With more than 3.5 million youth athletes participating in cheerleading in the U.S., including competition and school teams, the American Academy of Pediatrics (AAP) is issuing recommendations to improve the safety of the sport and reduce the risk of injury, including concussions.
In an updated policy statement, the AAP recommends athletes be screened each year with preparticipation physical evaluations to give pediatricians the chance to assess any injuries while informing patients and families about ways to practice the sport safely. The policy statement, “Safety in Cheerleading: Epidemiology and Recommendations,” published online Oct. 21 marks the first update to AAP guidance since November 2012. The policy statement, written by the Council on Sports Medicine and Fitness, will be published in the November 2024 Pediatrics.
Policy statements created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.
Despite the large number of athletes in the sport and its recognition by the US Olympic and Paralympic Committee, cheerleading is not recognized as a sport federally or by the National Collegiate Athletic Association. This means enforcement and compliance falls on cheer governing bodies such as USA Cheer to manage compliance In the past decade, rates of participation in cheerleading and the athleticism demanded in competitions have increased. During the same timeframe, rule changes and increased awareness of concussions and their symptoms have helped to make the sport safer and minimize potential injuries.
While the sport retains an overall low injury rate, injuries that occur can be more severe, including concussions. Pediatric Sports Medicine Physician Jennifer King, DO, FAAP,a co-author of the policy statement said this is due to the athleticism needed for competition teams that involve stunting – where teammates are hoisted into the air and thrown – and tumbling – gymnastic or acrobatic skills.
“Competition in the sport can be fierce, pushing cheerleaders to engage in more and more complex stunts and tumbling,” Dr. King said. “It’s imperative that coaches and staff make practices and competitions as safe as possible to reduce or avoid injuries.”
Rule changes implemented by the National Federation of State High School Associations and American Association of Cheerleading Coaches and Administrators included a prohibition of basket tosses on hard surfaces such as basketball courts, a safety precaution AAP encourages as part of its recommendations. This stunt, where flyers are tossed into the air by multiple bases with interlocked hands and then caught, has been limited to being performed on grass, mats or rubberized track surfaces to cushion any possible falls.
This rule change led to a 74% reduction in catastrophic injuries over a 10-year period, according to data from a study published in Sports Health
Concussion incident rates have increased, accounting for 31% of all cheerleading injuries from 2010 to 2019 reported by athletic trainers when compared to the 4% to 6% reported from 2006 to 2009, according to data from the National Electronic Injury Surveillance System. This increase may be due in part to awareness and reporting of the signs and symptoms of the injury. Concussions typically occur during stunting and tumbling routines when cheerleaders make contact with another athlete or surface.
AAP recommends cheerleaders receive routine preparticipation physical exams, supervision by qualified coaches certified in both training and spotting for stunts, and safety guidelines that consider the physical and developmental stages of young athletes.
The AAP also recommends:
- Scholastic cheerleading should be overseen by state associations and school athletic departments in all 50 states.
- Short pyramids should not exceed the height of two people with spotters always on hand.
- Written emergency action plans should be in place in all gyms and facilities where practices and competitions take place.
- Competitions and practices should only be held at facilities that are compliant with safety guidelines and rules established by agencies such as USA Cheer, the NFHS, or the US All Star Federation.
· Cheerleaders, coaches, and parents need to be educated in the signs and symptoms of concussions.
“Cheerleading can be an engaging but demanding sport for its athletes. Just like in other sports, we need to monitor athletes’ health after any injuries, especially head injuries,” Dr. King said. “Take some time off if needed. Long term health and well-being should be the ultimate goal.”