A recent study highlights the risks of "catastrophic injury" in cheerleading, and says that cheerleaders are under-reporting concussion symptoms-but what do the facts and figures really mean?
The study, published in the Journal of Pediatrics, used a computer-based cognitive testing system called ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) to obtain a baseline measurement of cheerleaders' cognitive performance at the beginning of the season. The same testing was used again after concussion injuries.
The study found that when measured objectively, even athletes who report being "symptom-free" often still have neurocognitive deficits.
"Given these results, it is of concern that most return-to-play decisions after concussion have relied heavily on the athlete's self- report of symptoms," the study authors noted. "This study demonstrates that even athletes who report being symptom-free may continue to exhibit neurocognitive deficits of which they are either unaware or are failing to report. Furthermore, our data suggest that if neurocognitive testing is unavailable, then the treating physician should be cautious in returning athletes to play based on their self-report of symptoms alone."
One of the reasons this study is getting so much attention is that the researchers also cited other studies we already knew about, which highlight significant risks associated with cheerleading.
But is cheerleading really that much riskier than other sports? Let's take a closer look at the facts behind cheerleading injuries and concussions.
How risky is cheerleading?
The recent study cited research indicating that "cheerleading carries the highest rate of catastrophic injury in sports, accounting for 66% of all catastrophic injuries in female athletes." Catastrophic injuries include closed-head injuries, skull fractures, and cervical spine injuries resulting in permanent brain injury, paralysis, or death.
The American Association of Cheerleading Coaches and Administrators (AACCA) disagrees with the accuracy of that statement, noting that both increased participation and the extended season of cheerleading must be factored in when considering the number of injuries. Cheerleaders often participate year-round, cheering in the fall for football and soccer, cheering for basketball in winter, competing in the spring, and attending camps in the summer.
However, the AAP's statement also looks at rate of injury (injuries per exposure to the sport), not just the total number of injuries. Even when considering the rate of injury, cheerleading still takes the top spot for girls' high school sports in terms of catastrophic injuries.
Despite the higher risk of catastrophic injury, cheerleading has a lower risk of overall injury than other sports. The AAP statement says, "although the overall risk of injury is lower in cheerleading than in most other sports, the risk of catastrophic injury is considerably higher for cheerleading."
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Has cheerleading gotten more dangerous?
Yes, absolutely. As both participation in cheerleading and the degree of stunting difficulty have increased, so have cheerleading injuries. Trips to Emergency Departments have increased by more than 500 percent in the last quarter-century or so.
Data from the Consumer Product Safety Commission found that cheerleader injuries accounted for 4954 emergency department (ED) visits in 1980. The number of cheerleader-related ED visits rose continually, to 6911 in 1986, 16 982 in 1995, 22 603 in 2000, and 24 675 in 2002.
When are injuries occurring?
According to this study, the vast majority (84 percent) of cheerleading injuries occur during practices as opposed to during games or competitions.
Overall, 60 percent of cheerleading injuries occur when the athletes are doing stunts, such as pyramids, lifts, and basket tosses. Stunts accounted for a full 96 percent of concussions, researchers noted.
What position in the squad has the greatest risk?
While it makes sense that most injuries occur during stunts, research results vary on whether any of the three cheerleading positions -- flyers, bases, and spotters -- are at a higher risk for injury. What is known for sure, though, is that the person at the great risk isn't necessarily the "flyer"--the person at the top or in the air.
The authors of this most recent study wrote that in their clinical experience, "spotters and other participants who are often in base positions are at risk for being kicked in the head or knocked to the ground when a stunt is not executed as planned."
What about concussions?
A study published in the Journal of Athletic Training reported that 6 percent of cheerleading injuries are concussions.
The rate of concussion is relatively low in cheerleading compared to other girls' high school sports. Concussion rates in cheerleading are significantly lower than in girls' soccer, basketball, lacrosse, softball, and field hockey, says the AAP.
However, concussions in cheerleading are on the rise, so it's certainly not an issue to ignore. Between 1998 and 2008, concussion rates for cheerleading rose 26 percent each year, a rate greater than any other girls' sport studied, reported the AAP. The rate of concussion also increases with age and competitive level.
Compared with other sports, do cheerleaders under-report injuries more often?
No. This recent study does look at under-reporting of symptoms in cheerleading, but the focus of the study is really whether computerized ImPACT testing is better at identifying concussion symptoms than the athletes are. Sure enough, the researchers found that doctors shouldn't rely on an athlete's self-reporting of symptoms when deciding when the athlete should return to the sport.
But that's not a cheerleading issue, it's a sports issue. It's clear that athletes, from high school to pro, consistently under-report their injuries for a huge number of reasons.
Is college cheerleading safer or more dangerous?
A study evaluating injuries in cheerleaders and level of participation found a much higher rate of head injuries at the collegiate level compared with junior high and high school level. Between 1982 and 2002, the overall injury rate was five times higher than that in high school cheerleaders.
Does the NCAA classify cheerleading as a sport?
Well, it's complicated. Cheerleading isn't a competition sport in the National Collegiate Athletic Association (NCAA). To be clear, the NCAA has never said that cheerleading can't be a sport. It's just that there hasn't yet been a big enough push to make it happen. For the NCAA to designate cheerleading as an "emerging sport," a proposal would have to be submitted from a sport community.
The proposal would have to address a variety of factors, says the NCAA, including participation at all levels (high school, intramurals, club level), potential NCAA structure and rules, opinions of a coach association, interest from conferences and support from the U.S. Olympic Committee, if relevant. The sport community also must demonstrate that at least 20 programs are competing at the collegiate level (in club, varsity, NAIA or other such competition) to prove that there is a core foundation on which the sport can grow.
In an interesting contrast to all that, cheerleading is included in NCAA catastrophic insurance plans, provided that the squad is practicing or performing at an official NCAA event and that the coach is safety certified by a nationally credentialed organization.
How can anyone possibly think cheerleading isn't a sport?
At this point, pretty much everyone realizes that cheerleading is a sport. The issue really is whether it's consistently seen as a competition sport, partly because not all cheerleading squads participate in competitions.
In 2010, a U.S. District Court ruled that even competitive cheerleading can't automatically be considered a sport under Title IX, which ensures that schools provide equal opportunities to both sexes. The court ruled that Quinnipiac University in Connecticut couldn't offset its Title IX responsibilities by counting competitive cheer as a sport, because Quinnipiac's competitions lacked consistent scoring systems and an organized competition system. In that specific case, the court ruled that cheerleading didn't provide the same "quality of opportunities" as other varsity-level sports.
At least one state sees things differently, though: In 2009, the Wisconsin Supreme Court ruled that cheerleading is legally considered a full-contact sport in that state, which means that participants can't be sued for accidentally injuring someone else.
It's quite the catch-22. Between the NCAA and the U.S. District Court, it's like cheerleading can't be an organized sport because it's not an organized sport. (Unless we're talking about financial liability, in which case everyone seems happy to call it a sport.)
-By Joslyn Gray
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