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Cheerleading Injuries on the Increase

Youthful cheerleaders, mostly girls, getting hurt as sport turns serious

TUESDAY, Jan. 3, 2006 (HealthDay News) -- Cheerleading's transformation from a sidelines activity to a sophisticated sport has resulted in a sharp increase in injuries, mostly among girls.

Injuries related to cheerleading among 5- to 18-year-olds more than doubled between 1990 and 2002, concluded a study appearing in the January issue of Pediatrics.

"Cheerleading used to be just standing on the sidelines waving pom poms and leading the crowd in cheers, but now it's incorporating highly technical gymnastics skills, pyramids, throwing each other up in the air," said Brenda Shields. She is lead author of the study and research coordinator at the Center for Injury Research and Policy at Columbus Children's Research Institute in Columbus Children's Hospital in Ohio. "All of these are leading, we hypothesize, to an increased rate of injury."

"Athletes are bigger, stronger and faster in almost any sport than 10 to 20 years ago. There are more aggressive maneuvers, and kids are starting at younger and younger ages, and that leads to more injuries," added Dr. Todd Schlifstein, an assistant professor of rehabilitation medicine at New York University School of Medicine. "Do they really have the skill to do what they're trying to do? They're doing so much so fast and so young, are they physically capable?"

The American Association of Cheerleading Coaches and Advisors estimates that up to 3.5 million people (including adults) participated in cheerleading activities in 2002. This is a far cry from cheerleading's origins in the winter of 1898, when Johnny Campbell led cheers at a Minnesota University football game.

Recent concerns about injuries, especially catastrophic ones, have led to some attempted reforms.

In 2002, the University of Nebraska-Lincoln (UNL) athletic department announced that cheerleading stunts and tumbling would be banned, based on the fact that cheerleading was responsible for a disproportionate share (57 percent) of catastrophic injuries sustained by female college and high school athletes. The announcement cited one UNL cheerleader who had fractured her neck while doing a handspring during practice in 1996. The ruling, however, was reversed by a new athletic director in 2003.

Shields and her co-author analyzed data from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System for children aged 5 to 18 during the years 1990 through 2002.

About 209,000 children were treated in U.S. hospital emergency departments for cheerleading-related injuries during the time interval covered in the study. That works out to about 16,100 reported injuries each year. The number of injuries increased by 110 percent during the time period, the researchers said.

Almost all of the injured children (97 percent) were female and 85 percent of the injuries occurred in children 12 to 17 years of age. The average age of injured children was 14.

The bulk of injuries (37 percent) affected the lower extremities, while 26 percent involved upper extremities, 18 percent head and neck and 16 percent the trunk of the body.

"The 12-to-18-year-olds sustained primarily lower extremity injuries such as strains or sprains," Shields said. "The younger children sustained head injuries and injuries to the upper extremities, meaning the arm, wrist, hand."

Slightly more than half (52 percent) of the injuries were strains and sprains, 18 percent were soft tissue injuries such as bruising, 16 percent were fractures and dislocations, 3 percent were lacerations and another 3 percent concussions and closed head injuries.

Most patients were treated and released the same day, while some -- those with fractures or dislocations -- were more likely to be admitted to the hospital.

"Most of them are minor injuries and 98 percent of them are released the same day, but if 3 percent are concussion or head injuries, that's concerning," Schlifstein said.

The authors put forth three recommendations to help curb the problem.

The first involves implementing a set of universally enforced rules and regulations directed at increasing the safety of cheerleading. "Currently a lot of schools and coaches have their own safety rules, but they're not the same as another school down the road and may not be as stringent," Shields said.

Such rules might include requiring that performing of routines, either in practice or at a game, be done on an impact-absorbing surface such as a gym mat and that a certified coach be present during training.

The second recommendation would be mandatory completion of a safety training and certificate program by all cheerleading coaches. "Currently, a lot of coaches are not truly trained in coaching cheerleading," Shields explained. "They are just teachers that take on the responsibility and don't know what they're doing."

The final recommendation is to develop a national database to track cheerleading-related injuries so interventional strategies could be more carefully evaluated.

More information

For more on safety in cheerleading, go to the American Association of Cheerleading Coaches and Advisors.

SOURCES: Brenda Shields, M.S., research coordinator, Center for Injury Research and Policy, Columbus Children's Research Institute, Columbus Children's Hospital, Ohio; Todd Schlifstein, D.O., assistant professor, rehabilitation medicine, New York University School of Medicine, New York City; January 2006 Pediatrics
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