Center director Frederick O. Mueller, PhD, and medical director Robert C. Cantu, MD, found that high school cheerleading accounted for 65.1% of all catastrophic sports injuries among females over the past 25 years, and that college cheerleading accounted for 66.7% of all female sports catastrophic injuries in that age group.
“A major factor in this increase [of cheerleading injuries] has been the change in cheerleading activity, which now involves gymnastic-type stunts. If these activities are not taught by a competent coach and keep increasing in difficulty, catastrophic injuries will continue to be a part of cheerleading.”—Frederick O. Mueller, PhD
Dr. Mueller, who is also professor of exercise and sports science in the University of North Carolina’s College of Arts and Sciences, said, “A major factor in this increase [of cheerleading injuries] has been the change in cheerleading activity, which now involves gymnastic-type stunts. If these activities are not taught by a competent coach and keep increasing in difficulty, catastrophic injuries will continue to be a part of cheerleading.”Surge in unregulated cheerleading teams, contests, translates into more injuries and deaths
Between 1982 and 2007, there were 103 fatal, disabling, or serious injuries recorded among female high school athletes, with the vast majority (67) occurring in cheerleading. No other sports registered double-figure tallies; gymnastics (9) and track (7) had the second and third highest totals, respectively.
Among college athletes, there have been 39 such injuries: 26 in cheerleading, followed by three in field hockey and two each in lacrosse and gymnastics.
“For cheerleading injuries to account for two thirds of all catastrophic injuries to female athletes in high school and college is a huge red flag that will require identifying what factors put athletes at risk for injury to begin with, implementing new strategies, studying effects, and making new changes to increase effectiveness. We have to stop comparing cheerleading injuries to other sports, or defending the alarming number of life altering injuries, and get serious about learning from injuries that have already happened,” said Kimberly Archie, executive director of the National Cheer Safety Foundation (www.nationalcheersafety.com).?
According to the report, almost 95,200 female students take part in high school cheerleading annually, along with about 2150 males. College participation numbers are hard to find because cheerleading is not an NCAA sport. The report also notes that, according to the NCAA insurance program, 25% of money spent on student athlete injuries in 2005 resulted from cheerleading.
That insurance covers only cheerleading accidents that occur at sporting events, not those that happen during cheerleading competitions. Ms. Archie told Musculoskeletal Report that such freestanding competitions are behind much of the growth in participation because they allow participation of cheer teams that are not affiliated with schools or athletic teams.
Indeed the most recent death of a high school cheerleader occurred at such an event—the Minuteman Cheerleading Championships in Worcester, Massachusetts. On April 17, 2008, Lauren Chang of Newton, Massachusetts, died after being kicked in the chest, leading to collapsed lungs. Ms. Chang's injuries, and those of Medford (Mass) high school freshman Ashley Burns in 2005, occurred in the context of a stunt Dr. Mueller describes as among the more dangerous moves in cheerleading: the basket toss.
“A stunt pod of three or four people at the base throws a 'flyer' about 25 feet into the air. She does flips, twists, and stunts on the way down, and they are supposed to catch her and lower her safely to the ground,” Dr. Mueller said. Unlike the situation in gymnastics, where similar movements are done, cheerleaders rarely have thickly padded landing spaces to break the fall if something goes wrong, or have emergency plans in place when it does [go wrong].
According to the National Cheer Safety Foundation, that is exactly what led to Ms. Burns's death. According to Ms. Archie, 14-year-old Ashley Burns made the Medford High School's cheerleading squad as a freshman. On August 9, 2005, while practicing with her team, she was perfecting a double down from an arabesque, a stunt she had done correctly many times before. This time, she was unable to complete the second twist and landed stomach down in her stunt pod's arms.
“Ashley Burns died because an ambulance was not called until she collapsed and was throwing up blood,” Ms. Archie said. “She was unconscious when emergency aid arrived and was pronounced dead on arrival to Saints Memorial Medical Center from internal bleeding. An autopsy later revealed she died from blunt trauma that ruptured her spleen, leading to internal bleeding.”
Translating research into practice
The delay in medical services in the Burns case is typical rather than rare in cheerleading, according to Dr. Mueller's data. He said that, unlike other sports, most cheerleading teams do not have medical personnel on site during competition and do not have emergency plans for dealing with injuries. “Cheerleading should be considered a sport and as such should have qualified coaches, safe facilities, preparticipation physical exams, sports medicine care, and safe travel.”
In the wake of the Burns and Chang deaths, Ms. Archie's foundation prepared a 9-page Rehearsed Catastrophic Injury Emergency Plan for Competitive Cheerleaders to aid coaches during emergencies. It can be downloaded at http://www.nationalcheersafety.com/emergencyplan.pdf.
Mueller and Archie both think cheerleading should be categorized as a sport, with appropriate oversight in terms of participant health evaluations, coaching credentials and training, team safety, and emergency preparedness. So far, only 19 states have agreed, and Dr. Mueller said that has been due in part to opposition from coaches and vendors.
Reference
1. Mueller FO, Cantu RC. Twenty-first annual report. National Center for Catastrophic Sport Injury Research. 2008. Available at htttp://www.unc.edu/depts/ncssi/AllSport.htm.
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