The slide deck by Dr. Dave Tilley for understanding and preventing back injuries in gymnastics.

1. 5 Keys to Understanding and Preventing Lower
Back Pain in Gymnastics
Dr. Dave Tilley DPT, SCS,CSCS
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Outline For Today
Why should we worry about back pain in gymnastics?
Why types of back pain and injuries occur ?
Why causes back pain in gymnasts?
What should we focus on?
How do I know if its serious?

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Why Should We Worry About Back Pain?
1. By far the number one injury I see in gymnasts
• causes multiple days, weeks, months, and entire seasons of missed
practice
2. Highly correlated to gymnasts quitting the sport
• Due to recurrent pain, burnout, or fear of long term consequences
Research Articles 1-7

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Why Should We Worry About Back Pain?
3. The same problems that cause back pain reduce performance
• Limit ability to master and use basics in gymnastics
• Limit ability to learn and perform more advanced skills
• Prevent long term athletic potential and competition success
Research Articles 1-7

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Back Pain
Epidemic
Workloads
Quality of
Backbend
Growth
Hip &
Shoulder
Core Control
& Strength
Early
Detection
Technique
Skill Force
&
Equipment

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Why types of back pain and injuries occur?
1. Backward Bending or Arch (Extension)
2. Forward Bending or Hollow (Flexion)
3. Impact or Landing (Compression)
4. Hanging (Traction)
Research Articles 8-13

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Backward Bending or Arch (Extension)
• BWO, FWO, BHS, FHS
• Yurchenko Vaults, Pac Releases, Front Giants
• Tipelts, Ring Giants, Chinese Taps
• Rotation skills (beam 2/1 dismount)
Muscle strain, Facet syndrome, spondylolisthesis
(stress fracture or pars)
Research Articles 8-13

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Forward Bending or Hollow (Flexion)
• Single or Double Tusk/Pike Skills
• In bar stalders, toe ons, jams
• Landing short or under rotating
Muscle spasms, disc herniation, ‘sciatic’
(nerve traction), ligament or joint capsule
sprain
Research Articles 8-13

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Impact (Compression)
• High impact landings / dismounts
• Impact + flexion
Ex: Under rotation double back
• Impact + extension
Ex: 1 ½ punch and ‘buckling’
Muscle strains, end plate damage, previous
injuries possible as well (spondy/disc injury)
Research Articles 8-13

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Hanging (Traction)
• Most often with swinging skills on uneven
bars, rings, parallel bars
• Traction + flexion
Ex: bottom of stalder/jam
• Traction + extension
Ex: release tap or Chinese tap
Muscle strains, end plate damage, previous
injuries possible as well (spondy/disc injury)
Research Articles 8-13

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What causes back pain in gymnasts?
1. Doing Too Much!
The elephant in the room… Improper work to rest, and not counting or
tracking repetitions by far the number one reason back injuries are so
common in gymnastics
Think about how many skills and how many reps gymnastics requires…
• Womens - BHS, FHS, BWO, FWO, Yurchenko, Beam BHS, Switch
Leap, ring jumps,, pacs, Tkachev, etc
• Mens – Tumbling floor, high power ring/high bar taps, tipely,
Research Articles
14-19

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How to Help.
Admit it as reality vs sweeping under rug
• Baseball and Tommy John comparison
Implement some form of monitoring and ‘capping’ of skill groups
“Stick 7 beam series, no more than 10” vs…. “beam for an hour”
”stand up 5 high bar dismounts, no more than 8”

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How to help.
Rotate event focuses to not overload certain skills
• Hyper extension skills, hard impacts, in bars
Try to diversify skill profile as able
Have radically open communication lines and screen regularly

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2. Quality of Back Bends
• What is not happening above or
below often made up in the lower
back of gymnasts
• “Hinge” Points
• Limited flexibility/strength,
technical ability, fatigue
Research Articles 8-13

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How to Help – Limited Shoulder of Flexibility
• Start with screening
• Focus on soft tissue flexibility, full range control, and strength
• Modify skills until flexibility improves
• Change skills if really not seeing progress
• Be stickler about proper basics and technique!
Research Articles 20 - 26

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Some of my ‘go to’ soft tissue care and stretching exercises

18. 18shiftmovementscience.com
Some of my ‘go to’ active flexibility exercises

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How to Help – Limited Hip or Shoulder Strength
• Every sport has natural to overuse pattern
• Gymnastics tends to be lats, pecs, ‘hollow’, quads, inner thigh, and
calves
• Must make sure physical prep trains balance
• Gymnastics tends to overlook upper back, rotator cuff, glutes, hip
rotators

20. 20shiftmovementscience.com
Some of my ‘go to’ exercises

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3. Improper Technique or Increased Fatigue
The best flexibility, strength, and prehab program in the world
won’t make up for proper basics, technique, or workload
management
May be one step back for five step forward
• Requires communication, trust, patience, and work!
Research Articles
14-19

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How to Help – Technique
Take time to really nail basics
• ‘5 dimensions of a line’ from Nick Ruddock
• Shape Changing
• Basic Kneeling back bend drills
• Basic landing drills

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How to Help – Fatigue
Manage short term fatigue with the ‘cap’ per event, rotating
event process, and very robust physical prep program
Manage cumulative fatigue by using periodization and planning
• total volume of skills, routines, strength, cardio per week
or month

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4. Limited Core Control and Strength
• Core Control – Ability to use and engage core muscles to
protect spine
• Core Strength – Ability to buffer forces through the spine and
prevent “buckling”
Research Articles
10-11

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How to Help?
• Train core control, gymnastics core strength, and non
gymnastics core strength equally
• Train all aspects of the core equally

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• Creating Movement
• Resisting MovementCore
Research Articles
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Front Back Side Rotation Compression Traction
Leg Lift Arch Ups Side Plank
Around The
World
Landing Drills Swinging Drills
Creating Movement

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Front Back Side Rotation Compression Traction
Overhead
Medball Throw
Weighted Sled
Drag
Suitcase Carry
Side Medball
Throw
Farmer Carry Weighted Pull Up
Resisting Movement

31. Core Examples

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5. Growth Spurts, and Need for Patience
• Periods of rapid growth are highly correlated to overuse and
acute injuries
• Why?
• Tissue is immature and can’t handle high force
• Remember forces of gymnastics are massive!
Research Articles 27 - 31

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How to Help
• Education and patience!
• Modify volume of hard impacts, even competitions if needed
• Double up on flexibility, strength, prehab, basics in practice
• Screen growth monthly to look at ‘Peak Height Velocity’ and attempt
to forecast spurts
Research Articles 27 - 31

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Growth Screening
Standing - Leg Growth
Sitting– Torso Growth
Wingspan – Arm Growth

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5. Lack of Early Detection
• Athletes not speaking up
• Coaches or parents not listening
• Coaches or parents not having best screening tools
• Medical providers not having best screening tools

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How to Help - Screening Guidelines for Coaches
• Build a culture of trust, education, and communication
• My ‘3 days 3 times’ rule of thumb
• If symptoms not improving within 3 days of rest recovery, seek
medical treatment
• If small ‘tweaks’ or ‘pulls’ keep happening (hence 3rd time), seek
medical treatment

37. 37shiftmovementscience.com
Forward Bend
Backward Bend and Turn
Heel Drop
Hang
Seal Stretch and Rock Back

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43. THANK YOU!
Questions? Chime in on the Hero Lab
Facebook page or email
dave@shiftmovementscience.com