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Coaching Key to Safe Cheerleading

By Dr. Eric W. Edmonds

Cheerleading is an activity that crosses athletics with performing arts. Due to this duality, some observers consider cheerleaders to be athletes and others consider them to be performers; but, either way you look at it, the participants are often at significant risk for sporting injuries.

Originating at the University of Minnesota as an all-boy activity intended to direct crowds at football games in 1898, it has since grown to a predominately girl-dominated sport with an estimated 1.5 million participants annually. Of those, about 85,000 are high school participants. When evaluating the incidence of injuries in high school athletics, football is a perennial forerunner for injuries across genders. However, cheerleading has the highest percentage of catastrophic injuries (fatalities, spinal cord or other disabling injuries) per participant across all genders, and accounts for 65 percent of all female athletic catastrophic injuries.

Similar to gymnastics, cheerleading involves any array of tumbling, jumping, dancing and stunting. Some routines are still done to direct crowds to cheer; whereas, other routines are only performed for cheer competitions. Although it is not currently designated as an official sport by the NCAA, there are All-Star competitions for primary school kids, high school competitions, college teams and even professional teams. The NCAA does recognize the activity and actively requires cheer coaches to be certified by nationally recognized safety programs.

The injuries most often arise from stunting. This aspect of cheerleading is best defined by the building of pyramids which incorporates at least one flier and one base participant. The injury patterns seen for the fliers and the base are unique to those positions in the pyramid.

In general, the most common injuries include sprained ankles, sprained wrists, back injuries, concussions, broken arms, knee injuries, broken noses and broken collarbones. The fliers tend to sustain fractures and wrist injuries, as well as head and back injuries when dropped. In contrast, base performers will often sustain shoulder injuries, as well as knee and ankle injuries as they attempt to keep the flyer from falling.

The only preventive measure likely to make any difference to cheerleaders is adequate coaching and instruction. Parents should remain vigilant when observing cheer squad practices to ensure that all the participants are receiving sufficient guidance and direction from coaches. Likewise, coaches need to keep the cheerleaders focused on their tasks and provide step-wise education on all advanced activities.

Dr. Eric W. Edmonds is a pediatric and adolescent orthopedic sports medicine specialist at Rady Children’s Hospital-San Diego and an assistant professor of orthopedics at UC San Diego. He can be reached at