Cheerleaders' Stunts Raise Risk of Serious Injury

MIAMI — Although the overall risk of injury in cheerleading is low, the activity accounts for more than half of all catastrophic sports injuries in females, Dr. Teri McCambridge said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

In the last 25 years, cheerleading has progressed from a spirit-raising sideline activity to an exacting athletic endeavor, and with that change, there has been an increase in the number of injuries among cheerleaders.

Partner stunts, particularly basket tosses and pyramids, account for the greatest number of cheerleading injuries. In a basket toss, three or four “bases” toss a “flier” into the air. The flier reaches heights of 6–20 feet before falling into the arms of the bases. Most basket toss injuries occur indoors, when cheerleaders perform them in a gymnasium during winter sports.

Performing stunts on an improper surface during a game or practice session is one common yet preventable cause of serious injury. According to surveys completed by 425 high school cheerleaders in the Midwest, 10% of cheerleading practices are held in the cafeteria or hallway, where the concrete floors offer minimal padding. Other contributors include performing stunts on wet floors, forming pyramids without mats or spotters, trying to perform stunts in a short time frame, and cheerleading too close to the field or court, said Dr. McCambridge, a pediatrician at Johns Hopkins University, Baltimore.

The American Association of Cheerleading Coaches and Administrators (AACCA) has published safety guidelines, including pyramid restrictions of two levels in high school and 2.5 levels in college. Following these guidelines can prevent cheerleaders from attempting skills beyond their developmental abilities.

In a larger context, a primary issue with cheerleading is the lack of standardized rules and regulations. Various cheerleading associations have published guidelines, but universal guidelines do not exist. Moreover, cheerleading coaches are not required to obtain a universal safety certification; as of 2003, only 30% of coaches were certified.

Some states require coaches to be AACCA safety-certified before they can teach children stunts, however, and beginning this year, the National Collegiate Athletic Association (NCAA) will require all coaches to have AACCA safety certifications. Some insurance companies are also requiring coaches to be AACCA-certified before they can obtain liability insurance.

These issues of nonregulation likely stem from the fact that cheerleading in most cases is not considered a sport according to the NCAA definition, and it is thus not as well regulated as other sports. This exclusion makes cheerleading squads ineligible for funding that can help pay for coaches, equipment, and other expenses, but it also frees them from constraints of sports such as having a defined competitive season. The debate on whether to classify cheerleading as a sport is ongoing.

“It would help us as primary care providers to have it be a sport,” Dr. McCambridge said, “because then the NCAA would track their injuries, and we could make more educated changes in their safety requirements.” She predicted that the nonregulated state of cheerleading would likely end if cheerleading becomes an official sport.

Pediatricians can do their part to help ensure cheerleaders' safety by providing guidance to their own cheerleading patients. (See box.)

Dr. McCambridge encouraged those who provide sports coverage to high schools to advocate for safety certification requirements in their schools.

Padding, Matting, and Lighting Spell Safety

Dr. McCambridge recommended that physicians discuss the following questions with families of cheerleaders:

▸ Is a separate practice area available?

▸ Is there sufficient space—floor space and ceiling height—for the type of stunts being performed?

▸ Are there enough spotters present for the stunt being performed?

▸ Are nearby objects properly padded?

▸ Is there adequate matting?

▸ Is there adequate lighting?

▸ Are the cheerleaders practicing and performing on an appropriate flooring surface?

▸ Are the cheerleaders in appropriate attire (tennis shoes, tight-fitting clothes, no dangly earrings or facial piercings)?

MIAMI — Although the overall risk of injury in cheerleading is low, the activity accounts for more than half of all catastrophic sports injuries in females, Dr. Teri McCambridge said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

In the last 25 years, cheerleading has progressed from a spirit-raising sideline activity to an exacting athletic endeavor, and with that change, there has been an increase in the number of injuries among cheerleaders.

Partner stunts, particularly basket tosses and pyramids, account for the greatest number of cheerleading injuries. In a basket toss, three or four “bases” toss a “flier” into the air. The flier reaches heights of 6–20 feet before falling into the arms of the bases. Most basket toss injuries occur indoors, when cheerleaders perform them in a gymnasium during winter sports.

Performing stunts on an improper surface during a game or practice session is one common yet preventable cause of serious injury. According to surveys completed by 425 high school cheerleaders in the Midwest, 10% of cheerleading practices are held in the cafeteria or hallway, where the concrete floors offer minimal padding. Other contributors include performing stunts on wet floors, forming pyramids without mats or spotters, trying to perform stunts in a short time frame, and cheerleading too close to the field or court, said Dr. McCambridge, a pediatrician at Johns Hopkins University, Baltimore.

The American Association of Cheerleading Coaches and Administrators (AACCA) has published safety guidelines, including pyramid restrictions of two levels in high school and 2.5 levels in college. Following these guidelines can prevent cheerleaders from attempting skills beyond their developmental abilities.

In a larger context, a primary issue with cheerleading is the lack of standardized rules and regulations. Various cheerleading associations have published guidelines, but universal guidelines do not exist. Moreover, cheerleading coaches are not required to obtain a universal safety certification; as of 2003, only 30% of coaches were certified.

Some states require coaches to be AACCA safety-certified before they can teach children stunts, however, and beginning this year, the National Collegiate Athletic Association (NCAA) will require all coaches to have AACCA safety certifications. Some insurance companies are also requiring coaches to be AACCA-certified before they can obtain liability insurance.

These issues of nonregulation likely stem from the fact that cheerleading in most cases is not considered a sport according to the NCAA definition, and it is thus not as well regulated as other sports. This exclusion makes cheerleading squads ineligible for funding that can help pay for coaches, equipment, and other expenses, but it also frees them from constraints of sports such as having a defined competitive season. The debate on whether to classify cheerleading as a sport is ongoing.

“It would help us as primary care providers to have it be a sport,” Dr. McCambridge said, “because then the NCAA would track their injuries, and we could make more educated changes in their safety requirements.” She predicted that the nonregulated state of cheerleading would likely end if cheerleading becomes an official sport.

Pediatricians can do their part to help ensure cheerleaders' safety by providing guidance to their own cheerleading patients. (See box.)

Dr. McCambridge encouraged those who provide sports coverage to high schools to advocate for safety certification requirements in their schools.

Padding, Matting, and Lighting Spell Safety

Dr. McCambridge recommended that physicians discuss the following questions with families of cheerleaders:

▸ Is a separate practice area available?

▸ Is there sufficient space—floor space and ceiling height—for the type of stunts being performed?

▸ Are there enough spotters present for the stunt being performed?

▸ Are nearby objects properly padded?

▸ Is there adequate matting?

▸ Is there adequate lighting?

▸ Are the cheerleaders practicing and performing on an appropriate flooring surface?

▸ Are the cheerleaders in appropriate attire (tennis shoes, tight-fitting clothes, no dangly earrings or facial piercings)?

MIAMI — Although the overall risk of injury in cheerleading is low, the activity accounts for more than half of all catastrophic sports injuries in females, Dr. Teri McCambridge said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

In the last 25 years, cheerleading has progressed from a spirit-raising sideline activity to an exacting athletic endeavor, and with that change, there has been an increase in the number of injuries among cheerleaders.

Partner stunts, particularly basket tosses and pyramids, account for the greatest number of cheerleading injuries. In a basket toss, three or four “bases” toss a “flier” into the air. The flier reaches heights of 6–20 feet before falling into the arms of the bases. Most basket toss injuries occur indoors, when cheerleaders perform them in a gymnasium during winter sports.

Performing stunts on an improper surface during a game or practice session is one common yet preventable cause of serious injury. According to surveys completed by 425 high school cheerleaders in the Midwest, 10% of cheerleading practices are held in the cafeteria or hallway, where the concrete floors offer minimal padding. Other contributors include performing stunts on wet floors, forming pyramids without mats or spotters, trying to perform stunts in a short time frame, and cheerleading too close to the field or court, said Dr. McCambridge, a pediatrician at Johns Hopkins University, Baltimore.

The American Association of Cheerleading Coaches and Administrators (AACCA) has published safety guidelines, including pyramid restrictions of two levels in high school and 2.5 levels in college. Following these guidelines can prevent cheerleaders from attempting skills beyond their developmental abilities.

In a larger context, a primary issue with cheerleading is the lack of standardized rules and regulations. Various cheerleading associations have published guidelines, but universal guidelines do not exist. Moreover, cheerleading coaches are not required to obtain a universal safety certification; as of 2003, only 30% of coaches were certified.

Some states require coaches to be AACCA safety-certified before they can teach children stunts, however, and beginning this year, the National Collegiate Athletic Association (NCAA) will require all coaches to have AACCA safety certifications. Some insurance companies are also requiring coaches to be AACCA-certified before they can obtain liability insurance.

These issues of nonregulation likely stem from the fact that cheerleading in most cases is not considered a sport according to the NCAA definition, and it is thus not as well regulated as other sports. This exclusion makes cheerleading squads ineligible for funding that can help pay for coaches, equipment, and other expenses, but it also frees them from constraints of sports such as having a defined competitive season. The debate on whether to classify cheerleading as a sport is ongoing.

“It would help us as primary care providers to have it be a sport,” Dr. McCambridge said, “because then the NCAA would track their injuries, and we could make more educated changes in their safety requirements.” She predicted that the nonregulated state of cheerleading would likely end if cheerleading becomes an official sport.

Pediatricians can do their part to help ensure cheerleaders' safety by providing guidance to their own cheerleading patients. (See box.)

Dr. McCambridge encouraged those who provide sports coverage to high schools to advocate for safety certification requirements in their schools.

Padding, Matting, and Lighting Spell Safety

Dr. McCambridge recommended that physicians discuss the following questions with families of cheerleaders:

▸ Is a separate practice area available?

▸ Is there sufficient space—floor space and ceiling height—for the type of stunts being performed?

▸ Are there enough spotters present for the stunt being performed?

▸ Are nearby objects properly padded?

▸ Is there adequate matting?

▸ Is there adequate lighting?

▸ Are the cheerleaders practicing and performing on an appropriate flooring surface?

▸ Are the cheerleaders in appropriate attire (tennis shoes, tight-fitting clothes, no dangly earrings or facial piercings)?