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Pediatricians Issue Guidelines for Preventing Cheerleading Injuries


With the number of cheerleading injuries continuing to climb, the American Academy of Pediatrics released a policy statement Monday offering recommendations for ways to prevent such injuries.

The policy statement, which will be published in the November 2012 issue of Pediatrics, recommends that all 50 states designate cheerleading as a sport to ensure that cheerleading squads have qualified coaches, access to certified athletic trainers, and injury surveillance.

Currently, only 29 state high school athletic associations recognize cheerleading as a sport, according to the AAP, and the National Collegiate Athletic Association currently does not. The AAP doesn't specify why the other 21 states have yet to recognize cheerleading as a sport, but Title IX, the federal legislation that prohibits gender discrimination in any federally financed education activity, could be playing a role. (If schools were to add cheerleading as a sport, they may be required to add another sport for boys, too, depending on the gender ratio of their student-athletes compared to their overall student population.)

As cheerleading has grown more competitive over the years, the stunts have become more complex, leading to a rise in both participation and injuries. From 1990 to 2003, there was a 20 percent rise in the number of cheerleaders 6 or older, going from 3.0 million to 3.6 million, according to the AAP.

Over the past three decades, injuries resulting from cheerleading have risen as well, by over 400 percent, according to the U.S. Consumer Product Safety Commission. In 1980, a total of 4,954 emergency-room visits were reported as a result of cheerleading injuries; by 2007, that number rose to 26,786.

A total of 221 of those cheerleaders were hospitalized, according to the AAP's policy statement.


Catastrophic injuries resulting from cheerleading have also increased significantly over the past few decades, going from 1.5 per year from 1982 to 1992 to 4.8 per year from 2003 to 2009, according to research from the University of North Carolina at Chapel Hill that the AAP cited. Complicated stunts including basing/spotting, tumbling, and falls from heights accounted for the majority of cheerleading injuries.

"Cheerleading has become extremely competitive in the past few years, incorporating more complex skills than ever before," said Dr. Cynthia LaBella, co-author of the new guidelines, in a statement. "Relatively speaking, the injury rate is low compared to other sports, but despite the overall lower rate, the number of catastrophic injuries continues to climb. That is an area of concern and needs attention for improving safety."

Beyond designating cheerleading as a sport in all states, the AAP recommends:

• Having all cheerleaders undergo a preparticipation physical examination, as well as having access to "appropriate strength and condition programs";

• Cheerleading squads should not perform pyramids, tosses, or tumbling on hard, wet, or uneven surfaces; and,

• Cheerleaders should only attempt such stunts after demonstrating "appropriate skill progression and proficiency."

"Most serious injuries, including catastrophic ones, occur while performing complex stunts such as pyramids," said Dr. Jeffrey Mjaanes, co-author of the new guidelines, in a statement. "Simple steps to improve safety during these stunts could significantly decrease the injury rate and protect young cheerleaders."

For what it's worth, the National Federation of State High School Associations banned a move earlier this year known as a "double down," which involved high school cheerleaders performing a double twist to a cradle. (A "cradle" is when a cheerleader dismounts from a stunt and gets caught by other cheerleaders, face-up.)

The NFHS cited injury risk, specifically to the heads of cheerleaders, when announcing the ban of the move back in April.

Photos, from top: Junior varsity cheerleaders perform a drill for the camera after a high school football game was canceled at Leesburg High School in Florida last year. (Joshua C. Cruey/Orlando Sentinel/MCT)

Massillon High School cheerleaders get the crowd going at a large football pep rally held at Paul Brown Tiger Stadium for ESPN's "TitleTown USA" in 2008 in Massillon, Ohio. (Ken Love/Akron Beacon Journal/MCT)

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