Are there any long-term health issues that can stem from men's gymnastics?

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Lots of them Injuries Injury Rate in Gymnastics: Table 1 compares injury rate data from studies that have included training/competition exposure time as the denominator. Differences in injury rates between the studies are most likely indicative of how an injury was defined within each study. If an injury is broadly defined as "any gymnastics-related incident that resulted in a gymnast missing any portion of a workout or competitive event" (Cain, Cochrane, Caine and Zemper, 1989, p.813) then the reported injury rate will tend to be higher than a study that narrowly defines an injury as a problem that was attended to by a physician (Snook, 1979).

For example, the study by Sands et. Al. (1993) included very minor injuries, whilst Lindner and Caine (1990) carefully excluded injuries that gymnasts were able to 'work through' in training or competition.

The problem with excluding less severe injuries is that many of the common gradual onset/overuse type injuries will not be reported. In order to reliably compare studies (both within and across sports), injury definitions must be standardised, and they must be sensitive enough to register the very common 'non-specific' overuse type injuries that gymnasts suffer regularly (McAuley, Hudash and Shields, 1987). Reinjury: There is only one gymnastics epidemiological study describing the incidence rate of reinjury.

The NCAA (1994) reported 2.2 reinjuries per 1000 athletic exposures for women, and 0.5 reinjuries for men. Caine et. Al.

(1989) expressed reinjury as a percentage of total injuries and found that 33% of all injuries were attributable to earlier occurrences of the same injury. The authors suggested that this figure indicates that gymnasts often return to training and competition before they are fully rehabilitated. Practice vs. Competition: Data from studies investigating the proportion of injuries occurring in practice compared with competition have found that between 79% and 97% of injuries occur during practice (Pettrone and Ricciardelli, 1987; Kerr and Minden, 1988; Garrick and Requa, 1980; Lindner and Caine, 1990; Wadley and Albright, 1993; NCAA, 1994).

However, when time spent competing compared with practising was accounted for, (i.e. Exposure denominator data were included) it was found that the injury rate was three times greater in competition than in practice (NCAA, 1994). These data indicate that although most injuries occur during practice (due to spending more time practising than competing), the injury rate is greater in competition.

Injury Onset: The onset of sports injuries is typically categorised as being either gradual (overuse) or sudden (acute). Injury onset data from epidemiology studies, presented in Table 2, indicate that, with the exception of one study by Caine et. Al.

(1989), between 57% and 82% of injuries recorded in gymnastics were of a sudden nature. No explanation for this anomaly was cited by Caine et. Al.

, however, the authors were uniquely thorough in ensuring all injuries were recorded. That is, injury data were gleaned from several sources including training diaries, coaches reports, onsite inspection by the primary investigator, and interviews with the athletes. This is in direct contrast with Sands et.

Al. (1993) who left the reporting of injuries completely to the athletes. Consequently, it is likely that the percentage of gradual onset injuries is reduced by negligent recording of 'non-specific' overuse injuries (McAuley et.

Al. , 1987). In some cases, gymnasts perceive their overuse type injuries as being so common that they do not report them as injuries (Meeusen and Borms, 1992).

The reporting of injuries is also influenced by how an injury is defined, and because, generally, no distinction is made for an acute injury that is superimposed on a chronic injury mechanism (Caine et. Al. , 1996).

Type of Injury: A comparison of injury type from prospective studies of women's competitive gymnastics (see Table 3) indicates that sprains (19% - 47%) and strains (6.4% - 35%) are consistently the most common type of injury to female gymnasts. A study of male gymnasts has also reported that sprains and strains are most common (NCAA, 1994). The high proportion of these injuries is not surprising given the highly repetitive nature of impacts associated with landings from dismounts, and during floor routines (Caine, Lindner, Mandelbaum, and Sands, 1996).

The data in Table 3 are also influenced by injury definition and data collection methods. The high proportion of non-specific overuse type injuries in the study by Caine et. Al.

(1989) is indicative of their thorough injury recording methods, whilst the lower percentage of mild injuries reported by Wadley and Albright (1993) and Snook (1979) reflects that injuries for these studies were defined as problems presented to medical staff. Location of Injury: A comparison of injury location data from prospective studies of female competitive gymnasts (see Table 4) indicates that the lower extremity was injured most often (54.1% - 70.1%), followed by the upper extremity (15.1% - 25%), and the spine/trunk region (7.5% - 16.7%). Of the lower extremity injuries, ankle injuries were most common, followed by the knee and then foot/toes.

In the upper extremity, the wrist, elbow and hand/fingers were most often injured as a percentage of total injuries, and for the spine/trunk region, injuries to the lower back were most frequent. For male gymnasts, there is evidence to indicate that along with a higher proportion of lower extremity injuries (36.4% - 43.1%), there is a higher proportion of upper extremity injuries (36.4% - 53.8%) when compared with women (Bak et. Al.

, 1994; Weiker, 1995; Lueken, Stone and Wallach, 1993). In terms of specific body parts for the men, there were a large proportion of lower back, ankle, knee, wrist and, in particular, shoulder injuries. The high frequency of shoulder injuries in male gymnasts is most likely the result of extra physical demands placed on the shoulder area in events such as rings, pommel horse, and horizontal bar.

Head/Spine/Trunk: There is little doubt that, although not as common as lower extremity injuries, the severity of lower back problems in gymnastics is of considerable concern. Case-studies indicate that gymnastics lower back injuries tend to have a gradual onset (which may reduce the reported incidence of back problems), involving primarily advanced level gymnasts (Caine et. Al.

, 1996). This implicates experience and competitive level as risk factors for injury. Common sites of lower back injury include vertebral bodies and intervertebral discs.

Severe injuries include vertebral endplate abnormalities, and pars interarticularis damage with resultant spondylolysis (stress fracture) and spondylolisthesis (slipping of one vertebra onto another) (Caine et. Al. , 1996).

The movements most likely to result in lower back injury are chronic repetitive flexion, extension and rotation demanded of the spine and its associated structures during gymnastics (Hall, 1986). In addition, the extreme loading forces resulting from dismount and tumbling landings place the spine and lower extremities under enormous stress (Caine et. Al.

, 1996). This stress has been implicated in pars interarticularis spondylolysis and spondylolisthesis, and in the genesis of vertebral growth plate disorders which may disrupt growth and/or lead to chronic degenerative changes in the spine (Brukner and Khan, 1993). Lower extremity: In gymnastics, the lower extremity, like the spine, is involved in absorbing large repetitive forces over a long period of time.

The magnitude of these forces is approximately four times body weight (BW) for takeoffs (Takei, 1991), and 12 times BW for landings (Panzer, Wood, Bates and Mason, 1988). Data gleaned from prospective studies indicates that lower extremity injuries typically occur suddenly from a 'missed move' (Linder and Caine, 1990), and are most often ankle sprains, lower leg strains (Caine et. Al.

, 1989) and knee dislocations (Linder and Caine, 1990). Lower extremity injuries with a gradual onset typically include ankle impingements (from chronic pointing of the foot), lower leg stress fractures and compartment syndromes (from the repetitive stress associated with landing), and patellofemoral knee problems (from biomechanically dysfunctional tracking of the patella) (Meeusen and Borms, 1992). Upper extremity: Upper extremity forces have magnitudes of 1.5 times BW for vault, 3.9 times BW for horizontal bar, 9.2 times BW for rings, 2.0 times BW for pommel horse and 3.1 times BW for uneven bars (Caine et.

Al. , 1996). Case and cross-sectional studies indicate a large number of gradual onset injuries involving the distal radius, and distal humerus, and include distal radial growth plate disorders, and, primarily in females, osteochondritis dissecans of the humeral capitellum (loose bodies in the elbow) (Caine et.

Al. , 1996). Both of these problems are severe, and are the result of shear and compressive forces to stressed and immature joints (Singer and Roy, 1984).

Shoulder injuries are especially common amongst male gymnasts and are most frequently muscle strains (acute), or shoulder joint impingements (chronic) (Meeusen and Borms, 1992). Injury Severity/Time Loss: The quantity of time lost in training or competition as a result of injury is influenced by many factors including injury definition, personal motivation, peer pressure, coaching ethos, and the fact that for most injuries, gymnasts are able to keep training on a different apparatus. In research where injury and recovery time are clearly defined and recorded, some useful data are obtained.

Caine et. Al. (1989), reported that 41% of injuries required less than 8 days of recovery (defined as returning to previous training level), 33% required between 8 and 21 days, and 26% required more than 21 days recovery.

In contrast, Lindner and Caine (1990) reported that only 3% of injuries required less than 8 days recovery, 34% between 8 and 21 days, and 67% more than 21 days. This large difference is due to the fact that Caine et. Al.

Were careful to register all injuries including minor strains, whilst the injury definition used by Lindner and Caine was designed to exclude minor injuries. This highlights the need to standardise injury definitions in order to compare different studies within and between sports. Injury Severity/Catastrophic Injuries: Catastrophic injuries include fatalities and serious injuries such as quadriplegia.

In gymnastics, the very few reported case-studies of catastrophic injuries occurred on the trampoline, mini-tramp, and to a lesser extent, the springboard. Most of these injuries occurred whilst performing back or forward somersaults on the trampoline. The case-studies also reported that catastrophic injuries were most often sustained by highly experienced gymnasts (and/or trampolinists), which may indicate these gymnasts are more at risk of catastrophic injuries due to the complexity of the manoeuvres they are performing (Caine et.

Al. , 1996). Drop-Out and Long-Term Impact of Injuries: It has been reported that injury acts as a potential source of motivation for drop-out in gymnastics (Caine et.

Al. , 1996). Dixon and Fricker (1993) retrospectively examined injuries to 42 male and 74 female elite artistic gymnasts at the Australian Institute of Sport between 1982 and 1991.

They reported that 7% of the gymnasts retired from gymnastics due to injuries requiring surgical intervention, including meniscus lesions, a cruciate ligament rupture, and a stress fracture of the foot. In Caine et al's study (1989), 42% of the elite club gymnasts dropped out of gymnastics during the year long study. This difference reflects the fact that retrospective examinations of medical reports (as in the study by Dixon and Fricker) preclude the possibility that a gymnast leaves as a result of numerous chronic injuries.

An investigation into the long term effects of injury by Wadley and Albright (1993) reported that 45% of previously injured gymnasts still were bothered by the injury approximately three years later. Furthermore, 46% of the gymnasts reported that their injury was not fully recovered after three years, but that they were still "capable of strenuous physical activity" (Wadley and Albright, 1993 p.314). These studies tend to suggest that, although injuries to gymnasts may be chronically long term, they are not catastrophic in nature, and nor do they prevent retired gymnasts from leading a physically active existence.

Injury Risk Factors for Gymnastics: Epidemiological risk factors are categorised as being either extrinsic or intrinsic. There are no studies that indicate with any degree of certainty that a particular risk factor causes an injury. This is mostly because injuries very rarely occur as a result of one single risk factor (Caine et.

Al. , 1996). The results of studies attempting to investigate analytical epidemiology should be viewed with caution given the design limitations present in nearly all such studies.

In most cases, these studies are able to link a risk factor with injury - but this in no way suggests that the risk factor causes the injury. For example, Steele and White (1986) reported that taller gymnasts are more at risk of injury. This does not suggest that a particular gymnast's height caused an injury, but rather that height may be one of several contributing factors in the occurrence of an injury.

Intrinsic risk factors: Intrinsic risk factors are athlete based characteristics that predispose an individual to injury. These include physical characteristics, motor/functional characteristics, and psychological influences. Physical characteristics: Biomechanical efficiencies may be gained with particular physiques: decreased height and weight elicit a greater ratio of strength to weight, greater stability and a decreased moment of inertia.

Body fat adds to mass without adding to power producing capability therefore fat mass is detrimental to the gymnast. In addition there is an emphasis on leanness for aesthetics by coaches and judges. There may be an increased risk of injury during periods of rapid body growth (Caine, Cochrane, Caine, and Zemper, 1989) due to "increased moments of inertia, increased muscle-tendon tightness, and decreased epiphyseal strength" (Caine et.

Al. , 1996, p.233). Lindner and Caine (1990) reported that 'injury prone' gymnasts were characterised by rapid growth, with greater body size, age and body fat.

However, it was suggested by Caine et. Al. (1996) that greater body size and body fat tend to characterise older gymnasts who have also had more years of training and compete at higher levels.

In other words, the risk factors of age, body size, and body fat percentage confound with the competition level. Steele and White (1986) reported that weight, mesomorphy, standing lumbar curvature, age and height accounted for 70% of the observed variance in injury-proneness as evidenced by previous history of injury for elite British female gymnasts. Claessens et.

Al. (1996) investigated physique as a risk factor for ulnar variance in 156 skeletally immature elite female gymnasts. It was concluded that female gymnasts who were more mature and had a physique characterised as relatively tall with high lean body mass were at a greater risk for developing positive ulnar variance.

There was no relationship between ulnar variance and training characteristics. Further research is required to ascertain the relationship between gymnastics injury and height, body weight, body fat, and musculoskeletal biomechanical characteristics. Motor characteristics: Many physiological or motor characteristics, including flexibility, muscle weakness, balance, and endurance, have been indicated as potential risk factors in gymnastics and other sports.

However, for the most part their relationship to injury risk is unclear. Studies often gather data using retrospective or cross-sectional designs, but this leaves the relationship between injury and potential risk factors uncertain (e.g. Steele and White, 1986). In such studies, the 'chicken or egg' type question of whether the injury causes the risk factor, or the risk factor causes the injury, remains unanswered.

Perhaps the most publicly bandied about risk factor in modern sport is flexibility (either too much or too little! ). In gymnastics a large degree of flexibility is demanded of the gymnasts (for aesthetic and skill reasons), and yet it is unclear whether or not a high amount of flexibility (and associated destabilisation of the joint structures) does increase the risk of injury (Caine et.

Al. , 1996). The British "Training of young athletes" study indicated that strength and flexibility did not exert a significant role in determining injuries for elite gymnasts aged between 9 and 18 years (Maffullini et.

Al. , 1994), however, the incidence of injuries was not high. The number of push-ups performed in two minutes may be predictive of musculoskeletal injuries in army trainees (Jones et.

Al. , 1993) but it is not known whether this type of relationship is valid for gymnastics injury. Further studies on functional skills and the risk of injury are required in gymnastics.

Psychological characteristics: Researchers have recently begun to investigate the influence of psychological factors, including life stress, anxiety, and self-esteem, on the risk of injury to gymnasts (Kerr and Minden, 1988; Kolt and Kirkby, 1995). There appears to be some evidence that anxiety is related to the occurrence of injury (Kolt and Kirkby, 1994). However, studies published to this date have used retrospective designs which makes it impossible to determine whether or not the gymnasts were anxious because they were injured, or because the injury led to increased anxiety.

Extrinsic risk factors: Extrinsic risk factors are those that impact on an athlete externally, including exposure (time and event), training methods, environmental conditions (e.g. Time of season), and equipment. Exposure to activity: As gymnasts become more skilled, the amount of time spent training increases (exposure time), and consequently the number of injuries increases. Also, research generally supports an increase in injury rate as competition level increases (Caine, 1989; NCAA, 1994; Mackie and Taunton, 1994; Weiker, 1995).

This is possibly because, as gymnasts reach a higher level of competition, they perform more complex (and risky) manoeuvres. Caine et. Al.

(1989) reported that the most injury prone gymnasts (based on time loss due to injury) were elite level competitors. Research on the men's and women's gymnastics event most associated with injury indicates that the largest percentage of injuries occur on the floor (Garrick and Requa, 1980; Caine et. Al.

, 1989; Lindner K.J., Caine, 1990; Wadley and Albright, 1993; Sands et. Al. , 1993; NCAA, 1994; Bak et.

Al. , 1994). However, studies are required that include event specific exposure time as the injury rate denominator.

Therefore, it is uncertain as to whether the number of injuries on the floor is due to the nature of floor exercises themselves (e.g. Repetitive trauma from tumbling) or because more time is spent on the floor, or a combination of the two. Training conditions: Epidemiological research has indicated that a higher proportion (Linder and Caine, 1990; Weiker, 1985; Pettrone and Ricciardelli, 1987) and rate (NCAA, 1994) of injuries occur when gymnasts are not assisted by spotters. There is no doubting the importance of spotters in reducing the likelihood of injury, yet it is the nature of gymnastics that eventually a gymnast must perform a complex routine unassisted.

When investigating injury patterns during gymnastics training sessions, Lindner and Caine (1990) reported an increased risk of injury with length of time on a particular apparatus. This was attributed to poor concentration, and the authors recommended that training sessions should involve more rotations to decrease the likelihood of a gymnast becoming inattentive. Furthermore, their data indicated that more injuries occurred when gymnasts were performing well learned, basic or moderately difficult manoeuvres.

This indicates that, although there is evidence of an increased risk of injury with increased movement complexity (as reported by Caine et. Al. , 1989), many injuries occur performing less complex movements simply as a consequence of inattention on the part of the gymnasts.

There is epidemiological evidence that sudden onset injuries occur more frequently relatively early in training sessions (Caine et. Al. , 1989, Lidner and Caine, 1990).

This is possibly because of one or more of several reasons: a) insufficient warm-up; b) poor progressions into training routines; and c) more complex skills are practised early in a training session when gymnasts are most fresh. Seasonal variations (based on altered training regimes at specific times of the year) in the incidence of injury have also been investigated (Dixon and Fricker, 1993). These studies have reported increased injury rates: a) following periods of reduced training or immediately after a holiday (Caine et.

Al. , 1989, Sands et. Al.

, 1993) possibly due to the sudden increase in training intensity; b) immediately prior to competition (Sands et. Al. , 1993; Kerr and Minden, 1988) perhaps as a consequence of increased anxiety, and/or performing under-prepared routines; c) during competitive routine preparation (Caine et.

Al. , 1989, Sands et. Al.

, 1993), again, because routines are hurriedly prepared, or because of increased levels of fatigue; d) during competition (Caine et. Al. , 1989, Sands et.

Al. , 1993) where anxiety is at its highest and there is less protection (spotting and landing pads). Equipment: Improved gymnastics safety equipment, in the form of sprung floors, sprung beams, thicker landing mats and fibre glass rails has offset the expected decrease in injury incidence by enabling the performance of increasingly complicated and risky performance routines (Caine et.

Al. , 1996). The high rate of injury during competition has led to some suggestions of increasing the thickness of landing mats used in competitions.

Poorly attended safety equipment is implicated in the occurrence of some injuries such as the numerous reported cases of gymnasts spraining an ankle by landing between badly aligned mats. Further research is required on the effect of the intensity of activity, the types of equipment and the types of activity (e.g. Warm-up and stretching) on injury risk. Sources: http://www.coachesinfo.com/article/?id=67#2 .

The main health risk is faster development of the degenerative diseases usually seen in old age. The effect of injuries and reinjuries over time from gymnastics leads to increased osteoarthritis (OA, or “wear-and-tear" arthritis), and other joint problems and increased back and shoulder trouble. Thus, arthritis and separation in the shoulders, chronic back pain, and knee, ankle and wrist problems are what many male gymnasts face as they age.

While not usually a devastating problem, osteoarthritis and these other painful conditions can make life much less pleasant and can cause the former gymnast to limit certain activities and make other life style adjustments. This can at times lead to depression, as well as health effects from medications such as NSAIDs and steroids used to ease the pain of the condition-----------------------------------------------------BACKGROUNDThere are two forms of injury common in gymnastics: either gradual (overuse) or sudden (acute). The acute injuries are more likely to be reported, but the gradual injuries are just as important, if not more so, in terms of long-term health.

All gymnasts suffer more injuries in practice than in competition, and all gymnasts who suffer injury suffer more severe injuries in competition than in practice. Female gymnasts suffer more reinjuries (2.2 per 1000) than male gymnasts (0.5 per 1000). However, the type and location of injury varies by sex of gymnast in part because women and men do different routines on different equipment as described by the following from Wikipedia:"Artistic Gymnastics is usually divided into Men's and Women's Gymnastics, each group doing different events; Men compete on Floor Exercise, Pommel Horse, Still Rings, Vault, Parallel Bars, and High Bar, while women compete on Vault, Uneven Bars, Beam, and Floor Exercise.

In some countries, women at one time competed on the rings, high bar, and parallel bars (for example, in the 1950s in the USSR). "From the cited website:"For male gymnasts, there is evidence to indicate that along with a higher proportion of lower extremity injuries (36.4% - 43.1%), there is a higher proportion of upper extremity injuries (36.4% - 53.8%) when compared with women (Bak et. Al.

, 1994; Weiker, 1995; Lueken, Stone and Wallach, 1993). In terms of specific body parts for the men, there were a large proportion of lower back, ankle, knee, wrist and, in particular, shoulder injuries. The high frequency of shoulder injuries in male gymnasts is most likely the result of extra physical demands placed on the shoulder area in events such as rings, pommel horse, and horizontal bar.

""A variety of medical conditions were present in the gymnasts including low back pain, Servers disease, patellofemoral pain, Osgood-Schlatters disease, elbow dislocation, shoulder subluxation/tendonitis, anterior ankle impingement, and L5/S1 spondylolisthesis. ""An investigation into the long term effects of injury by Wadley and Albright (1993) reported that 45% of previously injured gymnasts still were bothered by the injury approximately three years later. Furthermore, 46% of the gymnasts reported that their injury was not fully recovered after three years, but that they were still "capable of strenuous physical activity" (Wadley and Albright, 1993 p.314).

These studies tend to suggest that, although injuries to gymnasts may be chronically long term, they are not catastrophic in nature, and nor do they prevent retired gymnasts from leading a physically active existence. ""The onset of sudden injuries was 67% for the male artistic gymnasts, 67% for the women artistic gymnasts, and 50% for the rhythmic gymnasts. The percentages of injuries in training were 67% for male artistic gymnasts, 56% for women artistic gymnasts and 100% for the rhythmic gymnasts.

Injury localisation was noticeably different for all three groups. Rhythmic gymnasts suffered most injuries to the hip region of the body. Artistic women suffered most of their injuries to the lower extremities (ankle and knee) while artistic men suffered the majority of their injuries to the upper extremity (elbow and wrist).

"The difficulty is that this does not assess the effects of overuse injuries over decades. Other studies show that arthritis of the joints involved can be more severe in joints subjected to overuse, and that back problems and other overuse injuries can lead to faster development of degenerative diseases commonly seen in old age. According to http://www.emedicine.com/pmr/topic97.htm:Overuse injuries are not associated with direct mortality but morbidity, however, is significant.

The impact of these injuries varies from the occasional annoyance to loss of function due to frank tissue destruction. In many performing artists, musicians, craftsmen, and workers, loss of function at even a minor level can result in a significant loss of livelihood, and with it all the associated difficulties. The direct economic impact of overuse injury in the workplace is immense.

The indirect impact is nearly incalculable if the amount of health care dollars involved is considered. Of particular note, one interesting review of worker demographic data suggests that workers with cumulative trauma disorders were subjected to employment discrimination. Depression and quality of life issues have both been described after a diagnosis of chronic overuse injury.

Sources: http://www.coachesinfo.com/article/?id=67 AND http://en.wikipedia.org/wiki/Gymnastics AND http://www.emedicine.com/pmr/topic97.htm .

Mostly muscular and skeletal problems Male gymanasts are prone to back injuries as a result of hyperextension and hyperflexion. Strength training helps, but elite athletes are prone to pushing to the limit and beyond. Male gymnasts are also prone to joint problems from the stresses they put on them.

Knees and shoulders are most at risk, but every joint takes astonishing punishment from their exercises. As long as they're not taking steroids (an endemic problem among elite athletes of all sorts), I'm not aware of any other long-term problems. Female gymnasts are prone to problems brought on by excessive dieting to maintain weight, leading to a whole slew of internal organ problems (lack of menstruation is almost universal), but from what I've seen male gymnasts are not as prone to that.

Nonetheless, I'd watch out for it.

1 This is a purely qualitative answer but my sister was a gymnast, and herself and a male gymnast friend (a European Champion) came up with a theory that gymnastics makes you short. Their theory was purely based on observation of other gymnasts, and that he is about 5'5, when all his brother are well over 6' and he was the tallest til he was 8 and started training hard. They decided it was something to do with the impact on your joints.

Obviously not scientific, but interesting! .

This is a purely qualitative answer but my sister was a gymnast, and herself and a male gymnast friend (a European Champion) came up with a theory that gymnastics makes you short. Their theory was purely based on observation of other gymnasts, and that he is about 5'5, when all his brother are well over 6' and he was the tallest til he was 8 and started training hard. They decided it was something to do with the impact on your joints.

Obviously not scientific, but interesting!

2 From what I have read in researching my answer, taller gymnasts are more likely to be injured that shorter ones. From what I have observed as I have watched various friends of my daughter progress in gymnastics, taller gymnasts are also more likely to have a difficult time successfully completing many of the moves or in completing them "gracefully" and so are more likely to drop out of gymnastics. So in some ways, tall gymnasts self-exclude themselves from the sport.

However, in many other sports it has long been recognized that extreme physical training is not recommended for young athletes as musculoskeletal disorders are more often created or made worse. Because of the way we grow, it is quite possible that impact on young joints equals damage to the growth plates on the long bones, thus leading to shorter height.

From what I have read in researching my answer, taller gymnasts are more likely to be injured that shorter ones. From what I have observed as I have watched various friends of my daughter progress in gymnastics, taller gymnasts are also more likely to have a difficult time successfully completing many of the moves or in completing them "gracefully" and so are more likely to drop out of gymnastics. So in some ways, tall gymnasts self-exclude themselves from the sport.

However, in many other sports it has long been recognized that extreme physical training is not recommended for young athletes as musculoskeletal disorders are more often created or made worse. Because of the way we grow, it is quite possible that impact on young joints equals damage to the growth plates on the long bones, thus leading to shorter height.

I cant really gove you an answer,but what I can give you is a way to a solution, that is you have to find the anglde that you relate to or peaks your interest. A good paper is one that people get drawn into because it reaches them ln some way.As for me WW11 to me, I think of the holocaust and the effect it had on the survivors, their families and those who stood by and did nothing until it was too late.