A new policy statement issued today by the American Academy of Pediatrics (AAP) recommends that cheerleading be designated a sport (as opposed to an “activity”) and be subject to the same safety rules and monitoring as other high school and college sports.
The AAP notes that although most high schools and colleges have cheerleaders, only 29 state high school athletic associations recognize cheerleading as a sport, and the National Collegiate Athletic Association (NCAA) does not include competitive cheerleading in its list of sponsored sports, a fact I find absolutely astonishing.
According to the policy statement, cheerleading has increased dramatically in popularity over the last 30 years, and has evolved from leading the crowd in cheers at sporting events into a competitive, year-round sport involving complex acrobatic stunts and tumbling.
And those complex acrobatic stunts are leading to a significant surge in cheerleading injuries, says the AAP.
The most common injuries are sprains and strains to the lower extremities, the AAP says. Although the overall injury rate remains relatively low, cheerleading sees some of the most serious and severe injuries of all girls’ sports. Cheerleading has accounted for approximately 66 percent of all catastrophic injuries in high school girl athletes over the past 25 years, and more than 70% in college women athletes. Catastrophic injuries include direct trauma such as concussion, skull fracture, and spinal cord injuries. Catastrophic injuries can also include those that are indirect, such as heat stroke or cardiac collapse.
Concussion rates in cheerleading, at 0.06 incidents per 1,000 exposures, are lower than in other girls’ sports, such as soccer (0.36), basketball (0.16–0.21), lacrosse (0.20), softball (0.07–0.11), and ﬁeld hockey (0.10). However, pediatricians are concerned because from 1998 to 2008, concussion rates in cheerleading increased by 26% each year, a rate greater than any of the other girls’ sports studied.
What increases a cheerleader’s risk of injury?
- Age and competitive level: Younger cheerleaders (age 5 through 11) are more likely to suffer fracture or dislocation, while older cheerleaders have higher rates of strains and sprains. Rates of concussions increase with age and competitive level, likely because of the increasing difﬁculty of stunts.
- Higher BMI.
- Previous injury.
- Performing stunts — regardless of what role the cheerleader has in the stunt. The AAP says that some data indicate that bases and ﬂyers are at similar risk for injury during stunts, but others suggest that bases are at higher risk.
- Supervision by a coach with low level of training and experience.
- Cheering on harder surfaces.
The policy statement went on to explicitly state “critical heights” for different floor types. Critical height is deﬁned as the approximate fall height below which a life-threatening injury would not be expected to occur. Critical height is much higher for a landing mat on a foam ﬂoor (11 ft) and for a spring ﬂoor (10.5 ft) than for concrete or vinyl tile ﬂoor (0.5 ft). Critical heights for natural grass, artiﬁcial turf, and wood gym ﬂoor are 3.5 ft, 4 ft, and 4.5 ft, respectively. The most serious cheerleading injuries occur at or above the critical height for the surface on which the cheerleader is performing at the time of injury.
What does the AAP recommend?
- The American Academy of Pediatrics recommends that its chapters and individual pediatricians, especially those serving as school physicians, advisors, or consultants, work with their interscholastic athletic associations and other state and local cheerleading regulating bodies to ensure that the following guidelines are followed to reduce cheerleading injuries.
- Cheerleading should be designated a sport so that it is subject to rules and regulations set forth by sports governing bodies (eg, NCAA, NFHS) and school athletic departments. Designation of cheerleading as a sport will afford it the same beneﬁts as other sports, such as availability of athletic trainers, improved access to medical care, limits on practice time, better facilities, certiﬁed/qualiﬁed coaches, and inclusion in injury surveillance data.
- Cheerleaders should have a physical examination before participating in a cheerleading program, and should have access to appropriate strength and conditioning programs.
- Cheerleaders should be supervised by qualiﬁed coaches who have been trained and certiﬁed in proper spotting for gymnastics and partner stunts, safety measures, and basic injury management.
- Cheerleaders should be trained in proper spotting techniques and should only attempt stunts after they have demonstrated appropriate skill progression and proficiency required to complete the stunt. Spotters and bases should have adequate upper body and core strength and balance to support ﬂyers.
- Technical skills, such as pyramids, mounts, tosses, and tumbling, should not be performed on hard (e.g., concrete, asphalt), wet, or uneven surfaces or surfaces with obstructions. No cheer events should take place on dirt, vinyl ﬂoors, concrete, or asphalt.
- Pyramids and partner stunts should only be performed on a spring ﬂoor or with a landing mat on either a traditional foam ﬂoor or grass/turf.
- Pyramids should not be more than 2 people high and should only be performed with spotters.
- Coaches should follow rules for execution of technical skills set forth in the most recent version of the NFHS Spirit Rules Handbookand the AACCA Cheerleading Safety Manual.
- Coaches, parents, and athletes should have access to a written emergency plan, designed by school administrators in conjunction with the team physician and/or certiﬁed athletic trainer. Whenever possible, a certiﬁed athletic trainer or physician should be present at practices and competitions.
- Cheer competitions should be held in venues that are compliant with guidelines of the National Cheer Safety Foundation and the AACCA.
- Any cheerleader showing signs of a head injury should be removed from practice or competition and not allowed to return until he or she has received written clearance from a physician or qualiﬁed health care provider. Coaches, parents, and ofﬁcials should be knowledgeable regarding the cause, prevention, recognition, and response to concussion. Free online educational materials are available through the Centers for Disease Control and Prevention and the NFHS.
Do you have a kid that participates in cheerleading? How worried are you about injury?
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