Introduction

Gymnastics is a sport that requires grace, strength, and flexibility, which can lead to a wide range of ailments². It was first mentioned in writing 4000 years ago in Egypt and was added to the Olympic Games in 700 BC¹. Extreme upper and lower body strength is needed. ³

Gymnasts can sustain injuries at a rate of 1.08 to 50.3 per 1000 hours of exposure. Compared to practice, competition results in more injuries. Recreational gymnastics is less likely to result in injuries than competitive gymnastics. Ankle sprains are the most frequent lower extremity injuries in gymnastics, followed by internal derangements of the knee. But in men’s gymnastics, upper body injuries—more especially, shoulder injuries—are the most frequent. The most frequent abilities that result in injuries for gymnasts are flips and front/back handsprings. Spondylolysis, ostoechondritis dissecans of the capetillium and talus, gymnast wrist, grip lock, patellofemoral syndrome, Sever’s disease, and ankle sprains are uncommon ailments that are frequently observed when caring for the young gymnast.¹

Predicting the result and harmful nature of particular behaviour is ultimately necessary for injury prevention. In addition to having a thorough understanding of the technical and medical components of damage, making such forecasts necessitates a deep understanding of the sport. Efforts to prevent injuries must be based firmly on science and medicine and make practical connections to gymnastics as it is currently practiced.⁷

·       Risk that are ignored by gymnasts.

1.Pits that are not filled to the top with foam, are too shallow, or not padded properly.

2. Mats that are old and have lost both their resiliency and absorbency.

3. Inadequate matting for the nature of the skill being performed.

4. Gymnasts that are not properly conditioned to withstand the stresses

and strains of training and competition.

5. Poor understanding of the mechanics of safe skill performance

6. Practicing while fatigued

7. Too much confidence in spotting

8.Poor spotting skills

9. Unwarranted and disruptive parental intrusions

 Injury is certainly dangerous, and the goal of all safety initiatives is to eliminate inadvertent risks of harm. Therefore, deliberate countermeasures that can be utilised to stop an injury’s threat, decrease its likelihood, and lessen its impact are what link safety and injury prevention⁸

The HE program consisted of breathing and postural awareness exercises in addition to 5 basic HE poses performed three times each.

Hypopressive exercise (HE) has gained interest as a postural and breathing programme for deep trunk muscle training. In addition, team sports professionals have lately begun utilising HE as an exercise rehabilitation approach and a neuromuscular injury prevention technique. In order to activate the deep core stabilising musculature without putting pressure on the pelvic tissues, HE blends postural corrective poses with targeted breathing techniques. A deep, slow, latero-costal breath accompanied with an end-expiratory apnea linked to rib cage expansion is the conventional breathing technique. There are two more names for this breath-holding technique: "diaphragmatic aspiration" and "abdominal vacuum." HE has been proposed as a method of training for core stability.⁴ Core evaluation must be dynamic and include special functions (planted leg tension control) and evaluation of movement directions (three-level function). Rehabilitation must include restoration of the core itself, as well as the core as the basis of limb function.¹¹

Hypopressive exercise (HE) is contraindicated in patients with CVD because it involves isometric positions performed with low lung volume, which is thought to increase blood pressure.

Neuromuscular training is a strength and conditioning method that combines sport-specific and core movements, including balance, core strength and dynamic stability. The goal of a neuromuscular training program is to optimize performance, prevent injury or rehabilitate⁶

The Y-Balance Test (YBT), derived from the Star Excursion Balance Test (SEBT), has been reported to be a valid and reliable measure of dynamic balance. For YBT to be implemented in daily clinical practice, control values ​​are necessary for accurate interpretation of test results.  These standard values ​​to determine the work capacity of patients.⁹  

UQYBT is a reliable UE CKC test that can be used to evaluate one-sided UE performance in closed chain. UQYBT seems to be most related to dynamic tests that deal with core stability and UE performance¹⁰  The YBT-UQ is a tool that can be used to quantitatively analyze an gymnast ability to reach with the free arm while weight bearing on the contralateral upper limb.¹²

NEED FOR THE STUDY:

Balance is a key to any gymnast, whether you are tumbling on the floor, swinging on parallel bars or landing at the end .Therefore learning to maintain balance in a variety of positions is one of the 1^st key to develop.

Core strength is absolute ‘must have’ in gymnasts. The events and skills that they perform requires massive amount of core strength. If there is a problem in core and neuromuscular control then there are chances of instability and injury.  Injury is certainly harmful, and all safety programs involve the prevention of unintentional threats of harm. Thus, safety and injury prevention are linked by intentional countermeasures that can be used to prevent a threat of injury, prevent the likelihood of an injury, and reduce the damage caused by an injury. So, the core muscles should work in coordination to keep the vital organs safe. This also blends in assisting the lungs for breathing.

RESEARCH QUESTION:

Is there any effect of hypopressive exercise programme on dynamic neuromuscular control in semiprofessional gymnasts?

Hypothesis:

Null hypothesis [H0] – There will be no significant effect of hypopressive exercise programme on dynamic neuromuscular control in semiprofessional gymnasts.

Alternative hypothesis [H1] - There will be significant effect of hypopressive exercise programme on dynamic neuromuscular control in semiprofessional gymnasts.

AIM:

To find the effect of hypopressive exercise programme on dynamic neuromuscular control in semiprofessional gymnasts.

OBJECTIVE OF THE STUDY:

1.     To study the effect of Hypopressive exercise programme on improving core strength.

2.     To study the effect of Hypopressive exercise programme on improving balance.

REVIEW OF LITERATURE

1.     Hernández-Rovira, Esther; Rial-Rebullido, Tamara; Alonso-Aubin, Diego A.; and Cañabate Ortiz, Dolors (2024) Conducted A study on "Effects of Hypopressive Exercise on Dynamic Neuromuscular Control in Female Roller-Skaters.  20 competitive female roller-skaters (13-22 years of age, SD 2.25) performed a 30-minute HE session once weekly before the regular roller-skating practice for 6 weeks. The HE program consisted of breathing and postural awareness exercises in addition to 5 basic HE poses performed three times each.  Dynamic neuromuscular control was assessed with the Y-Balance Test (YBT), posterior back chain kinematics with the sit and reach test and peak expiratory flow rate with digital spirometer Significant differences were also revealed between baseline and after the intervention for the sit and reach test (p â‰¤ 0.01) and peak expiratory flow (p = 0.01). No differences in forced expiratory volume in the first second were found (p = 0.04) Findings suggest that a 6-week HE program could be a feasible neuromuscular option for training dynamic balance, posterior back chain kinematics and peak expiratory flow in female roller-skaters.

2.     Teijido SL, Rebullido TR, Gómez-Tomás C, Alonso-Aubin DA, Chulvi -Medrano Conducted a study on Effects of Hypopressive Exercise on Posterior Back Chain Kinematics and Pulmonary Function in Professional Female Basketball Players. Journal of Sport Rehabilitation. [2021 Dec 20].an alternative lumbo-pelvic injury prevention program and claimed to be a means of respiratory and flexibility improvement.: A total of 17 professional female basketball players (mean age 20.7 y, SD: 3.50; body mass index, 21.71, SD: 1.69). Participants performed 8 HE weekly sessions of 30 minutes. The analysis of variance revealed significantde been proposed as a new paradigm in rehabilitating the pelvic floor. Its claims contraindicate the recommendation for pelvic floor muscle training during the postpartum period. Obective :To determine whether hypopressive abdominal gymnastics is more effective than pelvic floor muscle training or other alternative conservative treatments for rehabilitating the pelvic floor. Results: Hypopressive gymnastics is less effective than pelvic floor muscle training for activating pelvic floor muscles, achieving closure of the levator hiatus of the anus and increasing pelvic floor muscle thickness, strength and resistance differences between the 3 measurement periods for thoracic mobility (P > .01); forced expiratory volume in the first second (P < .05) while no statistical differences were found for the rest of spirometry outcomes. Significant differences were also revealed between baseline and after the intervention for the sit and reach test (P > .01), peak expiratory flow (P = .01), and forced expiratory volume in the first 25 seconds (P = .04). Also, significant differences between weeks were found in levels of lumbar pain (P = .003) and the finger to floor test (P = .002). Finding : HE program can improve posterior back chain and chest wall kinematics as well as lower lumbar pain levels. However, no gains seem to be observed for the majority of pulmonary variables except for peak expiratory flow and forced expiratory volume in the first seconds.

3.     Bellido-Fernández L, Jiménez-Rejano JJ, Chillón-Martínez R, Lorenzo-Muñoz A, Pinero-Pinto E, Rebollo-Salas M.  Conducted a study on Clinical relevance of massage therapy and abdominal hypopressive gymnastics on chronic nonspecific low back pain: A randomized controlled trial. Disability and Rehabilitation. [2022 Jul 31]; The sample included 60 adults with CNSLBP. The participants received MT (n = 20), AHG (n = 20), or MT + AHG (n = 20). Each group received 8 interventions. Result found was The ODI change scores were significantly higher (p < 0.05) in the MT + AHG group than in the other two groups. Significant differences were found in the results of NRS, Schober’s test, and SF-12 PCS (p < 0.05) in each group. There were significant differences (p < 0.05) between the values of SF-12 MCS in AHG and MT + AHG groups. The combination of both therapies provides more benefits in terms of lumbar disability in patients with CNSLBP in the short term. This improvement is clinically relevant.

4.     Mendez-Rebolledo G, Olcese-Farias Y, Brown-Villegas D. conducted a study Balance control in artistic gymnasts and its comparison under three training methods: a pilot trial. Human Movement. [2022;23]. 33 female artistic gymnasts were selected and randomly assigned to 3 training groups: CONV, SEBT, or NM. The Y-Balance Test evaluated balance control. ANOVA (group × time) with repeated measures was used to compare the effects of training. In the dominant lower limb, significant pre- and post-intervention differences were observed for SEBT training in the posteromedial direction (p = 0.0003; % change = 13.4), as well as in NM in the anterior (p = 0.0001; % change = 23.9), posteromedial (p = 0.0001; % change = 23.1), and total index (p = 0.0001; % change = 17.8) of the Y-Balance Test. Moreover, NM training presented significant differences compared with CONV (p = 0.0001; % change = 14.0) and SEBT (p = 0.0001; % change = 12.8) in the posteromedial direction; it also exhibited differences compared with CONV (p = 0.0392; % change = 8.8) and SEBT (p = 0.0065; % change = 11.3. Results in a significant improvement in balance control compared with CONV and SEBT training in female artistic gymnasts.

5.     de Viñaspre Hernández RR.  Conducted a study on Efficacy of hypopressive abdominal gymnastics in rehabilitating the pelvic floor of women: A systematic review. Actas Urológicas Españolas (English Edition. [2018] [Nov 1] Hypopressive abdominal gymnastics has been proposed as a new paradigm in rehabilitating the pelvic floor. Its claims contraindicate the recommendation for pelvic floor muscle training during the postpartum period. Obective :To determine whether hypopressive abdominal gymnastics is more effective than pelvic floor muscle training or other alternative conservative treatments for rehabilitating the pelvic floor. Results: Hypopressive gymnastics is less effective than pelvic floor muscle training for activating pelvic floor muscles, achieving closure of the levator hiatus of the anus and increasing pelvic floor muscle thickness, strength and resistance.

6.     KriÅ¡tofič J, Malý T, Zahálka F. Conducted a study on  THE EFFECT OF INTERVENTION BALANCE PROGRAM ON POSTURAL STABILITY. Science of Gymnastics Journal.[ 2018 Jan 1]. The experimental group (n = 18) performed a specific balance program in addition to their regular training sessions and the control group (n = 15) underwent their normal sport regim The multi-sensory FOOTSCAN platform was used for the posturographic examination. We evaluated the parameters Centre of Pressure (COP) in the tests: narrow standing position with (NS-VC) and without (NS-WC) visual control, flamingo stance on the preferred leg (FPL) and non-preferred leg (FNL). results revealed a significant effect of time on changes in PS in bipedal tests regardless of group and visual control (F1,62 = 4.65, p = 0.03, η2 p = 0.07). Visual control had a significant effect on PS in both groups (F1,62 = 12.55, p = 0.001, η2 p = 0.17). The intervention program had a significant effect on PS in one leg standing position (FPL: COPpretest = 1006.01 ± 396.17 mm, COPpost-test = 875.78 ± 284.24 mm, t17 = 2.34.

7.     Vicente-Campos D, Sanchez-Jorge S, Terrón-Manrique P, Guisard M, Collin M, Castaño B, Rodríguez-Sanz D, Becerro-de-Bengoa-Vallejo R, Chicharro JL, Calvo-Lobo C. Conducted a studyon The main role of diaphragm muscle as a mechanism of hypopressive abdominal gymnastics to improve non-specific chronic low back pain: a randomized controlled trial. Journal of Clinical Medicine[2021 Oct 27];  objective of this study was to determine the effects of an 8-week program of hypopressive abdominal gymnastics (HAG) on inspiratory muscle strength, diaphragm thickness, disability and pain in patients suffering from non-specific chronic LBP. Methods: A total of 40 patients with chronic LBP were randomly divided into two groups. The experimental group carried out an 8-week supervised program of HAG (two sessions/week), whereas the control group did not receive any treatment. Outcomes were measured before and after the intervention, comprising diaphragm thickness during relaxed respiratory activity, maximal inspiratory pressure (PI_max), pain intensity (NRS), pressure pain threshold and responses to four questionnaires: Physical Activity Questionnaire (PAQ), Roland–Morris Disability Questionnaire (RMQ), Central Sensitization Inventory (CSI) and Tampa Scale of Kinesiophobia-11 Items (TSK-11). Results: Statistically significant differences (p < 0.05) were observed for greater thickness of the left and right hemi-diaphragms at inspiration, as well as higher PI_max and decreased NRS, CSI and RMQ scores in the intervention group. After treatment, the increases in the thickness of the left and right hemi-diaphragms at inspiration and PI_max, as well as the decrease in the NRS and RMQ scores, were only predicted by the proposed intervention (R² = 0.118–0.552).

8.     Wojcik KA, Machado LT, DE BRITO CI, Rebullido TR .Conducted a study that, Can 5-weeks of  Hypopressive Exercise Influence Sagittal Lumbo-Pelvic Position in Athletic and Non-Athletic Females?. International Journal of Exercise Science[ 2023].  The aim of this study was to compare the effects of HE on the sagittal lumbo-pelvic posture in athletic and non-athletic females. It was hypothesized that a 5-week training program of HE could influence lumbo-pelvic position while reducing abdominal circumference and low back pain in athletic and non-athletic females. Twenty normoweight females (mean age = 24.8 (SD 3.5) years; body mass index = 22.4 (SD 1.6) kg/m2) participated in this study. Ten athletic females were rugby players (RG), and 10 females were non-athletic (SG). Participants completed twenty minutes of HE twice weekly for 5 weeks. Before and after the intervention, two-dimension photogrammetry was used to assess lumbar lordosis and pelvic horizontal alignment. A Visual Analog Scale was used to assess low back pain and cirtometry was used to assess abdominal circumferences at umbilical, supra and infra-umbilical levels. An analysis of variance between moments revealed no significant differences in lumbar lordosis and pelvic positioning but showed significant differences for abdominal circumferences between groups. No significant differences between groups were found for other variables. Significant correlations were found between the three different abdominal circumference measurements (p > 0.05) but not between lumbar lordosis and abdominal circumferences. These preliminary findings indicate that a 5-week HE intervention displayed non-significant changes in lumbar lordosis, pelvic horizontal alignment, and low back pain but a significant reduction in abdominal circumferences in non-athletic and athletic females.

9.     Mitova S, Avramova M, Gramatikova M. Conducted a study on Effectiveness of hypopressive gymnastics in women with pelvic floor dysfunction. Journal of Physical Education and Sport. [2022 Feb]. This study aims to trace the effect of hypopressive and specialized Kegel exercises in women with this problem. Methodology: UDI-6, IIQ-7 Questionaire and Kiel test for abdominal, back and gluteal musculature are used for assessment of the patients. Fourty-seven women were recruited and randomly divided in tree– experimental group 1 (EG 1 N=15), experimental group 2 (EG2 N=16) and experimental group 3 (EG3 N=16). For the women of EG 1 therapy includes – Hypopressive exersice, the EG 2 received Kegel exercise and EG 3 received – a combination of both. Every women received five procedures per week for 3 months. Assessment form were done before and after therapy. Results: Initial measurements from the Kiel test for abdominal muscles for EG 1 is 17.00±3.07 sec. and finally achieve 32.07±5.47 sec. The EG 2 initial values are 18.75±2.89 sec. and 43.75±7.24 sec. after treatment. For EG 3 was 17.63±4.06 sec. and 53.31±4.27 sec. We compare the results obtained after treatment between EG 1 and EG 2, EG 2 and EG 3 and EG 1 and EG 3. There were no differences between tree groups after analyze the results of UDI-6 questionnaire. The mean values of IIQ-7 for the EG 1 were as follows: 70.56±2.48 before and 50.48±2.8 after hypopressive exercise. For the EG 2 mean values before treatment were 69.98 ±3.26, and decrease to 45.53±3.28 after treatment. There were no statistically significant differences between EG 1 and EG 2. For the EG 3 mean values before treatment were 72.69±3.37, and decrease to 37.14±2.8 after treatment.

10.  Da Cuna-Carrera I, Alonso-Calvete A, Soto-González M, Lantarón-Caeiro EM.  Conducted a study on How do the abdominal muscles change during hypopressive exercise ? Medicina [2021 Jul 9]. The aim of this study was to examine the thickness of abdominal muscles at rest and during hypopressive exercise in supine and standing positions with ultrasound imaging in healthy adults. Methods: A cross-sectional study was carried out in 99 healthy university students. The thickness of the abdominal muscles at rest and during hypopressive exercise was assessed with ultrasound imaging in supine and standing positions. Results: During hypopressive exercise, there was a significant increase in the muscle thickness of transversus abdominis (p < 0.001) and internal oblique (p < 0.001) in supine and standing positions. External oblique only increased its thickness significantly in the standing position (p < 0.001) and rectus abdominis did not change during the hypopressive exercise in any position (p > 0.05). In conclusion, hypopressive exercises seem to increase the thickness of the deepest and most stabilized muscles such as transversus abdominis and internal oblique.