Prevention Of Achilles Tendon Ruptures In Female Gymnasts By NSAIDs And Maintenance Of Floor Equipment

One in five female collegiate gymnasts suffers an Achilles tendon rupture (ATR). Many gymnasts suffer from chronic tendinitis and use non-steroidal anti-inflammatory drugs (NSAIDs) for pain management. There is anecdotal evidence that ATRs occur more frequently during competition than training. Training floors are used daily, sometimes for over 10 years, while floors at competition sites are often new and well-serviced. Consequently, training floors feel “soft” and worn-out, while competition floors feel “stiff”. PURPOSE: To test the hypothesis that NSAIDs prevent ATRs, potentially through their anti-inflammatory action. In addition, we hypothesized that mechanical floor properties partly determine tendon strain during floor exercise. METHODS: Gymnasts from 78 US collegiate teams were invited to complete a survey. In addition, ankle joint angles as a proxy of tendon strain during landing from back-tumbling-take-offs on “soft” and “stiff” gymnastics floors were determined using video imaging. RESULTS: Of 103 female gymnasts, 21 (20.4%, 95% CI: 13.6% to 29.4%) experienced an ATR. Of the 21 ruptures, 20 occurred during takeoff. Relative to the number of gymnastics hours, ATRs occurred 23-times as frequently at competition compared to training sites (P < 0.05). NSAID use was higher in gymnasts without tendon rupture (27.6%, 95% CI: 18.6% to 39.0%) compared to gymnasts with rupture (5.5%, 95% CI: 0.6% to 35.5%). This effect of NSAID use was confirmed by multiple linear regression analysis, identifying NSAID use (P < 0.05) as a negative predictive factor. Ankle joint angles were in a more dorsiflexed position on a stiff (103.5 ± 1.1 degree) than on a soft floor (117.0 ± 4.1 degree, P < 0.05). CONCLUSION: Our data suggest that NSAIDs prevent ATRs, potentially through lessening chronic tendinitis. Our data also demonstrates that the mechanical properties of the gymnastics floor equipment at least partly determine Achilles tendon strain. These outcomes provide a strong rationale for future studies investigating which gymnasts may benefit from prophylactic NSAID use. Furthermore, preventing softening of training floors by better maintenance and service, may condition the musculoskeletal system of gymnasts during training for the tendon strain experienced on well-serviced competition floors.