INTRODUCTION Gymnastics is a highly demanding sport with high impact and repetitive stresses on the musculoskeletal system and in particular the spine.

METHODS A retrospective analysis of the injuries recorded over a period of 10 years (2007-2018) in 156 elite Greek Gymnasts competing in international level was performed. A total of 2390 injuries were recorded for a rate of 1,5 new injuries per athlete per year.

RESULTS Acute low back pain that kept the athlete out for an average of 3 training sessions was the most common pathology (20%). Degenerative disk changes (end plate changes, disc dehydration) were found in 25% of 48 lumbar MRI scans performed for persisting low back pain. Established spondylolysis was rare (3%) but MRI detected pedicle bone marrow oedema was more frequent (8%). Hyperextension of the spine during dismount from high bar or floor exercises was reported as mechanism of injury by most athletes. The thoracic spine was least affected (0,7%) but was related with more severe injuries. Neck injuries (mostly muscle sprains) were less frequent (2,8%), but resulted in longer absence from training. Rhythmic gymnasts had significantly more overuse type injuries compared to artistic gymnasts (p = 0.049). The majority of injuries were conservatively treated with physiotherapy, core stability and staged return to sport. Spine surgery was necessary only in 3 cases: a T10 fracture with paraplegia after a trampoline accident, a female athlete with severe Scheuermann kyphosis and a male gymnast with lumbar disk herniation.

DISCUSSION Gymnastics is a sport with a high incidence of musculoskeletal pathology - mostly overuse type of injuries. Few studies have addressed the issue of spinal injuries in gymnastics and there is a lack of documentation in order to establish preventive measures. A detailed evaluation of the mechanism of injuries is needed in order to assist sport authorities in revisiting the Code of Points and improve the safety of athletes.