Objective:​ To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's gymnastics and identify potential areas for injury prevention initiatives.

Background:​ In the 1988–1989 academic year, 112 schools were sponsoring varsity women's gymnastics teams, with approximately 1550 participants. By 2003–2004, the number of varsity teams had decreased 23% to 86, involving 1380 participants. Significant participation reductions during this time were particularly apparent in Divisions II and III.

Main Results:​ A significant annual average decrease was noted in competition (­­­−4.0%, P < .01) but not in practice (­­­−1.0%, P = .35) injury rates during the sample period. Over the 16 years, the rate of injury in competition was more than 2 times higher than in practice (15.19 versus 6.07 injuries per 1000 athlete-exposures;​ rate ratio = 2.5, 95% confidence interval [CI] = 2.3, 2.8). A total of 53% of all competition and 69% of all practice injuries were to the lower extremity. A participant was almost 6 times more likely to sustain a knee internal derangement injury in competition than in practice (rate ratio = 5.7, 95% CI = 4.5, 7.3) and almost 3 times more likely to sustain an ankle ligament sprain (rate ratio = 2.7, 95% CI = 2.1, 3.4). The majority of competition injuries (approximately 70%) resulted from either landings in floor exercises or dismounts.

Recommendations:​ Gymnasts with a previous history of ankle sprain should either wear an ankle brace or use prophylactic tape on their ankles to decrease the risk of recurrent injury. Preventive efforts may incorporate more neuromuscular training and core stability programs in the off-season and preseason conditioning to enhance proper landing and skill mechanics. Equipment manufacturers are encouraged to reevaluate the design of the landing mats to allow for better absorption of forces.