why so many NCAA Achilles tears?

REPOST with comments from Dr. Bill Sands included.

tessen_kim_uugym16… Utah’s gymnastics team was dealt its second major blow of the season when freshman Kim Tessen tore her Achilles last Saturday. Tessen had strung together a solid debut season and was coming off her best meet of the year before the injury.

Tessen’s season-ending injury follows up Sabrina Schwab’s season-ending ACL tear. …

Tessen is the fifth Red Rock to tear her Achilles in as many years. But Utah isn’t unique, as several other teams have watched athletes succumb to the same injury this season and over the years.

“I think last year we (NCAA teams) had 16 Achilles tears reported, and this year we are already at eight or nine,” said Farden. …

Utah gymnastics still focused despite second season-ending injury

Leave a comment if you have ANY idea how we might reduce the number of Achilles ruptures.

Read a thread on the topic on College Gymnastics Board.

 

William A Sands, PhD, FACSM:

The Achilles tendon injuries, particularly ruptures are complex. Having studied this problem for over 20 years, I believe there is a small constellation of causative factors working separately and together. However, prediction and prevention remain elusive. I have several presentations with high-speed video of athlete and spring floor interactions, but the files are quite large. I’ve presented at the USAG Congress on this very topic more than once. Seems like it always falls on deaf ears. Well, one more try…

James Linderholm alerted me to a recent discussion on Achilles tendon injuries. I saw a list of these injuries on Rick McCharles site. Below are some references to which you might want to refer when describing and discussing what is known about these injuries and some potential causative factors.

In my view, there are several potential causes, almost impossible to tease apart.

1. The wear-and-tear of long years of training is certainly a factor. Countermeasures for this include the use of ultrasound to examine the tendon and other local structures.

2. We can probably infer from a number of studies that injury incidence and rate are linked to body composition and anthropometry (ie weight and size). Countermeasures for this can include technique alterations, nutritional interventions, and reduction of training load.

3. Floroquinolones are known to cause problems with connective tissue strength and load characteristics. I will assume that most, if not all, sports medicine professionals are aware of this problem and no longer use these types of antibiotics. However, it may be worth a check to ascertain the role(s) of these medications, history of use, and so forth. The evidence, in my view, is pretty clear. Unfortunately, long-term use has not been investigated sufficiently for determination of whether historical use may cause problems. I’m not a physician, so please check with your team doctors.

4. Technique may be involved in that anecdotal discussions have indicated that athletes with low take-off impact angles may be more vulnerable. Most, but not all, Achilles tendon injuries occur during take-offs when ground reaction forces can exceed 15-22 times body weight. Work by Bruggemann and colleagues has shown that the bundles of the tendon are load differentially depending on placement of the feet, ankle and foot anatomy, and other factors.

5. The spring floor may contribute. I have made efforts for more than 20-years to study the spring floor and its relation to take-off injuries. AAI and Whitey Anson have been very generous in helping me work on this problem. There are some interesting aspects that are addressed in citations below, and on my website: http://www.advancedstudyofgymnastics.com. Interestingly, Achilles tendon injuries have occurred on coil spring floors and foam-type floors. I believe that the natural frequency responses (rates of vibration from depression to rebound) are not consistent between the gymnast’s lower extremities and the spring floor. Unfortunately, equipment companies must follow FIG specifications and I believe these specifications, while ensuring some uniformity in design, do not take enough account of biological factors. It is also interesting to note that when T&T coaches are queried about Achilles tendon injuries – these injuries are practically unheard of. Note that the tumbling apparatuses are very different from the artistic gymnastics spring floors. On querying T&T coaches I found that only one Achilles tendon rupture was recalled, and this athlete was a former artistic gymnast and approximately 35-years old. High-speed videography of T&T tumbling surfaces has shown that the lower extremity mechanics are quite different from those used on artistic gymnastics spring floors. T&T tumbling strips are simply more forgiving than artistic gymnastics spring floors.

6. EVERYONE wants to reduce or eliminate these injuries. I hope the information below will enhance discussions that lead to countermeasures that work.

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Rick Mc

Career gymnastics coach who loves the outdoors, and the internet.

4 thoughts on “why so many NCAA Achilles tears?”

  1. Below is my response to a thread on the College Gymnastics Coaches Board from 2015. It didn’t seem to get any traction, so I thought I’d try it again. The Achilles tendon injuries, particularly ruptures are complex. Having studied this problem for over 20 years, I believe there is a small constellation of causative factors working separately and together. However, prediction and prevention remain elusive. I have several presentations with high-speed video of athlete and spring floor interactions, but the files are quite large. I’ve presented at the USAG Congress on this very topic more than once. Seems like it always falls on deaf ears. Well, one more try…

    William A Sands, PhD, FACSM

    1 April 2015
    Greetings,
    James Linderholm alerted me to a recent discussion on Achilles tendon injuries. I saw a list of these injuries on Rick McCharles site. Below are some references to which you might want to refer when describing and discussing what is known about these injuries and some potential causative factors.
    In my view, there are several potential causes, almost impossible to tease apart.
    1. The wear-and-tear of long years of training is certainly a factor. Countermeasures for this include the use of ultrasound to examine the tendon and other local structures.
    2. We can probably infer from a number of studies that injury incidence and rate are linked to body composition and anthropometry (ie weight and size). Countermeasures for this can include technique alterations, nutritional interventions, and reduction of training load.
    3. Floroquinolones are known to cause problems with connective tissue strength and load characteristics. I will assume that most, if not all, sports medicine professionals are aware of this problem and no longer use these types of antibiotics. However, it may be worth a check to ascertain the role(s) of these medications, history of use, and so forth. The evidence, in my view, is pretty clear. Unfortunately, long-term use has not been investigated sufficiently for determination of whether historical use may cause problems. I’m not a physician, so please check with your team doctors.
    4. Technique may be involved in that anecdotal discussions have indicated that athletes with low take-off impact angles may be more vulnerable. Most, but not all, Achilles tendon injuries occur during take-offs when ground reaction forces can exceed 15-22 times body weight. Work by Bruggemann and colleagues has shown that the bundles of the tendon are load differentially depending on placement of the feet, ankle and foot anatomy, and other factors.
    5. The spring floor may contribute. I have made efforts for more than 20-years to study the spring floor and its relation to take-off injuries. AAI and Whitey Anson have been very generous in helping me work on this problem. There are some interesting aspects that are addressed in citations below, and on my website: http://www.advancedstudyofgymnastics.com. Interestingly, Achilles tendon injuries have occurred on coil spring floors and foam-type floors. I believe that the natural frequency responses (rates of vibration from depression to rebound) are not consistent between the gymnast’s lower extremities and the spring floor. Unfortunately, equipment companies must follow FIG specifications and I believe these specifications, while ensuring some uniformity in design, do not take enough account of biological factors. It is also interesting to note that when T&T coaches are queried about Achilles tendon injuries – these injuries are practically unheard of. Note that the tumbling apparatuses are very different from the artistic gymnastics spring floors. On querying T&T coaches I found that only one Achilles tendon rupture was recalled, and this athlete was a former artistic gymnast and approximately 35-years old. High-speed videography of T&T tumbling surfaces has shown that the lower extremity mechanics are quite different from those used on artistic gymnastics spring floors. T&T tumbling strips are simply more forgiving than artistic gymnastics spring floors.
    6. EVERYONE wants to reduce or eliminate these injuries. I hope the information below will enhance discussions that lead to countermeasures that work.

    ***1. Arndt A, Bruggemann GP, Koebke J, Segesser B. Asymmetrical loading of the human triceps surae: II. Differences in calcaneal moments. Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 1999;20(7):450-5.
    ***2. Arndt A, Bruggemann GP, Koebke J, Segesser B. Asymmetrical loading of the human triceps surae: I. Mediolateral force differences in the Achilles tendon. Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 1999;20(7):444-9.
    ***3. Arndt AN, Bruggemann GP, Koebke J, Segesser B. Asymmetrical loading of the human triceps surae: I. Mediolateral force differences in the Achilles tendon. Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 1999;20(7):444-9.
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    15. Epstein D. The Sports Gene. New York, NY: Penguin Books; 2013.
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    ***45. Sode J, Obel N, Hallas J, Lassen A. Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. European journal of clinical pharmacology. 2007;63(5):499-503. doi:10.1007/s00228-007-0265-9.
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    50. Yee CL, Duffy C, Gerbino PG, Stryker S, Noel GJ. Tendon or joint disorders in children after treatment with fluoroquinolones or azithromycin. The Pediatric infectious disease journal. 2002;21(6):525-9.

    Spring Floors

    ***1. Arampatzis A, Bruggemann G-P. Energy and performance – storage and return of elastic energy by gymnastic apparatus. In: Leglise M, editor. Symposium Medico-Technique. Lyss, Switzerland: International Gymnastics Federation; 1999. p. 29-37.
    ***2. Arampatzis A, Bruggemann G-P, Klapsing GM. Control of leg stiffness and its effect on mechanical energetic processes during jumping on a sprung surface. In: Hong Y, Johns DP, editors. Proceedings of XVIII International Symposium on Biomechanics in Sports. I ed. Hong Kong, China: The Chinese University of Hong Kong; 2000. p. 23-7.
    ***3. Arampatzis A, Stafilidis S, Morey-Klapsing G, Bruggemann GP. Interaction of the human body and surfaces of different stiffness during drop jumps. Medicine and science in sports and exercise. 2004;36(3):451-9.
    ***4. Arndt A, Bruggemann GP, Koebke J, Segesser B. Asymmetrical loading of the human triceps surae: II. Differences in calcaneal moments. Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 1999;20(7):450-5.
    5. Bieze Foster J. Efforts to reduce gymnastics injuries focus on spring floors. Biomechanics. 2007;14(1):11-2.
    6. Boyer KA, Nigg BM. Muscle tuning during running: Implications of an un-tuned landing. Journal of biomechanical engineering. 2006;128:815-22.
    7. Denoth J, Nigg BM. The influence of various sport floors on the load on the lower extremities. In: Morecki A, Fidelus K, Kedzior K, Wit A, editors. Biomechanics VII-B. 3-B ed. Baltimore, MD: University Park Press; 1981. p. 100-5.
    8. Gormley JT. An investigation of two spring-floor type characteristics and the muscular response in gymnasts of different body mass and skill performance levels. Underdale: South Australia. South Australia College of Advanced Education. Author. Underdale, South Australia: South Australia 1982 1982.
    9. Holvoet P, Lacouture P, Duboy J. Energetic requirements of three gymnastic takeoff techniques from the floor. Journal of Human Movement Studies. 1999;36:237-51.
    10. Janssen JM, inventor Janssen-Fritsen Holding B.V., assignee. Gymnastics exercise floor. Netherlands2007.
    ***11. McNeal JR, Sands WA, Shultz BB. Muscle activation characteristics of tumbling take-offs. Sports Biomechanics. 2007;6(3):375-90.
    12. Moritz C, Farley CT. Human hopping on damped surfaces: strategies for adjusting leg mechanics. Proceedings of Biological Science. 2003;270(1525):1741-6.
    13. Moritz C, Farley CT. Passive dynamics change leg mechanics for an unexpected surface during human hopping. Journal of applied physiology. 2004;97(4):1313-22.
    14. Moritz C, Farley CT. Human hopping on very soft elastic surfaces: implications for muscle pre-stretch and elastic energy storage in locomotion. Journal of Experimental Biology. 2005;208(Pt 5):939-49.
    15. Moritz C, Farley CT. Human hoppers compensate for simultaneous changes in surface compression and damping. Journal of biomechanics. 2006;39:1030-8.
    16. Moritz C, Greene SM, Farley CT. Neuromuscular changes for hopping on a range of damped surfaces. Journal of applied physiology. 2004;96(5):1996-2004.
    17. Nigg BM, Yeadon MR, Herzog W. The influence of construction strategies of sprung surfaces on deformation during vertical jumps. Medicine and science in sports and exercise. 1988;20(4):396-402.
    ***18. Paine DD. Spring floor resilience and compliance modeling. Salt Lake City, UT: University of Utah; 1998.
    19. Peikenkamp K, van Husen M, Nicol K. Vertical surface reaction forces during landing movements on hard and elastic gymnasium surfaces. In: Riehle HJ, Vieten MM, editors. ISBS ’98 XVI International Symposium on Biomechanics in Sports. I ed. Konstanz, Germany: UVK – Universitatsverlag; 1998. p. 552-5.
    20. Peikenkamp K, van Husen M, Nicol K, editors. An empirical and modeling analysis of the area-elastic surface in a gymnasium. ISBS ’99 Scientific Proceedings of the XVII International Symposium on Biomechanics in Sports; 1999 June 30-July 6, 1999 1999; Perth, Western Australia. Edith Cowan University: Edith Cowan University.

    ***21. Sands WA, Puzzles and Paradoxes – Gymnastics. Anais do II Seminario Internacional de Ginastica Artistica e Rithmica de Competicao; 2010 29-30 June 2010 2010; Campinas, Brazil. Centro de Convencoes UNICAMP Campinas-SP: Centro de Convencoes UNICAMP Campinas-SP.
    22. Sands WA. Interactions of the gymnast and spring floor. Sports Performance and Tech. 2014;1(7):29-33.
    ***23. Sands WA, Alumbaugh B, McNeal JR, Murray SR, Stone MH. Comparison floor exercise apparatus spring-types on a gymnastics rearward tumbling take-off. Science of Gymnastics Journal. 2014;6(2):41-51.
    ***24. Sands WA, George GS. Somersault trajectory differences: Foam block versus coil spring floor. Technique. 1988;8(1):8-9.

    Sands, W.A., McNeal, J.R., Alumbaugh, B., Penitente, G., Jemni M., Murray, S.R., Chin-Yang,
    C., Sole, C.J. & Stone, M.H., (2013). Tumbling Take-Off Foot Contact Comparisons – Two
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    Meeting, Indianapolis, IN. 28 May-1 June. P 182, Dec. 2012. Vol. 45 No. 5 Supplement
    S453.
    Sands, W.A., Smith, S.L., Kimmel, W.L., Wurtz, B.R., McNeal, J.R. (2007). Spring floor vs air floor.
    USA Gymnastics National Congress, San Jose, CA 18 Aug 2007.
    Sands, W.A. (2013). Biomechanics of the tumbling take-off, with special attention to the Achilles tendon.
    USA Gymnastics National Congress, Hartford, CT., 15 Aug 2013.
    McNeal, J.R., & Sands, W.A., Shultz, B.B. (2003). Preactivation of lower extremity muscles during
    Various tumbling take-offs. Science in Gymnastics Symposium, Anaheim, CA 23 August 2003.

    25. Seeger JD, West WA, Fife D, Noel GJ, Johnson LN, Walker AM. Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population. Pharmacoepidemiology and Drug Safety. 2006;15(11):784-92. doi:10.1002/pds.1214.
    26. Shields BJ, Smith GA. The potential for brain injury on selected surfaces used by cheerleaders. J Athl Train. 2009;44(6):595-602. doi:10.4085/1062-6050-44.6.595.
    27. Smith J, inventor Improvement in Gymnastics Apparatus. United States patent 108401. 1870 18 October 1870.
    28. Stefanyshyn DJ, Nigg BM. Work and energy influenced by athletic equipment. In: Nigg BM, Macintosh BR, Mester J, editors. Biomechanics and Biology of Movement. Champaign, IL: Human Kinetics; 2000.
    29. Weller SM, inventor Cushioning Device and Spring Floor System Incorporating Same. United States2011.
    30. Wilson BD, Neal RJ, Swannell PD. The response of gymnastic sports floors to dynamic loading. The Australian Journal of Science and Medicine in Sport. 1989;21(1):14-9.
    31. Wilson BD, Swannell P, Millhouse D, Neal R. A biomechanical investigation of gymnastic take off and landing surfaces. Technical Report to the Coordinator Applied Sports Research Program, Australian Sports Commission, Canberra, ACT, Australia. Canberra, ACT, Australia: Australian Sports Commission; 1986.
    32. Yeadon MR, Nigg BM. A method for assessment of area-elastic surfaces. Medicine and science in sports and exercise. 1988;20(4):403-7.

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    offlineGatorgymnastic
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    Apr 2 15 8:52 PM
    Thank you! That is interesting that T & T gymnastics does not have these rates of achilles ruptures. Floor must be changed!!!!!

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  2. As you know from Dr. Sands, the spring floor is a contributor. I proved that the Weller Spring Floor is easier on the athletes using the FIG apparatus test, an impact style test. This was verified by the Engineering Manager at AAI, but was never released. Weller Floor reduces the peak impact forces on the athlete, and reduces significantly both the intensity and duration of floor vibrations. So while Sands says FIG standards must be followed, the Weller Floor proves it can be safer and also meet FIG specs.

    I participated in Dr. Sands’ study “Comparison of Floor Exercise Apparatus Spring-types on Gymnastics Rearward Tumbling Take-off.” He summarized in his report, “Although this study did not show enhanced take-off performance based on spring-type, the influence of the spring on performance and safety remains a possibility.” http://www.academia.edu/22159896/Comparison_of_Floor_Exercise_Apparatus_Spring-types_on_a_Gymnastics_Rearward_Tumbling_Take-off

    When he was supposed to be releasing this data at the 2012 Olympic Trials, he was not permitted to do so. “For legal reasons” he said using air quotes, to the standing room only crowd at the USAG meeting advertised to talk about the Weller floor. At about the same time, strangely, AAI announced they were not changing their floor based on this research.

    Other things we studied included that AAI springs go solid or bottom out, while Weller springs don’t. Also that the rate of force development, and a comparison of the resultant forces all favor Weller.

    To be clear, AAI asked for “exclusivity” on my invention but then refused to deal after the head to head test I did in their factory. While it proved our claims, they came to realize that the floor contributing to injuries is a big problem for them, in addition to cratering their market share. AAI is the chairman of the USAG Board “Equipment Committee” so they have the ability to block it.

    They told their dealers not to speak to me and implemented a “moratorium” and complete censorship, never releasing the data. Instead, proliferating false and misleading information that Sands’ studies prove there are no differences with Weller.

    AAI and USAG withheld relevant research and information concerning the safety of the athletes and their enjoyment of the sport to their membership. This is in complete conflict with their Code of Ethical Conduct. They have threatened many, including but not limited to, Valeri Liukin, and Kevin Mazeika, for engaging with me. Ron Galimore told coaches that I am a “threat” and not to speak to me.

    They realize the mistakes they made with Palmer, an early spring floor design, causing them to lose command and control of the equipment. In spite of the fact that they are a public organization, a non profit, with the main purpose of selecting teams for international and Olympic competitions.

    USAG and AAI have conspired along with the NCAA to maintain this exclusive relationship to maintain command and control of the gymnastics equipment used in NCAA gyms and competitions also. They have disabled many of our sales directly. The actual contract between them mandates that AAI is the sole provider for equipment at several national events, but they have intentionally misinformed and misrepresented to the industry that AAI is the only permitted equipment in their competitions everywhere.  There is no known agreement or transparency that allows this in perpetuity.

    USAG and AAI simply turn a blind eye to the safety of our athletes, in this case, to maintain a monopoly in the USA. The most obvious evidence is that I am the approved supplier for The Walt Disney Company and Shanghai Disneyland Resort. They have no conflicts and select our product for the safety of their performers. And Nellie Kim, President FIG Technical Committee makes us her only endorsement.

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