NEW ORLEANS – The increasing rate of injuries, especially catastrophic ones, among cheerleaders has prompted the American Academy of Pediatrics to publish its first policy statement on the competitive, year-round activity.
Although the overall risk of injury in cheerleading is lower than for other sports, it accounted for 65% of all catastrophic injuries to high school female athletes and almost 71% of those in college during a 30-year period ending in 2009.
"The academy feels that cheerleading is a valuable activity," said report author Dr. Cynthia LaBella at the annual meeting of the American Academy of Pediatrics. "We just want to make sure that [the cheerleaders] have the same safety precautions in place as those participating in other sports do," noted Dr. LaBella, medical director of the Institute for Sports Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago.
The American Academy of Pediatrics (AAP) has made 12 recommendations to help reduce cheerleading injuries, including a call for cheerleading to be designated as a sport "so that it is subject to rules and regulations set forth by sports governing bodies ... and school athletic departments," according to the report (Pediatrics 2012;130:966-971).
Cheerleading has become increasingly popular, with approximately 400,000 participants in high school cheerleading alone, according to 2009 data from the National Federation of State High School Associations. Yet only 29 state high school athletic associations recognize cheerleading as a sport, according to the AAP report.
Being classified as a sport, the academy points out, brings safety resources and regulations such as qualified coaches as well as access to athletic trainers and team physicians.
The academy also recommends that cheerleaders undergo a preparticipation physical examination and have access to appropriate strength and conditioning programs.
The catastrophic injury rate among female high school cheerleaders was between 0.5 and 1.62, compared with 0.44 for gymnastics. The rate was 0.3 or lower for female athletes participating in sports such as soccer, basketball, and softball. Catastrophic injuries included closed-head injury, skull fractures, cervical spine injuries, paralysis, and death.
Naseem S. Miller/IMNG Medical Media
Dr. Cynthia LaBella discusses the AAP's new report on preventing cheerleading-related injuries.
Dr. LaBella said the lower rate of catastrophic injury among gymnasts could be due to the level of supervision, better conditioning programs, and more protective equipment, including flooring.
The AAP also recommends that cheerleaders be supervised by qualified coaches who have been properly trained and certified, and avoid performing certain technical skills on hard, wet, or uneven surfaces. "No cheer events should take place on dirt, vinyl floors, concrete, or asphalt," wrote Dr. LaBella and coauthor Dr. Jeffrey Mjaanes, of the departments of orthopedic surgery and pediatrics at Rush University Medical Center, Chicago.
In addition, the AAP recommends that any cheerleader who shows signs of a head injury "should be removed from practice or competition and not be allowed to return until he or she has received written clearance from a physician or a qualified health care provider."
The number of U.S. cheerleaders 6 years and older increased from 3.0 million in 1990 to 3.6 million in 2003, and girls represented 96% of the participants, according to the report.
Middle and high school cheerleaders have lower overall injury rates than collegiate-level cheerleaders, partly because older cheerleaders are better skilled and tend to perform more complex gymnastics and height-based stunts, the authors noted.
Meanwhile, the number of hospital emergency department visits for cheerleading injuries rose from roughly 5,000 in 1980 to 27,000 in 2007, a 400% increase. Of these injuries, 98% were treated and released.
Lower-extremity injuries are the most common injuries (30%-37%), followed by upper-extremities injuries (16%-19%) and trunk injuries (7%-17%).
Concussions and other closed-head injuries account for 4%-6% of all cheerleading injuries, according to the AAP report. Meanwhile, head and neck injuries account for roughly 15% of all cheerleading injuries seen in emergency departments.
Although the concussion rate in cheerleading is low (0.06 per 1,000 exposures) compared with other girls’ sports such as soccer (0.36), the rate increased by 26% annually from 1998 to 2008.
"Our goal is to make people more aware of the potential injury risk," said Dr. LaBella, who is also an associate professor of pediatrics at Northwestern University in Chicago.
She encouraged cheerleaders and those who supervise them to report the injuries. "That knowledge of what's going on with injuries will help with making further recommendations for the future."
Dr. LaBella had no disclosures.