Back Pain Progression for Gymnasts

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2016 National Congress Back Pain Slides PDF

A Return to Play Progression from Back Pain for Gymnasts

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Like any injury, it’s critical for gymnasts to have a plan of action when they return from back pain.

We also know, just like in any patient, gymnasts are not compliant when it comes to completing their rehab and at home exercises! Now, with that being said, I’ve also had gymnasts who eat this protocol up and come out with amazing strength and amazing core control. They also don’t have pain, and their performance soars!

So what makes this protocol different from other protocols? Keep reading to find out more!

The Gymnast Care Return from Back Injury Protocol takes the most important 20% movements in gymnastics, and gets an 80% benefit rate.

This protocol and the movements found within it, are multipliers for gymnastics movement. So you’re getting a much larger return for your time and energy by implementing these exercises and movements!

But first, let’s start at the beginning.


There’s never been a flow chart that includes coaches and parents when it comes to gymnastics back pain. So here’s the first of it’s kind!

back pain flow for coaches parents copyAny time we get to the “Begin/review Core Control Protocol” then we begin here:

Return From Back Injury Progression

Progression for Gymnasts with Back Injury

Any time we return to play from injury, it’s critical that we follow a progression. We’ll know exactly where are athletes are currently, and we’ll know where they have to go in order to get back to play.

With so much rehab, we don’t have a return to play protocol that can be followed. There’s no way to test our athletes to find out where they are, and many times, rehab fails.

We have 4 steps in this progression:

  1. Pain Reduction
  2. Control
  3. Form
  4. Strength

Let’s find out what’s in each step and how you as a coach or parent will interact with this protocol!

Phase 1: RestPhase 1: Pain Reduction

First and foremost, it’s critical that we eliminate pain from our gymnasts. Gymnasts are not adults (in most instances). They do not have the experience or maturity to know what pain is serious, and what is soreness.

They also do not have the mental capacity to deal with pain. Their pain will manifest itself as FEAR, discouragement, being timid, and so much more. You have to let your gymnast eliminate their pain and we do this with REST!


After serious back injury, the pain will subside in 3-12 weeks (when there has been a serious injury like a pars fracture, aka spondylolysis). In less serious injuries like a sprain of the joint or strain of the muscles, it takes far less time. Then, we can slowly start to progress.

But if you can return a gymnast to their sport stronger, and with more control and better skills, why wouldn’t you take a couple months to get it right?

Are we in this gymnastics for short term gains, or for a great career? Great careers do not end in injury, burnout or overtraining! (click to Tweet this line!)


Phase 02 Return from Back InjuryPhase 2: Control

What I see most with gymnasts is they have little or no control outside of flexion. Gymnasts are great at HOLLOW…but not so great when they have a neutral spine or extension.

Here’s a test: have your gymnast lay on her back, knees bent, arms by the side. Have her tighten her core. What happens? Shoulders round, and the pubic bone pops in the air as the pelvis goes into a posterior pelvic tilt. This position is hollow!

Then, point out what just happened and have them try to do it without manipulating their pelvis or shoulders. You’ll see it’s very difficult for them and takes a lot of brain power!

In the Control Phase, we’re not increasing strength. We’re teaching their bodies how to move properly.

Adding strength on top of dysfunctional movement always ends in injury!


12d (2) copyPhase 3: Form

Now that are athletes are able to demonstrate basic control over their bodies, we can now start thinking sport specifics again.

In Phase 3, we continue with our progression, and coaches start adding drills into our gymnasts progression. This is where the coaches role really starts to heat up!

We need our coaches to think through the processes that have created injury in our gymnasts to begin with. Is the gymnast not punching correctly? Do their shoulders not open correctly on a round off? Are they arching on bars?

This is where you shine coaches! Start addressing these issues. Begin with no stress drills and always remember that the athlete has to remain pain free! Then, continue to stress these drills as their strength increases.


Phase 04 Return to Play from Back InjuryPhase 4: Strength

What is strength? Have you ever thought about what this entails? Even better, what is power?

When we stress proper movement we get strength. When we stress proper movement dynamically, we get power!

But always remember, when we put stress and skills on top of dysfunctional movement, the only result that we can have is injury. That’s why this progression is so important. We MUST learn to move properly first, then we can start to get to the strength component. According to Dr. Bill Sands article, “Should Female Gymnasts Lift Weights,” he recommends using the squat, deadlift, press, and pull down to develop the strength that protects gymnasts.

That’s why we move towards the goals set forth in this Phase as 1/2 bodyweight lifts in these categories. Remember, just like stretching and other components of the physical body, this is a process and it takes time to develop strength.

Remember, now that we’re into developing the proper strength, we can move our athletes back to skills. Our goal is develop the strength/power to do skills first, then add the movement of the skills on top of the developed power!


Back Pain Presentation

So now, watch the Back Pain Presentation that was given at USA Gymnastics National Congress 2014 on back pain to tie all of this together.

The exercises and discussion can be found in the Gymnast Care Community…click here to find out more!

Dr. Joshua Eldridge

About Dr. Joshua Eldridge

Dr. Joshua Eldridge has specialized in protecting gymnasts from injury. He is the inventor of The X Brace, and has developed a treatment protocol for Sever's disease and heel pain that has helped thousands of gymnasts throughout the world. Dr. Eldridge brings practical, easy injury care and prevention that can be done at home.