Marte Charlotte Dobbertin Gram

• Gram, Marte Charlotte Dobbertin; Fagerland, Morten & Bø, Kari (2026). PHYSICAL CAPACITY OF HIGH-LEVEL RHYTHMIC GYMNASTS. Science of Gymnastics Journal (ScGYM). ISSN 2232-2639. 18(1), p. 97–111. doi: 10.52165/sgj.18.1.97-111. Full text in Research Archive Show summary

  Overuse injuries in the lower back, knees and hip/groin are common among competitive rhythmic gymnasts. The aetiology and mechanisms are multifactorial, and insufficient physical capacity relative to sport specific requirements may be one of several factors causing overuse injuries. The aims of the present study were to investigate strength and flexibility in the lower back, knees and hip/groin in relation to requirements within rhythmic gymnastics (RG), and to identify possible adverse movement patterns that can be targeted through exercises in future injury prevention research. This was a cross-sectional clinical study where all rhythmic gymnasts in a Northern European country’s national team and their recruitment group were invited to participate. The clinical assessment followed a standardized test protocol and consisted of selected tests on strength, flexibility and RG-specific movements. Background variables (anthropometrics, weekly training hours, previous injuries, present health problems and other health measures) were collected in an electronic questionnaire. Twenty of 24 rhythmic gymnasts (83%), aged 12-19 years, participated. Seven selected tests not previously tested for reliability underwent a test-retest of intra-rater reliability in 10 gymnasts. Intraclass correlation coefficient (ICC) values ranged from 0.84 to 0.98 and Cohen’s kappa values ranged from 0.74 to 1.0. The clinical tests identified insufficient strength and ability to transform passive range of motion into active range of motion. In addition, adverse movement patterns related to lower back (one-segment hyperextension) and knee (valgus) were observed. Randomized controlled trials are needed to study the effect of incorporating these findings into an injury prevention program within RG.

• Gram, Marte Charlotte Dobbertin; Fagerland, Morten & Bø, Kari (2025). Pelvic floor muscle training by competitive rhythmic gymnasts at regular training sessions did not reduce urinary incontinence: a cluster-randomised trial. Journal of Physiotherapy. ISSN 1836-9553. 71(2), p. 117–124. doi: 10.1016/j.jphys.2025.03.006. Full text in Research Archive Show summary

  Question What is the effect of an expanded warm-up program including pelvic floor muscle training (PFMT) compared with usual warm-up on bother and prevalence of urinary incontinence (UI) among rhythmic gymnasts? What is the self-perceived effect of PFMT, including its progression over time, assessed via the global rating of change? Design A cluster-randomised controlled trial with concealed allocation and intention-to-treat analysis. Participants Gymnasts had to be ≥ 12 years of age and training in rhythmic gymnastics ≥ 3 days/week. Twenty-three rhythmic gymnastics clubs were randomised to an experimental group (12 clubs, 119 gymnasts) or a control group (11 clubs, 86 gymnasts). Intervention The experimental group performed one set of 8 to 12 near-maximum pelvic floor muscle contractions and exercises for the knees, lower back and hip/groin as warm-up before each training session for 8 months. The control group continued rhythmic gymnastics training as usual without PFMT or additional lower back and lower limb exercises. Outcome measures Primary outcomes were bother from UI (score 0 to 21) and prevalence of UI, each measured by the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI-SF). The secondary outcome measure was the self-perceived effect and its progress over time, assessed using the global rating of change (–5 to 5). Results The difference between the groups in the ICIQ-UI-SF total score (ie, UI bother) was clearly negligible (MD –0.48, 95% CI –1.27 to 0.31). The prevalence of UI reduced from 46 to 41% in the experimental group and increased from 32 to 34% in the control group; despite this, the risk difference at 8 months was negligible (RD 0.07) and the confidence interval spanned mainly negligible effects (95% CI –0.08 to 0.21). Experimental group participants rated their global change at a mean of 2.1 (SD 1.7). Conclusion Eight months of warm-up before rhythmic gymnastics training sessions that included one set of 8 to 12 near-maximum PFM contractions did not reduce UI bother. The effect on UI prevalence was also likely to be negligible, despite experimental group participants perceiving benefit from the intervention.

• Gram, Marte Charlotte Dobbertin; Fagerland, Morten & Bø, Kari (2025). Efficacy of a Rhythmic Gymnastics-Specific Injury Prevention Program: An Assessor-Blinded Cluster-Randomized Controlled Trial. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 35(2). doi: 10.1111/sms.70022. Full text in Research Archive Show summary

  Overuse injuries are common among competitive rhythmic gymnasts, with an estimated weekly prevalence of 37% and with the knees, lower back, and hip/groin as the most common injury locations. Reduced physical capacity (e.g., strength and flexibility) has been hypothesized to contribute to the high prevalence of overuse injuries. The primary objective of this trial was to assess if exercises targeting reduced physical capacity in the knees, lower back, and hip/groin reduce the prevalence of overuse injuries compared with usual training. Twenty-three rhythmic gymnastics clubs were cluster-randomized to an intervention group (IG: 12 clubs and 119 gymnasts) and a control group (CG: 11 clubs and 86 gymnasts). Included gymnasts had to be ≥ 12 years of age and training ≥ 3 days per week. The IG performed a targeted injury prevention program (IPP) during training/warm-up for 8 months (November 2022 to June 2023). The CG performed usual training. The prevalence of overuse injuries in the targeted locations was measured monthly in both groups using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2). The response rate to OSTRC-H2 was 94%. There was no difference in the prevalence of overuse injuries in the targeted locations between the two groups; odds ratio = 0.86 (95% CI 0.32 to 2.29); p = 0.77 for intervention vs. control. The results suggest that a targeted IPP alone is not enough to prevent overuse injuries in the knees, lower back, and hip/groin among competitive rhythmic gymnasts. Other measures (e.g., load management and proper training planning) might be targeted in future studies.Trial Registration:ClinicalTrials.gov: NCT05506579

• Schulz, Marina; Bø, Kari & Gram, Marte Charlotte Dobbertin (2024). Knowledge and Communication About the Menstrual Cycle Among Rhythmic Gymnasts, Ballerinas, and Dancers. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 22(1). doi: 10.3390/ijerph22010013. Full text in Research Archive Show summary

  While moderate exercise supports regular menstrual cycle (MC) function, many female athletes experience MC symptoms that negatively influence their training and performance. Hereby, knowledge and communication about this topic are important to promote an athlete’s health and wellbeing. Hence, this study aimed to assess the knowledge and communication surrounding the MC among Norwegian rhythmic gymnasts, ballerinas, and dancers. In total, 116 rhythmic gymnasts, ballerinas, and dancers aged ≥ 16 years training ≥ 3 days per week completed an electronic questionnaire. Of these, 63% (n = 73) reported a lack of knowledge about the MC’s influence on physical fitness and performance, and 39% (n = 45) rated their coaches’ or pedagogues’ knowledge as low. With only 32% of participants discussing the MC with their coaches/pedagogues, communication was found to be limited. Seventy-three percent felt uncomfortable during training or competition due to their attire and recommended darker colors and more options in size and layering. The study highlights a significant gap in knowledge and communication about the MC among female athletes and coaches/pedagogues in aesthetic sports. It also recommends improving athletes’ choice of attire for greater comfort and confidence.

• Gram, Marte Charlotte Dobbertin; Clarsen, Benjamin Matthew & Bø, Kari (2020). Injuries and illnesses among competitive Norwegian rhythmic gymnasts during preseason: a prospective cohort study of prevalence, incidence and risk factors. British Journal of Sports Medicine. ISSN 0306-3674. 55, p. 231–236. doi: 10.1136/bjsports-2020-102315. Full text in Research Archive Show summary

  Objectives: Rhythmic gymnastics is an Olympic sport that demands high training volume from early age. We investigated the extent of, and risk factors for, injuries among competitive Norwegian rhythmic gymnasts. Methods: One hundred and seven of 133 (80.5%) female rhythmic gymnasts (mean age: 14.5 years (SD 1.6), mean body mass index: 18.9 (SD 2.2)) participated. All gymnasts completed a baseline questionnaire and the ‘Triad-Specific Self-Report Questionnaire’. Injuries, illnesses and training hours were recorded prospectively for 15 weeks during preseason using the ‘Oslo Sports Trauma Research Center Questionnaire on Health Problems’ (OSTRC-H2). Results: Response rate to OSTRC-H2 was 97%. Mean overuse and acute injury prevalence were 37% (95% CI: 36% to 39%) and 5% (95% CI: 4% to 6%), respectively. Incidence was 4.2 overuse injuries (95% CI: 3.6 to 4.9) and 1.0 acute injuries (95% CI: 0.5 to 1.6) per gymnast per year. Overuse injuries in knees, lower back and hip/groin represented the greatest burdens. Previous injury increased the odds of injury (OR 30.38, (95% CI: 5.04 to 183.25)), while increased age (OR 0.61 per year, (95% CI: 0.39 to 0.97)) and presence of menarche (OR: 0.20, (95% CI: 0.06 to 0.71)) reduced the odds of all injuries and substantial injuries, respectively. Conclusions: Overuse injuries were common among Norwegian rhythmic gymnasts. Younger gymnasts had higher all-injury risk. Gymnasts who were not menstruating had higher substantial injury risk. Injury prevention interventions should start at an early age and focus on preventing knee, lower back and hip/groin injuries.

• Gram, Marte Charlotte Dobbertin & Bø, Kari (2019). High level rhythmic gymnasts and urinary incontinence: Prevalence, risk factors, and influence on performance. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. doi: 10.1111/sms.13548. Full text in Research Archive Show summary

  Urinary incontinence (UI) is common among exercising women, but no studies have been found in rhythmic gymnasts. The aims of the present study were to investigate the prevalence and risk factors for UI in rhythmic gymnasts and the impact of UI on performance. This was a cross‐sectional study including all rhythmic gymnasts competing at the highest national and international level in Norway. One hundred and thirty‐three gymnasts from 22 sports clubs were invited to participate. Background data and possible risk factors were collected via electronic questionnaires. UI was assessed by Urinary Incontinence short form (ICIQ‐UI SF). The "Triad‐specific self‐ report questionnaire" was applied to assess the female athlete triad. Joint mobility was assessed by Beighton score. Logistic regression analysis was used to assess possible risk factors. One hundred and seven nulliparous rhythmic gymnasts (80.5% response rate) from 21 sports clubs, with mean age of 14.5 (SD 1.6) years, participated in the study. Thirty‐four (31.8%) reported UI with 21 (61.8%), 3 (8.8%), 6 (17.6%), and 4 (11.8%) reporting stress, urgency, mixed urinary incontinence, and leakage for no obvious reason, respectively. BMI, hypermobility, menarche, disordered eating, and hours of training were not found to be risk factors for stress urinary incontinence. Twenty‐four gymnasts with UI (70.6%) reported incontinence to influence sports performance; 10 (29.4%) reported to be afraid of visible leakage and 5 (14.7%) that the leakage would happen again. Seventy‐four (69.1%) had never heard about the pelvic floor. In conclusion, UI is common in rhythmic gymnasts and may influence sports performance.

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• Gram, Marte Charlotte Dobbertin; Clarsen, Benjamin Matthew & Bø, Kari (2021). Injuries and illnesses among competitive Norwegian rhythmic gymnasts during preseason - a prospective cohort study of prevalence, incidence and risk factors. British Journal of Sports Medicine. ISSN 0306-3674. 55, p. A11–A11. doi: 10.1136/bjsports-2021-IOC.25. Full text in Research Archive
• Gram, Marte Charlotte Dobbertin; Clarsen, Benjamin Matthew & Bø, Kari (2021). Injuries and illnesses among competitive Norwegian rhythmic gymnasts during preseason - a prospective cohort study of prevalence, incidence and risk factors. Full text in Research Archive
• Gram, Marte Charlotte Dobbertin (2026). Overuse injuries, urinary incontinence and menstrual symptoms among Norwegian rhythmic gymnasts and dancers. Norges idrettshøgskole. ISSN 9788250206472. Full text in Research Archive Show summary

  Background: Overuse injuries in the knees, lower back, and hip/groin are common among competitive rhythmic gymnasts. Reduced physical capacity (e.g. strength and flexibility) has been hypothesized to contribute to the high prevalence of overuse injuries. Furthermore, more than 30% of competitive rhythmic gymnasts report urinary incontinence (UI), of which 70% experience a negative influence on sports performance. While pelvic floor muscle training (PFMT) has 1A level of evidence to treat UI in the general female population, there is little evidence about its effect among young female athletes. Female athletes within endurance and team sports report their physical fitness and performance as relatively worse during the early follicular and late luteal phases of the menstrual cycle (MC) due to a high prevalence of physical and psychological MC symptoms. The prevalence of MC symptoms and self-perceived influence of MC on physical fitness and performance among female aesthetic sport athletes and performing artists (e.g. gymnasts, ballerinas and dancers) is unknown. Methods and aims: This PhD project consist of four studies each addressing identified knowledge gaps within injuries and injury prevention, pelvic floor and menstrual health among Norwegian rhythmic gymnasts and dancers. Study I was a cross-sectional clinical study of 20 Norwegian national team rhythmic gymnasts investigating physical capacity in relation to requirements within rhythmic gymnastics (RG), as well as possible adverse movement patterns, in the most common injury locations. Study II and III was a cluster-randomized controlled trial (RCT) comparing the effect of an RG-specific injury prevention program (IPP) on monthly prevalence of overuse injuries in the knees, lower back and hip/groin (study II) and PFMT on bother and prevalence of UI (study III) among competitive Norwegian rhythmic gymnasts. The intervention group (12 RG-clubs, 119 gymnasts) performed the RG-specific IPP and PFMT during each warm-up/RG training for 8 months, while the control group (11 RG-clubs, 86 gymnasts) performed usual warm-up/RG training. The prevalence of overuse injuries in the targeted locations were measured monthly in both groups using the “Oslo Sports Trauma Research Centre Questionnaire on Health Problems” (OSTRC-H2) (study II), while UI bother (score 0 to 21) and prevalence were measured by the “International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form” (ICIQ-UI-SF) (study III). Study IV was a descriptive cross-sectional survey of 116 Norwegian rhythmic gymnasts, ballerinas and dancers, investigating menstrual function, hormonal contraceptive (HC) use, MC symptoms, and self-perceived influence of MC on physical fitness and performance. Results and conclusion: In study I, clinical tests identified insufficient strength and ability to transform passive range of motion into active range of motion, especially in the hip/groin. In addition, adverse movement patterns related to lower back and knees were observed. These findings served as the basis for the exercises selected to the RG-specific IPP in study II. In study II, there was no difference in the monthly prevalence of overuse injuries in the targeted locations between the two groups; odds ratio=0.86 (95% CI 0.32 to 2.29); p=0.77 for intervention vs. control. The results suggest that an RG-specific IPP alone is not enough to prevent overuse injuries among competitive rhythmic gymnasts. In study III, the mean between group difference in the ICIQ-UI-SF total score (i.e. UI bother) was clearly negligible (MD –0.48, 95% CI –1.27 to 0.31). The prevalence of UI reduced from 46% to 41% in the intervention group and increased from 32% to 34% in the control group. Despite this, the risk difference at 8 months was negligible (RD 0.07) and the confidence interval spanned mainly negligible effects (95% CI –0.08 to 0.21). The results suggest that 8 months of PFMT during each warm-up/RG training do not reduce UI bother or prevalence among competitive rhythmic gymnasts. In study IV, all participants had gone through menarche and 40% used HC. The majority (88%) reported one or more MC symptoms during their MC, causing 43% to alter training. Phase 1 (bleeding), followed by phase 4 (1-4 days before bleeding), had significantly higher number of reported MC symptoms compared to the other MC phases. The worst self-perceived physical fitness and performance occurred during the bleeding phase.

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