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Health & Exercise Forum

Cheerleading Injuries: Part I of II

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Mar 28, 2009

Dr. Mackarey's Health & Exercise ForumGuest Columnist- Janet M. Caputo, PT, OCS

In the past week, three people have asked me to write a column on cheerleading injuries: Sally Davis, team and squad specialist at Battaglia’s Sporting Goods in Scranton, Mari LaBelle, whose daughter Caroline is suffering from lower back pain as a cheerleading base and lifter at Scranton Prep, and Michelle Knowles, whose daughter Susan suffered and ankle injury early in her cheerleading career at Prep. Many of these injuries require medical attention and rehabilitation similar to those of an athlete.

Cheerleading originated in1898 at a Minnesota University football game to raise school unity through leading the crowd in cheers. Since 1980, cheerleading progressed to include highly skilled and competitive athletes. Increased injury rates occurred in response to this evolution. Research indicates that injuries increased 110% from 1990 through 2002, while participation increased only 18%.

Ligament sprains and muscle strains related to overuse are the most prevalent. Most common injury sites are ankle (22%), knee (15%), hand (13%) and back (12%). Head and neck injuries comprise only 7% of injuries but can be the most severe.

Most injuries occur during gymnastic maneuvers and partner stunts. Partner stunts can produce the most catastrophic injuries resulting in death or permanent, severe disability. Overuse injuries of the arms are common because of its use for weight bearing. Ankle and knee ligament injuries occur in the landing and impact phase of tumbling runs. Low-back injuries result from hyperextension. Shoulder and wrist problems develop in athletes at the base of pyramids or in partner lifts which require significant upper body strength. Athletes at the top of pyramids and lifts have the greatest fall risk resulting in catastrophic injury, fractures and dislocations.

Knowledge of the origin of injuries will assist in future prevention. This article will explore several reasons why injuries occur:


Cheerleaders are susceptible to overuse injuries because their sport is year-round. Cheerleaders perform through three seasons, peak for nationals and attend training camps in summer.


Experience plays a role in the frequency, type, and severity of injuries. Experienced cheerleaders attempt complex stunts. Less experienced cheerleaders have more frequent but less severe injuries because of poor conditioning, inadequate supervision, or attempting difficult maneuvers prematurely.


Immature coordination and strength and open growth plates account for certain age-related injuries. Head and neck injuries are more prevalent in youngsters due to larger head size and higher center of gravity causing them to fall head first.


Pyramid formations and basket tosses increase fall-related injuries. Decisions to abolish these stunts are controversial. If not taught proper fall technique, young children and participants in non-contact sports tend to brace with their arms instead of falling to diffuse the impact.

Lack of conditioning and physical preparedness

Current research proves that strong, flexible athletes with good coordination sustain fewer injuries. Without good preseason training, cheerleaders can not endure the weight bearing and pounding throughout the season.

Untrained coaches, poor decision-making by instructors, and inadequate supervision

Cheerleading is not considered a sanctioned sport by the majority of schools. Therefore, cheerleading is not subject to the same safety regulations. Coaches are not trained properly to deal with or prevent injuries. Squads even exist without coaches!

Risk-taking attitudes

Competition is fierce since many cheerleaders are seeking college scholarships and participate in complex stunts to impress scouts. Many cheerleaders and coaches feel that basket tosses and human pyramids “wow the crowd” and provide the excitement and entertainment expected.

Inadequate equipment and non-cushioned surfaces

Many cheerleaders wear fashionable shoes that lack cushioning and stable bases. These shoes can not accommodate a cushioned insert or custom orthotic.

Cheerleaders practice in hallways with inadequate space and insufficient height. They perform on hardwood floors and turf without mats. The uneven surfaces on football fields increase the incidence of ankle sprains.

Poor nutrition

Peer pressure to stay slender heightens injury from weak bones from poor nutritional habits by excessive dieting. Weak bones are susceptible to stress fractures from jumping and pounding.

Attempting difficult stunts before being ready

Maneuvers are more aggressive and individuals are participating at younger ages. The popularity of televised competitions may encourage attempts to mimic difficult maneuvers before adequate training. Consider age, physical ability, skill level and experience before attempting complex stunts.

To avoid risk without reason, join us next week for several approaches recommended to make the sport of cheerleading safer!

Visit your doctor regularly, and listen to your body.