Flipping Knee Pain

Knee pain is a common complaint in high level gymnastics. This sport demands high intensity with both training and competition. Most athletes cannot make it through a full career without any issues.  Fortunately, the science and knowledge regarding these injuries continues to improve. From my viewpoint as a physical therapist, gymnastics coach and retired competitive gymnast I see an opportunity to address the rate of injury and have a role in prevention.

The most common knee pain in gymnasts is typically due to “over use”. Osgood Schlatter’s, jumper’s knee, patellar apophysitis and patellofemoral pain syndrome are words you will often hear when diagnosing these athletes with knee pain. Gymnasts often train 20 hours or more each week, with running, jumping, forceful landing and intense conditioning included in their daily work outs. With this level of training and competing, how can injuries be prevented?

In order to decrease rates of OVERUSE injuries, gymnasts HAVE to be given time to REST. Gymnastics is a year-round sport where the attitude is one that has been built on a long history of intense training without breaks in order to prevent a decrease in skills or strength. Most of this attitude is just that, historical. Strength and neuromuscular activation does not diminish with short bouts of decreased activity, and in fact, rest allows muscles to recover and perform more efficiently.  Many studies support this fact. For those still in doubt and fearful of performance decline, there are ways to create this “rest” without taking a complete day or more off from training. This can be done with a regular change in routine so that gymnasts are not repetitively stressing the same joints and muscles in the same way every day. Alternating work done on harder surfaces in exchange for drills onto mats, or decreasing the overall number of repetitions of a hard vault running and landing surface each day can decrease overall load on a gymnast’s body and decrease their risk of injury. To take a page from endurance sports using a periodization schedule which builds active rest weeks into a training year can be a very effective way to maximize performance gains while allowing complete recovery from training.

There are many times when pain is occurring due to abnormal mechanics in the knee or lower extremity. These mechanical issues can come from several different factors including motion limitations in the ankle or hips, an abnormal pattern of muscle activation, or limb structure. An example of a muscular issue involves the quadriceps. Gymnasts tend to be extremely strong in the quadriceps muscles due to training and the nature of many skills. However, putting more emphasis on glute strengthening during drills and conditioning will take stress off of the knee by decreasing load from the quads.

Skilled physical therapists are experts in finding mechanical faults and correcting them, resulting in decreased pain and injuries rates while maintaining performance. There are times when injuries occur and prevention isn’t always possible. These are times when it is crucial to seek out professional care to restore strength and function while returning to sport activity. My background in gymnastics gives me the upper hand when treating these young athletes. I hope to continue to work with coaches and gymnasts as I see the health of the athletes a number one priority in sports.

Krystal Reyes PT, DPT