Objectives To examine the prevalence of young gymnasts with tibial bone-stress-injuries (BSIs) and its association with anthropometrics, pubertal-stage, bone properties, and muscle strength during two years. Study design Follow-up. Setting Gymnasium. Participants 129 female competitive gymnasts (aged 11.6 ± 1.8yrs). Main outcome measures Gymnasts were clinically evaluated at baseline, after one-year (first follow-up) and after two-years (second follow-up) for BSIs, anthropometrics, training-volume, puberty, bone-status, and muscle-strength. Results Prevalence of BSIs was significantly higher in pre-pubertal (64.7 %) compared to entering-puberty (30.9 %) and late-pubertal gymnasts (4.4 %) (p = 0.032). Tibial-strength and muscle-strength were significantly higher in gymnasts with no-BSIs compared with those with =2 episodes of BSIs (p < 0.001 and p < 0.05, respectively). Significant interactions (timeXBSIs) were found for bone-status (F(2, 254) = 4.296, p = 0.015), and for plantar-flexors and knee-extensors muscle-strength (p = 0.019 and p = 0.002, respectively). Nominal-regression showed that reduced tibial-strength, reduced plantar-flexors, pre-puberty and entering-puberty differentiated between participants with =2 episodes of BSIs and non-injured (p < 0.05). Conclusions Pre-pubertal gymnasts had the highest prevalence of clinical-BSIs compared with entering-puberty and late-pubertal gymnasts. Reduced tibial-strength, reduced muscle-strength, and being pre- or entering-puberty were parameters associated with BSIs in two or three of the assessments. Screening gymnasts from young age and implementing injury-prevention programs may reduce bone injuries. Highlights • BSIs is highly prevalent among pre-pubertal female gymnasts. • Lower tibial bone status, reduced muscle strength and being pre- or entering-puberty were associated with two or more episodes of BSIs during a two-year follow-up period. • The high incidence of BSIs among pre-pubertal gymnasts highlights the need for implementation of prevention strategies.
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