Cheerleading: A rapidly growing, yet overlooked sport

Cheerleading is one of the most popular sports among female athletes ranging from 6-30 years old, yet it is only officially recognized by 29 states as a high school sport and it is not recognized by the NCAA as an officially sponsored sport. Not only are the number of participants growing by 18% per year, but the number of injuries seen among cheerleaders is also growing as the sport is evolving from a sport in which participants formerly would engage the crowd in simple cheers to a sport that involves a great deal of acrobatics and gymnastics. This evolution of the sport into a “high-flying” acrobatic and gymnastic display along with the advent of the “all-star” teams that are designed solely for competition has led to cheerleading being the number one cause of catastrophic injuries (injuries that result in the failure of one or more bodily systems) among female athletic participants.
One of the biggest contributing factors to the types of injuries that can be seen in cheerleading is actually the rapidly growing nature of the sport. Because cheerleading began in the 1800’s as a way to engage the crowd in football games with cheers, claps, and toe-touch jumps, many never considered it to be a real sport, despite the fact that the sport has evolved over the years into one in which young men and women are performing flips, jumps and stunts that not only can result in heavy impact upon the lower extremities, but can also lead to head trauma and other catastrophic injuries when stunts are performed improperly.

The lack of recognition of cheerleading as a sport not only causes the participants who train rigorously to feel second-class, but it more importantly affects the safety of the sport because there are less regulations and requirements for adequate coaching, training facilities, and injury monitoring among the high school and collegiate participants. For example, when a sport is NCAA sponsored there are regulations set forth by the governing body regarding practices and training facilities as well as injury reporting and regulations on the athletic training availability.

Cheering being an “overlooked” sport has also led to much less funding for research and less mandatory data collection by the NCAA in regards to injury epidemiology and statistics. Such a delay in officially recognizing cheerleading as a sport is the major contributing factor for the lack of literature and sport-specific injury prevention guidelines.

Although the injury rate per 1000 exposures to the sport is only 0.9 (a figure that is significantly lower than most other sports), the rate of catastrophic injury is between 0.5 and 1.62 (a figure that is significantly higher than sports such as soccer, field hockey, basketball and gymnastics). This data suggests that cheerleaders are injured less often than other athletes, but when the injuries occur, they are more likely to be severe in nature. This has been attributed to the types of stunts performed and the surfaces in which the stunts are performed on.

A recent paper, published by the American Academy of Pediatrics (AAP), not only examined the injury rates and epidemiology of cheerleading, but it set forth twelve suggestions for injury prevention for cheerleaders and cheering coaches. Furthermore, it examined the most common injuries sustained among cheerleaders, both male and female.

When examining all age groups, the lower extremity was by far the most common site for injuries comprising 30%-37% of all injuries. This was followed by the upper extremity (21%-26%) and the head/neck (16-19%). It was further noted that when examining only younger participants (6-11 years old), upper extremity injuries were more common.

Among all injury types, sprains and strains are, not surprisingly, the most common injuries, comprising 53% of all injuries. Coming in second are abrasions/contusions, which made up 13%-18% of injuries, followed by fractures/dislocations at 10%-16% of all injuries. Head injuries made up only 3.5%-4% of all cheering injuries. The researchers reported that younger cheerleaders were 1.6 times more likely to sustain a fracture or dislocation when compared to older cheerleaders.

Though concussion rates for high school cheerleading are relatively low when compared to other girls’ high school sports, the concussion rates in cheerleading increased 26% each year from 1998 to 2008, a rate that is much higher than any of the other girls’ sports that have been studied.

So what does this data mean and what can we do as physicians, trainers, coachers, parents and participants to help reduce the number of cheerleading injuries? Without a doubt, it is certainly an issue that must be dealt with in the near future in regards to sports medicine and athletic regulation. As cheerleading continues to grow and remain popular among young females as well as among an ever-growing male population, we must begin by recognizing it as an officially sponsored sport at the high school and collegiate levels to ensure that the participants receive the same pre-season training schedules, access to licensed trainers, coaches and team physicians, as well as adequate training facilities and equipment.

Furthermore, as mentioned earlier, there are twelve recommendations by the AAP which were designed to help reduce cheerleading injuries as well. A summary of the guidelines are as follows:

1. Designate cheerleading as a sport so that it is subject to rules set forth by the athletic governing bodies.
2. Require pre-participation physical exams for all cheerleading programs AND allow them access to adequate strength training facilities.
3. Require qualified supervision by coaches who are trained and certified in proper spotting for gymnastics and injury management.
4. Train all cheerleaders in proper spotting techniques and allow stunt attempts to occur only after the individual has demonstrated appropriate skill progression and proficiency.
5. Technical skills like pyramids, tossing, and tumbling should not be performed on hard surfaces such as concrete or on wet or uneven surfaces. No cheering events should take place on concrete, vinyl, or dirt.
6. Pyramid/partner stunts should be done on spring floors or with a landing mat on a foam floor or grass/turf.
7. Pyramids should not be more than 2 individuals high and only performed with spotters
8. Coaches should follow rules for stunts set forth in the most recent version of the NFHS Spirit Rules Handbook.
9. When possible a certified athletic trainer should be present at all events and practices and parents, coaches and participants should be familiar with an emergency plan designed by the school in conjunction with a team physician or athletic trainer.
10. All cheer competitions should be held in a venue that is compliant with the National Cheer Safety Foundation guidelines.
11. Any Cheerleader with signs of head injury should be removed from participation and not allowed to return until cleared by a qualified health care provider.
12. We must continue to monitor and submit all catastrophic cheerleading injuries to the National Center for Catastrophic Sports Injury Research in order to better understand cheerleading injuries and continually update prevention methods and strategies.

As one can see, cheerleading is not what it used to be and it will only continue to become more extreme with higher stunts and more intricate routines. I, like many of the readers who will read this, was unaware of the exact nature of the injuries and the lack of recognition as a sponsored sport by the NCAA. We must not write cheering off as a “girly” sport, with mild tumbles and clapping, because the longer we refuse to acknowledge cheering as a sport, the more individuals will suffer injuries and catastrophic events.

For more information about cheerleading and our own Massachusetts regulations check out: MSSAA Cheerleading

For the Spirit Handbook mentioned in the AAP’s twelve guidelines check out: http://www.nfhs.com/c-229-spirit.Aspx

Please feel free to leave me any comments, feedback, concerns, or insight on this page or email me at c_meltsakos@nymc.edu. Also, if you like what you've read subscribe to the feed to get my articles sent directly to your inbox!

Resources:

Bagnulo A. (2012). Cheerleading injuries: A narrative review of the literature. Journal of Canadian Chiropractic Association. 56(4): 292-298.

Policy Statement (2012). Cheerleading Injuries: Epidemiology and Recommendations For Prevention. Pediatrics. 130(5): 966-971.

Shields BJ, Smith GA. (2009). Cheerleading-Related Injuries in the United States: A Prospective Surveillance Study. Journal of Athletic Training. 44(6): 567-577.