The United States women’s gymnastics team keeps winning gold, but at what cost to the athletes?

Other teams do not have that luxury. The Romanians, for instance, have so few senior elites at present that they had to invite the British team to flesh out the roster at their most recent national championships. As a result of their depleted ranks, the Romanians practice extreme caution. After struggling with foot pain, Sandra Izbasa, the Olympic champion on the floor exercise, is not competing at this year’s worlds so she’ll be protected for the 2012 London Games.

The Russians are also playing it safe. Their star, world champion Aliya Mustafina, tore her ACL in April and could’ve theoretically been ready to compete in two events in Tokyo. Instead, the coaching staff decided to leave her home and allow her to fully recover for the Olympic year. Their past champion, Svetlana Khorkina, who competed at every European championships, worlds, and Olympics from 1994 to 2004, was also protected from unnecessary roughness and repetitions. The Russians are training their gymnasts as individuals, tailoring the approach to the needs of each one. A little more rest for an injured gymnast and extra repetitions for those who can handle it. Sacramone and Li, both older athletes, could’ve benefited from that sort of approach.

John Geddert, coach of national champion Jordyn Wieber, who is predicted to vie for the all-around title in Tokyo later this week, wrote about his athlete’s preparation for the world championships on his blog. Though he was diplomatic, Geddert questioned some of the decisions being made. He noted that from Sept. 5, when the first camp started, until the end of worlds, the girls would have only two days off (three if you counted the travel day to Tokyo) out of 42. “I would have liked to see a few more strategically assigned rest days,” he wrote.

In this way, Geddert seems to have more in common with the modern Romanians and Russians than the woman at the helm of his program. Martha Karolyi embodies the old-school Romanian philosophy about training—more is better. This was successful for her when the sport was less difficult, when an athlete had one or two major elements in a routine, not six or seven. But Karolyi hasn’t updated her philosophy on training and competition in the last few decades. She is like a Cold War warrior who acts as though the Soviet Union is still the enemy.

Karolyi’s practices are tolerated because even if the gymnasts do not perform to potential, they still do well enough. In addition, her presence helps shape a narrative for NBC’s melodramatic coverage—the sexist “Martha is watching you” story. At these national competitions, Martha appears on TV as much as the athletes. Every time a female athlete finishes her routine, the NBC commentators immediately say something like, “She’s looking over to Martha Karolyi to see if she liked it,” as though the gymnast cannot assess how she has done without input from others. (Male gymnasts are not subject to the same sort of commentary.)

Martha Karolyi shouldn’t shoulder all the blame for the injuries suffered by Alicia Sacramone and others. Sacramone’s Achilles, for instance, has been a problem throughout her career. Karolyi, though, clearly could’ve done more to accommodate each of her athletes and taken more precautions in the run-up to the world championships. The United States’ latest gold medal shouldn’t obscure the fact that female gymnasts keep breaking down, and not simply because gymnastics is a risky sport. With less than a year to go until the London games, we’ll find out if the United States finally learns to train smartest instead of hardest. If it doesn’t, the U.S. team—which will head to the Olympics as defending world champions for the third straight time—will again be bested by wisely paced athletes.