Project Summary/Abstract
Gymnastics is a leading cause of head injury among sports- and recreation-related activities and is the second
most common cause of emergency room visits for non-fatal traumatic brain injury among non-contact sports. As
a sport, gymnastics is composed of six disciplines that utilize various skills to showcase balance, power, and
artistry. The physical demands of the sport often lead to a variety of injuries, including concussion. Concussions
in gymnastics commonly occur from falls and missed landings, but gymnasts are also exposed to direct (contact)
and inertial (non-contact) accelerations of the head while performing complex skills that are generally not
associated with concussion but may affect recovery following concussion. Additionally, athletes may experience
impairments to memory, concentration, and vestibular/ocular-motor symptoms following concussion, but effects
from repetitive rotational head movements, such as those experienced by gymnasts, are not well-understood.
With ~ 5 million Americans participating in gymnastics-related activities, there is a critical need to understand the
head accelerations experienced by gymnasts and their relationship to concussion-related clinical outcomes to
inform safety recommendations, including post-concussion return to play protocols, in the sport. The objective
of this study is to characterize kinematics (i.e., accelerations, velocity) of the head across skills performed in
artistic gymnastics and their relationship to concussion-related clinical outcomes and evaluate the effect of safety
modifications on reducing kinematic loads experienced by gymnasts. In Aim 1, 16 beginner-level (8 male, 8
female) and 16 advanced-level (8 male, 8 female) artistic gymnasts (ages 11-15) will be fitted with mouthpiece-
based head motion sensors. Biomechanical data will be collected and quantified during all practices to determine
the frequency, magnitude, and duration of head accelerations experienced during normal participation of the
sport. In Aim 2, we will engage stakeholders in the gymnastics and sports medicine communities to identify and
evaluate skill-specific safety modifications to reduce head kinematics in gymnastics. Enrolled gymnasts will
complete a series of skills with two progressive safety modifications; the effect of safety modifications on reducing
head accelerations will be evaluated. In Aim 3, the relationship between exposure to head accelerations during
normal participation of gymnastics and concussion-related clinical outcomes will be evaluated. Changes in pre-
to post-study cognition and postural control and acute changes in concussion-related symptoms will be
monitored using validated clinical assessment tools and evaluated with respect to head acceleration measuring
during the study. This R21 exploratory/developmental research study seeks to ultimately change the paradigm
of concussion safety in gymnastics and will result in key data to support a large-scale study to develop and
evaluate a biomechanically-informed return to play protocol for gymnastics. This approach will provide a
framework that may be expanded to other disciplines of gymnastics and acrobatic sports to improve the safety
of over 5 million athletes participating in acrobatic activities.
