ACSM Olympic Games Expert Commentary

Ankle Sprains in Gymnastics

Each year, more than 86,000 gymnastics-related injuries are treated in hospitals, doctors' offices and hospital emergency rooms. Gymnasts run, jump and tumble on soft surfaces and compete on narrow equipment, which makes them prone to ankle sprains. Considered a ligament injury, 75 percent of sprains are classified as lateral ankle sprains.

Here are a few things gymnasts should consider:

There are three grades of ankle sprains. A grade one means that the ligament is not completely torn it’s just injured but stable. Grade two and three lateral ankle sprain involve a complete tear of one or two ligaments.

The problem with a lateral ankle sprain in sports is typically the pain and instability.  Long term, most ankle sprains respond well to resting, icing, and compression to get the swelling down and a period of immobilization. If the ankle is stable, taping it can help support it during a competition – this form of treatment is commonly used during major competitions like the Olympics.

For those athletes with a more severe ligament tear, taping the ankle typically will not provide the kind of support needed to compete at a more advanced level. Definitive treatment will require some form of support, bracing or immobilization. If a gymnast with a lateral ankle sprain decides to compete they may be forced to make small adjustments to their routine due to pain or fear of re-injury. Ultimately this will significantly affect their performance.

If a gymnast is faced with a severe ankle injury, rest and medical attention is always the best course of action.

David A. Porter, MD, PhD, FACSM

Methodist Sports Medicine Center

Clarian Human Motion, Indianapolis

Ice Vest Precooling

The idea that some mild degree of pre-cooling (a slight reduction in body core temperature of 0.5-1.0 °C prior to exercise) might reduce thermal stress during exercise in the heat has been around for over 20 years. Many studies have demonstrated that pre-cooling results in less thermal strain during exercise, i.e. a lower body core temperature during exercise of similar intensity.  While pre-cooling has been shown to modify (improve) the thermoregulatory responses to exercise not all studies have demonstrated a clear improvement in performance. Lately, using an ice vest has been shown to provide adequate pre-cooling to lower body core temperature prior to exercise and appears almost as effective as more sophisticated pre-cooling procedures (i.e. water immersion, whole body cooling garments) in lowering body temperature.  Use of such ice-vests has allowed researchers to get out of the laboratory and evaluate pre-cooling in the field.  Recent fieldwork has verified that pre-cooling with an ice-vest can reduce body temperature and reduce thermoregulatory strain during most, but not all real or simulated athletic competitions. Overall, endurance athletic events seem to respond best to ice-vest pre-cooling.  Fieldwork has verified the ability to reduce the rise in core temperature under actual 4-5 km race conditions.  In addition, pre-cooling with an ice vest prior to an interval workout (8 x 1000 m) is able to keep body core temperature lower during the first 5-6 repeats. In addition, peak power output during a high intensity cycling exercise (Wingate test) is higher in athletes who undergo ice vest pre-cooling. In contrast, no real advantage has been ascribed to pre-cooling individuals performing high intensity-intermittent exercise (simulated soccer match).  Laboratory tests have provided good evidence that pre-cooling with an ice vest can reduce thermal strain and improved performance.  However, improved athletic performance from ice vest pre-cooling in competitive events has not been verified. Overall, ice vest pre-cooling does not impair performance but does reduce thermal strain in competitive athletes. Regardless of its impact on performance ice-vest pre-cooling should be beneficial to the health and safety of endurance athletes.

Gary W. Mack, PhD, FACSM

Department of Exercise Sciences, Brigham Young University