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Rise of Gymnast Lower Back Pain: Understanding Causes and Solutions

Athlete, Gymnastics /
Gymnast Back Pain

Gymnastics is a sport that demands high levels of strength and flexibility. Unfortunately, it comes with many challenges. This blog post will discuss gymnast lower back pain and why it is so prevalent. 

Some studies have shown that anywhere from 25% to 85% of gymnasts have lower back pain. [Reference: (1. Spine Injuries in the Sport of Gymnastics. David Kruse, MD and Brooke Lemmen, MD)]. 

If you are thinking, “WOW, That’s a lot of back pain.” Yes, it is.

Click here for the 6 Best Exercises for Gymnast Back Pain!

Why gymnast lower back pain? Is my athlete at risk?

Gymnastics is a sport that places unique physical demands on athletes, making them particularly susceptible to lower back pain. Factors contributing to this risk include:

1. Nature of the Sport

    • Hyperflexion is excessive forward bending of the spine. A lot of rounding in your lower back can increase the stress on the discs and nerves. This movement can also irritate the paraspinal muscles of your lower back (the tiny muscles that connect each vertebra together).
      •  
        • Skills:
          •  
            • front/back rolls
            • front/back tucks
            • kips
    • Hyperextension is excessive backward bending of the spine. This is the typical movement that is unique to gymnastics that causes most lower back pain. The number of repetitions of these movements can be excessive and can lead to lower back pain.
        • Skills:
          •  
            • Back walkover
            • Back handspring
            • front walkover
            • front handspring
    • High Impact landings from skills can put excessive force through your body’s joints. The landing surfaces of beam, floor and vault can also put excess stress through the joints of your body. If your muscles are not strong enough to withstand the stress, or your technique is incorrect this can lead to injury.

2. Biomechanical

The way in which your body moves is crucial to staying healthy while competing in gymnastics. If you cannot move correctly, your body will compensate to perform the skill but at a big cost such as injury. 

    • Decreased Shoulder Flexion will cause the athlete to move excessively from their lower back to make up for the missing movement.
    • Decreased thoracic mobility will make it difficult to extend and twist from the upper back, putting more stress on your lower back.
    • Decreased Hip Extension will force your lower back to extend EVEN MORE because the front of your hip does not have the flexibility to kick backward.
    • Decreased core strength will put more stress on the ligaments and bony structures of your spine to provide stability while performing skills.

3. Previous injury

The biggest risk factor for getting injured is having a history of previous injury. It is not known exactly why but a few hypotheses are:

    • Change in Mechanics to take the stress off of the injured area. 
    • A physical injury is also a brain injury. Your brain needs time to rewire how to activate the correct muscles to perform a task. 
    • Not fully completing rehab and returning to sport before you are really ready. Unfortunately, most Physical Therapists and Athletic Trainers may not fully understand the specific needs of gymnasts. The intensity of your rehab plan may be TOO LITTLE, and you have not rebuilt your capacity to withstand the stress of certain skills.

4 Common Gymnast Lower Back Pain Injuries

1. Spondylolysis

    • This is a stress fracture in the vertebrae, often caused by repetitive movements. Arching backward, twisting repeatedly, and high-impact landings can lead to this type of injury. 

2. Spondylolisthesis

    • When there is a fracture on both sides of the vertebra and the vertebra starts to slip forward. 

3. Discogenic back pain

    • Injury to the disc of the spine. This often happens with repetitive forward bending, backward bending, and previous lower back injury. 

 

MYTHBUSTER:

Disc Herniations CAN BE painful, but are not always the source of pain. Brinjikji et al. (2015) has shown that many people can have disc herniations but are asymptomatic. There is usually a biomechanical cause associated with disc herniations that must be addressed to get rid of back pain while practicing gymnastics.

 

 

4. Mechanical/Gymnast Back Pain

    • This is any other type of lower back pain that cannot be explained through imaging or other diagnosis by a healthcare provider. Even if the reports come back with “nothing wrong” to report, your child is not lying to you when they are reporting their lower back pain. 
    • In my experience working with gymnasts since 2011, most UNDER REPORT their pain levels because they want to continue competing so please take their complaints seriously.

KEY TAKEAWAY: 

Lower back pain in gymnasts is REAL. It is important to take lower back pain seriously and seek medical treatment for these injuries.

Can gymnast lower back pain be prevented?

I believe that we can lower the incidence of lower back pain in gymnasts by taking the correct approach. Here are some ways to decrease the risk of lower back pain in your athlete:

1. Mobility Training

Addressing the lack of range of motion in the shoulders, hips, and upper back is crucial to preventing (and treating) lower back pain.

SHOULDER MOBILITY FOR GYMNASTS

HIP MOBILITY FOR GYMNASTS

 

2. Strength Training

11.6-14.8x body weight is being compressed through a gymnast’s back while landing from their skills. To reduce the impact that these repetitive landings have on the bony structures, your muscles can provide support. 

Getting stronger is not only proven to be safe but is ESSENTIAL in preventing injury in gymnasts.

GET STRONGER with SAMARA

In Motion Physical Therapy is now offering Strength Training with former gymnast and current PT Student Samara Kelhoffer, CSCS.

Strength Training

3. Appropriate Loading

It is important to plan out the season with your coaching staff to determine the proper amount of training and surface types that your athlete will be working on. 

It is important to be cautious when ramping up the workload of the gymnast and avoid sudden spikes in training volume or intensity. 

Conversely, it is also important not to UNDERTRAIN. The athlete must be performing their skills and strength training with enough volume to withstand the rigors of competition season. 

4. Rotating Skills

It is important to recognize that certain skills in gymnastics create similar stress on the body. By planning out sessions, coaches can help decrease injuries in their athletes by avoiding repetition on various apparatus for the day/week.

5. Focus on proper technique

Gymnastics is a sport of precision. The slightest decrease in pointing your toes can result in a deduction. 

This attention to detail is a crucial component of injury prevention. Athletes need to progress through their skills PROPERLY, with good form and technique.

CHECK OUT OUR VIDEO ON LANDING TECHNIQUE

 3 Mistakes with Landing Mechanics

6. Culture

This is a tricky topic for me to discuss, as I did not grow up as a gymnast. When I started working with gymnasts, the culture behind the sport was eye-opening to me. 

A gymnast once told me that her coach blamed her lower back pain on the fact that she was “overweight” 

    • NO, she was not overweight
    • NO, your weight has nothing to do with lower back pain
    • NO, we should not associate weight with ability (especially in pre-teen girls)

Please advocate for your athletes, and if something does not feel right with the culture of the gym please speak up. Your athlete should be working hard, feel supported and challenged, and HAVE FUN.

What does treatment look like for a gymnast lower back injury?

If your gymnast is experiencing lower back pain it is imperative to seek medical treatment from a qualified professional. Below is a high level overview of what your return to sport process should look like.

1. Rest/Load Modification

The first step is to remove the source of stress and injury in the athlete. This may mean taking complete rest for a few weeks, or it may mean making modifications with skills and avoiding certain movements. 

2. Physical Therapy

High-quality rehabilitation is a necessary component of resolving lower back pain in gymnasts. Rehab should be broken down into a few phases.

    • Acute: After the initial injury the tissues need time to start healing. The main focus during this phase is to control pain and inflammation and reintroduce gentle movements that promote blood flow and mobility. 
    • Repair: Now it is time to progress core stability and strengthening exercises to support the injured structures of the lower back. This should be done progressively. The athlete should also start a gym program (low-impact aerobic training) to promote blood flow and cardiovascular fitness. 
    • Remodel: Reintroducing movements through all directions along with strengthening through these ranges is important to do. These exercises should become more challenging as rehab progresses. 
    • Athlete/Gymnast: Sessions should now resemble warm-ups, and strength workouts, and involve jumping and impact. The athlete should slowly start reintroducing skills on easier surfaces and monitoring their workload.

The athlete, their caregivers, medical team (Doctors and PTs) and gymnastics coach will work TOGETHER for their athlete to discuss a plan for returning to the sport successfully.

3. Sleep/Nutrition/Stress Management

    • Sleep is important to proper injury recovery (among MANY other things). I know it can be hard with all of the rigors of being a student-athlete, but it must be a priority. Create a bedtime routine, eliminate blue lights before bedtime, and aim for 7-9 hours MINIMUM per night.

    • Nutrition is required to FUEL your body. Despite activity levels being lower, this does not mean you need to eat less. Focus on nutrient-dense, whole foods and adequate water intake.

    • Stress Management is something a lot of us can work on, myself included! Most gymnasts that I know are high achievers and put immense pressure on themselves to be “perfect” in all aspects of their lives.

Injuries can provide a silver lining. We learn how to manage stress, recover from set backs and accept what is (and what is not) in our control.

Conclusion

Lower back pain is a challenge for many gymnasts. Never underestimate the importance of taking this injury seriously and seeking appropriate medical treatment. 

The good news is there are solutions to deal with lower back injuries.  Making some adjustments to your training with mobility exercises, strength training and planning for your season will help set you up for success. 

If you are a gymnast on Long Island experiencing lower back pain, In Motion Physical Therapy is here to help! Contact us today to learn more and to schedule your first appointment for physical therapy or strength training near Farmingdale.

References:

    1. https://shiftmovementscience.com/gymnasticsbackpainguide/
    2. https://www.hss.edu/condition-list_spondylolysis-pars-fracture.asp
    3. https://gymnasticsmedicine.org/spine/
    4. https://gymnasticsmedicine.org/back-pain-in-gymnastics/#:~:text=In%20summary%2C%20gymnasts%20who%20experience,avoid%20back%20pain%20and%20injury
    5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/