Gymnastics as a sport has seen an exponential rise in the number of national participants over the past three decades. Increased involvement in the United States is demonstrated in the success that the United States recently experienced in the summer Olympics. Participation in gymnastics is represented by a triangle with the Olympic and international gymnast at the apex, attaining a degree of skill pursued by tens or hundreds of thousands of athletes for every gymnast at the highest level. This achievement results from dedication to and an intense curriculum that is accompanied by practice and competition involvement for as many as 30 to 50 hours per week. Although the elite gymnast may be involved at this level of training, the most common gymnast is the younger child in a class such as tumbling or a similar activity, with an attendant lower level of potential for injury. Within these extremes, more than 4 million athletes take part in events that range in difficulty from the most benign to those with a slim margin for error. The cumulative effect of participation for each of these athletes and their specific characteristics result in an injury prevalence as high as other sports.

The injury profile for each of these groups is distinct and dependent on the amount of time spent involved in the sport. For the elite gymnast, the time is extensive, with entry into organized training occurring as early as 4 or 5 years of age with peak involvement in the early to mid teens and retirement from competition in the sport at age 20 years or soon thereafter. During this 10- to 15-year-long career, the athlete generally reaches a practice and competition apex of 50 hours per week. The injury characteristics of this person include acute injuries such as fractures and ligamentous tears, which should be qualified as accidents, and chronic injuries, such as distal radius physis “stress fractures” and dorsal impingement, which, owing to their frequency and mechanism, are more appropriately termed consequences of this level of participation. Unlike the elite gymnast with chronic injuries, the tumbler has an injury profile akin to any age-comparative group, with distal radial, supracondylar humerus, and forearm fractures representing most of the acute injuries. Chronic injuries, by definition, are not seen in this group.

The management of each of these types of athletes is different: that of the casual participant may be similar to that of the nonathlete without the short- and long-term consequences that management will have on the return to competition. Formal gymnasts, however, owing to the narrow window of opportunity for progression to the elite level, require the method of management that will return them to competition as quickly as possible with the lowest probability of injury, even though that management may not be conventional. It is this deviation from expectation and treatment that poses the greatest challenge for the physician, that is, how to return gymnasts to train and compete even though they are still injured and will in many instances continue to be symptomatic throughout their career.