Cheerleading has changed a lot over the years. It has also become a good deal more dangerous. What began as a group of smiling faces leading the crowd in cheers at sporting events has become a competitive sport that involves acrobatics and tumbling. This evolution has meant that cheerleading injuries —the kind requiring a trip to the hospital or ER — have increased in number and severity over the last 30 years. The number of cheerleaders has also increased: from 1990 to 2003, the number of US cheerleaders 6 years and older increased by approximately 600 000 from 3.0 to 3.6 million.

Strains and sprains are the most common types of injuries, but the number of catastrophic injuries has increased.

Of course, injuries to cheerleaders have also gone up. They have more than quadrupled during the period from 1980, to 2007.

Enter the American Academy of Pediatrics.

The AAP has recently made the case for cheerleading to be designated as a sport. The If it becomes an official sport, it will be subject to the same resources and regulations that have made many other sports safer for children and teens. Only 29 state high school athletic associations recognize cheerleading as a sport, and the National Collegiate Athletic Association (NCAA) does not include competitive cheerleading in its list of sponsored sports.

Making cheerleading as a sport would mean that certain resources and safeguards would automatically have to be put in place. These safeguards include: mandates for qualified coaches, well-maintained practice facilities, preseason conditioning, limits on practice time, access to certified athletic trainers and team physicians, and mandatory pre-participation physical examinations. It would also ensure that injuries occurring during cheerleading would be included in the NCAA and high school sports surveillance data which would improve the overall safety of current and future participants by identifying trends and risk factors.

The rate of injury among cheerleaders increases with age and competition level, with the highest injury rate being found among collegiate cheerleaders. Strains and sprains are the most common types of injuries, but the number of catastrophic injuries has increased. This trend is likely a reflection of how much cheerleading has grown in popularity. The number of children and adolescent cheerleaders is way up, with children as young as three years old participating. At the same time, more complex gymnastic skills have become common in routines. There has also been improved reporting of cheerleading injuries.

The AAP became involved because it believes that the cheerleaders would benefit from improved conditions, training, screening, and coaching which are available to other athletes. It would like the cheerleaders to have pre-participation physical examinations to identify any conditions that might put them at increased risk for illness or injury. They also argue for cheerleaders to have access to strength and conditioning programs as a way of decreasing their likelihood of injury.

The Academy also recommends that:

  • Cheerleaders should be supervised by qualified coaches, those who are specifically trained in gymnastics. Coaches should know the safety measures for stunts and basic injury management.
  • To improve the safety of stunts and pyramids, all cheerleaders should be trained in proper spotting techniques and should have enough upper body and core strength to act as spotters.
  • Performance of skills such as pyramids and tumbling should be done on appropriate surfaces such as spring floors, landing mats, grass turf or foam floors rather than on concrete, asphalt, or wet or uneven surfaces.
  • The height of pyramids should be limited and the core strength of members of the base layer of a pyramid must be determined to be sufficient to the task.

The number of head injuries and concussions is low relative to other girls’ high school sports such as soccer and lacrosse, but they have been increasing and now comprise 4 to 6% of cheerleading injuries. Consistent with the approach to head injuries in other sports, the Academy recommends that if a cheerleader sustains a head injury he or she should be removed from practice or competition until cleared by a health care provider.

And finally, the AAP calls for continued reporting and research in order to determine what types of injuries occur, when and why they happen, and what measures appear to be helpful in decreasing the severity and rates.