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Abstract
During this critical stage of development, children experience rapid physiologic, neurologic, and psychological growth.3 Participation in Olympic-level gymnastics may place inappropriate physical and psychological demands on these children, which may have long-term, indeed lifelong, adverse consequences.6 ,7 Physical Injuries Gymnastics is an intense, repetitive, high-impact sport, and most elite gymnasts do not pass through childhood and adolescence without injury.4 ,8 The risk of injury increases with longer practice time, the degree of difficulty of the routines, and age-related vulnerability of the skeletal system.1 ,3 ,6 ,9 ,10 Repetitive stress on the developing musculoskeletal system, which has a much higher cartilage content than in adults, may cause an accumulation of minor physical insults that can result in permanent injury or deformity.11 ,12 These injuries include stress fractures; growth-plate fractures; wrist and elbow injuries; spinal injuries such as scoliosis, spondylolysis, and spondylolisthesis; and reflex sympathetic dystrophy.13 ,14 Moreover, training more than 18 hours per week before and during puberty may alter the growth rate and prevent the attainment of full adult height.15 ,16 The pressure to practice and compete while injured compounds the risk of impaired skeletal development and permanent deformity.17 ,18 Overtraining with incompletely healed injuries may contribute to reflex sympathetic dystrophy.