Sport
Gymnastics asks for strength, power and flexibility from a young age, with hard landings and the hands used as feet. Injury rates are high and rise with level: wrists and backs in young gymnasts, ankles and knees from landings and, rarely, serious head and neck injuries. The one prevention trial found that extra exercises alone didn't prevent overuse injuries, so training hours, growth spurts, recovery and coaching matter as much as conditioning.
This guide covers artistic, rhythmic and trampoline gymnastics: the common injuries, growth and the growth spurt, British Gymnastics' rules on weighing and concussion, what the Whyte Review found, eating enough, conditioning and jump training, trampolines at home, in parks and in clubs, and when to see a doctor. It includes a conditioning workout and a warm-up, with a 3D demo of every move. We're not connected with British Gymnastics or any club.
At three Olympic Games there were 84 injuries for every 1,000 gymnasts taking part, and at a French national centre 91% of elite women's artistic gymnasts were injured each season. Higher competitive level went with more injuries.
About half of adolescent artistic gymnasts had wrist pain in pooled studies, and half of young gymnasts in one study had X-ray signs of stress at the wrist's growth plate. Stress fractures in the back of a vertebra were found in about 14% of 1,391 gymnasts across 11 studies.
The one prevention trial, a longer warm-up in 205 rhythmic gymnasts for 8 months, didn't reduce overuse injuries. Training hours, growth spurts and recovery matter too.
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Injury risk peaked around the growth spurt in trampoline gymnasts, and British Gymnastics advises modifying training then, going back to basics and keeping flexibility rather than pushing for more.
After the Whyte Review heard about weighing that was "coach-led and quite unnecessary", British Gymnastics' policy says coaches must not weigh gymnasts; only qualified practitioners may, with consent, for gymnasts over 10.
A gymnast with a suspected concussion must stop at once, then follow the UK's grassroots concussion guidelines back to training.
Women's artistic gymnastics has vault, uneven bars, beam and floor; men's has floor, pommel horse, rings, vault, parallel bars and high bar. Rhythmic gymnasts work with apparatus at extreme ranges of movement, trampolinists land somersaults and twists on the bed, and tumbling and acrobatic gymnastics share much of the same evidence.
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The Compendium of Physical Activities, from published measurements, gives general gymnastics 3.8 metabolic equivalents (METs), recreational trampolining 6.3 and competitive trampolining 10.3. The UK's National Health Service (NHS) counts gymnastics as vigorous activity, and as muscle- and bone-strengthening activity for children.
Training hours rise steeply with level: about 10 hours a week in regional youth gymnasts in one trial, about 30 in elite-oriented girls before puberty, and 36.6 in elite rhythmic gymnasts.
The sites the studies point to:
Higher level and more competition, a previous injury (about 30 times the odds in young rhythmic gymnasts), the growth spurt and high training loads, and, for wrists, age 10 to 14 and more intense training and hours. These are associations, and no screening test has been shown to predict who will be injured.
Landing mechanics; wrist and forearm capacity, built gradually; shoulder-blade and rotator cuff strength for support and hanging; trunk strength in hollow and arch shapes; leg strength and power; and active control of the flexibility the sport needs.
Each study counted injuries its own way, so the figures in different lines aren't comparable. Most studies come from artistic gymnastics, and many from the US.
The numbers, by group:
Wrist pain affected about half of adolescent artistic gymnasts in pooled studies (low-certainty evidence), and went with age 10 to 14 and with training intensity and hours. In 59 young non-elite gymnasts, 51% had X-ray signs of stress at the growth plate at the end of the forearm bone, more often with pain. Our gymnast's wrist guide covers treatment.
Low back pain affects 25% to 50% of competitive gymnasts, most in rhythmic gymnastics. Stress fractures in the back of a vertebra (spondylolysis) were found in 13.8% of 1,391 gymnasts across 11 studies, 17% of Spanish elite artistic gymnasts, and 34% of girls in gymnastics with back pain at one US clinic. Our spondylolisthesis guide covers them.
Ankle sprains were the commonest diagnosis at the Olympic Games. Gymnastics had the highest anterior cruciate ligament (ACL) injury rate of any type of sport in a meta-analysis: 4.80 per 10,000 athlete-exposures in women, about 5.5 times the rate in men. Achilles and kneecap tendon problems were common in young competitive gymnasts. Our sprained ankle, ACL injury and Osgood-Schlatter guides cover these.
Gymnasts get osteochondritis dissecans, a damaged patch of cartilage and bone, further back in the elbow than throwers do, from bearing weight on a straight elbow. Shoulder instability and tendon injuries made up about 4% to 8% of female artistic gymnasts' injuries, most often on the uneven bars. Our elbow OCD, elbow pain and shoulder guides cover these.
Dowel grips can catch on the bar and lock, which can break the forearm. Check grips and straps for wear, and use the right grip for each apparatus.
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Concussion was the commonest specific injury in US college women's gymnastics (8.4%). In 62 gymnasts seen with concussion at a children's sports medicine clinic, the floor was the commonest event, and 20% had been knocked out. Catastrophic head and neck injuries are rare: 1.66 per 100,000 athlete-seasons in US school and college gymnastics over 40 years, the highest rate outside American football, and falling each decade.
In 5 years of injuries at one clinic, most were ligament injuries in the legs; trampolinists hurt forearms and knees, tumblers ankles, and acrobatic gymnasts wrists.
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The one prevention trial in gymnastics, in rhythmic gymnasts, found no effect, and none has been done in artistic or trampoline gymnastics. The rest comes from guidance and from other sports, and each note says so.
Clubs in Norway were randomised:
In 21 national-level trampoline gymnasts, injury risk peaked at about 90% of predicted adult height, around the growth spurt, and rose with weekly training load. British Gymnastics flags gymnasts at 85% to 96% of predicted adult height as at greater risk, and advises modifying and adapting training, going back to basic skills or drills, extra physical preparation, care with landings and surfaces, maintaining rather than improving flexibility, and encouraging gymnasts to tell their coach about joint pain, back pain or tight muscles.
An expert consensus found no evidence that young children benefit from specialising early in most sports, but named gymnastics and figure skating as possible exceptions, because the top level comes in the teens and early twenties. It says children who train more hours a week than their age, or more than 16 hours of intense training, should be watched closely for burnout and overuse injury. The American Academy of Pediatrics (AAP) links burnout with early specialisation and says gymnasts should be allowed to stop when they choose.
The Whyte Review heard that gymnasts were commonly told to keep training while injured, sometimes until the injury got worse. A senior practitioner told the review that modified training can be responsible when the coach, the gymnast, the sports science team and, for children, a parent decide on it together. The AAP says athletes should never take medicine before training to mask pain.
Little is known about preventing gymnasts' wrist injuries. Experts suggest limiting excessive wrist loading, keeping wrist range, good technique, and wrist and trunk strength. The AAP lists wrist braces among ways to lower the risk, but in a lab study of 23 young gymnasts, guards cut how far the wrist bent back while raising another wrist load during back handsprings, and no trial has tested them on injuries. Our gymnast's wrist guide covers what to do when a wrist hurts.
Once a stress fracture is diagnosed, starting physiotherapy within a week did better than resting first in 64 young athletes: back to sport 38 days sooner, and back pain came back in 3% against 29%. In competitive gymnasts with low back pain, 8 to 12 weeks of core stability training reduced pain in small trials. No trial has tested back injury prevention in gymnasts.
The AAP says ACL prevention programmes that teach landing and stopping, with hamstring strengthening, should be part of every gymnast's training. They haven't been tested in gymnasts; our ACL injury guide gives the evidence from other sports, where such warm-ups cut ACL injuries in girls and women.
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The AAP advises trained coaches, spotting available at all times, well-kept mats and apparatus, learning skills in order, and no fooling around near foam pits or trampolines. On trampolines, most injuries happen with more than one person on the mat, and neck injuries with falls and somersaults, so our suggestion is one person at a time and somersaults only with coaching.
No screening test predicts gymnastics injuries. Hypermobility alone wasn't linked with injury in a small national team, and in rhythmic gymnasts both too little and too much flexibility went with problems. Stretching didn't prevent injuries in trials across sports.
A small randomised trial in the UK:
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In 54 female artistic gymnasts aged about 15, 8 weeks of jump training in cluster sets, with short rests inside each set, raised countermovement jump 2.9 cm more than no jump training; traditional sets added 1.6 cm.
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In 9 elite-oriented girls before puberty, training about 30 hours a week, adding heavy resistance and high-impact jump training improved drop-jump performance more than apparatus training alone, and the gains faded in competition periods.
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In rhythmic gymnasts, both too little and too much flexibility went with complaints. British Gymnastics advises maintaining rather than increasing flexibility during the growth spurt, and our splits guide explains how strength at the end of your range builds range you can use.
Conditioning is part of the coach's plan, usually in most sessions. Our suggestion: extra jump blocks of 6 to 8 weeks, twice a week, starting low and adding contacts week by week as the trial did, with technique checked first; heavy lifting for teenagers only with supervision, as the NHS advises; less jumping and handstand work during growth spurts and after time off; and the hardest conditioning away from competition days.
The evidence so far suggests training doesn't stunt growth, but it's limited. An expert committee for the International Gymnastics Federation reviewed the studies and concluded that adult height isn't compromised by intensive training, and that it doesn't appear to slow the growth spurt or puberty. In a cohort of 328 elite gymnasts, artistic gymnasts finished below the height predicted from their parents' heights, but within the margin of error. Gymnasts who stay in the sport are a highly selected group who tend to be smaller, which muddies the question.
In 67 elite rhythmic gymnasts, energy availability was low, first periods came late (at 15.3 on average) and cycles were irregular. In a Norwegian study, rhythmic gymnasts who hadn't started their periods had more substantial injuries, which may reflect age or not eating enough.
The NHS asks children and young people to be active for an average of at least 60 minutes a day, and gymnastics counts. It says young people can use weights if a qualified adult trains them to use weights correctly and supervises them.
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The mandatory points, in brief:
The Whyte Review, an independent investigation for Sport England and UK Sport, received over 400 submissions. Over a quarter described excessive weight management: weighing, often daily, that it called "coach-led and quite unnecessary", with gymnasts purging or dehydrating and some developing eating disorders. Over 40% described physical abuse, including training on injury and overstretching.
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When you eat too little for the training you do, your body saves energy by turning down other jobs. The International Olympic Committee (IOC) calls this REDs (relative energy deficiency in sport, also written RED-S): it can stop periods and harm bone, health and performance, in girls and boys and women and men.
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Athletes in aesthetic and lean sports such as gymnastics reported more drive for thinness than other athletes, and researchers suggest eating disorder risk may be unusually high in elite gymnastics, though it's hard to study. The NHS says criticism of your eating habits, body shape or weight, and pressure to be slim, make an eating disorder more likely.
If you have, or think you might have, an eating disorder, see a GP as soon as you can, or talk in confidence to the eating disorder charity Beat: 0808 801 0677 (England), 0808 801 0432 (Scotland), 0808 801 0433 (Wales) or 0808 801 0434 (Northern Ireland), 3pm to 8pm, Monday to Friday. Concerns about weighing, comments on weight or forced stretching can go to the club welfare officer or British Gymnastics' welfare team.
British Gymnastics' poster: gymnasts with a suspected concussion must immediately sit out of the gymnastics activity. Then follow the UK's grassroots guidelines: no training or competition for at least 24 hours, an assessment within 24 hours by a healthcare professional or NHS 111, a gradual return, and no competition before day 21. Our concussion guide covers the stages.
In 12 gymnasts wearing mouthguard sensors, some skills early in their progressions, such as Yurchenko and Tsukahara vault timers to the back and a handstand forward roll, were among those with the most head rotation. A return to gymnastics after a concussion should take that into account.
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After a fall onto the head or neck, with neck pain, numbness, tingling or weakness, don't move the gymnast: the UK guidelines say only healthcare professionals with the right training should move someone with a suspected neck injury. Call 999.
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The AAP strongly discourages home trampolines: most injuries happen when more than one person is on the mat, neck injuries come from falls off and from somersaults, and nets and padding haven't cut the risk much.
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Children injured at trampoline parks had more leg injuries and more often needed surgery than those hurt on home trampolines, but fewer concussions.
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Competitive trampolining with qualified coaches and step-by-step progressions is a different setting, and the AAP gives it separate recommendations (our reading).
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80% of 35 elite trampolinists leaked urine during training, and many former trampolinists still leaked years later. In rhythmic gymnasts, 32% leaked and most had never heard of the pelvic floor. Pelvic floor exercises added to a group warm-up didn't help, so see a pelvic health physiotherapist for individual training; our pelvic floor guide explains.
Built on the site's warm-up guide and British Gymnastics' growth spurt advice (editorial). No gymnastics warm-up has been tested on injuries, and the rhythmic gymnastics trial's longer warm-up didn't reduce overuse injuries.
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The movement on the figure: Quadruped wrist rocks
The conditioning workout's jumps from the youth vault trial, its landings, wrist, shoulder and trunk work, and the warm-up's wrist rocks. Each has a 3D demo.
3D demoTuck jumpIntermediate · No equipment
3D demoJump squatIntermediate · No equipment
3D demoHurdle hopsIntermediate · Other / check instructions
3D demoStanding broad jump with stuck landingIntermediate · No equipment
3D demoSnapdown to athletic landingBeginner · No equipment
3D demoBox drop landingIntermediate · A step
3D demoQuadruped wrist rocksBeginner · No equipment
3D demoWrist curlsBeginner · A dumbbell
3D demoScapular push-up (push-up plus)Beginner · No equipment
3D demoPike push-upIntermediate · No equipment
3D demoHandstand at the wall (Adho Mukha Vrksasana, chest to wall)Advanced · A wall
3D demoHollow body holdIntermediate · No equipment
3D demoLocust pose (Salabhasana)Beginner · No equipment
3D demoSide plankIntermediate · No equipmentThe first two are new: a conditioning workout built on the youth vault trial and a gymnastics warm-up. The others build handstands, wrists, shoulders, pulling strength and jumps, protect knees, train the splits safely, look after the pelvic floor, and take you through light exercise after a concussion. The animal moves suit young children.
A gymnastics conditioning session: jumps from the youth vault trial, landings, wrist and shoulder strength, wall handstands, and hollow and arch holds.
45 minIntermediate22 movesOther / check instructions, A stepA gymnastics warm-up: skips, wrist circles and rocks, shoulder work, cat-cow, hollow and arch holds, leg swings, short splits holds and landings.
15 minBeginner18 movesA band, A wallBuild toward a handstand: wrist prep, dolphin pose, pike push-ups, crow, the wall handstand and freestanding holds.
25 minAdvanced8 movesA wallWrist mobility and forearm strength for desk work, climbing, push-ups and handstands.
10 minBeginner7 movesA wall, A dumbbellA 25-minute band routine for healthy shoulders: move the shoulder and upper back through their range, then strengthen the rotator cuff and shoulder blades.
25 minBeginner12 movesA wall, A bandA full-body calisthenics workout with a ladder for every move: rows to pull-ups, push-ups, split squats to skater squats, dips, hamstring curls and knee raises.
45 minBeginner11 movesPull-up barWork up to your first pull-up: dead hangs, scapular pulls, rows, negatives and assisted pull-ups.
25 minBeginner7 movesPull-up bar, A stepAn advanced jump training session: pogo hops, box jumps, split squat jumps, broad jumps and depth jumps.
30 minAdvanced8 movesA bench or box, A stepA 20-minute warm-up that trains your knees to track over your toes: side-hip strength, squats and lunges with alignment practice, balance and quiet landings.
20 minBeginner10 movesA wall, A bandFront-split and middle-split days: hip flexor, hamstring and inner-thigh stretches, then strength in the stretched position. Alternate them 3 to 4 times a week.
25 minIntermediate16 movesA wall, An anchor pointA 5-minute daily pelvic floor workout for women and men: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentA 20-minute light session after a concussion: a symptom check, 10 to 15 minutes of easy cycling or walking, gentle bodyweight moves and a cool-down.
20 minBeginner8 movesCardio machine, A bench or boxFifteen minutes of animal moves, jumps and balance games for children, building the muscle- and bone-strengthening activity they need, with nothing to buy.
15 minBeginner16 movesA wallFor adult gymnasts, and for older teenagers with a coach supervising. Keep the hardest sessions away from competition days.
A 12-week calisthenics plan for beginners: three bodyweight sessions a week with push-up, pull-up, squat and dip ladders, and a bar if you have one.
3 training days40 minBeginner3 days a weekA 12-week beginner barbell program: squat every session, alternate bench and row with press and deadlift, and add weight each time until it stalls.
3 training days50 minBeginner2 days a weekTwo full-body strength sessions a week: the minimum that meets health guidelines, with every set, rep and rest, and an 8-week progression.
2 training days45 minBeginnerInjury risk peaks around the growth spurt. Modify training, go back to basics, keep flexibility rather than push it, and tell the coach about joint pain, back pain or tight muscles, as British Gymnastics advises.
See a doctor, as the AAP advises, and don't take painkillers to train through it. Stress injuries at the wrist's growth plate need early diagnosis: our gymnast's wrist guide explains.
See a GP or sports physiotherapist: it can be a stress fracture, and starting physiotherapy early helps once it's diagnosed.
Build strength and control before chasing more flexibility, and see a physiotherapist. Our hypermobility guide explains the advice for unstable joints.
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A seizure during gymnastics could injure you. Talk to your doctor or epilepsy nurse, and tell the coach what to do, as our epilepsy guide explains.
The NHS advises against sports with a risk of falling or bumping your tummy, and our pregnancy guide lists gymnastics among them. Talk to your midwife, and don't learn new upside-down skills.
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The NHS advises speaking to your GP first if you haven't exercised for some time or have a medical condition, and the PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) lists the questions to check. Adult beginners' classes with qualified coaches are a good start.
It's common and treatable: see a pelvic health physiotherapist, and our pelvic floor guide.
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Talk to the club welfare officer, or contact British Gymnastics' welfare team.
After a fall onto the head or neck, with neck pain, numbness, tingling or weakness, don't move the gymnast and call 999. Only healthcare professionals with the right training should move them.
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The NHS says to call 999 if someone has hit their head and:
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Stop at once: if in doubt, sit them out. No training or competition for at least 24 hours, an assessment within 24 hours by a healthcare professional or NHS 111, and no competition before day 21. Contact NHS 111 straight away if they're being sick or feel dizzy.
Go to A&E (accident and emergency) or call 999 if an injured wrist or arm is numb, tingling or has pins and needles, a bone is sticking out, or it has changed colour or shape or is at an odd angle. Get help from NHS 111 if it's very painful, you can't use it, or the swelling or bruising is large or getting worse. A wrist that's swollen or painful the next day needs a doctor, and our gymnast's wrist guide covers wrist pain that builds with training.
Get advice from NHS 111 now if your knee is very painful, you can't move it or put any weight on it, it's badly swollen or has changed shape, or it locks, gives way or clicks painfully. Our ACL injury guide says what to do next.
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Back pain for more than 2 weeks, or worse when arching back, needs a doctor. Call 999 or go to A&E if back pain comes with pain, tingling, weakness or numbness in both legs, a loss of feeling around your genitals or bottom, or changes in your bladder or bowels.
Pain in one spot of a bone that builds with training, then aches at rest or at night, can be a stress fracture: stop that training and get it checked. Our stress fracture guide explains.
See a GP if periods stop or haven't started by 15, or if you're worried about your eating; you can also call Beat on 0808 801 0677.
Call 999 if someone faints while exercising, can't be woken within a minute, or has chest pain or a pounding, fluttering or irregular heartbeat. Call 999 for sudden chest pain that doesn't go away, pain that spreads to your arms, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or breathlessness.
The evidence so far suggests it doesn't: an expert review concluded adult height isn't compromised by training. But the evidence is limited, and gymnasts are partly smaller because smaller children are picked and stay in the sport.
It's common, but in young gymnasts it goes with stress injury at the wrist's growth plate. A wrist that's swollen or painful the next day needs a doctor. Our gymnast's wrist guide explains.
About a third of girls in gymnastics with back pain at one US clinic had a stress fracture. Pain for over 2 weeks, or worse when arching back, needs checking.
British Gymnastics bans coaches from weighing gymnasts and calls excessive weighing poor practice on the fringe of abuse, and the Whyte Review found weighing that was coach-led and unnecessary, linked with some gymnasts developing eating disorders.
The Whyte Review heard of coaches using their body weight to force gymnasts into splits, sometimes to the point of tears and injury, although British Gymnastics' own policies had said since at least 2012 that coaches shouldn't put their full body weight on a gymnast or cause excessive pain when stretching. Our splits guide explains why harder stretching adds no range.
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In a lab study they cut how far the wrist bent back but raised another wrist load, and no trial has tested them on injuries. The AAP lists braces among ways to lower risk, so the evidence is mixed.
The AAP says nets and padding haven't cut the risk much, and most injuries happen with more than one person on the mat.
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It's common, in 80% of elite trampolinists in one study, but it's treatable with individual pelvic floor training. A group warm-up version didn't help rhythmic gymnasts.
Ankle sprains and other leg injuries in women, arm and shoulder injuries in men, and in young gymnasts wrist pain and stress fractures in the back. The floor exercise causes the most injuries, and concussion was the commonest specific injury in US college gymnastics.
The wrists take several times body weight in handstands, vaults and tumbling, and in growing gymnasts that can stress the growth plate at the end of the forearm bone. See a doctor if a wrist is swollen or still painful the next day.
The evidence so far suggests it doesn't, but it's limited. An expert review for the international federation concluded that training doesn't compromise adult height, and in one cohort artistic gymnasts finished a little below their predicted height but within the margin of error. Gymnasts are often smaller partly because smaller children are picked and stay in the sport, which makes it hard to be sure.
Back pain is common, and stress fractures in the spine are more common in gymnasts than in most sports. Pain that lasts more than 2 weeks, or is worse when arching back, should be checked, and starting physiotherapy early helps young athletes get back sooner.
Coaches must not weigh gymnasts, and it's always the gymnast's choice. Only qualified sport science or medicine practitioners may weigh gymnasts over 10, with consent each time, to track growth or for performance reasons, and the result is shared only with the gymnast.
Stop at once and don't go back that day: if in doubt, sit them out. Get assessed within 24 hours, then follow a gradual return with no competition before day 21. Call 999 for red flags such as repeated vomiting, a fit or getting drowsier.
Jumps and landings, wrist and shoulder strength for handstands and bars, hollow and arch holds for the trunk, and leg strength. Six weeks of extra jump training improved vault take-off in youth gymnasts in a small trial.
Many hypermobile children enjoy it. If joints hurt, sprain or slip, build strength and control before chasing more flexibility, and see our hypermobility guide for the advice on unstable joints.
The American Academy of Pediatrics strongly discourages home trampolines: most injuries happen with more than one person jumping, and neck injuries with falls and somersaults. If you use one, our suggestion is one person on it at a time and no somersaults without coaching.
Hard landings load the pelvic floor: 80% of elite trampolinists in one study leaked during training. It's common but treatable with individual pelvic floor training, so see a pelvic health physiotherapist and our pelvic floor guide.
Exercise education for people who play sport, not a personal prescription or a diagnosis, and clinical review of these pages is pending. Check with a GP or physiotherapist before hard training if you have a heart condition, chest pain, dizziness or an injury that isn't settling, and stop for sharp or increasing pain. Health disclaimer.
