Factors Associated With Achilles Tendon Rupture in Women’s Collegiate Gymnastics

Abstract

Background: Achilles injury risk in women’s collegiate gymnastics is 10-fold higher than in all other collegiate sports. This study aims to identify risk factors for Achilles tendon ruptures in collegiate female gymnasts. Hypothesis: Gymnasts with Achilles tendon ruptures will be more likely to report early gymnastics specialization, elite-level training before college, and performance of high-difficulty skills on floor and vault. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Anonymous surveys were distributed to current and former collegiate female gymnasts, aged 18 to 30 years, via coaches, athletic trainers, Twitter, and ResearchMatch. Information about Achilles tendon ruptures, gymnastics-related injuries, sport specialization, event/skills participation, and medication use were collected. Results: A total of 581 gymnasts were included. One hundred gymnasts (17.2%; 95% CI: 14.1%-20.3%) reported Achilles tendon ruptures during collegiate training or competition. Most ruptures (91%) occurred on floor exercise; 85.7% of these occurred during back tumbling-take-off. Compared with gymnasts without ruptures during college, a greater percentage of gymnasts with ruptures competed at a Division I program, trained elite, competed difficult vaults and floor passes before and during college, competed in all 4 events during college, identified as Black/African American, and used retinoid medications. Conclusion: Achilles tendon ruptures are more common in women’s collegiate gymnastics than other sports. Competing at the elite level, performing difficult floor and vault skills, and competing in all 4 events may increase the risk for an Achilles tendon rupture. Potential nontraining risk factors include retinoid exposure and Black/African American race. Future studies regarding the mechanisms of Achilles tendon ruptures in female collegiate gymnasts are warranted. Clinical Relevance: Collegiate gymnasts who compete at the elite level, perform high levels of difficulty on floor and vault, and compete in all 4 events may be at increased risk for Achilles tendon ruptures.

A Research and Clinical Framework for Understanding Achilles Injury in Female Collegiate Gymnasts

“…This could lead to a situation where a younger, prepubescent athlete is training the same high-level skill as their postpubertal teammate, whose tissues have had time to adapt to the high forces seen during these skills. This situation may contribute to Bonanno et al's (5) findings that college gymnasts who suffered AT rupture were more likely to have trained higher level tumbling skills at a younger age. This was the first study we are aware of that associates high level tumbling skill development with an athlete's age, and more research is needed on developmentally appropriate methods of training the high-level tumbling skills required at the collegiate level.…”

“…Current recommendations for youth sports suggest weekly practice hours should not exceed the athlete's age in years due to increased injury risk (43,44). Despite these evidence-based recommendations, many precollegiate gymnasts practice upwards of 20 h·wk −1 (5). While lack of knowledge regarding these guidelines may be a contributing factor, coaches who are aware may feel that additional practice hours beyond age recommendations are necessary to gain a competitive advantage, without recognizing the importance of varying training load patterns in prevention of gradual-onset injuries (43).…”

Return to sport in elite gymnastics: Unprecedented training interruptions provide lessons for the future

“…Year-round training of ≥30 hours per week is the standard for elite gymnasts. [2][3][4] There is a pervasive belief that continuous training is necessary for competitive success and that time off will negatively affect performance. [5][6][7][8] Because there is no "off season" in elite gymnastics, there has been no way to examine these long-held beliefs in a scientific way.…”

“…Following the World Health Organization's (WHO's) classification of COVID‐19 as a pandemic in March 2020, 1 the implementation of facility closures to aid in “flattening the curve” resulted in unprecedented barriers for elite gymnasts to continue training. Year‐round training of ≥30 hours per week is the standard for elite gymnasts 2–4 . There is a pervasive belief that continuous training is necessary for competitive success and that time off will negatively affect performance 5–8 .…”

Foot and Ankle Awareness in the Athlete

“…The last paper 1 presented within this focus topic is very important, given the increasing number of Achilles tendon ruptures seen across all sectors. Bonanno and associates 1 in New York illustrate the significant risk in women’s gymnastics. These soft-tissue injuries are no longer relegated to the male enthusiast in the 28- to 48-year-old range.…”