What Are ‘the Twisties’ in Gymnastics? Simone Biles Faced the Condition at the Tokyo Olympics

With the Paris Olympics in full swing, all eyes are on gymnastics—one of the most anticipated events of the Summer Games. The U.S. women's gymnastics team has been celebrating after winning a gold medal in the team final on July 30.

One of the worst things that could happen to a gymnast in high-level competition—and something that led gymnastics legend Simone Biles to withdraw from the Tokyo games—is a phenomenon known as “the twisties.”

Here’s all you need to know about the condition, which has become a conversation point once more now that the 2024 Olympics have commenced.

What are the twisties?

The Cleveland Clinic describes the twisties as “a mental block that creates a dangerous disconnect between mind and body while gymnasts are airborne.”

“All of a sudden, there’s a disconnect in the feedback loop,” Matthew Sacco, a sports psychologist at the Cleveland Clinic, explained. “The brain and body are no longer communicating efficiently, and that causes a gymnast to lose sense of where their body is in space while they’re in the air.”

There are varying levels of the twisties. A gymnast could shake them after one turn or practice, or they can escalate, lasting for days, weeks, and even months, as the anxiety associated with the condition compounds the problem.

The cause “can be a little bit of everything and anything,” Sacco noted, including doubt, stress, and the quest for perfection—especially when athletes are competing at high levels.

Though the twisties are most often connected to gymnastics, they can affect any competitor who requires a grasp on their proprioception sense—your body’s ability to sense its position and movement even without visual cues. Other sports that require this include diving, martial arts, and various forms of jumping.

In gymnastics, there’s a particular kind of proprioception called air sense, or air awareness, that’s needed for gymnasts to orient themselves when they are airborne, to ensure a safe landing. Without air sense, an athlete is in danger of harming themselves.

What activities can help address the twisties?

According to the Cleveland Clinic, there are multiple avenues for gymnasts to pursue if they are experiencing the twisties.

Getting back to the more basic building blocks of gymnastics—the components that eventually will be put together to do more complicated skills again, is something Sacco recommended. Or, athletes can focus on a skill they are confident with—something they know they will nail.

Athletes can also utilize a foam pit, which would offer a softer landing to gymnasts as they practice routines. Without the fear of getting hurt, some anxiety may dissipate.

There are more mental tools athletes can utilize to help, which includes relaxation techniques to mitigate stress, breathing techniques, routine changes, taking breaks, seeking the help of a mental health professional, and visualization. Ultimately, gymnasts say, it just takes time for the twisties to resolve.

Mental health is widely regarded as an important aspect of athletic performance, especially as striving for perfectionism and the general pressure of sports can cause stress. According to Montana State University Athletics, in order to ensure athletes' mental well being, we should be "promoting wellness and preventing mental illness, not only responding to mental illness after it happens.”

How did the twisties impact Simone Biles at the Tokyo Olympics?

When Biles—winner of seven Olympic medals—competed at the Tokyo Olympics in 2021, she ended up withdrawing from most of her events, citing the twisties, which were likely the result of a combination of mental stress and pressure leading up to the event. She talked about how the twisties—something she had experienced in the lead-up to the 2016 Olympic Games in Rio and prior to the 2019 season—kept her from competing safely.

Biles was interviewed on the popular Call Her Daddy podcast in April, and went into detail about what happened at the Tokyo Olympics three years ago. The 27-year-old said she was “fighting [her] body and [her mind]” while trying to show up for her team. She said that everyone in the room could likely tell that she had the twisties, since her skills looked completely different than they usually did.

“The best way I can describe it is everyday you drive a car—if one day you woke up and you had no idea how to drive a car, your legs are going crazy, you have no control of your body,” Biles told host Alex Cooper. “You’ve been doing something for so long, and you now no longer have control. It’s terrifying.” 

Read More: Simone Biles and Why We All Get the ‘Twisties’ (Even If We Can’t Fly)

What other athletes have admitted to experiencing the twisties or something akin to them?

Biles largely popularized the term among non-athletes during the Tokyo Olympics, but many other gymnasts have come out and explained their own experiences with the condition. Biles' training mate Joscelyn Roberson, who is an alternate on the women's team in Paris, has experienced this multiple times.

2016 Olympian and teammate of Biles, Laurie Hernandez, explained to the Olympics blog how terrifying the twisties are, and how the phenomenon can make an athlete doubt their talent, proving to be a difficult cycle.

“The rhythm is off, and your brain will, like, stutter-step for half a second and that's enough to throw off the whole skill,” said Hernandez. “And, so, it happens, and it takes a second to get over that.”

Former U.S. national team member Aleah Finnegan—who is now representing the Philippines at the Paris 2024 Olympics—has also opened up about her own experience. Speaking out in 2021, via a post shared on X (formerly Twitter), Finnegan said: “I've had the twisties since I was 11. I cannot imagine the fear of having it happen to you during competition. The more you psych yourself about it, the worse it becomes.”

At the Beaumont Gymnastics Academy in Texas, KFDM reported in July that several young gymnasts are currently struggling with the twisties.

One young girl said of her back walkover on the balance beam: “I lost it and it's like I have a mental block about it.” She goes on to say she is “scared” to mess up. The gymnastics academy told reporters that they are implementing multiple activities to build back the gymnasts’ confidence.

What do experts say about the twisties and how they can be addressed?

Jamie Shapiro, professor of sport and performance psychology at the University of Denver, tells TIME that “one of the top reasons” she gets a call from parents is due to mental blocks that keep their gymnast children from doing skills. The twisties are just one example related to twisting skills.

Dr. Dakari Quimby, a clinical psychologist and professor at the University of Southern California, says that even though he hasn’t worked with the twisties specifically, it isn’t a unique concept to him since, per his estimations, about “30 to 60% of athletes deal with some type of performance anxiety.”

Shapiro says trying to help with the twisties is a “paradox,” since she has found that the more attention someone pays to that skill that they're having a block behind, the worse the twisties can get. So often the best first piece of advice is to do nothing.

“My recommendation is usually to take a break,” Shapiro says. “The brain usually needs some sort of reset or rest, just like from a physical injury.”

After that, Shapiro’s advice mirrors what the Cleveland Clinic recommends: heading back to basics and slowly building back up to more intense skills, perhaps even having gymnasts watching videos of themselves doing the skill.

“Since the mind and body have already learned that skill previously, it should come back faster than if you're learning the skill to begin with, because those motor programs are stored in the brain and the body somewhere,” Shapiro says. “It's just like accessing it again.”

Quimby often tries to help his patients see that anxiety is really a “protective force for us against danger,” and that the twisties are about a disconnect with the body as it responds to a perceived danger. Responding to anxiety often means “just to kind of build back up that confidence and realize that it's not necessarily as dangerous as maybe your body is telling you it is.”

Shapiro also emphasizes that an important aspect of getting back to feeling safe in a skill is ensuring that the athlete is alleviated of not just their own internal pressures, but also external pressure from parents and coaches. Ultimately, it must be up to the athlete to decide when they are ready to perform a skill again. 

That confidence in coming back from the twisties is helpful in moments when the condition could return, something Shapiro and Quimby both say is a possibility and a common fear. The hope, though, is the first time someone does activities to come back from the twisties, they then have tools they can utilize should it happen again in the future.

“It’s all about feeling a lack of control, so I try to give the person a sense of control by allowing them to say, ‘Hey, I've done it before, I could do it again,’” Shapiro says. “It’s that confidence of having a plan, and being like ‘I can do this.’”