Category: sport medicine

The “twisties” phenomenon is real.

I’ve experienced it myself and have had several national team gymnasts who have gone through it as well.

I see two dangers:

(1) over medicalizing/psychologizing the issue and (2) giving an invisible symptom as a fairly easy excuse to avoid training and competing.

Medicalizing/psychologizing: this phenomenon is not a “mental health” problem. This is a problem of spatial orientation.

Unfortunately, we know too little about human spatial orientation to be very definitive.

I tried studying spatial orientation while at Utah because of this issue and the use of the term “blacking-out” to describe the same thing that too often occurs on the trampoline.

Unfortunately, a sport-oriented problem like this does not get funding.

While a magnified stress response may be a partial cause, I can tell you that you don’t have to be highly stressed to experience it.

Physicians studying trampoline injuries found that the majority of serious injuries occurred among highly trained athletes and dead-center in the middle of the bed (i.e., they didn’t fall off). The physicians indicated that they thought the trampolinist “blacked out.” However, there is no real loss of consciousness, just orientation.

Moreover, it can be scary as hell when it happens.

Spatial orientation while twisting and somersaulting can be a serious challenge to the integration of the vestibular apparatus, vision, and kinesthesis.

For example: if you stand upright and take your right arm, bend the elbow 90 degrees so that the hand is in front of you, and hold one finger so that it points upward; then rotate your hand in a largish horizontal circle keeping the finger pointing upward. Let’s say you decided to rotate the hand so that it makes a counterclockwise circle as you view it from above (looking down at the circle), if you keep the hand circling counterclockwise while you simultaneously raise your arm/hand so that it circles above your head you will note that the hand is now turning in a clockwise direction. Your brain knows the difference between clockwise and counterclockwise rotation, and you can probably picture that the somersaulting gymnast spins a twist in one direction while going from “right-side-up” to “upside-down” during a somersault. Combining the two orientations results in motor control problems like you experience when trying to rub you stomach and pat your head.

Blindfolded athletes can tell which direction they’re spinning (twisting) while standing upright. However, sometimes they have trouble telling such directions when they are inverted suddenly.

Obviously, a gymnast must pass from an upright body orientation to an inverted body orientation sometimes through two or three somersaults while twisting.

Finally, the loss of spatial orientation can be somewhat “sticky” and remain with an athlete from minutes to months.

Here are some references from work I did on spatial orientation:

via email

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2. As for the malingering problem, I’m not sure where to go.

I definitely don’t have any magic fixes. However, too often I’ve found that when these symptoms arise, the athlete’s anxiety can certainly be blamed, but much of the anxiety comes from poor preparation.

I suspect that if athletes are prepared “better” there would be fewer such problems. Moreover, I’d like to encourage coaches to investigate the problem thoroughly before jumping to the idea that the athlete is lazy or unmotivated.

William A Sands, Ph.D., FACSM