Just a year after returning to training, the four-time Olympic champion cemented her reputation as the greatest female gymnast of all time.

Watching four-time Olympic champion Simone Biles flip, twist and spin, it’s easy to take it all for granted.

She’s the greatest female gymnast of all time – the only one who, after this week, owns four world all-around titles and 14 world gold medals overall.

Her total of 20 medals at the World Artistic Gymnastics Championships puts her level with Russia’s Svetlana Khorkina for the most won by a female athlete.

Biles picked up six medals in Doha, the first woman to collect one in every final at a World Championships for 31 years.

In her first Worlds since 2015, Biles also debuted a new vault which will bear her name when the International Gymnastics Federation (FIG) updates its code of points.

News Simone Biles practises her new vault in Doha This would be known as "the Biles" if the four-time Olympic gold medallist ...

“I think there's a lot to be proud but most proud of that I'm here, I made all the event finals, medalled in all of the events and I survived."

She, of course, did more than survive. But the week started in dramatic fashion when Biles posted on social media that she was in hospital with a kidney stone.

Less than 24 hours later, after nailing all four routines in the qualifying competition, she proudly told media in the mixed zone she was calling the stone her ‘Doha Pearl’.

By the end of the week, the kidney stone scare seemed like a distant memory.

Biles also makes you forget that what she is doing is not only difficult, it’s the most difficult gymnastics ever done by a female.

She makes it look easy, and it most certainly is not.

‘She would quit every three days’

All of this came almost exactly a year to the day after Biles returned to the gym.

She returned to training in November 2017 but continued to travel to fulfill sponsorship obligations until mid-December, according to coach Cecile Landi, a 1996 Olympian for France.

“She was in the gym for 2-3 days, she started to feel better,” Landi said. “And then she had to start all over again, and she was like, ‘I tried, I think I need to quit. That’s it. It’s too hard.’ She would quit every three days."

Biles told Olympic Channel, “It was hard to get back in the rhythm because every time I got back in the rhythm, I would leave. And so, every time I would come back it was almost like I had to restart.”

Finally, she got into the rhythm, but not without hiccups.

In May as her competitive return approached, Biles struggled.

According to Cecile Landi, she wouldn’t tumble backwards or go for skills on the balance beam.

“She mentally couldn’t do it anymore. We were like, ‘Well, what are we going to do? How do we do this? How do we pick her up from the ground?’”

She and husband Laurent, who also coaches Biles along with Biles’ parents, managed to figure it out.

“Her parents have been amazing, and she’s been willing to do a lot of things mentally and physically that are different than she’s used to,” Cecile Landi explained. “Now, she’s seeing the results, and I think it’s helping her.

“But to have Simone Biles not tumble backwards, it’s a little scary.”

Biles said, “I really had to find my purpose for it and really make sure I was doing it because I wanted to. “I definitely found that.”

Finding her voice

The year in which Biles stepped away from the sport made her stronger mentally, she said last week.

That mental strength has been on display in 2018. She not only seems more thoughtful during interviews, but also hasn’t shied away from speaking her mind.

At the U.S. Championships in August, Biles had no issue taking on then-USA Gymnastics CEO Kerry Perry.

When asked if Perry who notorious avoided interacting with the media should speak up, she replied succinctly, “Yes, it’s her job.”

Just before leaving for Doha, Biles took to Twitter to confront interim USA Gymnastics CEO Mary Bono for a tweet criticizing Nike, one of her sponsors, and its campaign featuring Colin Kaepernick.

“I think in those specific moments you need to use your voice in a positive manner as long as it doesn’t draw negative attention,” said Biles. “And you really stick to what you are saying and what you believe in.”

“I know that it is going to have a very big impact on the decisions that have to come forth, so I have to be wise as well,” she said of the moments she has chosen to speak up. “But she also made that decision to put that out there, so she has to be ready for whatever feedback she got.”

Bono resigned just five days into her tenure.

More to come

That Biles is back dominating the sport after just a year is unprecedented.

London 2012 Olympic champions Gabby Douglas and Aly Raisman, like Biles, took a year off after their success in London 2012 before beginning their Rio 2016 campaigns.

Each thought they’d be back to compete at the 2014 World Championships, but neither was. Instead, both spent months and months focusing on their physical conditioning before even getting back to working gymnastics elements.

Not Biles. By April, she had all of her Rio 2016 gymnastics back. And then some.

Simone Biles now has a record 14 World Artistic Gymnastics Championships gold medals

"In our sport, I've not seen any athlete that takes this much time off and comes back better. I've never seen that before,” said U.S. high performance coordinator Tom Forster. “So, she's an anomaly for sure in a really cool way. Really, I think we're witnessing history."

But don’t expect to see Biles rest on her laurels until the 2020 Olympic Games in Tokyo roll around.

“Everyone is like ‘Just sit it out.’ Just take another year off,” she said of skipping out on next year’s Worlds. “You came back and you won. It’s fine. But you also need that confidence going into the Olympics.”

So, she’ll go home. Take a short vacation. And then start again.

“We'll sit down with Cecile and Laurent and go over (any changes to my routines),” Biles said at the end of the Worlds.

"I'll go on a little vacation, and, then, you get back into the grind."