Why Simone Biles getting 'the twisties' was so terrifying and what recovery could look like

• Before Simone Biles stepped back at the Tokyo Games, she had a near disaster on vault.
• Biles seemed to get lost in the air - an experience known as "the twisties."
• The twisties can lead to serious injury for airborne gymnasts, and getting past them can take time.

When Simone Biles scratched from the women's team all-around final Tuesday after a near disaster on vault, the world outside gymnastics learned a new term: the "twisties."

This is what Biles later said happened to her, and many of the gymnasts watching noted that she seemed to get lost in the air.

Her head was turned right as she was twisting left. She opened her arms up way too early and completed only 1 1/2 of the 2 1/2 twists she was supposed to pull around. She landed in a deep squat and lunged forward and somehow managed not to fall. Her score, 13.766, was the lowest one for the American team.

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The Amanar, the 2 1/2 twister she intended to do, is a vault that Biles has performed for nearly a decade. And just two days before the botched attempt, she performed a beautiful Amanar in the qualification round of competition.

-#TokyoOlympics (@NBCOlympics) July 26, 2021

This is clearly not a matter of an athlete struggling with technical aspects of a skill or not being physically prepared. There's something else at work here.

"They say that they just can't do what they have always been able to do," Robert Andrews, a sports-performance consultant who used to work with Biles, wrote in an email of his gymnast clients who came to him to work through mental stressors and blocks. "Some just stand there and can't move. They say they have this weird feeling in their body. When they have that feeling, they know that they are not going to be able to do the skills they normally do easily."

"There's something so telling about the twisties," Luke Wiwatowski, a member of Australia's gold-medal-winning 2010 Commonwealth Games team, explained in an email. Like many other former gymnasts who were watching Biles' vault Tuesday, he immediately tweeted that it appeared the most decorated gymnast in history got lost in the air and had the twisties.

"Generally, it's one extra twist or one less twist and there is urgency in the body in flight to do two different things at once," he said. "It makes for an awkward flight phase often with arms and legs in odd positions."

The flight phase is what your body does in the air after you lift off the vaulting table. The intended flight phase for Biles' vault was 2 1/2 twists. "You can see her arms stretch open pretty early in her flight phase," Wiwatowski said. "I've also had the privilege of seeing Biles compete in real life and I've never seen a warm up like that before."

(As a journalist who has covered Biles' career since her first senior meet in 2013, I, too, have seen her do that vault live in training and in competition dozens of times over the years, and I have never seen anything like what happened in the warm-up and the first rotation of the women's team finals.)

Wiwatowski likened that urge to picking a scab: "You know you shouldn't do it, but every fiber of your being is pushing you to pick that crusty coagulated blob."

As we've seen with Biles, the twisties can strike anytime, anywhere, even in the biggest meet of your life. Wiwatowski said it typically appeared for those working on new skills. "For example," he said, "a common skill for the twisties is a front salto that you absolutely cannot do without a full twist."

He mentioned a former teammate of his who struggled with this on vault. "His competition vault was a tsukahara double twist," he said. Usually in warm-ups, gymnasts will do a non-twisting version of their vault as a timer, to get a feel for the apparatus. But Wiwatowsk's teammate simply couldn't pull that off. "He just couldn't do a straight layout without adding a full twist so that became his warm up," he said.

Andrews says that when gymnasts come to him to work through mental blocks like the twisties, he first takes stock of any stressors like injuries or relationships with coaches and teammates (and even parents). "For some, it is the stress of making it to a new level in gymnastics, trying to get a college scholarship, or making the national team," he said. Then, he said, they start working on resolving the stressors to "calm the brain and the nervous system."

"We also do a lot of work to teach them how to listen to their bodies' warning signs that they are heading down the wrong path," he continued. Andrews noted that Biles had more stressors than most, being forced to represent USA Gymnastics, the institution that enabled her sexual abuse by Larry Nassar, because it's the only pathway to the games.

"USAG and Nassar, being a high-profile Black athlete in these politically charged times, being the GOAT, expectations of perfectionism every time she goes out, and more we don't know about," he said.

On the gymnastics side of things, Wiwatowski said it was a matter of returning to fundamentals and building back up. But "going back to the basics" isn't really an option when the twisties strike at a competition like the Olympics. As Aleah Finnegan, a current US elite gymnast, pointed out on Twitter, the training facilities at competitions don't have the aids that are necessary to safely address a bout of the twisties.

-aleah (@aleahfinn) July 28, 2021

"It's extremely dangerous especially since the mats that they train on aren't as forgiving as a foam pit or a soft and squishy mat," Finnegan wrote. Training aids such as the ones that Finnegan mentioned, which are standard in most gyms around the world, aren't available at competitions, which means the Olympic training gym that Biles now has access to is not the right place for her to work through this.

Not to mention that getting past the twisties can take time - sometimes months - to resolve. "This isn't as easy to fix as just sleeping it off and hoping for a better day tomorrow," one former gymnast and diver pointed out on Twitter.

But Biles doesn't have the luxury of time to work through the twisties. The Tokyo Games are underway, and she and her coaches have to figure out quickly whether it is safe for her to compete in the apparatus finals or whether she needs to withdraw from those as she did from the all-around and the team final.

As Biles has made abundantly clear, she intends to prioritize her physical and mental well-being ahead of Olympic medals, of which she already has several. The twisties are not only terrifying but dangerous, especially in a sport like gymnastics where athletes are airborne. The worst-case scenario isn't a lost competition or even a serious injury, like a ruptured Achilles. In gymnastics, it can result in paralysis, or even death. (Though not an example of the twisties, the accident that led to the paralysis of the Chinese gymnast Sang Lan in 1998 as she appeared to get lost on a timer points to the omnipresent danger inherent to gymnastics.)

As Biles has shown, a matter so serious cannot necessarily be addressed on the Olympics' timeline.