Dr. Amy Xu got hooked on cheerleading in the fifth grade.
As she pursued the sport in high school and college, she witnessed how the routines started demanding increasingly complex acrobatic feats — tall human towers and tumbling passes with many twists and flips.
It wasn’t unusual for her and her teammates to get concussions and other injuries.
“I saw individuals that are constantly battling through chronic conditions, suffering through acute injuries because it's a sport that requires practice and participation all year long,” says Xu, now an orthopedic resident at the Hospital for Special Surgery in New York.
Xu, who has published research on injuries related to cheerleading, says the sport that isn’t really talked about much in the literature.
Pediatricians are now raising awareness of the risks. For the first time in over a decade the American Academy of Pediatrics has issued an updated statement this week on the risks of injuries related to youth cheerleading, and how to prevent them.
The group is calling for cheerleading to be formally recognized as a sport, and for cheerleaders to get the same resources and support as other athletes.
Dr. Gregory Canty, who co-authored the AAP statement, says he sees cheerleading patients “daily” in his medical practice.
“As the athleticism and the height on [cheerleading] stunts get higher and higher, that leads to an increased risk of injury — and some degree of serious injury,” says Canty, medical director at the Sports Medicine Center at Children’s Mercy hospital in Kansas City, Mo.
And while the overall rate of injury in cheerleading is two to three times lower than girls’ soccer or girls’ basketball, cheerleading injuries, particularly concussions, “can be severe and they can have prolonged recovery time,” Canty says.
Cheerleading has gotten more athletic and more dangerous over the years.
Back in the 1800’s, men led cheers on the sidelines at games. Now, the vast majority of the 3.5 million U.S. youth in cheerleading are girls between the ages of 6-17. And the sport has evolved from clapping and waving on the sidelines into intricate multi-person routines, or stunts, that involve jumping, tumbling and tossing athletes in the air.
USA Cheer, a sports governing body, describes “stunt” cheerleading as “one of the fastest growing female sports in the country.”
Stunting is also implicated in nearly 70% of the concussions reported in high school cheerleading, according to data included in the AAP report. “The concussion risk has gone up quite a bit” in the past ten years, says Canty, adding that concussion diagnoses and reporting have also improved in that time.
“I see quite a few cheerleaders for persistent post-concussion symptoms,” says pediatric neurologist Dr. Brittany Poinson at Children’s Hospital New Orleans, who wasn’t involved in the new AAP report. “A lot of families who have kids involved in cheer don’t recognize the risks, but it definitely occurs.”
The risk of injury runs high even during practice.
Cheerleading’s concussion rate during practice ranks third behind boys’ football and boys’ wrestling practices, according to the AAP report. “That may correlate with the fact that they’re still acquiring the skills and they're trying to learn the proper techniques to protect themselves,” Poinson says.
Injuries in cheerleading often happen when athletes doing multi-person aerial stunts collide with each other or the ground. Policy changes have already made some stunts safer.
In 2006, governing bodies for the sport began prohibiting the “basket toss” – when a cheerleader is launched into the air by a team of people whose hands are interlocked – on hard ground. Research shows that requiring the “basket toss” to be performed on absorbent surfaces such as grass or rubber mats cut catastrophic injuries related to the move by nearly 75% in the following decade.
“What that highlights for me is that if we take a look at where and when these injuries happen, it can lead to real changes that continue to make the sport safer while keeping it exciting for participants,” Canty says.
Despite the sport’s popularity, the National Collegiate Athletics Association and many state high school sports associations don’t recognize it as an official sport. That makes it hard to collect comprehensive data on injuries and ultimately improve the safety of the sport, says Canty.
Formal recognition would also improve access to qualified coaches, training facilities and injury care, according the AAP policy statement.
“There are injuries [in cheerleading] that are severe and frequent, and [cheer teams] should be given access to the same resources as other athletic teams like football and soccer,” says Xu.
In its policy statement, the AAP also calls for physical health screenings for prospective athletes and emergency action plans that are posted prominently in training facilities.
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