The Baltimore Sun

Core strength, conditioning, athletic prowess. These words do not typically bring visions of cheerleaders instantly to mind. But as football season hits high gear, so does that of cheerleading -- and these days, cheerleading is every bit as challenging as the sport played on the field, says Dr. Richard Hinton, a sports orthopedic surgeon at Union Memorial Hospital and an assistant team physician for the Baltimore Ravens.

Recently, there has been a lot of buzz about the dangers of cheerleading. What is causing the discussion?

The buzz was generated by a study from the [National Center for Catastrophic Sport Injury Research] based in Chapel Hill, N.C. ... It found that cheerleading is safe relative to overall injuries, but it is high for catastrophic injuries -- or major head injuries, spinal-cord injuries or back injuries that cause permanent injury or death.

For girls, cheerleading has the highest rate of catastrophic injuries -- compared to basketball, volleyball and other sports.

How high is the incidence of these injuries?

It isn't as high as football or pole vaulting is for boys, but it is the highest cause of catastrophic injuries for girls. Those injuries are not common: There is one catastrophic injury for every 200,000 athletic exposures. So [they] are rare, but compared to other activities that scholastic-age girls are involved in, that is high.

What is causing the injuries?

Cheerleading has become an athletic sport. It is no longer something secondary to the sport they are cheering. Cheerleaders are facing higher physical demands. They are better athletes, and they are putting themselves in somewhat higher danger.

The sport has changed to include stunts such as pyramid building or what's called a basket toss [a stunt in which a cheerleader is tossed into the air and caught by teammates with interlocked hands]. And there is a fair amount of injury involved. Interestingly, it is higher during the winter months, because they are inside on harder surfaces -- like that of a basketball court. So when they fall, it can result in greater injuries.

We've spoken about catastrophic injuries. What other injuries are cheerleaders prone to suffer?

I normally see the same sorts of injuries that I see with dancers or gymnasts. I see shoulder injuries, wrist pain from tumbling and a high rate of knee problems.

Many female athletes do have a high risk of ACL [anterior cruciate ligament] injury, but that is no higher in cheerleading than it is for soccer or basketball. And it is higher for girls than boys.

What can be done to decrease the risk of injuries?

To decrease injury, there should always be a spotter, and the spotters should be an integral part of the program so they are trained and coached and they know their jobs. [In addition], some rules suggest limits for how high pyramids can go, or how high the basket toss can be and discourage the use of trampolines to increase the height of jumps.

And cheerleaders should perform on a padded surface so they aren't falling on concrete or hard wood floors.

What kinds of training or conditioning should cheerleaders be doing?

They should follow the same sorts of general training -- year-round general training -- as other athletes: core strengthening of the abdomen, lower back and buttocks. And take a break from cheerleading during the year.

Are there steps parents can take to help prevent injuries?

All parents should talk to their kids' coaches to see what the expectations are and what the training routine should be. ... They should ask for descriptions of the more demanding tricks or stunts [that] their children will be expected to do.

They also should make sure ... that the most demanding activities are at the appropriate level for the skill set of the children. Twelve-year-olds are not going to be doing what 18-year-olds are doing.

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