A Literature-Based Framework for Neuromuscular Screening in Gymnasts

Abstract

Background: Gymnastics exerts severe neuromuscular stress on athletes who start intensive training at an early age when the skeletal and neuromotor growth is the most active. Although there is a high prevalence of injuries, with up to 91% of elite Women’s Artistic Gymnastics (WAG) athletes sustaining at least one injury per season[2] —a figure that has been validated—, sport-specific neuromuscular screening frameworks have not been developed. Currently used instruments, including the Functional Movement Screen (FMS) and Y-Balance Test (YBT), show poor predictive ability when individually used in gymnasts, and a multifactorial, gymnastics-specific instrument is necessary.

Purpose: To review existing evidence on neuromuscular screening, injury risk factors, landing biomechanics, training load, and maturation-related risk in gymnasts and to suggest an evidence-based, practical neuromuscular screening framework with an assessment template to be used by clinicians, coaches and sports scientists.

Methods: A systematic literature review based on narrative literature searches was carried out in PubMed, Cochrane Library, Scopus, SPORTDiscus, and CINAHL with a restriction to peer-reviewed open-access articles published in January 2020 to December 2024. Keywords were a combination of gymnastics, neuromuscular screening, injury risk, landing biomechanics, FMS, Y-Balance Test, training load, proprioception, and maturation. Twenty high-quality studies were selected after independent dual screening. The study designs were systematic reviews, meta-analyses, prospective and retrospective cohorts and validation studies. Based on the synthesised evidence, a proposed Gymnastics Neuromuscular Screening Assessment Form was created.

Findings: The prevalence of injury among competitive gymnasts is excessive; 60.5% of all injuries among youth gymnasts occur to the lower limbs[3], where the ankle, knee, lumbar spine, and wrist have the highest burden of injury[2,4]. Impaired proprioception, landing biomechanical dysfunction, limb strength asymmetries, and maturational neuromuscular disturbances during peak height velocity (PHV)[3,14] are examples of neuromuscular risk factors. FMS and YBT composite scores are not good stand-alone predictors of area under the curve (0.54–0.59) but multifactorial models including training load, injury history and growth status have shown better risk stratification[6,10]. The magnitude of ground reaction forces at gymnastics landings is 7.1–15.8 times body weight[7], making the evaluation of landing mechanics a vital part of the screening process.

Conclusions: It is proposed that a six-domain gymnastics neuromuscular-screening framework, including movement quality, range of motion, lower limb strength, proprioception, landing mechanics, and training load, be operationalised in a systematic assessment template. The broad implementation of this framework in the gymnastics training context with interdisciplinary collaboration has a significant potential to decrease the burden of injuries and facilitate the health of athletes in the long term.