Objectives-An 18 month prospective injury survey was conducted on 64 Australian elite and subelite female gymnasts. The aims were to determine the rate of injury, anatomical location, and types of injury incurred by female competitive gymnasts, and to compare the findings with data collected retrospectively from the same sample of gymnasts. Methods-Thegymnasts recorded (weekly) in an injury record booklet the number of hours trained and information on any injuries suVered over that week. Results-The sample reported 349 injuries, a rate of 5.45 per person (6.29 for the elite and 4.95 for subelite gymnasts) over the 18 month survey. Injuries to the ankle and foot (31.2%) were the most commonly reported, followed by the lower back (14.9%). The most prevalent type of injury were sprains (29.7%), followed by strains (23.2%), and growth plate injuries (12.3%). The elite gymnasts reported that, for each injury, they missed fewer training sessions (p = 0.01), but modified more sessions (p = 0.0001) than their subelite counterparts. Further, the elite gymnasts spent 21.0% of the year training at less than full capacity because of injury. Although a significantly higher number of injuries were recorded in the prospective study (p = 0.0004), no diVerences were found between the distribution of injury by anatomical location or type between the two methods of data collection. Conclusions-The findings have important implications in terms of training procedures and periodic screening of gymnasts. (Br J Sports Med 1999;33:312-318)

Theories regarding how exercise can become addictive, and studies of withdrawal from exercise are reviewed. Several physiological mechanisms, including endogenous opioids, catecholamines, and dopamine pathways, have been implicated in exerdse dependence. The higher levels of endogenous opioids found following strenuous exercise, has prompted researchers to suggest that a form of auto-addiction to these hormones might be responsible for continued excessive exercising in humans. As well, investigators have suggested that, exerdse dependence could be the result of a dependence on the exercise stimulated release of catecholamines, resulting in an over-arousal of the sympathetic nervous system. Moreover, the increased stimulation of dopaminergic brain structures by exercise, and the likely involvement of these structures in behavioural and pharmacological addictions, could provide another explanation for exercise-dependent behaviour. Finally, reports of withdrawal symptoms following cessation of regular exercise, has led investigators to propose that exercise can, like pharmacological and other behavioural stimuli, become addictive.

Women reporting severe premenstrual symptoms were allocated nonrandomly to a cognitive-behavioral coping skills treatment (n = 13), a nonspecific treatment (n = 12), or a waiting-list group (n = 12). Repeated measures analyses of variance showed that, compared with control subjects, the coping skills group reported significant reductions in premenstrual symptomatology and irrational thinking at posttreatment and at 9-month follow-up. There were no significant differences between the waiting-list and control intervention groups at any time of testing. It was suggested that the increased irrationality reported at pretreatment should be viewed not as a "cause" of premenstrual problems but as a product of the stresses experienced in the premenstruum phase. The findings of this study indicated that cognitive-behavioral coping skills treatments can reduce the negative effects of premenstrual symptoms and that those reductions can be maintained over time.

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