Episode 67 Elspeth "Elly" Hart - How Many Did You Lose to Get One Olympian? The Hidden Cost of Elite Youth Gymnastics

The American Olympic gymnastics team is doing exceptionally well, but at what cost? With kids us young as 12 doing between 30 and 40 hours of training a week, gymnastics is easily one of the most physically demanding youth sports in the world. So what happens when training loads rise faster than growing bodies can handle?In this episode, Elspeth (Elly) Hart, Physician Assistant, Certified Athletic Trainer, and gymnastics medicine specialist at Boston Children’s Hospital, joins host Andrew Rizza to explore the unique medical realities of caring for young gymnasts.The conversation examines why gymnastics requires a sport-specific approach to injury diagnosis and treatment, particularly in young athletes with open growth plates and high repetitive loading. Dr. Hart explains why persistent back pain in gymnasts should never be dismissed, how spinal stress injuries can become lifelong problems if missed, and why early intervention can dramatically improve healing outcomes.The discussion also explores “gymnast wrist,” overtraining culture, mental health pressures, and the challenge of balancing elite performance with long-term wellbeing. Dr. Hart also clarifies why emerging AI technology is likely to help reshape injury prevention in the sport.MEET THE GUESTElspeth "Elly" Hart, DScPAS, PA-C, MPAS, ATC, LAT- Physician Assistant & Certified Athletic Trainer - Micheli Center for Sports Injury Prevention, Boston Children's Hospital - Medical Staff, USA Gymnastics - Founder, Gymnastics Medicine: Education and ResearchTOPICS DISCUSSED- Why gymnastics medicine emerged as its own subspecialty - Training load, sports specialization, and when overuse injuries begin in gymnastics- Spondylolysis and the protocol for healing it - What “gymnast wrist” is and why it is often missed- How AI and wearables could finally bring evidence-based load management to the sport- Mental health as a clinical priority HIGHLIGHTS01:29 – Dr. Hart's Journey into Gymnastics Medicine04:51 – Sponsor: Boston Orthopedics and Wellness05:55 – Gratitude for the Work of Dr. Micheli07:41 – ATC and PA Dual Credentialing & Gymnast Experience09:19 – Competitiveness in Athlete Care12:00 – Gymnast Training Loads, Injury Risk, and Age14:26 – USA Gymnastics Safety Criteria18:11 – AI & Technology for Load Monitoring23:31 – Common Gymnastics Injuries27:24 – Spondylolysis Treatment Protocol30:54 – Long-Term Risks of Untreated Injuries32:45 – Gymnast's Wrist: Signs & Symptoms35:54 – Implementing Off-Season Rests in Gymnastics38:54 – Injury Prevention Strategies for Gymnasts42:32 – Supporting Athlete Mental Health47:28 – Key Tools for Clinicians Treating Gymnasts51:35 – Lightning Round: Injury Prevention Exercises & AdviceQUOTES:17:52 – "My big question is, how many athletes did you lose to get that one athlete? And what are those athletes who didn't make it to the Olympics, how are they doing? How are their bodies? How are they recovering?”13:19 - “My first age of where we're really seeing the repetitive overuse is starting around age 10, but usually maybe even up until 13 or 14. But I have yet to meet a gymnast who has not had an overuse injury before, or I should say after, the age of 14.” 17:38 - “But I think the trouble is that, to be totally honest, our team is doing so great. We have won so many Olympic games, so a lot of coaches don't want to change the way that they're coaching because it's successful, right? It's creating an Olympic athlete." LINKS Elspeth (Elly) Hart on LinkedIn — https://www.linkedin.com/in/elspeth-elly-hart-252b06150/ Boston Children's Hospital – https://www.childrenshospital.org Micheli Center for Sports Injury Prevention – https://www.themichelicenter.com Gymnastics Medicine Education and Research – https://gymnasticsmedicine.org “Common upper extremity gymnastics injuries and gymnastic specific return to play protocols” — https://pubmed.ncbi.nlm.nih.gov/40433250/ SPONSORBrought to you by Boston Orthopedics and Wellness — helping you recover faster, move better, and perform at your best with advanced orthopedic and wellness care.Get 15% off your first visit: https://www.bostonorthopedicandwellness.comDISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed.#SportsMedicine #Gymnastics #YouthSports #InjuryPrevention #PediatricSportsMedicine