Study protocol for a prospective cohort study describing the injury characteristics in elite gymnasts in TeamGym: the Swedish TeamGym Injury Cohort - STIC.

INTRODUCTION: Gymnastics consists of several different disciplines, whereof TeamGym is one. TeamGym is a young discipline with sparse research. The aim of the study is to investigate the injury characteristics in Swedish elite gymnasts competing in TeamGym including training load and other physical and psychological factors associated with injury. METHODS AND ANALYSIS: The Swedish TeamGym Injury Cohort is a longitudinal prospective cohort study for 52 weeks that includes the junior (15-17 years) and senior (≥18 years) Swedish female and male national teams in TeamGym. A baseline questionnaire will be sent out in an online application (SmartaBase) regarding demographics, previous injuries, gymnastics-related factors, for example, time at elite level and psychosocial factors such as stress, athletic identity, coping skills, personality traits and coach-athlete relation. A weekly questionnaire will be sent out in SmartaBase every Sunday and will monitor injuries using the Oslo Sports Trauma Research Centre Overuse Questionnaire, gymnastics-related factors, for example, landing surfaces, stress, recovery and training load. A test battery for the lower extremity will be performed. Data for ankle dorsiflexion, hop tests and ankle plantarflexion strength/endurance will be collected. ETHICS AND DISSEMINATION: This project was approved by the Swedish Ethical Review Authority (2023-06653-01) and is performed according to the Declaration of Helsinki. The results will be published in peer-reviewed journals, scientific conferences and shared with the Swedish Gymnastics Federation.

Incidence of acute injuries in Swedish gymnastics with a special focus on cruciate ligament injuries.

BACKGROUND: Gymnastics is a sport with unique technical and physical demands. Elements of high rotational landing impacts may lead to severe injuries. In order to understand the risks of the sport and design injury prevention programs the magnitude of acute injuries must be understood. The aim was to investigate acute injuries, medical invalidity and injury costs in gymnastics using national insurance data. METHODS: Insurance data covering acute injuries in Swedish gymnastics from October 2015 to October 2020 were analyzed. All Swedish gymnasts with either a training or competition license were included (N.=333,932 licenses, 249,823 females; 84,109 males). RESULTS: A total of 1733 acute injuries were reported, and the injury incidence was 5.2 per 1000 gymnast years, with no differences between upper and lower body. The arm followed by the foot and the knee were body locations with highest injury incidence. Skeletal injuries were most common in the arm and foot, and ligament injuries in the foot and knee. The proportion of cruciate ligament injuries was 37% of all knee injuries and 5% of all acute injuries. No significant difference between male and female gymnasts was observed. The highest proportion of medical invalidity was found in the knee (33%), the foot (22%), and the arm (20%). Sixteen percent of all cruciate ligament injuries led to medical invalidity and was the injury causing highest costs to the insurance company. CONCLUSIONS: The knee was the third most common injury location and the injury causing the highest medical invalidity.

Gymnasts' experiences and perception of a cruciate ligament injury.

BACKGROUND: Gymnastics is a high injury risk sport including difficult technique. A cruciate ligament injury is common, though there are no evidence-based guidelines for return to gymnastics. The gymnasts' experiences may add specificity to a guideline. Therefore, the aim of the present study was to describe the gymnasts' experiences and perception of a cruciate ligament injury. METHODS: An embedded mixed methods design. Semi-structured interviews in 14 gymnasts between March and August 2018. The gymnasts represented a variation in age, sex, discipline, level of gymnastics, re- ruptures, associated injuries and return to gymnastics. The Knee Injury and Osteoarthritis Outcome Score, compared with age matched cruciate ligament injured gymnasts in the Swedish National Knee Ligament Registry, and the Tegner's Activity Score were supplements to the interviews. The interviews covered injury occasion, rehabilitation, return to gymnastics and current experience of the knee joint and were analyzed using qualitative content analysis with an inductive approach. RESULTS: The Knee Injury and Osteoarthritis Outcome Score was consistent with the Swedish National Knee Ligament Registry and showed low levels in the subscales Quality of Life and sports/recreation. One third reported Tegner's Score <6 supporting low levels in Sports/Recreation. The text analysis resulted in two parts "This really happened, cold facts" and "Prerequisites and hindrances for return to gymnastics." The gymnasts' narratives were similar and reached saturation. CONCLUSIONS: A cruciate ligament injury is a large trauma, and the physical and psychological demands must be understood. The results of the present study may be included in a framework for return to gymnastics, where the individual prerequisites and goals should be determined. The timeline within this framework would depend on the extent of the injury, expected time for healing and physical as well as psychological demands with respect to gymnastics' level. It may also include suggestions for different psychological strategies and performance enhancement techniques to increase the gymnasts' self-efficacy and encourage and motivate the gymnasts through the long and demanding rehabilitation.

Sex and Age-Group Differences in Strength, Jump, Speed, Flexibility, and Endurance Performances of Swedish Elite Gymnasts Competing in TeamGym.

Purpose: To analyze sex and age group differences in strength, jump, speed, flexibility, and endurance performances of TeamGym athletes. Methods: A total of 91 Swedish elite gymnasts (junior female, n = 26, age = 15.4 y; senior female, n = 23, age = 20.0 y; junior male, n = 19, age = 15.6 y; senior male, n = 23, age = 20.6 y) participated in three testing sessions on three separate days. These were: (1) a series of flexibility tests for the lower- and upper-body; (2) strength tests for the lower- and upper-body; and (3) various types of jumps, a 20-m sprint-run, and a 3,000-m run test. Results: Males were 24% stronger in the back squat one-repetition maximum (relative to body mass) compared to females (P < 0.001, H g = 1.35). In the pull-ups and dips, 2.4 and 2.3 times more repetitions were completed by the males compared to the females (both P < 0.001, 0.70 ≤ R ≤ 0.77). However, females were similarly strong as males in the hanging sit-ups test (P = 0.724). The males jumped 29, 34, 33, and 17% higher in the squat jump (SJ), countermovement jump (CMJ), countermovement jump with arm swing (CMJa), and drop jump (DJ), respectively, compared to the females (all P ≤ 0.002, 0.14 ≤ η p 2   ≤ 0.60). In the 20-m sprint run, males were 4% faster than females (P < 0.001, R = 0.40). Moreover, the females had significantly better flexibility than the males in the trunk forward bending, front split, and side split tests (all P < 0.001, 0.24 ≤ η p 2 ≤ 0.54). In the 3,000-m run test, males were 11% faster than females (P < 0.001, η p 2 ≤ 0.54). Compared to junior athletes, seniors performed better in the pull-ups, dips, SJ, CMJ, CMJa, and 20-m sprint-run tests (all P ≤ 0.012, 0.31 ≤ R ≤ 0.56, 0.16 ≤ η p 2 ≤ 0.25), with separate within-sex age-group differences (i.e., juniors vs. seniors) that were significant for the males but not for the females in the SJ, CMJ, CMJa, and 20-m sprint-run tests (males: all P < 0.001, 0.67 ≤ R ≤ 0.69, 1.37 ≤ H g ≤ 2.01; females: all P = 0.298-732). Conclusions: Large sex and age-group differences were observed for most physical performance metrics with specific within-sex age-group differences only observed for male athletes, with male seniors performing better than juniors in the SJ, CMJ, CMJa, and 20-m sprint-run tests.