Gymnastics has one of the highest injury rates of all girls' sports, according to a survey of emergency room admissions.

Nationwide, an average of 27,000 children per year went to the ER for gymnastics-related injuries between 1990 and 2005.

"Many parents do not typically think of gymnastics as a dangerous sport," said study principal author Lara B. McKenzie, Ph.D., of Ohio State University, "In fact, many parents consider it an activity. Yet, gymnastics has the same clinical incidence of catastrophic injuries as ice hockey."

More than 600,000 U.S. children participate in gymnastics. Increasing skill difficulty introduced at younger ages, combined with long, intense practices, has raised concerns about safety.

Previous studies of gymnastics-related injuries have been largely anecdotal or have been extrapolated from generic evaluations of sports injuries. For their study, Dr. McKenzie and colleagues homed in on gymnastics-related injuries that required emergency-department treatment from 1990 to 2005.

They discovered that almost 426,000 young people, an annual rate of 26,600, had become injured during gymnastics.

82.1% of them were girls.

The numbers translate into an annual injury rate of 4.8 per 1,000 gymnasts. The rate doubled in the upper age categories (12 to 17), reflecting the increasing complexity and skill level of gymnastic competition.

Over 42% of injuries were to the upper extremities. Lower extremities were involved in 33.8% of cases, head and neck in 12.9%, and trunk in 10.4%.

Most of the injuries (44.5%) were muscle strains or sprains. Fracture or dislocation was seen in 30.4% of cases, abrasion/contusion in 15.6%, laceration/avulsion in 3.7%, concussion/closed head injury in 1.7%, and "other" in 4.7%.

On the bright side, the study, which was reported in the April issue of Pediatrics, noted a decline in the number of injuries over the course of the period studied — from 28,700 in 1990 to 21,500 in 2005.