DOHA, Qatar (AP) — A bout with a kidney stone did little to slow down Simone Biles.

The reigning Olympic champion easily posted the top all-around score of 60.965 during the early portions of qualifying at the 2018 world championships on Saturday, easily clearing the field and leaving little doubt that she remains atop the sport.

Biles spent a portion of Friday night in the emergency room. While she was cleared to compete, the stone — which she dubbed the “Doha pearl” — had not yet passed when the three-time world champion arrived as the Aspire Academy. She competed anyway, posting the highest scores on beam, vault and floor. She was also second on uneven bars through five of 11 qualifying groups.

The Americans, featuring three first-time competitors at the world championship level, rolled behind their star. The team score of 174.429 was more than 12 points clear of second-place Japan, an absurd margin for a powerhouse program that shows no signs of slowing down.

Defending world all-around champion Morgan Hurd led off on three of the four events for Team USA, and her all-around score of 56.465 nudged out Japan’s Mai Murakami for second and assured Hurd of a spot in the all-around finals next week.

Grace McCallum competed in three of four events, and her 14.6 on vault probably earned her a berth in the event finals. Kara Eaker drilled a 14.466 on balance beam and Riley McCusker overcame a stumble on beam to finish fifth in the all-around, though she won’t make the all-around final due to the rules that limit each country to two participants per event.

The public address system played a bell akin to the start of a boxing match when the U.S. headed to uneven bars to start the event. It might as well have signaled a technical knockout. Hurd led off with a 14.466 that seemed to send a message that while the faces with the stars-and-stripes on their leotards change, the expectations and the results do not.

Having Biles helps. The 21-year-old appears to be better now than she was when she won four gold medals and five overall at the 2016 Olympics. She’s intent on pushing the sport forward, and her astounding opening vault — a roundoff, half-twist onto the table, front double full off that has only previously been done in competition by men — sent a jolt through the crowd when she stuck the landing. Her score of 15.966 was the highest of the day on any event by a massive margin.

And Biles did it while gritting her teeth and fighting off pain that likely won’t subside until after she returns to the U.S. early next month. She’s going to be plenty busy in the interim. She’ll be in the team final, the all-around final and all four event finals over the next seven days.

Considering the way Biles overwhelmed the field on Saturday, it hardly seems like an issue. She came to the Middle East with 14 world championship medals already on her record, a total that figures to go up significantly before she leaves.

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