Original research
Acrobatic gymnastics injury: Occurrence, site and training risk factors

https://doi.org/10.1016/j.ptsp.2010.01.002Get rights and content

Abstract

Objective

To determine the incidence and risk factors for injury associated with the performance of acrobatic gymnastics.

Design

Retrospective injury and training survey.

Setting

New South Wales acrobatic gymnastics clubs.

Participants

Surveys were completed by 73 acrobatic gymnasts (69 female) aged 8–26 years.

Main outcome measurements

Data on injury incidence and frequency for injury site were collected. Multiple-regression and ROC curve analysis were used to evaluate training-associated injury risk factors.

Results

Half (50.7%) of the participants had sustained an injury associated with acrobatic gymnastics in the past 12 months, with 28.8% of participants affected by chronic injury at the time of the study. Age of onset for acute and chronic acrobatics-related injury averaged 13.9 (SD ± 3.03) and 14.7 (SD ± 3.85) years, respectively. Injury sites were predominately the knee, ankle and wrist. Risk factors for injury were having an age of ≥13 years and training for ≥8 h per week at age 11 years.

Conclusions

The results suggest that the 11–15 years age period is critical for the occurrence of injury in acrobatic gymnasts. This is possibly due to the adolescent growth spurt which may create an increased vulnerability to injury if training volume during this time is above a certain threshold.

Introduction

The performance of acrobatic skills has a history in the theatrical arena as well as being an international gymnastic discipline, Acrobatic Gymnastics or Sports Acrobatics. Reasons for undertaking training in acrobatic skills can be for recreation; to increase general fitness; as supplemental training for other performing arts and sports such as dance, cheerleading, circus arts, aerial and extreme sports; and as preparation for state, national and international acrobatic gymnastics competition. The most recent World Acrobatics Championships and International Age Games held in Glasgow in 2008 involved more than 500 competitors from 28 countries (Glasgow, 2009). Acrobatic gymnasts or acrobats compete in one of 3 categories: pairs, which may be men's, women's or mixed, women's trio and men's fours. During routines, acrobats must perform individual skills such as tumbling, as well as performing skills in groups where they use each other as the apparatus on which to perform static gymnastic skills such as handstands (Fig. 1a) and dynamic skills such as somersaults (Fig. 1b). For these group skills, acrobats act as either “bases” or “tops” in pair events and bases, tops and “middles” in women's trio and men's fours events The nature of acrobatics means that the smallest and often youngest member of the team acts as the top and as a consequence is required to perform the most risky aerial skills.

A significant injury to one acrobat affects the other team members and has the potential to render the whole team unfit to compete for the season. The performance of group acrobatics skills is influenced by each individual acrobat's body shape, weight and height, so it is difficult to substitute team members at short notice and hence an injury close to competition can be devastating for the whole team, not just the individual.

Despite the sport's international status, only a small number of studies have investigated acrobatic gymnastic training and occurrence of injury (Anwajler et al., 2005, Shi, 1998). Female acrobatic gymnasts display hypermobility of the spine, hip and shoulder compared with non-gymnasts, with 50% of acrobatic gymnasts reporting pain resulting from degenerative changes in the hip, knee and spine (Anwajler et al., 2005). Gymnastics has frequently been reported as the sport with the highest child and adolescent injury rate, especially in females (Emery, 2003, Singh et al., 2008). Studies investigating injuries in other gymnastic disciplines (e.g. artistic gymnastics, rhythmic gymnastics and cheerleading) which are related to acrobatics have yielded striking variations in injury rate that can mainly be attributed to differences in study design, the skill level of the gymnasts studied and the definition of injury (McAuley et al., 1987, Meeusen and Borms, 1992). Injury rates per 1000 h of artistic gymnastics participation range from 0.427 (Linder & Caine, 1989) in lower level female gymnasts, to 22.7 (Sands, Shultz, & Newman, 1993) in intercollegiate competition gymnasts. Of all the apparatus on which artistic gymnasts perform, the floor has been identified as the most hazardous (Caine et al., 1989, Garrick and Requa, 1980, Linder and Caine, 1989, Lowry and Leveau, 1982, Marshall et al., 2007, Meeusen and Borms, 1992, Pettrone and Ricciardelli, 1987) with floor-based routines accounting for up to 40% of sudden-onset injuries (Caine et al., 1989). Considering that acrobatic routines involve similar skills to artistic gymnastic floor routines, with the additional physical stresses of partner balances and throws, the incidence and prevalence of injury might be expected to be higher in the former discipline.

Injury rates in rhythmic gymnasts, who also perform skills requiring extreme flexibility comparable to that of acrobatic gymnasts performing as “tops,” have been reported as 1.08/1000 h of participation (Schulz, Marshall, Yang, Mueller, Weaver, & Bowling, 2004) whereas injuries in cheerleaders who perform comparable group skills to acrobats occur at the frequency of 39.7%–41.3% of cheerleaders sustaining an injury over a one year period (Jacobson et al., 2004, Jacobson et al., 2005). Injury rates in dancers, who also share common elements with acrobatics such as flexibility and artistry skills, range from 0.6 to 0.77 injuries per 1000 h of dance participation (Gamboa et al., 2008, Nilsson et al., 2001).

In light of the lack of research investigating the incidence/prevalence of injury in acrobatics, the aim of this study was to determine the incidence and to identify risk factors associated with these injuries. Secondary analysis investigated the site, type and mechanism of acrobatics-related injury.

Section snippets

Research design

This project employed a survey design, using a retrospective injury questionnaire for collection of quantitative and qualitative data.

Participants

Seventy-three acrobats currently training at a recreational or competitive level in NSW – based acrobatic clubs participated in this study. For the data to be representative of the population, it was determined that a sample size of 64 participants was needed to ensure that the standard error of each parameter estimate was smaller than one eighth of a standard

Results

Seventy-three surveys were returned, however 2 participants failed to answer the majority of questions regarding training and a further 2 participants did not answer questions regarding past years of training yet completed the questions on current training hours. Therefore the majority of the results represent the information collected from the remaining 69 surveys, which was greater than the minimum number determined as necessary for confidence in estimates based on the survey data.

Discussion

The occurrence of injury in this preliminary study of acrobats was found to be highest in those aged 13 years and over, and this is consistent with their increased intensity of training in terms of hours per week and competing level. Of this group, 50% were competing in Level 6 or above and averaging 11 h per week of training, while only 14.3% of participants aged 12 years or under competed at this level and intensity.

The injury rate of 2.94 per 1000 h of participation, or 1.21 injuries per

Conclusion

Acrobats are frequently injured in training and competition with the majority of injuries affecting the lower limb. Responses to the survey conducted here showed that acrobats aged 13 years and over were most likely to have sustained an acute or chronic injury. The results revealed that a specific weekly training threshold may exist for acrobats aged 11–15 years, which, if exceeded, increases the risk of injury. The most significant injury risk was training for ≥8 h per week at 11 years of age.

Ethical statement

None.

Conflict of interest

There are no conflicts of interest associated with this project.

Funding

There were no sources of funding for this project.

Acknowledgements

We wish to thank the Acrobatic Gymnastics Management Committee of Gymnastics NSW, the gymnasts and coaches of the NSW Acrobatic Gymnastics clubs who participated and Lynette Ward for their assistance.

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