Gymnasts’ Injury Risk Increases on Stiffer Competition Floors

Achilles tendon rupture more likely when floors ‘give’ less

Long Beach, Calif. (April 5, 2024)—Gymnasts who compete on stiffer floors than their training floors have a higher risk of experiencing an Achilles tendon rupture due to the positioning of their ankles, according to new research from the Burrell College of Osteopathic Medicine in New Mexico. Researchers will present their work this week at the American Physiology Summit in Long Beach, California. The Summit is the flagship annual meeting of the American Physiological Society (APS).

The Achilles tendon runs from the back of the heel up to the calf. Achilles tendon injuries, particularly ruptures where the tendon tears from too much strain, are common in the sport of gymnastics. Gymnasts who have competed for 10 years or more have a higher risk of developing Achilles tendon ruptures due to repeated microtrauma to the tendon, which weakens it. One of the causes of microtrauma in the Achilles tendon is overstretching. Overstretching can happen when the angle between the foot and the shin becomes too small during dorsiflexion (imagine pointing the toes up toward the sky). An Achilles tendon rupture usually requires surgical repair and recovery time ranging from six months to a year.

The research team invited more than 100 female college gymnasts to complete a survey about their experiences with Achilles tendon injury. The gymnasts—from 78 different colleges—answered questions that included whether they became injured at training or competition sites, where floor stiffness may differ.

Approximately 20% of the respondents had sustained an Achilles tendon rupture, and they were 23 times more likely to have been injured on a competition floor versus a training floor. Competition floors tend to be newer and stiffer than training floors, which affects how athletes land on their feet. On a softer practice floor, the gymnasts’ toes dig into the floor upon landing. There is less dorsiflexion in the ankles, which creates a larger angle between the foot and the shin. On a stiffer or harder floor, the toes are not able to grasp the floor as much, which creates more dorsiflexion and a smaller angle.

“If gymnasts would train on newer (stiffer) floors, their musculoskeletal systems [could] adapt to these conditions and [would] not suddenly experience greater Achilles tendon strain during competition on stiffer floors,” co-author Emily Muhlenhaupt said.

However, regular access to harder floors for training is not always possible. The researchers are investigating solutions that may help minimize the risk of Achilles tendon ruptures when practicing on softer surfaces.

“Our wish is that our research contributes to the safety of the sport and that administrators or professional organizations adopt performance standards for gymnastics floor equipment that would help to prevent injuries in gymnastics,” co-author Harald M. Stauss, MD, PhD, said.

NOTE TO JOURNALISTS: The American Physiology Summit will be held April 4–7, 2024, in Long Beach, California. To schedule an interview with the researchers, conference organizers or presenters, or to request abstract 1843, “Stiffer gymnastics floors result in more dorsiflexed ankles, potentially increasing the risk for Achilles tendon rupture,” contact APS Media Relations or call 301.634.7314. Find more highlights from the meeting in our Summit Newsroom.

Physiology is a broad area of scientific inquiry that focuses on how molecules, cells, tissues and organs function in health and disease. The American Physiological Society connects a global, multidisciplinary community of more than 10,000 biomedical scientists and educators as part of its mission to advance scientific discovery, understand life and improve health. The Society drives collaboration and spotlights scientific discoveries through its 16 scholarly journals and programming that support researchers and educators in their work.