Cheer Squad Injuries Rise

Chicago Tribune

(KRT)

CHICAGO - Kim Fernandez was at her desk when the phone rang with the news that her oldest daughter had been hurt during cheerleading practice.

"I just remember hearing the words `lots of blood,'" Fernandez said. "Becky caught an elbow in the nose. It was broken in five pieces, and she ended up having surgery."

Such injuries have become more common in cheerleading, a world that has changed vastly from the days when all one had to do was be perky, peppy and fill out a sweater.

Cheerleading-related injuries more than doubled over a 13-year period evaluated in January in the journal Pediatrics, though the number of youngsters participating rose just 18 percent. Almost 209,000 people ages 5 to 18 were treated at U.S. hospitals for such injuries from 1990 to 2002.

Researcher Brenda Shields of Columbus Children's Hospital in Columbus, Ohio, attributes the rise to ever-more breathtaking maneuvers. Just like diving, gymnastics and figure skating, the higher-flying the acrobatics, the more oohs from the crowd.

"It used to be that cheerleaders were just waving their pompoms on the sidelines," said Shields, research coordinator in the hospital's Center for Injury Research and Policy. "But now they're doing all kinds of complex gymnastic moves and getting thrown into the air."

The Illinois High School Association now recognizes cheerleading as a sport, not an activity. This year, for the first time, schools will move through local and regional levels to vie in March for a state title.

For Fernandez, that harrowing phone call in 2004 did nothing to curb her enthusiasm for back flips, human pyramids and X-out double full twists. All three of her daughters have cheered competitively for years, and the benefits far outweigh the risks, she said.

"If the coaching is good, the environment is controlled and the kids aren't pushed to do things they're not comfortable with, it's fine," she said.

In the Pediatrics study, researchers analyzed data from the National Electronic Injury Surveillance System, which monitors injuries treated in U.S. hospital emergency departments. They found that 52 percent of the cheerleading injuries were strains or sprains, 18 percent bruises or other soft-tissue abrasions, and 16 percent fractures or dislocations.

Age affects the way kids are hurt. Between the ages of 12 and 18, they were more likely to injure ankles and knees, while in elementary school fractures were more common, occurring mostly in arms and wrists.

"We believe that's because younger kids haven't been taught the right way to fall, so they stick out their arms and try to catch themselves," Shields said. "Older kids have more training and know how to roll into a fall."

Although the incidence of serious injuries was low - only 1.3 percent required hospitalization - the study underestimates the true numbers because it does not include patients treated at doctors' offices, student health centers or non-emergency facilities. About 4.1 million youngsters participated in cheerleading in 2004, according to Sporting Goods Manufacturers Association.

Shields said she would like to see a uniform set of rules and regulations, mandatory completion of safety training and a certification program for all coaches, as well as a national database that tracks injuries. "We need to develop a set of rules that everyone can abide by," she said.

The issue of cheerleading safety surfaces periodically, usually following a fatal mishap like one that occurred in Massachusetts in August. Ashley Burns, 14, died after being hurled into the air and landing on her stomach, causing her spleen to rupture. Her mother is pushing for legislation requiring protective equipment and on-duty emergency medical technicians at all cheerleading gyms.

While most experts say those measures would be excessive, they agree more precautions need to be taken.

Dr. Anthony Rinella, an orthopedic surgeon at Loyola University Medical Center, said he has seen many injuries to the back, neck and legs related to cheerleading. Sprains and strains are most common, but spondylolysis - a stress fracture of a vertebra in the lower back -can lead to chronic back pain. The patients are usually female athletes ages 10 to 13, "but I've seen it as young as age 6," he added.

"As we push kids to get into more competitive sports at younger ages - to take on attitudes that are more like junior Olympians - we need to be careful. During puberty, in particular, the bones are growing extremely fast and are just not as strong as they are in an adult," said Rinella, who would like to see more emphasis on stretching and conditioning.

All IHSA cheerleading squads must adhere to regulations governing safety, just as they do in track or baseball. That means there are limitations on certain stunts, such as the height of a formation. (In high school, girls must be supported by someone on the ground, while at other levels a team can build formations three or four people tall, said officials).

However, private squads - competitive cheerleading teams not tied to any school - are not bound by the same rules, said experts. Such teams are open to all ages, and there's even a category for the 5-and-younger set called "Tiny Cheer."

"I'm not saying that all-star teams are unsafe, but they do have a lot more freedom," said April Mahy, a high school cheerleading coach in the Chicago community of Tinley Park, site of one of the upcoming sectionals leading up to the state meet.

The squads have different goals. "Our objective is supporting our football and basketball team," Mahy said. "Their focus is competition, which means the more advanced skills and complex routines. But I do believe those (IHSA) rules are there for a reason."

Jim Lord, executive director of the American Association of Cheerleading Coaches and Advisors, applauds the Pediatrics report, especially for spotlighting the athleticism of participants and the need for qualified coaches. "It comes down to supervision," said Lord, whose organization offers safety training for coaches.

Kim Fernandez, whose daughters have participated in a recreational program, said the potential for injury is trumped by the positive aspects of the sport, such as the deep friendships that form.

Her daughter Becky Freeman, 19, cheered for seven years and is now a freshman at Benedictine University in Lisle, Ill. Besides the broken nose, she also broke her wrist a few years earlier, but she says she couldn't imagine not performing.

Another daughter, Amanda Freeman, a high school senior, has been rah-rahing since 6th grade. ("I think she's been more banged up in volleyball," said her mother).

And Amy Fernandez, 10, has been cheering since age 5. Her team, coached by her oldest sister, placed second in December at the American Youth Football and Cheer national competition in Tucson, which attracted 144 teams.

Amy - just 4-foot-3 and 50 pounds - is known as a "flier," the girl who is at the top of formations and at the mercy of "the bases" - or the girls who do the catching. She uses two words - "fun" and "scary" - to define her role.

"She's constantly up in the air," said her mother. "But I trust the bases; I trust the coaches. I know that accidents happen, but I also know that just like in any sport, there's risk."

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(c) 2006, Chicago Tribune. Distributed by Knight Ridder/Tribune News Service.