The mental block happens midair, while you are twisting.

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Simone Biles has pulled out of the Olympics All-Around Individual Final in order to "focus on her mental health," USA Gymnastics announced in a statement today.

The news comes after the 24-year-old gymnast withdrew from the Olympics Women's Team Final on Tuesday, where she completed one vault before telling her teammates she wouldn't be competing for the rest of the team competition. At the time, USA Gymnastics said in a statement that Biles had withdrawn "due to a medical issue." Hours later, in an interview with TODAY, Biles revealed that the medical issue was not a physical one, saying, "physically I'm good, I'm in shape. Emotionally that kind of varies on the time and the moment."

While speaking with reporters on Tuesday, Biles offered some more clarity about what might have been behind her decision to pull out of the team final—and now the individual all-around. "[My teammates] saw it a little bit in practice.. having a little bit of the twisties," Biles told the press.

Upon hearing that Biles had "the twisties," former and current gymnasts took to social media to share just how serious the mental phenomenon is. One former gymnast's Twitter thread about "the dreaded twisties" went viral. Others shared their own experiences with the condition:

But what exactly are "the twisties"? And why would a gymnast potentially need to pull out of a competition for them? Here's how three sports psychologists—two of whom are former gymnasts—explain it.

What are 'the twisties'?

The twisties is an informal term used to refer to a certain kind of mental block that a gymnast can experience as they are in the air during a twisting skill. When someone gets the twisties, there is a disconnect between the brain and body, Jamie Shapiro, PhD, a certified mental performance coach who is the co-director of the Master's in Sport and Performance Psychology program at the University of Denver, tells Health. "The body knows what to do and motor programs are stored in the brain, but the brain is having trouble accessing those motor programs," she explains.

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Credit: Getty Images

Shapiro, a former club and collegiate gymnast, says that the brain-body disconnect brought on by twisties can cause an athlete to lose their sense of where they are in the air, making athletes feel "a loss of a sense of control over the movement." That can have both physical and mental implications. Physically, the twisties can make a gymnast unable to perform the skill(s) as they were previously able to. Mentally, that inability to perform the skill(s) can cause anxiety, exacerbating the mental block.

How serious are the twisties?

"Gymnasts have a wonderful inner sense," Allie Wagener, PhD, a licensed psychologist who specializes in sport and performance psychology at Premier Sports Psychology, tells Health. It's scientifically known as proprioception, or the body's ability to sense its movement and position in space. That means that, as they are twisting through the air, gymnasts know where they are relative to the ground. That's important since that awareness lets you know when and where you are going to land, preventing you from falling or landing in the wrong position. "But what happens when the twisties come is you kind of lose your sense in the air. You kind of lose where you are, and you almost become disoriented," Wagener, a former gymnast says. "It's super scary. It can be terrifying because if you don't know where you are in the air, you don't know how to land, and that's what can be pretty dangerous for injuries."

Sometimes what happens after experiencing the twisties is, as a gymnast goes for their next attempt, they worry about the feeling happening again, "which just exacerbates that fear even more." That fear can lead to a balk, meaning the gymnast comes out of a skill too early or does not attempt it at all (say, running past the vault rather than pushing off the springboard), Shapiro says, both of which can jeopardize an athlete's safety.

Why do gymnasts get the twisties?

There can be mental or physical reasons behind the twisties.

A mental cause could be stress and anxiety, according to Shapiro. These can cause mental blocks because of the physical and cognitive changes that occur under stress: your focus becomes too narrow or wide; you have increased muscle tension, heart and breathing rate, or sweat response; you experience racing, negative, or distracted thoughts.

"Usually is starts with fear of failure and not want to disappoint others—or extremely high expectations that the athlete internalizes," Patrick J. Cohn, PhD, a mental training expert who is the president and founder of Peak Performance Sports, tells Health.

As far as physical causes of the twisties, there's focal dystonia. Shapiro describes this as "a neurological condition involving involuntary muscle spasms, which could result from overuse of the muscles."

Or, oftentimes, the twisties can happen "out of the blue," Shapiro says. A gymnast can go into a skill and then, for whatever reason, they feel off in the air.

How long do the twisties last?

The twisties can be something that happens just during one or two attempts. Or it can be something that happens for a day and, the next day, the athlete has their in-air sense back. Or it can last for months—Wagener has worked with a male collegiate gymnast who had the twisties for several months.

Because everyone's experience with the twisties is different, there is no standard for how long it takes to overcome.

"It could take days, weeks, years, or someone might never get over it," Shapiro says. "It can be career-ending for an athlete."

In most cases, though athletes do overcome the twisties, Cohn says. In his experience, it typically takes two to four months of work to overcome the issues.

How can a gymnast overcome the twisties?

There are different techniques people can do to overcome their twisties, though what works can vary from person to person. Visualization can be one technique, which can mean simply picturing what the skill should look like.

Progression is another technique. Let's say a gymnast is experiencing twisties with a double twist, for example. With progression, they start with a half twist, then do a full twist, then a twist and a half, eventually building their way up to the goal of a double twist. Starting with a more basic skill and gradually reminding your body where you are in the air can help build up your confidence. "I think coaches can be extremely influential and helpful to support and remind to trust your body and to trust muscle memory," Wagener says.

When you're experiencing the twisties, you can also try focusing on a different skill—particularly one that you're confident with—rather than forcing yourself to attempt the skill tied to your twisties. "You can just take a break from it, go work on something else, and then maybe return to it," Wagener explains. "Sometimes you need to take that stress that pressure away from it."

Watching video of yourself do the skill(s) and doing the moves while watching video so that you can see and feel yourself go through the movement can also be a helpful, Shapiro says. Even developing simple cue words to say to yourself during the routine can keep you focused on the skill rather than the fear and other distractions, she suggest.

Speaking with a sports psychologist might also help with overcoming the twisties.

"One thing that I usually advise parents and coaches to do is give the athlete a break and don't ask about it—the athlete is already anxious, and asking about it or pushing it too soon can exacerbate the mental block due to increased pressure and stress," Shapiro says. "Sometimes, the athlete needs a break from the skill or the sport." 

Do only gymnasts get the twisties?

No. An athlete in any sport that involves twisting, flipping, or rotating—really, any time you need to spot where you're going to land—can develop the twisties.

Athletes in other sports, as well as musicians and stage performers, can develop their own version of the mental block. "It is most commonly referred to as the 'yips' in golf and baseball where athletes suddenly can't putt or throw the ball where they want to," Shapiro says. "Musicians may also experience the 'yips' where they can't play a piece they were previously able to perform. There is also 'stage fright' for performing artists which could be quite debilitating."

With the news of Biles experiencing the twisties, Wagener says it's a good reminder to everyone that high-profile athletes who have high amounts of pressure and stress are humans "just like you and I." "Creating a safe, and inclusive, and supporting environment for these athletes to do their craft" is important, she says. "It's OK to have an off day, it's OK to have a bad day, especially in a sport where you're judged on perfection."

The situation also highlights the fact that training your mind is just as important as training your body. "These athletes tend to train their bodies so hard through practices, through specialized coaches, and I think sometimes having that training for your mind is just as important but often gets missed," Wagener says. "And even when you are trained mentally and physically, we can still have things that disconnect and have off days and that's really normal. You can be the most mentally resilient, strong person and still have an off day, and I think normalizing that, especially among elite athletes, is really important."

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