Screening & Assessment of Gymnasts

Regular screening is important to appropriately plan physical preparation and to monitor efficacy of training programs.  Tests, where possible, should be repeatable, reliable, valid, sensitive and specific.  Additionally, they should be well controlled, recorded, quick and easy to perform1.

 

Gymnasts require strength and power to control the high forces they produce in addition to balance, co-ordinated movement, stability and extreme mobility2, if any of these components are inadequate, injury may occur, and performance may suffer.

Movement

The Functional Movement Screen (FMS) is comprised of seven individual tests designed to identify sub-optimal movement patterns and asymmetries3.  The FMS is well researched4-14, reliable5,6, reasonably specific, and may predict injury risk10,12, however, it demonstrates poor validity and sensitivity1 with no clear evidence that scoring well improves performance1.  Despite these limitations it seems sensible to use at least some of the FMS with gymnasts in conjunction with other tests.

 

The overhead squat is useful because it assesses bilateral and symmetrical mobility of the shoulders, thoracic spine, hips and ankles4 during a multi joint movement.  The shoulders and torso stabilise the dowel whilst the legs move4, similar to many gymnastic movements.  Furthermore, whilst a higher velocity assessment of landing is necessary15, correct squatting pattern at low velocity seems a logical starting point for assessing landings.   Sub-optimal squatting technique such as knee valgus should be identified and addressed to minimise injury risk16.

 

The in-line lunge assesses stability and mobility in a triple flexed position whilst examining knee stability4, in a movement particularly useful for beam17.  A lateral lunge can also be assessed to examine frontal plane stability.

 

The hurdle step examines reciprocal motion of the legs, assessing single leg stability whilst one leg is flexed and the other extended4.  This pelvis dissociation is required in many gymnastic elements so asymmetries or abnormalities can be easily assessed in this low velocity test.

 

The stability push-up evaluates neuromuscular control and co-ordination required for trunk stability during arm movement4, important for appropriate transfer of forces through the body.   Due to the high incidence of back pain in female gymnasts18 a lumbar extension pain clearing test should also be performed.  In hypermobile athletes, it may be useful to evaluate trunk stability or endurance in conjunction with shoulder mobility as increased shoulder mobility with poor trunk stability indicates inadequate neuromuscular control required to stabilise the glenohumeral joint, possibly predisposing to injury 19.

 

Although often overlooked, rotational stability is required in gymnastics and can be easily assessed as part of the FMS, evaluating the ability of the trunk to stabilise in multiple planes4

Mobility

Gymnasts have extreme joint range of motion (ROM) requirements, requiring excellent hip, shoulder, ankle, wrist and spine ROM2.  It is suggested that inadequate mobility may inhibit technique, causing compensation with excessive or undesirable movement elsewhere leading to pain or injury20,21.  Conversely, hypermobility, appears to be common in female gymnasts22, whilst good mobility is advantageous, poorly controlled excessive mobility can lead to injury23-25 so should be identified and addressed.

SHOULDER

High forces go through the gymnasts shoulders at extreme ranges of motion, thus excellent shoulder mobility, strength and stability is required.  Poor shoulder kinematics should be identified by screening due to potential associations between poor shoulder movement and injury, as well as undesirable compensatory movements26-28, however no literature has examined this in gymnasts.  The scapulothoracic (ST) and glenohumeral (GH) joints are primarily responsible for shoulder flexion and overhead weightbearing29.  Effective handstand movements require 180° shoulder flexion, with the majority provided by the GH joint with some from ST joint upward rotation and posterior tilt of the scapula29.   If ST rotation is decreased, then compensatory GH joint activity occurs which may be associated with shoulder injury26,28, however it is theorised that excessive ST upwards rotation may also cause shoulder pain29, thus both little and too much ST ROM is undesireable.  Thoracic spine extension also contributes to efficient shoulder function including posterior tilt of the scapular so should be examined as well29.

 

A combination of several tests are utilised to assess shoulder mobility in a combination of gymnastic relevant planes of motion including flexion, abduction/internal rotation & adduction & external rotation4 and thoracic mobility.  

 

Functional Movement Screen (FMS) shoulder mobility.  This evaluates bilateral shoulder range of motion (ROM) combining internal rotation with adduction on one side and external rotation with abduction on the other4.  It is easy and quick to perform and provides gymnastic relevant information Both sides are assessed in each position, and a ‘shoulder clearing test’ performed which if pain is detected requires investigation by a heath care professional is advised4.

Seated overhead shoulder mobilty.  Despite a lack of research, evaluation of seated overhead mobility is described and utilised by gymnastics healthcare practitioners30, examining shoulder flexion and overhead shoulder mobility with the shoulders in a variety of positions used in gymnastics.

ANKLE

Restricted ankle dorsiflexion ROM alters gait31 and landing mechanics, potentially predisposing to lower limb injury32-36.   The weight-bearing lunge test provides a valid assessment for ankle dorsiflexion ROM37 with good reliability38.   This is easy and quick to measure with minimal equipment required, however various shin angles and distances from the wall have been suggested as indicative of restricted ROM with no clear consensus on what defines restriction.39

WRIST

The wrist is crucial for maintaining the bodies centre of mass (COM) above the base of support during handstands40-41.  Thus, it has been theorised that inadequate wrist extension ROM means gymnasts cannot maintain their COM over their base of support during a handstand without compensation from the shoulders, lumbar or thoracic spine42 causing suboptimal technical ability and potential back or shoulder pain.  Therefore, despite no research, assessing weight bearing wrist extension may be useful.  The degree of wrist extension can be measured in addition to observing for pain43.

HIP

The FMS overhead squat assess hip, ankle, shoulder & thoracic spine mobility33.   Splits on the line is commonly utilised concurrently as it examines hip ROM and asymmetry in a gymnast specific position.  As there are multiple muscles involved in the ability to perform the splits, including hip flexor, hip adductors, hamstring, calf and gluteals, requiring appropriate neuromuscular co-ordination and flexibilty as well as joint anatomy variability other tests may be required to identify which of these is the limiting factor45.

STRENGTH & POWER

Assessment of strength, muscular endurance and power is useful to identify deficiencies and asymmetries which may limit the ability to control and produce force.

LANDING MECHANICS

During tumbling gymnasts produce high forces in extremely short times, with ground contacts times of < 150ms46. The ability to control these forces and land appropriately is critical, both for execution scores47 and to minimise risk of injuries48-50.  Knee and ankle injuries during landing are common51-53 with many linked to poor landing mechanics, especially in females, therefore sub-optimal landing patterns should be identified.   Knee valgus and inadequate knee and hip flexion have been associated with increased injury risk51,52, consequently, assessment of frontal plane and sagittal plane movement during a jump landing is required. This is valid and effective at identifying sub-optimal landing mechanics with good reliablity51-55..  Four high risk sub-optimal landing strategies may be seen; excessive knee ligament loading, resulting in knee valgus, femur adduction & internal rotation, excessive quadriceps activation compared to hamstring, inadequate trunk control and large leg to leg asymmetries56,57.  Unilateral hop landings can also be assessed, identifying any ipsilateral trunk lean, contralateral pelvic drop, or hip adduction or internal rotation55.

LOWER LEG STRENGTH & POWER

Single leg-hop tests reliably indicate unilateral strength & power58, demonstrating the ability to rapidly decelerate and control force59, with poor scores a risk factor for hamstring injury59.  A variety of hop tests have been described in the literature, mainly for injury rehabilitation, including single hop, triple hop, lateral hops and square hops63-67.    Although not definitive, large asymmetries, often defined as >10-15% may be implicated in injury68.

TRUNK MUSCLE FUNCTION

Trunk muscle stability is important for force transfer69 and correct skill execution70. Furthermore, appropriate trunk muscle function may be important for injury prevention71,72.   Core stability requires coordination, muscle strength and endurance73 in task dependent patterns of muscle recruitment74.  Trunk endurance has been linked to lower back pain39, a common occurrence in gymnasts39.  Fatigue has been shown to adversely affect trunk stability in youth female gymnasts65 and although no evidence examining performance, inference suggests this may affect execution scores in aesthetic sports. Assessment of trunk musculature should likely include the trunk flexors, trunk extensors and lateral flexors due to their combined contributions to trunk ‘stiffness’ and evidence linking back extensor endurance with lower back pain18.   Most trunk muscle endurance tests use 3-4 isometric tests, all for maximal time18.  Some ‘normal’ endurance times for isometric trunk exercises have been suggested in men and women, as well as ratios between anterior and posterior trunk musculature75,76, however results in youth populations and gymnasts are lacking and gender differences exist77.  Moreover, these tests are isometric and may not represent the dynamic strength and stability gymnasts require.  Additionally, trunk musculature strength also contributes alongside endurance which is far more difficult to assess.  Considering these limitations, endurance results should be interpreted along with the trunk stability results from the movement screen however they may not represent functional trunk stability.

HAMSTRING STRENGTH

Insufficient eccentric hamstring strength has been implicated in hamstring injury along with poor hamstring compared to quadriceps strength and left to right asymmetries78-82.  Non-contact hamstring injuries usually occurring during high speed running or during extreme end range of motion79 both of which occur in gymnastics.  Additionally, adequate hamstring strength is important for deceleration during landing59.  Single leg hamstring bridges have been suggested as a simple and easy unilateral assessment the endurance of the hamstring musculature83 potentially useful as fatigue and asymmetry may be linked to injury82, however research into reliability, validity and normal values is lacking.  Nordic hamstring lowers demonstrate promise in assessing bilateral eccentric hamstring strength84.

CALF COMPLEX STRENGTH

During tumbling, gymnasts land and immediately take off again repeatedly, with forces of up to 15 x bodyweight going through the Achilles tendon2.  Additionally, performance in calf raise tests has been correlated with sprint speed85 thus potentially vault performance86-88 and inadequate calf endurance has been linked to medial tibial stress syndrome89 as such, unilateral calf raises have been widely used to assess calf muscle and Achilles tendon endurance90 and 1RM calf raise to assess strength91.  Asymmetries should be recorded, however there is very limited literature about assessment protocol and no normative data in gymnasts90.

Neuromuscular control/balance

The Y-balance test reliably evaluates dynamic stability and balance in different directions92,93 and is a good indicator of hip abduction strength94.  Furthermore, when evaluating assymmetries it identifies risk of lower limb injury95-96, thus this may be useful despite no research in gymnasts.

CONCLUSION

This gives an overview of potential gymnastic specific tests utilised by strength and conditioning coaches.  It is important that the tests are well controlled, repeatable, valid and reliable and the results are interpreted by a suitably qualified coach as a whole, considering the individual athlete, rather than using one test in isolation.  Whilst these tests have been selected based on available research, experience and an understanding of gymnastic movements, caution should be exercised when extrapolating data from non-gymnastic populations and many tests still have questions over validity55 with little or no data in gymnasts, upper body strecngth and power tests may also need to be examined.

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Gymnastics competition photos by Bills Photos © reproduced with kind permission