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EXPLAINED: Why Simone Biles Got The 'Twisties' And How Mental Health Has Come Under Spotlight In Sports

The 24-year-old Simone Biles is widely regarded as being among the greatest gymnasts ever

The 24-year-old Simone Biles is widely regarded as being among the greatest gymnasts ever

Mental health is increasingly coming into focus in elite sport. Here's why Simone Biles's case is not unique and what steps are being taken to address the issue

Sports is seen as an engagement and an outlet to stay physically fit and find a diversion away from mental stress and pressures. But the world of high-performance and professional sports is increasingly witnessing instances of athletes flagging mental health issues as a serious challenge in their pursuit of excellence. The likes of the US gymnast Simone Biles and Japanese tennis sensation Naomi Osaka have helped drive a conversation on athletes’ mental health and sportspersons from diverse disciplines have come out to say that their concerns echo with them. Here’s what you need to know about how mental health has zoomed into focus in sport.

What Cranks Up The Pressure In Sport?

Not just winning. The goal to excel is perhaps the easy part, it’s why people enter elite sport. Because they are chasing that record, or seeking the elusive prize. But there are many other things that go into the “burden" a sportsperson may feel she is carrying into a competition. Not least of which is the expectations that fans can have of her, and the hopes of “an entire nation" that athletes are routinely said to be carrying.

Take Biles for example. As she struggled to focus on her routine, eventually bowing out of the team final competition, Biles said she felt “like I have the weight of the world on my shoulders at times".


“Coming here to the Olympics and being the head star of the Olympics isn’t an easy feat," said the 24-year-old gymnast, who is widely considered to be the greatest that has graced the game. She had won four gold medals, including the individual all-around gold, at the 2016 Rio Olympics and was the hot favourite to defend her title at the Tokyo Games — a feat so rare that it has not been repeated since Vera Casalavska of the Czechoslovakia clinched her second title at the 1968 Games in Mexico City.

US-based psychiatrist Dr Leela R. Magavi told NBC that elite athletes can feel that “every single step that they take will be significantly scrutinised, and this kind of pressure is so severe" that it can affest their day-to-day activities. Such athletes who are “essentially symbolising and representing a country", can be exposed to stress in a way that “they lose that passion for the game that was the first reason they joined the game in the first place".

Indeed, that is exactly what Biles seemed to point to. “Put mental health first, because if you don’t, then you’re not going to enjoy your sport and you’re not going to succeed as much as you want to," she said.

What Happened To Biles?

As sports go, gymnastics is a highly risk-prone pursuit. The vaults, somersaults, stretches, all the turning on the arms and wrists need gymnasts to execute pitch perfect routines. One slip or misstep, and it may mean a career-threatening injury.

Biles told reporters after withdrawing from the team and individual finals that she was “having a little bit of the twisties". Initially, team doctors had said it was physical health concerns that had led her to sit out the contest, but Biles later made clear it was her mental health that she was worried about. “Physically, I feel good," she told NBC, adding that “emotionally, that kind of varies on the time and moment".

A columnist for CNN said that didn’t mean “she felt sad, or didn’t have her heart in it to compete. It means that her psychological state put her at significant physical risk". So, what are the “twisties"? Going by gymnast-speak, it is a common phenomenon which, however, is tough to explain as it involves the mind and the body. CNN said that “twisties are a mysterious phenomenon… your body just won’t cooperate, your brain loses track of where you are in the air". What that leads to is a gymnast not being able to perform a routine that she may have perfected and executed countless tiimes before.

BBC says that the “twisties" can “cause a person to lose their sense of space and dimension as they’re in the air, causing them to lose control of their body and do extra twists or flips that they hadn’t intended".

“In the worst cases, they can find themselves suddenly unable to land safely," it adds. It is easy to understand why a gymnast may feel vulnerable and scared at such a moment. Hence, Biles’s decision to not push her self when her mental make-up wasn’t perfect.

“I just don’t trust myself as much as I used to. I’m a little bit more nervous when I do gymnastics," she told reporters in Tokyo.

Is Biles’s Case Unique?

Apart from being seen as supreme examples of physical health and fitness, sportspersons are also regarded as being tough as nails mentally. Otherwise, how does one push herself to do what most of the billions of people on this planet can only dream of doing. However, taking on and conquering fears is not without its impact.

According to the International Olympic Committee (IOC), studies show that “mental health disorders affect up to 35 per cent of elite athletes at some stage of their careers". That is, every one out of three elite sportsperson you see would have struggled with mental health. Or, to look at it another way in Olympic season, more than 3,800 of the over 11,000 athletes at the Tokyo Games would have dealt with such concerns in their careers.

IOC says that symptoms of mental health crisis can “range from burnout and substance abuse to eating disorders, depression and anxiety". The triggers for these could involve everything from “poor sleep to selection pressures and premature retirement due to injury".

“While there isn’t any evidence to suggest that mental illness is more prevalent in elite athletes than the general population, it’s important to approach these problems in athletes, bearing in mind the special situation they’re in, and the big life stresses they face,” IOC Medical and Scientific Director Dr Richard Budgett had said in 2019.

From US swimmer Michael Phelps, the owner of 23 Olympics gold medals — the highest for any individual — to Team India captain Virat Kohli and Serena Williams, the holder of the highest number of Grand Slam titles, sportspersons have increasingly highlighted the importance of mental health. Naomi Osaka, who pulled out of this year’s French Open and Wimbledon, has repeatedly emphasised the need to prioritise mental health.

It helps that people at the top of their game have opened up as that shines a light on the issue throughout the sporting spectrum. After bowing out at Tokyo, Pranati Nayak, only the second Indian gymnast after Dipa Karmakar to have made it to the Olympics, was reportedly questioned for not attempting a second vault as part of her routine. But her coach defended the decision. “The worst thing for her would be if she ended up being injured in a mad scramble to get a medal," Lakhan Sharma was quoted as saying by The Indian Express.

But the conversation around mental health is still quite new. According to the Frontiers journal, “81 per cent of mental health studies focusing on elite athletes had been published between the years 2013 and 2018". It added that “this interest has, at least partly, been stimulated by the mental health movement found in global health-promotion programmes calling for greater responsiveness in society overall".

What Are Sports Bodies Doing About It?

Seized of the need to offer help to athletes who may be struggling mentally, the IOC says it is offering a “series of programmes and tools to help them recognise and tackle mental health issues".

At the Tokyo Games, the Paralympic Games Tokyo to follow and the upcoming Winter Olympics, athletes can access the Mentally Fit Helpline, which is “staffed by expert counsellors who can provide help, advice and support in over 70 languages". The helpline offers 24-hour support and counselling, and other critical interventions. IOC said that the service is free and can be accessed via phone, email, instant messaging or the iConnectYou app.

The 1933 Olympic Charter talks about how the future is “not free of danger (and) success is often the forerunner of misfortune". But it says that the IOC should work towards instilling in the minds of the sporting youth “that wonderful quality so neatly expressed in the Latin proverb: Mens sana in corpore sano". Roughly translated it means, “a sound mind in a sound body".

“We also have to focus on ourselves, because at the end of the day we’re human, too," Biles has said. “So, we have to protect our mind and our body, rather than just go out there and do what the world wants us to do."

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first published:July 30, 2021, 11:23 IST