Champion Sports Training - Safety 101: Cheerleading

Recently injuries in the sport of Cheerleading have been a very hot topic. Many national organizations have reported recent research from Columbus Children’s Institute at Columbus Children’s Hospital that show cheerleading injuries have doubled from 1990-2002. During this time there has been a reported increase in cheerleading participation by only 18%. Many people in the cheer industry feel this reported increase is dramatically underestimated and too low. Les Stella with USASF thinks the “growth may be closer to 150%.” One other point that Les addressed was the fact that many athletes in traditional sports “go directly to their school trainer and most cheerleaders go to the emergency room.” This example demonstrates the difference in how injuries are assessed and treated between cheerleading and other school sports.

Cheerleading has come a long way since first year medical student Jack Campbell from Minnesota became the first documented cheerleader in 1898. The sport continues to evolve as the University of Maryland became the first Division 1 school to consider competitive cheerleading as a varsity sport and count it toward its Title IX requirements. Cheerleading has evolved into a physically demanding sport that requires a significant amount of flexibility for toe touches and heel stretches, upper body and lower body strength for stunts, and explosive power in tumbling. As with any other sport, when there is significant growth in participation there is almost always an increase in injury rates.

REASONS CHEERLEADERS ARE INJURED
Some of the causative factors for injury include:

REDUCING THE RISK OF INJURY
Opportunities to reduce the risk of injury:

The last two points, dealing with injuries and conditioning the cheer athlete, are often overlooked or not addressed. As with many other traditional sports, strength and conditioning is often the last element to be addressed. Even until recently many baseball coaches avoided weight training and conditioning for fear of making their athletes too bulky or interfering with their skills. Most recent research in traditional sports (such as basketball, soccer, etc) shows that stronger athletes exhibit improved performance and a reduction in risk of injury.

Since most injuries occur during practice, it is important to have a process for dealing with both acute and chronic injuries. The most frequent injured area for cheerleaders is the lower extremity, specifically the knee, foot, and ankle.

DEALING WITH INJURY:
ACUTE INJURIES:
Lateral Ankle Sprains are one of the most common injuries seen in cheerleading. Injuries are classified into three grades.

When an athlete has immediate swelling and bruising, they should be seen by a physician as soon as possible.

Knee Injuries are common as well. One of the most catastrophic injuries an athlete can have is an Anterior Cruciate Ligament (ACL) Tear. The ACL is the main stabilizing ligament of the knee and is often injured when an athlete lands with all his/her weight on one leg in a hyperextended position. If a pop is felt with immediate swelling and pain, the cheerleader needs to be seen by a physician as soon as possible. Generally the athlete will need reconstructive surgery and will be out of competition for six months to one year.

Medial Collateral Ligament (MCL) sprains are injuries to the large stabilizing ligament on the inside of the knee and again often occur when the athlete lands awkwardly with the knee in an extended position. The grading system for MCL injuries is the similar to lateral ankle sprains. Injury to this ligament rarely requires surgery. Grade 3 sprains often require immobilization using a brace to prevent valgus forces and may keep the athlete out of practice or competition for two to three months. The athlete needs to be seen by a physician as soon as possible.

Patellar Dislocations can occur with tumbling or jumping. The athlete’s knee cap will be out of place and he/she will be in significant pain. This injury needs to be seen immediately and often requires a trip to the emergency room.

What needs immediate medical attention? ( Including but not limited to…)
1. Obvious deformity of soft tissue or bone
2. Spinal injury
3. Loss of consciousness
4. Numbness, tingling, or weakness in an extremity
5. Significant swelling, discoloration or bruising
6. Uncontrolled bleeding
7. Inability to put weight on an extremity or unwillingness to move an extremity

CHRONIC INJURIES:
Chronic injuries are often not as dramatic as acute injuries however they may be more difficult to deal with because it involves areas used so frequently during stunting and tumbling. There may be one incident the athlete can pin point or there may be no known cause for the injury. Often the athlete may notice stiffness or pain after practice in the involved joint or muscle. As the injury becomes more chronic in nature, the cheerleader may have pain while performing the activity and pain for several hours later. At this point the athlete should see a physician.

Some of these areas include: foot, ankle, knee, low back, shoulder and wrist.

Patellar Tendonitis (often called jumpers knee) occurs frequently during high volume training times. Pain is located below the knee cap and occurs with jumping activities. Pain may be described as a dull ache or sharp pain right below the knee cap. Treatment for this may include anti-inflammatory medications, Physical Therapy, a patellar strap to give compression to the tendon and utilization of ice after practice for ten to fifteen minutes can help reduce inflammation in the tendon.

Low back pain is usually a generalized ache in the lumbar region (lower back) and is aggravated with tumbling or stunting. This problem often responds well to Physical Therapy and a consistent core (abdominal/back muscles) strengthening program. If the cheerleader has pain or numbness radiating down an extremity, he/she should see a physician immediately. Any movement that makes the pain worse should be avoided during the healing process. Most back strains get better in two to four weeks.

Wrist pain is very common because of the stunting and tumbling involved in cheerleading. This can often be eliminated with relative rest, use of ice, or taping/wrapping (only during the activity). When the pain persists for several weeks, or the athlete has significant pain at the base of the thumb it should be assessed by a physician.

Chronic ankle pain occurs after an acute ankle injury. The cheerleader may have aching pain after practice that is often alleviated with rest. Physical Therapy focusing on strengthening of the lateral (outside) ankle muscles and proprioceptive (balance/coordination) exercises can reduce these symptoms.

PREPARING FOR THE INEVITABLE
To address issues with your team or gym you must first know what problems are occurring. Is their a problem with your coaching, facility, or conditioning of your athletes? It can often be helpful to keep a list of injuries that your program has had over the past twelve months that has limited an athlete’s ability to compete. It is critical to have a plan in the case of emergency situations.

The choice of physician the athlete is sent to is very important. The physician should have a good understanding of what type of movements and skills that your athlete is required to perform. Most Orthopedists with a sports medicine specialty have a good understanding of the requirements of today’s competitive cheerleader. Some family physicians can also effectively deal orthopedic injuries. The important point is ensuring that the care your athlete is delivering is administered by a health care professional that understands the demands of the sport of cheerleading.

TIP: Many physical therapy clinics or physician offices may provide weekly injury checks in which they send a medical professional to perform a screening of injured athletes. This is generally a free service. If you do not have a system in place to effectively deal with you injuries this is a good way to start.

Other important points include, having proper insurance coverage for your team; and having a consistent plan on when an athlete is allowed to return to participation. Having an agreement at the beginning of the season between the athlete, parent and coach might eliminate possible confusion of how injuries are dealt with. K & K Insurance offers policies for cheerleading teams and even offers discounts for USASF members.

SPORT SPECIFIC CONDITIONING
If you don’t have a conditioning program that is consistent and specific to the sport of cheerleading, it is time to integrate a program for next season. As mentioned earlier it is a natural process for a sport to resist strength and conditioning. In the early days of the sport, even football coaches resisted lifting weights. The fact is that without a structured program you are not going to get the most out of your athletes and you may be predisposing them to chronic or even acute injury.

Depending on your time allowances and needs you can make your program as comprehensive as you want. You can have a good conditioning program without having to buy a significant amount of equipment.

These areas should be included in your training program and generally in this sequence:
1. Balance and Coordination drills are important in reducing the risk of ankle injuries. Often cheerleaders that have sprained their ankles in the past re-injure themselves because of damage to proprioceptors (structures that give feedback to where their foot is in relation to the ground) in their ankles. There are many products out there that help build foot and ankle strength as well as proprioception. One simple exercise is to stand on one foot with the eyes closed and try to maintain this position for thirty seconds. Repeat this movement ten times.
2. Upper Body and Lower Body Strength can be achieved through simple body weight exercises such as lunges, squats, single leg calf raises, and push ups. More advanced training can be utilized by using resistance bands, and free weights.
3. Core Strengthening Program- the core muscles involve the abdominals, low back and hip musculature. Basic movements should be mastered first. This would include a spinal neutral position. To do this lie on your back with the hips and knees bent then contract your abdominals, hold five seconds and repeat ten times. As the athlete learns this basic movement, advance to more challenging exercises. Performing a superman position can build strength in the back muscles. Lie on the stomach and lift the arms/shoulders, legs at the same time. The athlete holds this position five seconds and repeats ten times.
4. Flexibility-this is important not only to flyers but also bases. The program should concentrate on the entire body and focus on the mid back, lower back and hip musculature. It is important that the program stretches the athlete symmetrically (both sides). Hold your stretches for twenty to thirty seconds in duration. Do not just stretch one side!

A warm up and cool down should be included in your exercise program. It can consist of a jog around your gym followed by gentle stretching. For more advanced athletes we often include a dynamic warm up in which the muscles are stretched through active movement.

You can tailor you program to meet your team’s needs. Bases may spend more time working on core, upper body and lower body strength and flyers may spend more time stretching and working on balance. However, each athlete should spend some time on each area.

CONCLUSION
Because of the high physical demands, and complex movements injuries will always be part of cheerleading as it is in every sport. However, by addressing the areas we have discussed and have control over, we can make the sport safer and better for everyone involved. Cheerleading is a safe sport and it is our job to keep it that way!

Key Areas to Address
Pre-participation physical
Proper facilities and equipment
Insurance coverage
Emergency plan for acute injuries
Plan for dealing with chronic injuries
Structured strength and conditioning program