been able to do (decreased
flexion) and is more likely to hyperextend (increased abduction) (Kim, 2014).  This elevated degree of abduction allows for
an increased risk of injury.   The post-menarche group demonstrated an
increased injury risk in noncontact anterior cruciate ligament than the
pre-menarche group.  This greater risk
was associated with the greater knee loads of the post-menarche groups (Kim, 2014).  In the study done by Notarnicola,
the rate of Achilles tendinopathy amongst female gymnasts and sedentary
females were compared. Notarnicola had noticed that a rate of about 17.5% of
young female gymnasts having Achilles tendinopathy was reported in literature,
but no solid studies had been done to prove or disprove that gymnastics had an
impact on the development of Achilles tendinopathy in these women (Notarnicola,
2013).  The study Notarnicola performed
showed that a higher oximetry value was found amongst artistic gymnasts, but no
exact correlations between age, years of sports activity (general and
gymnastics), or the knowledge of the main limb were observed (Notarnicola,
2014).  Oximetry values measure the
oxygenation of tissues or the blood in a specific body part.  Notarnicola and the team that assisted in the
study believe that aspects of artistic gymnastics cause a muscular overload and
hyperfusion of the tendon that causes the Achilles tendinopathy to occur more
commonly.In
an older study that was published in 1986, the development of spinal cord
issues in gymnasts was observed.  Out of
the 38 former gymnasts that were included in this study, 31 had spinal injuries
(Silver, 1986). Silver noted that most of these injuries were from landing on
body parts such as the head or neck while practicing.  These incorrect landings would transmit
excess force onto the cervical region and injure the spine.  The accidental landings that were believed to
be the cause of the spinal injuries of these patients often occurred from a
lack of proper supervision.  The fact
that these injuries were caused due to improper safety precautions help stress
the importance of making sure that proper skill progressions and correct spotting
techniques are occurring throughout any gymnastics routine and/or workout.  Gymnasts should be aware that incredibly
serious injuries can occur in the gym, even if proper safety precautions are
being taken.  Even when in a gym that has
proper equipment and trained staff, extra precaution is necessary.  One of the gymnasts included in the study was
twelve years old, which shows that injuries that occur can affect a person
physically, even at a young age.  In a
survey mentioned in this study, the majority of spinal injuries that were
reported were sprains and strains, but 4.7% were fractures (Silver, 1986).  Spinal fractures most commonly occur in the
cervical part of the spine, and fractures in this area can have a prognosis
from total recovery to total paralysis. 
Catastrophic spinal injury occurrence is not incredibly common, with
only “6 competitive gymnasts with spinal cord injuries treated at the
Orthopedic Department at the University of Heidleberg” between 1985 and 1997
(Nassar, 2005, p. 39).  This number is
greatly decreased from previous time frames, and part of the reason is that
better rules and regulations regarding safety precautions have been enacted to
better protect gymnasts.  Several other
studies show that the occurrence of catastrophic spinal injuries at club teams
is almost nonexistent, which can be considered as proof that gymnastics teams
are taking important precautions to prevent spinal injury.  The increased safety precautions are extremely
beneficial in preventing serious injury, but there is always a chance that a
skill will not be executed as planned, and in these cases, there is an
increased chance of spinal injury occurring.Ankle
injuries have been found to be 22% of the total gymnastics injuries during the
three most recent Olympics (Edouard, 2017).  During those three Olympics (2008, 2012, and
2016), 81 newly sustained injuries were reported out of 963 registered Olympic
gymnasts (Edouard, 2017).  Edouard and
his team concluded that, to prevent this high number of injuries from occurring,
ankles need to be taken into more consideration when acknowledging safety
precautions.  He found that ankle sprains
were the most commonly diagnosed ankle injury amongst Olympic gymnasts, and
this could largely be due to improper landings.  Gymnasts test their abilities, as they should,
throughout the Olympics, to qualify for individual medals, and in doing so,
they try their hardest stunts.  This can
cause issues because if one part of a skill, especially those performed at the
Olympics, is not executed perfectly, it is quite possible for the gymnast to
get seriously hurt.  It has been found
that college gymnasts have a 1.67 times greater chance to injure themselves
during a competition than to get hurt during their practices (Kerr, 2015).  This statistic is astounding because the
amount of time that a college gymnast spends in practice is a much higher
amount than the amount of time that they spend at competitions.  Ankle sprains can cause up to 17.9% of
injuries that result in time loss for college gymnasts, and when a gymnast
loses practice time it can make it more dangerous and cause them to injure a
different part of their body due to muscle loss (Kerr, 2015).  “When
considering time-loss injuries only, the injury rate during this study period
(…) was lower than rates reported in earlier NCAA ISP surveillance data,”
(Kerr, 2015, p. 877).  Kerr is stating
that time-loss injuries amongst college gymnasts are decreasing, which is
important to know because it shows that safety precautions are being upheld at
a greater level than before.  If safety
is being more considered at high levels, it shows that low levels are taking
the time to properly train gymnasts and coaches on how to be safe in the gym.Sleep
is also affected by gymnastics; in a recent study done by J. Dumortier, the
training load, total sleep time, and sleep efficiency was studied amongst
current female gymnasts, and direct correlations were found.  In younger gymnasts, it was found that they
had the highest total sleep time and sleep efficiency out of every age and
level that was observed.  A higher
training load was observed to lead to a lower total sleep time the following
night in all gymnasts, and training load was found to be the highest in junior
gymnasts.  For many people, it is
believed that they get their best sleep when they work out that day because
their body is exhausted, and exercise induced exhaustion allows for a more
peaceful rest, but this study shows that gymnastics can actually do the
opposite of what most exercise does in regard to sleep.  Total sleep time for World Championship
competitors the night before qualifications was found to be much lower than the
average total sleep time for World Championship competitors during the study
(Dumortier, 2017).  This could be because
of the added nerves due to the importance of the occasion, or it could be due
to the high training load during the podium training.  This study found a correlation between
decreased total sleep time and increased training load that led to a poor
gymnastics performance at competitions for all levels and ages of gymnasts.  Decreased amounts of sleep can also lead to
more injuries because when a person is tired they are more likely to be
careless.  Most gymnasts are in their
teenage years or younger, and there have been studies, such as the one done by
Anne Wheaton, that suggest that the probability of a teenager participating in
one of the five major risk factors of car accidents.  Wheaton found that teenagers who got less
than seven hours of sleep during school nights were more likely to participate
in risky behaviours, and “excessive sleepiness, which
is most often a result of not getting adequate sleep, has been shown to
increase the risk for motor vehicle crashes and other unintentional injury among
adolescents” (Wheaton, 2016, p. 339). 
This study shows that the decreased amount of sleep that gymnasts get
can increase risk factors of injuries, because a sleep deprived person is more
likely to make a mistake than a person with adequate sleep.  Sleep deprived gymnasts are more likely to attempt
a skill and not take the proper safety precautions than a gymnast that has had
proper amounts of sleep would.  This
makes gymnastics more dangerous than it already is, because the reduced amount
of sleep caused by gymnastics after hard practices can cause the next day’s
practice to be filled with bad decisions and lead to injuries.Gymnastics is believed to
cause physiological alterations, such as short stature and delayed puberty
symptoms, and these stereotypes are not scientifically known to be true. 
Robert Malina and a team of scientists studied gymnasts and their physiques,
and determined that there is not a feasible way with technology and knowledge
that is currently available to determine if gymnastics affects how a female’s
body matures.  Malina states “It is not possible (…) to establish
cause–effect relationships between training and outcome measures due to
limitations of available data, inadequate specification of training, failure to
consider other factors affecting growth and maturation” (Malina, 2013, p.
785).  Malina is disproving the common myth that gymnastics makes a person
short, by stating that there is not enough data and variables are not
controlled well enough for a definitive conclusion to be made about the
physiological effect of gymnastics. 
Studies that test what specific activities, ages, and genetic maturation
do to gymnasts have not yet taken place, therefore it cannot be totally
known at this time.  However, there have
been studies that have found that gymnasts are typically similarly genetically
inclined.  A study by G. Morucci has
found that “performances of ACE II gymnasts were significantly lower
than that of the ACE ID/DD gymnasts in the apparatus expressing power features,
confirming the predisposition of these athletes toward power-oriented
sport” (Morucci, 2014, p.460).  This shows that genetically gymnasts
are more inclined to be powerful, and many powerful body types are shorter and
more compact.  Successful gymnasts tend to be shorter because they
need to have the powerful body type, but gymnasts can be tall, they just are
less likely to succeed in higher, more competitive levels.  It is not
known if gymnastics itself makes a person shorter or delays puberty, but it is
believed that people that are genetically shorter in stature are more likely to
succeed at higher levels in gymnastics.

Gymnastics is a sport that millions
of people in the Unites States take part in, and it is important that the risks
and benefits of gymnastics are known to all the are thinking about or already
participate in gymnastics.  Major
benefits and risks have been discussed in this paper, such as bone, ligament,
and tendon development; as well as sleep, physical stature, and injury
risks.  These are all important things to
consider when contemplating using gymnastics as a source of physical activity,
but one must also consider the benefits and risks of other sports.  Any type of sport has risks and benefits, and
one must not be afraid to take some risks in order to reap the benefits of
living an athletic lifestyle.  Gymnastics
can prevent certain issues and diseases as one ages, but it can also cause
issues to develop, some each individual needs to make an informed choice for
themselves if gymnastics is worth the effort before investing time and money
into the sport.  

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