Physical Therapists Can Help Prevent Injury in Cheerleading

This blog was written by Kelly Boutchyard, PT, DPT | Kelly_Boutchyard@bshsi.org.

Cheerleading has been around since the late 1800’s.  Starting as mainly a sideline event full of chants and leg kicks, it has evolved over the years into a highly competitive sport of its own.  Cheerleading is now filled with stunts, jumps, dance, and gymnastics-style tumbling.  These new routine-style competitions create a whole new dynamic, thus increasing the risk of injury. The popularity of cheerleading has increased tremendously in the U.S. in the past 30 years, with participants as young as age three to the collegiate level.  This includes traditional school-based cheerleading squads, as well as “all-star” competition cheerleading squads, whose exclusive purpose is competing and is often a year-round commitment. With the increased physical demand and complexity of skills, along with the increased participation, cheerleading has developed an intense competitive spirit…which makes injury prevention a worthy discussion.

The areas of the body most commonly injured in cheerleading include wrists, shoulders, ankles, knees, head/neck and back. These injuries can range from muscle strains and ligament sprains to complete tears which require surgical repair.  Other injuries, such as fractures and dislocations can occur to even more catastrophic injuries such as spinal cord injury or traumatic brain injury.  The most common mechanisms of injury are basing/spotting stunts, tumbling and falls from stunting.  According to the American Academy of Pediatrics, some risk factors for injury include cheerleaders who have a higher BMI (body mass index), have sustained previous injury, perform stunts, and have coaches with low level of training and experience. The Consumer Product Safety Commission “reported 4,954 hospital emergency department visits for cheerleading injuries in 1980.  By 2007, the Consumer Product Safety Commission reported this number had climbed more than 400% to 26,786”.  Head and neck injuries account for about 15% of all cheerleading injuries seen in U.S. emergency departments.  In a prospective surveillance study, it was found that from 1998-2008, “concussion rates in cheerleading increased by 26% each year, a rate greater than any of the other girls’ sports studied.  Concussion rates increase with age and competitive level, likely because of the increasing difficulty of stunts”.

In order to prevent injury, it is important for cheerleaders to have active warm-ups and participation in strength training exercises, with focus on core, legs, and shoulders.  Proper body mechanics is critical to preventing injury, particularly when performing tumbling passes, jumps, and stunting.  The American Association of Cheerleading Coaches and Advisers (AACCA) has enforced rules and recommendations to increase safety, including required coach training and certification, proper strength and conditioning for all cheerleaders, and avoiding stunting and tumbling on hard surfaces, to name a few.  The AACCA lists all of their safety regulations to prevent injuries on their website.  Not all states recognize cheerleading as a sport.  If cheerleading was designated as a sport at the high school and college level, it would allow for benefits that could help to reduce and prevent injury.  These benefits include ensuring qualified coaches, adequate and well-maintained practice facilities, preseason conditioning, access to certified athletic trainers and team physicians, mandatory participation in physical examinations, and inclusion in injury surveillance data.  Injury surveillance data is used by the NCAA (National Collegiate Athletic Association) and NFSH (National Federation of State High School Associations) to determine safety rules and regulations in order to decrease risk of injury for each sport.

Physical Therapists can play a key role in injury prevention for these athletes.  Physical Therapists perform musculoskeletal evaluations and screens to identify areas of muscle imbalance, joint restriction, overall stability and coordination deficits that could precipitate an injury and/or pain in the future.  Physical Therapists provide exercise prescription to address these impairments with goals to improve flexibility and strength and teach proper body mechanics.  In addition to therapeutic exercises, they use manual therapy techniques to improve joint arthrokinematics and correct alignment.  Physical Therapists also perform soft tissue mobilization to enhance muscle activation and performance.  Vestibular rehabilitation is used post-concussive injury in order to facilitate safe return to play.  Working with a Physical Therapist after an injury can help recovery to maximize sport-specific potential and even prevent future injury.  So whether recovering from an injury or interested in preventing injury, you are in good hands with a Physical Therapist!