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Some sports look grueling — ice hockey, soccer, basketball, for example, with their yards of stops and starts, feints and runs. Others, like gymnastics, appear effortless and soaring. But in the first national study of gymnastics injuries, conducted by researchers at Nationwide Children's Hospital in Columbus, Ohio, 16 years of data show that there is nothing easy at all about gymnastics, and that injuries from the sport are as common as those in soccer, basketball and ice hockey — making gymnastics among the most dangerous sports for girls.

The findings don't surprise elite gymnasts, who endure hours of punishing training every day. "I always thought that gymnastics is one of the hardest sports, if not the hardest," says Carly Patterson, the reigning Olympic women's champion. "The amount of hours we train, it's a lot for your body, and there are going to be times when you get hurt." Such injuries can sometimes be life-threatening: last summer, Wang Yan, a Chinese Olympic gymnast who was competing at her national championships, fell head-first from the uneven bars and broke her neck; in 1998, another Chinese gymnast, Sang Lan, then 16 and competing at the Goodwill Games in New York City, fell while performing a warm-up vault and fractured her spine. Both athletes were paralyzed and are not likely to walk again.

Most injuries are not as grave as that. The Ohio survey, which analyzed data from the Consumer Product Safety Commission, included reports from 100 U.S. emergency rooms between 1990 and 2005. Five of every 1,000 children, ages 6 to 17 — about 27,000 children in all — who participated in some form of gymnastics sought medical care in the ER each year for a gymnastics-related injury. About 97% of the children were treated and released, mostly with sprains or strains — serious injuries, but not severe enough to require admittance to the hospital.

The majority of these injuries occurred in a supervised setting, such as in a gymnastics program at school (40%) or a competitive gymnastics club (39%). But the good news, according to the study, is that the overall rate of gymnastics injuries dropped 25% between 1990 and 2005. Much of that decline has to do with better equipment and improved safety measures. In the past, as gymnast Patterson recalls, the "horse" used for vaulting was much smaller and narrower, making certain maneuvers especially hazardous. "The horse used to be long and skinny, with only a limited space to put your hands. When you are doing a flip-flop onto it, you basically have to go to the right spot every single time, and that was a little scary. A lot of times, I would see people's hands slipping off, or missing the horse completely." The horse has since been remade longer and wider, to increase safety.

Shannon Miller, a two-time Olympic gold medalist and the most decorated U.S. gymnast in history, remembers other changes to the vault as well, including a larger, padded safety zone around the take-off point. "I remember it was a big thing in the gymnastics world," she says, when the International Gymnastics Federation's new rules required the springboard to be surrounded by a horseshoe-shaped mat. "You wouldn't get credit for the vault if you didn't have a safety mat," says Miller. "Before that, it was just the springboard, and if you launched crooked, then you were going to get hurt." Today, safety mats around all of the apparatuses are thicker, and better padded; officials are even talking about adding more spring to the floor exercise mat to reduce the pounding stress on bones and joints from tumbling.

"There are a lot of things that have been done to make gymnastics safer," says Miller, "but you can always do more." One measure would be to certify gymnastics coaches and clubs on a national level, ensuring a basic level of safety standards. No such system currently exists, but Steve Penny, president of USA Gymnastics, says his organization is hoping to create a USA Gymnastics University, whose goals will be to educate and certify coaches on training and safety practices. For now, parents should be looking for gyms that employ USA Gymnastics professionals and coaches, who are required to complete a safety certification that is renewed every two years.

As beautiful and fun as gymnastics is to watch, it's worth remembering that it is a sport, and that the safest way to enjoy practicing it is with trained professionals who can properly train and prepare young children. "You can't play at gymnastics," says Miller. "You shouldn't do pick-up gymnastics in your backyard. If you're doing it right, everything from your little toe to your little finger is constantly in motion. Everything is flipping, moving or turning. It works the entire body in a way no other sport does, and the more body parts that are moving, the more you are open to injuries. So, safety should absolutely be the number-one concern. And the more we document and learn about these injuries — what they are and how they are caused — the better we can prevent them in the future."

• Alice Park