Returning to Gymnastics After a Neck Injury

Gymnastics is a high-intensity sport. Several types of gymnastics events fall under the gymnastics umbrella: Women’s artistic, men’s artistic, rhythmic gymnastics, power tumbling, and trampoline. As with any high-intensity sport, the body is subjected to high demands during repetitive practice of skills and during competitions. Injuries can occur during practice or during competitions. Neck injuries can be mild or severe, accounting for 4-8% of all gymnastics injuries.

In any type of gymnastics, a neck injury requires proper treatment, and a return-to-sport protocol following injury should be implemented with care and adherence to safety precautions for the athlete’s well-being.

Causes of Neck Injuries in Gymnastics:

• Falls
• Improper landings
• High-impact movements such as twisting or flipping
• Overuse
• Repetitive stress
• Improper technique
• Lack of a proper spotter

Types of Neck Injuries in Gymnastics:

• Sprains: Injury to the ligaments of the neck, which could be due to a fall or insufficient rotation of a flip
• Strains: Injury to the muscles of the neck
• Disc injury: A disc injury can cause compression of a nerve in the neck
• “Stingers”: Injury to a nerve in the neck or shoulder, which can cause temporary weakness or numbness in one arm
• Cervical fracture: High-energy traumatic injury
• Spinal cord injury: Can be associated with cervical fractures

Physical Therapy Recommendations After Neck Injury

Phase 1: Acute

Initially, after injury, rest is the most common recommendation. During this stage of recovery, we focus on pain management and avoiding aggravating movements.

Phase 2: Sub-acute

Once the pain has been alleviated, gentle range-of-motion exercises and restoration of cervical mobility can begin. During this phase, the athlete is typically encouraged to start scapular strengthening exercises. Activation and strengthening of the muscles in the upper back and between the shoulder blades is important for cervical stability and should not aggravate the neck injury. Cervical muscle strengthening is usually performed in an isometric manner- activating muscles without moving the head.

Phase 3: Neuromuscular Control

As the athlete recovers, more neuromuscular control is added to their rehabilitation program. Proprioception is the knowledge of where your body is in space; this is vital for gymnasts, especially during tumbling when twisting and flipping. Rehab exercises will focus on head positioning during more dynamic moving tasks during this time.

Phase 4: Sport-Specific Retraining

The last stage of rehab for athletes is sport specific. For gymnasts, this means a collaborative effort between coaches and athletes to return to the gym. Slow return to tumbling, trampoline drills, and working in the foam pit is common during this time. We want to assess the athletes’ tolerance of these sport-specific skills, and a gradual increase in training is recommended.

Note: It is important to recognize that there is no set timeline or standard interventions for these phases of rehabilitation; each athlete and each injury is unique, and the rehabilitation process will be tailored to each individual based on a thorough physical therapy evaluation. Ensure that a qualified physical therapist guides your rehabilitation process.

Prevention and Safety for Gymnasts:

• Proper landing technique
• Adequate warm-up and stretching
• Strengthening neck muscles and surrounding muscles
• Proper mats
• Proper spotters
• Awareness of risk factors

Neck injuries in gymnasts are less common than other musculoskeletal injuries, but can be serious due to the high-impact, high-velocity nature of the sport. These injuries typically result from a poor landing or overuse of muscles, especially during skills that involve hyperextension, inversion, or rotation of the cervical spine. Research shows the importance of early identification of injury and a structured rehabilitation program that prioritizes cervical stability, scapular control, proprioceptive training, and a gradual return-to-sport plan.

If you or your athlete is recovering from a neck injury, contact one of our specialists who can help create an actionable plan for the best road to recovery. Our licensed physical therapists are movement experts who will assess the current condition and customize a plan specific to your goals.

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Caine DJ, Nassar L. Gymnastics injuries. Med Sport Sci. 2005;48:18-58. doi: 10.1159/000084282. PMID: 16247252.
2. Hrysomallis C. Neck Muscular Strength, Training, Performance and Sport Injury Risk: A Review. Sports Med. 2016 Aug;46(8):1111-24. doi: 10.1007/s40279-016-0490-4. PMID: 26861960.
3. Streifer M, Brown AM, Porfido T, Anderson EZ, Buckman JF, Esopenko C. The Potential Role of the Cervical Spine in Sports-Related Concussion: Clinical Perspectives and Considerations for Risk Reduction. J Orthop Sports Phys Ther. 2019 Mar;49(3):202-208. doi: 10.2519/jospt.2019.8582. Epub 2019 Jan 15. PMID: 30645949; PMCID: PMC7102493.