May 6, 2009

Introduction to the Issue

The origination of cheerleading in this country has been traced back to supportive fans right here at the University of Minnesota in 1898 (Boden, Tacchetti, & Mueller, 2003). Unfortunately, the activity of cheerleading, both in high school and collegiate settings, has become much more complicated today. Injuries resulting from cheerleading, both minor and severe, are increasing at an alarming rate and there has not been enough done to prevent these regrettable injuries.

Most people consider cheerleading to be a relatively safe sport, especially compared to other contact sports, like football (Magna’s Campus Legal, 2006). However, cheerleading injuries, especially catastrophic injuries, have been dramatically rising over the last twenty-five years and are continuing to do so (Magna’s Campus Legal, 2006). It is estimated that there are about one million participants in cheerleading activities in the United States, ranging from elementary school through professional sport levels (Jacobson, Redus, & Palmer, 2005). Four-hundred and fifty thousand of those participants are in high schools and colleges. Cheerleading has quickly become more appealing and is now one of the four most popular organized sports activities for females in high school (Boden, Tacchetti, & Mueller, 2003).

Even though the number of participants in cheerleading activities is increasing, the rates of injuries are still disproportionately high. The National Center for Catastrophic Sports Injury Research (NCCSI) has included a special section on severe cheerleading injuries in their 2007 annual report (Mueller & Cantu, 2007). The report has indicated that cheerleading is the leading cause of direct catastrophic injuries for all high school and college females, accounting for 55% of all high school direct catastrophic injuries, and 59.3% of comparable college injuries.

The 2007 NCCSI Annual Report also indicated that cheerleading injuries are a major cause of all sports-related fatalities for females (Mueller & Cantu, 2007). There were 75 direct deaths reported among high school and college female athletes from the fall of 1982 to the spring of 2007. Forty-two of these deaths resulted from cheerleading injuries. High school deaths totaled 25, and college deaths totaled 17. The majority of the deaths that were not caused by cheerleading were the result of gymnastics. The two sports share a variety of dangerous movements (e.g. tumbling).

There is a wide variety of injuries experienced by cheerleaders, varying also in severity. In an attempt to identify those most likely to experience injury and what type of injury is most common, Jacobson, Redus, & Palmer conducted a study of 30 Division IA schools in 2005. The median age of active cheerleaders responding was just over 20 years, and 78% of all respondents had been injured at some point in their cheerleading career. Most had been injured multiple times, with a median of 3.5 total career injuries and 16.7% reporting 5 or more career injuries. Roughly 87% of the injuries required treatment by a doctor and 40% required surgery. There is definitely a large amount of serious injuries resulting from this once relatively harmless activity.

The most common site for injury is the ankle (44.9%). Other sites include wrist/hand (19.3%), back (9.2%), and knee (11.2%). Varying sources cite that head and neck injuries, which tend to be much more serious, account for between 7 and 10% of all cheerleading-associated injuries (Jacobson, Redus, & Mueller, 2005). As the data indicates, cheerleading injuries occur most often in females. This is predominantly because the overwhelming majority of cheerleading participants are female. Females are also more likely to be the ones that perform the most dangerous aspect of stunts, such as being a “flyer” (one who is tossed or held up in the air by other cheerleaders). Data is unclear on male cheerleading injuries. Sometimes they are even intentionally left out of statistical studies (Mueller & Cantu, 2007).

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Photo Source: nationalspirit.com

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Risk Factors for Injury

One contributing factor to the increase in injuries is that cheerleading participants practice for significant amounts of time during a given week, and basically year-round. While many athletes condition all year long, cheerleading “seasons” can last much longer with active practice. They may cheer for a few different sports, such as football and basketball, which cover a large portion of the school year. In addition, they may be part of competition teams that practice during the summer months as well. The NCCSI report found an average cheerleading practice to last about 2.8 hours, and median annual practice days was 205.

There are a few significant risk factors that are most likely leading to the increase in number and severity of cheerleading injuries. First and foremost, the difficulty and danger of cheerleading routines has dramatically upped the risk. Gymnastic-like stunts are now common-place in cheer routines, including tumbling, and dangerous partner stunts (Jacobson, Redus, & Palmer, 2005). The role of cheerleaders has been expanded to include the purpose of being a highly skilled competing athlete, and with this change in focus comes increased competition and a willingness to risk injury for success (Mueller & Cantu, 2007). The main objectives of this activity no longer include leading cheers and chants from the sideline, but rather winning serious competitions and becoming the most innovative team with ever-increasing risky routine components.

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Picture Source: nationalspirit.com

The level of danger seems to be higher in collegiate settings than in high school settings. Research indicates that upper-extremity injuries (including head/neck injuries) may be more common in college because of the increase in partner stunts (Jacobson, Redus, & Palmer, 2005). The rate of injuries among college cheerleaders was five times that of high school participants from 1982 to 2002 (Boden, Tacchitti, & Mueller, 2003). Gymnastic-like maneuvers have the highest degree of difficulty and risk, and usually are performed by more experienced squads such as college teams or All-Star high school squads. All-Star teams are club teams that are established outside of the school system and are usually highly selective.

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Photo Source: nationalspirit.com

More difficult stunts and/or tumbling passes require the presence of a highly trained spotter to prevent injuries. Spotters and coaches may not be receiving the proper necessary training, which could be increasing the incidence of injury (American School Board Journal, 2005). A large proportion of catastrophic injuries either had an under-trained spotter, or did not have one present at all (Mueller & Cantu, 2007). A great deal of responsibility lies in the hands of the coach. They need to make sure their athletes are properly trained, and that spotters are always present. Coaches are under a lot of pressure to keep up with the competition by incorporating new, awe-inspiring stunts, because “all of the other cheerleading squads are doing it” (American School Board Journal, 2005, 56). However, they should make the distinction between a properly trained and able team, and a team that is not ready to perform complicated, dangerous stunts. When inexperienced teams attempt risky maneuvers, it makes them even more hazardous.


Continue reading "Risk Factors for Injury " »

Limitations to Progress/Prevention

Just as there are significant risk factors for these injuries, there are also significant limiting factors to progress and prevention in this area. Unfortunately, there is no primary organization to “govern” the safety practices for cheerleading. This leads to discrepancy in safety guidelines and recommendations. For instance, the American Association of Cheerleading Coaches and Administrators (AACCA), the National Cheerleaders Association (NCA), the Universal Cheerleaders Association (UCA) and the National Collegiate Athletic Association (NCAA) all have their own set of safety guidelines. While they may share many commonalities, one exclusive set of rules would be more effective.

Also, there is little or no enforcement of the guidelines as they are only recommended. Likewise, there are rarely any penalizations for not cooperating with recommendations. Some organizations will not allow a team to participate or their score will be deducted, but the effectiveness of this type of policy is unknown. It is important to remember that many injuries occur during practices, not just at competitions.

There also seems to be discrepancy between the different levels of teams. Varsity teams seem to receive more safety training and have higher levels of safety compliance than less-skilled junior-varsity teams (Kozlowski, 2001). This is especially worrisome as the lower-skilled teams likely need more safety guidance and supervision.

As discussed earlier, the lack of a central tracking/reporting system is a major deterrent for preventing injuries. To adequately assess the situation and make positive changes, one must first understand the nature and complexity of the problem. Because of the multiple differences in safety guidelines, and because most areas do not classify cheerleading as a sport, data is very difficult to collect. Even the NCCSI has been identifying incomplete information sources. The NCCSI began collaborating with the National Cheer Safety Foundation in 2008 for data collection on cheerleading-related injuries and deaths. Through this collaboration it was determined that the NCCSI (which previously reported 70 catastrophic injuries from 1982 to 2007) did not have record of at least 30 additional injury events (Mueller & Cantu, 2007).

Additional risk factors that may limit injury prevention stem from the current disjointed safety system. There may be a considerable lack of experience of both participants and coaches that are not recognized. In addition to improperly trained coaches, insufficient supervision is an issue. Participants may not be conditioned properly for performing stunts with increased difficulty, and such stunts may be practiced and/or performed on inappropriate surfaces/equipment.

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Photo Source: upainc.net

Continue reading "Limitations to Progress/Prevention" »

Suggestions/Prevention Strategies

As previously discussed, there is a definite need for more accurate and complete data collection and analysis, as well as further research. Data collection in this field is severely lacking. The scope of this issue could be much worse than the current data shows. A central agency for safety regulation of the cheerleading “industry” would be the most effective tool for preventing injuries. It is likely beneficial for two branches of one central agency to be formed, one to govern high school cheerleading, and one to govern collegiate cheerleading. Such an agency would also help to streamline data collection. More research is needed to determine the most significant risk factors for injury so they can become prevention priorities. Specific prevention strategies should be investigated to determine their efficacy.

William Haddon, Jr. also developed ten strategies for injury prevention which are widely applicable just as the matrix is. The strategies are outlined below as well as their practicality when applied to high school and college cheerleading.

1. Prevent the creation of the hazard in the first place.
With the growing popularity of cheerleading, is it not practical to discontinue its existence.

2. Reduce the amount of the hazard created
The application of this strategy would be to reduce the occurrence of dangerous stunts. Unfortunately, I do not think this is possible, as the competitive cheerleading teams are actually increasing their use of these stunts.

3. Prevent the release of a hazard that already exists.
This strategy would be best addressed by reducing or eliminating the host site for dangerous activity: competitions. This too is unpractical, as they are a major source of income for the for-profit cheerleading organizations and a big attraction for cheerleading teams.

4. Modify the rate of spatial distribution of the hazard from its source
This is one of the practical applications. The easiest way to apply this strategy is to enforce adequate safety regulations, especially for facilities. This is a must for injury prevention in this area.

5. Separate in time or space the hazard from that which is to be protected
The same applications as used in the 4th strategy apply here: enforce facility and equipment safety standards.

6. Separate the hazard and what is to be protected by a material barrier
Use of proper mats/padding on which routines are practiced and performed is the best way to implement this very practical strategy.

7. Modify relevant basic qualities of the hazard
This is a practical strategy as well. Many times during competitions, improper and completely unregulated activities (such as “stunt-fest” where stunting occurs without proper spotters or equipment) are either allowed or encouraged. These activities should be banned immediately.

8. Make what is to be protected more resistant to damage from the hazard
Participating athletes should be in the best physical condition possible for performing their complex routines and wear protective gear where applicable. This too can be easily accomplished.

9. Move rapidly to detect and evaluate damage that has occurred and counter its continuation and extension
This can be accomplished by improving data collection methods and enforcing the use of properly trained coaching/safety staff.

10. Stabilize, repair, and rehabilitate the damaged object
Practical application of this strategy would be to ensure quick and adequate medical care for injuries that do occur.

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References

References

Boden, B. P., Tacchetti, R., & Mueller, F. O. (2003). Catastrophic cheerleading injuries [Electronic version].The American Journal of Sports Medicine, 31(6), 881-888. From JSTOR.

Dorning, A. m. (2008, April 22). Cheerleader deaths: unimaginable but true. Retrieved April 4, 2009, from EbsoHost.

Jacobson, B. H., Redus, B., & Palmer, T. (2005). An assessment of injuries in college cheerleading: Distribution, frequency, and associated factors [Electronic version]. Br J Sports Med, 39, 237-240. From JSTOR.

Kozlowski, J. P. (2003). Lack of safety information and training faulted in cheerleader injury [Electronic version]. NRPA Law Review, 34-41. From American Search Premier.

Mueller, F. O., & Cantu, R. C. (2007). Catastrophic sports injury research [Electronic version]. . From JSTOR.

Pennington, Bill. (2007, March 31). As Cheerleaders Soar Higher, So Do the Risks. New York Times (Late Edition (east Coast)), p. A.1. Retrieved April 6, 2009, from ProQuest Newsstand database.

Three cheers for safer cheering! [Electronic version] (2006). Magna's Campus Legal, 21(2). From EbsoHost.

What would you do if injuries to your cheerleaders were increasing [Electronic version]. (2005). American School Board Journal . From EbsoHost.

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Photo Source: aacca.org

Haddon's Matrix For Cheer Injuries

Download file

Relevent Links

National Cheer Safety Foundation:
http://www.nationalcheersafety.com/

National Cheerleaders Association Safety Page:
http://www.nationalspirit.com/Safety.aspx

American Association of Cheerleading Coaches and Administrators:
http://www.aacca.org/

National Center for Catastrophic Sports Injury 25th Annual Report (2007):
http://www.unc.edu/depts/nccsi/ReportAnnual.pdf

National Cheerleaders Association Safety Schoo/Rec Safety Guidelines:
http://www.nationalspirit.com/pdfs/hs_sgb.pdf

Relevent Video Links

The following link shows some of the routines showcased earlier this month at the NCA Collegiate Cheer Championships in Daytona Beach, FL. These routines really showcase the complexity and dangerous stunts that are incorporated into competition cheerleading.


http://varsity.com/event/1144/2009_ncanda_collegiate_cheer_and_dance_championship.aspx


The following links are all user-submitted videos on the youtube.com video website. They are all from the same competition as above (NCA Collegiate Championship). They are not videos from regular competition however, but from an endorsed event during the competition festivities called "stuntfest". There are no safety regulations that must be followed during these activities.

http://www.youtube.com/watch?v=vJmcWjH_kPc

http://www.youtube.com/watch?v=oB5eeXXprts

http://www.youtube.com/watch?v=Wo_SXoC7i-4

http://www.youtube.com/watch?v=aUb92IPeSn0

http://www.youtube.com/watch?v=XUyJRQumFZ0

http://www.youtube.com/watch?v=ucqm94-k2jE


May 19, 2009

Website Information

Author:

Julie Zimmerman, MPH candidate
University of Minnesota School of Public Health
Environmental Health Sciences Division

zimme550@umn.edu


This website was created in conjunction with the requirements for the class Public Health 6120: Injury Prevention in the Workplace, Community, and Home. The purpose was to identify a public health injury problem, explore the severity of the problem, as well as develop strategies for its prevention and control.