Development of a Biomechanically-Based Post-Concussion Return to Play Protocol for Gymnasts

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Project Summary/Abstract Gymnastics is a leading cause of head injury among sports- and recreation-related activities and is the second most common cause of emergency room visits for non-fatal traumatic brain injury among non-contact sports. Despite this, return to play protocols in gymnastics have scarcely been researched. As a sport, gymnastics is composed of six disciplines: men’s artistic, women’s artistic, rhythmic, acrobatic, trampoline and tumbling, and aerobic gymnastics that utilize various skills showcasing balance, power, and artistry. Women’s artistic gymnastics is the most popular discipline of gymnastics and has been recommended for developing strength and coordination in female youth athletes. However, the physical demands of the sport often lead to a variety of injuries, including concussion, and females disproportionately represent a higher percentage of gymnastics- related injuries treated in hospitals. Athletes recovering from concussion are reintegrated back into sport using a guided return to play protocol. Existing post-concussion return to play protocols developed for contact sports, such as football, may not be relevant to acrobatic sports and are not grounded in biomechanical evidence informing the unique exposure profile of gymnasts. With ~ 5 million Americans participating in gymnastics-related activities, there is a critical need to understand the complex loading environment of the head in gymnastics to inform return to play protocols in the sport. The objective of this study is to characterize kinematics of the head across women’s artistic gymnastics skills for the development of a biomechanically-informed post-concussion return to play protocol in the sport. In Aim 1, 11 beginner-level (age 11-13) and 11 advanced-level (age 13-15) gymnasts will be fitted with mouthpiece-based head motion sensors. Biomechanical data will be collected and quantified during all practices to determine the frequency and magnitude of head accelerations experienced during normal participation of the sport. A sub-sample of athletes will complete a series of skills with two progressive safety modifications, to evaluate the effect of safety modifications on reducing head acceleration. In Aim 2, mixed methods will be used to integrate return to play guidelines identified from literature and data from Aim 1. Stakeholders will be engaged to develop and refine a biomechanically-informed post-concussion return to play protocol in women’s artistic gymnastics. Outcomes will include characteristics of the protocol and dissemination materials for national organizations to consider for adoption. This R03 small pilot study seeks to change the paradigm in which concussions are managed in gymnastics and will result in methods and key data to support a large-scale study evaluating the effectiveness of the return to play protocol on reducing symptomatic episodes and recovery time following concussion while assessing optimal implementation strategies in this environment. This approach will provide a framework that may be expanded to other disciplines of gymnastics and acrobatic sports to improve the safety of over 5 million athletes participating in acrobatic activities.