We’ve all heard the horror stories: the pop! from a too-short vault, the head-first crash from a beam dismount, the terrifying falls from a release skill on bars. But the majority of gymnastics injuries — 65–70 percent of them, in fact — aren’t dramatic; they happen from years and years of over-use. 

According to gymnastics coach and physical therapist Dave Tilley of Shift Movement Science, “Young athletes are exposed to massive impact forces that may reach 8.8–14.9 times [their] body weight, 1000’s of times per month, and pretty much year round.” 

Factor in the fact that most gymnasts are still growing, and you’re left with a wide range of injuries that many gymnasts will face throughout their careers. Here are five of the most common ones, how they’re caused, and how best to prevent them.

1. Sprained or Fractured Wrist

Humans aren’t supposed to walk on their hands — yet gymnasts do, every day. And while ankles have evolved over thousands of years to be able to withstand massive amounts of force, wrists haven’t. Unsurprisingly, then, wrist injuries are caused when too much force is placed on them, particularly when they’re hyperextended — such as during handstands and back handsprings. Multiply that times the thousands of times that a gymnast may practice those skills in a day, and it’s easy to see why wrist injuries are so common.

This is a particularly serious predicament with young gymnasts, whose growth plates haven’t yet fused into solid bone; their joints aren’t able to sustain as much impact as those of gymnasts who are fully grown. Growth plates aside, there are a number of bones, ligaments, tendons, nerves, and blood vessels that are at risk of injury during hyperextension. 

To prevent wrist injuries, coaches should keep tabs on the amount of wrist-heavy skills their gymnasts do in a given practice; the heavier the volume, the greater the impact, and the more prone the wrists are to injury. Tilley also puts an emphasis on wrist flexibility — if the joint is overworked, it can become stiff — and shoulder flexibility, which can reduce the amount of wrist extension needed during handsprings, tumbling, and handstands. Gymnasts should also do exercises to increase the weight-bearing strength of their wrists, so that they can withstand greater pressure without wear and tear.

2. & 3. Osgood-Schlatter Disease & Sever’s Disease

Many young gymnasts are familiar with Osgood-Schlatter Disease and Sever’s Disease, which are caused by inflammation of the growth plates in the knees (OSD) and heels (Sever’s). 

According to Tilley, “The main reason gymnasts get so many impact ankle or knee injuries is because they are simply doing too much, too fast, and are kids who have not yet fully matured.” Just like in the wrists, the growth plates in the knees and heels are mainly cartilage, not bone — making them unsuited to the stress of forceful impacts. Those impacts include smaller, repetitive movements, such as in sprinting, jumping, and leaping, or the larger forces generated from tumbling, vaulting, or dismounting; landing forces on a gymnast’s lower body have been measured at 14.2–15 times body weight. 

These injuries “point to a problem with numbers of skills being done to hard surfaces per day or week, an underdevelopment of lower body strength, and improper landing mechanics,” writes Tilley. So to prevent them, coaches should get to the root of the problem. The number of impacts should be tracked each day, and limits should be imposed on each event. Gymnasts should rotate landing surfaces: Tumbl Trak, pits, rod floors, and padded mats are all fair game. And while most traditional gymnastics programs work to strengthen the quads, hip flexors, inner thighs, and calves, Tilley urges coaches to pay attention to the countering muscle groups — the glutes, deep hip rotators, hamstrings, and shins — and train them with the same intensity. 

Tilley is also a huge advocate of tracking gymnasts’ growth, especially in the case of Osgood-Schlatter Disease and Sever’s. 

“Ankle, knee, and many other growth plate injuries tend to come on strong when periods of rapid growth are going on,” he writes. “Keeping a proactive measure of this growth can be really helpful in forecasting times of elevated risk, and consequently time when people will inevitably need to pull back on training.”

4.. Achilles Injuries

What happens when Sever’s Disease goes untreated? As the gymnast gets older and the growth plates in the heel close, the forces from impact get transferred into the Achilles tendon — and a host of new injuries ensues. Step one: Achilles tendonitis, when the tendon gets tiny tears and becomes inflamed. Step two: Achilles tendinosis, when the tendon starts to degenerate. And over the years, as the gymnast develops more power and skill and continues to load on the ankle, the already-weakened tendon can tear completely. 

Like all over-use injuries, monitoring numbers and switching up surfaces is the key to prevention. (Nowhere is that more apparent in the case of the Achilles, since a major Achilles injury is usually the result of years and years of over-use.) 

But Tilley specifically calls out landing technique as a major source of Achilles issues: “Landing with the feet/knees together, with an upright torso, hips tucked under, and mainly using the knees, is not the ideal way to absorb force,” he says. Instead, gymnasts should land with their feet hip-length apart and their knees in line with the hips, decelerating into a squat position. This allows for the hamstrings, quads, glutes, and core to absorb the force of the landing, rather than the Achilles tendon taking all of the heat.

5.. Lower Back Injuries (Muscle Pain, Stress Fractures, Spondyloliosisthesis)

“I do not think that people in the gymnastics community appreciate the insanely high forces, and the insanely high repetition numbers, that a gymnast’s spine is subject to during training,” writes Tilley. 

What’s “insanely high?” The compressive forces on the spine during a dismount can clock in at 11.6–20 times body weight. Multiply that by the thousands of landings a gymnast will do in a week of training — plus the stress of extensions from countless back and front handsprings, front aerials, Yurchenko-style vaults, twisting skills, and releases like Pak saltos and Tkatchevs — and you’re at high risk of developing muscle pain, stress fractures, or spondyloliosisthesis (when a spine segment slides forward due to a stress fracture and repetitive hyper extension movements). 

What’s more, gymnasts are rarely given the recovery periods necessary for their backs to heal, strengthen, and adapt, creating a cycle of fatigue and over-use.

But how to prevent injuries caused by skills that form the very basis of the sport? Start at a young age. 

“Gymnasts very commonly do not learn proper ‘global extension’ patterns,” says Tilley. “Often very flexible young gymnasts will use their lower back as the ‘go-to point’ for back bending skills, when they should be taught to use their shoulders, upper back, and hips to dominate the back-bending motion.” 

As gymnasts get older, they should rotate the events that they’re training hyperextension skills each day, avoiding any surge of activities that may put stress on their backs. Shoulder and hip flexibility — which takes pressure off the lower back during back-bending skills — should be highly prioritized. And gymnasts should learn how to strengthen and brace their cores properly, so that their bodies can help absorb the massive forces upon landing.

Injuries, unfortunately, are a part of every athlete’s life. But through proper education and technique — and by speaking up when something is wrong — gymnasts can stay healthier, happier, and free to do the sport that they love.

Brette Warshaw is a freelance writer and consultant based in New York City. You can follow her at @bstarwarshaw.