Over the past 20 years, the athleticism involved in cheerleading has increased dramatically. Cheerleading in the United States is a year round competitive activity. Cheerleaders are asked to perform through 3 seasons, peak for national competitions, and attend cheerleading-training camps in the summer. Cheerleading begins at an early age and is estimated to include over a million participants between elementary school and the professional sports levels. Cheerleading is a kind of sports which combines music and physical activities and usually associates with football and basketball.

There are five elements in this sport including stunts, tumbles, dance, cheers, and jumps. However, the origin of cheerleading does not contain so many components. In the 1880’s, a graduate student of Princeton, Thomas Peebles, took the Princeton cheers to the University of Minnesota, where football and fight songs were becoming very popular. After that, the idea spread across the country. In 1898, a medical student of the University of Minnesota named Johnny Campbell assembled a group to energize the team and the crowd with the first organized cheer: This set the stage for cheerleading to begin.

In the 1960’s, cheerleaders were shaking pompoms, and doing toe-touch jumps, the splits, and claps to get the crowd to cheer for their team). The evolution of cheerleading to a sport was again developed by the University of Minnesota as the women became known for their athletic ability by including gymnastics in their routines. Cheerleading developed more showmanship and became more entertaining, and has evolved from service-oriented cheering on the sideline of other sports to a highly skilled athletic competition in its own right.

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The elevation of cheerleading to skilled athletic competition has brought with it an increase in the absolute number of injuries. The number of emergency department visits attributed to cheerleading injuries increased between 1980 and 1994, from 4954 to 16,000. Almost 50% of all catastrophic injuries (injuries resulting in death or permanent or partial disability) suffered by high school female athletes during competitions between 1980 and 1998 occurred during participation in cheerleading.

Cheerleading was almost an extreme sport which involves gymnastic types of building human pyramids, showing body flexibility on partner’s palm and basket tossing flyer in the air. These risky moves are asked to continue making progress in many aspects such as dance, motion, jumps, tumbling, and skills of stunts. Gymnastic-type element of cheerleading is considered to be a major factor related to the high risk for cheerleading-related injury.

Johnson and Easter stated that the national pay more attention to the risk of cheerleading started from a seriously accident happened in basketball game between Southern Illinois University and Bradley University in 2006. During the ball games, a cheerleader from Southern Illinois University named Kristi Yamaoka hit her head after her falling from a human pyramid but she still continued to perform until she was moved away from the game. In the accident she suffered from a fractured vertebra, concussion, and a bruised lung.

According to the investigation, the reason for Kristi Yamaoka fall down was she lost her balance, therefore, some athletic conferences tried to prohibit lots of stunts with high risk of unbalance. For example, the Missouri Valley Conference tried to make a rule to ban its member from allowing cheerleaders to be launched or tossed and from taking part in formations higher than two levels. The same things happened in National Collegiate Athletic Association (NCAA). During its conferences and tournaments NCAA recommended limiting pyramids two and one half levels high or higher, and basket tosses.

On July 11, 2006, the American Association of Cheerleading Coaches and Administrators (AACCA) established those prohibitions under the AACCA College Cheerleading Safety Rules. These injury preventions undertake an important cheerleading risk management initiative with a goal of enhancing safety for college cheerleaders. According to the National Center for Catastrophic Injury Research Due to their severe nature, catastrophic sports injuries usually receive considerable local media attention and, in the case of collegiate or professional sports, even national media attention.

While these types of injuries are rare, they can cause permanent neurological deficits or even death, which can be devastating to athletes and their families. In addition, these types of injuries also can result in major long-term medical costs. The National Center for Catastrophic Sports Injury at the University of North Carolina has presented athletic injury data and defines a catastrophic injury as non-fatal resulting in permanent severe functional brain or spinal cord disability.

The Center further defined direct injury as resulting directly from performing the specific activities of a sport, indirect injury as caused by systemic failure as a result of exertion while participating in a sport. Catastrophic injuries are then subdivided into three categories: fatal, nonfatal, and serious. A nonfatal injury is one in which the athlete suffers a permanent severe functional disability. A serious injury is a severe injury with no permanent functional disability. An example of a serious injury would be a fractured cervical vertebra without paralysis.

Females have been participating in competitive sports for years. Since 1972, the passage of Title IX has female sport participation grown dramatically. With this increased participation has come an increase in injuries—both minor and catastrophic. There are more female cheerleaders than male cheerleaders, and the women are usually at the top of the pyramid or being thrown into the air during basket tosses, so the majority of injuries occurred in female cheerleaders. Between 1982 and 2009, female college and high school athletes sustained 165 direct and 73 indirect fatalities and catastrophic injures.

Of the 165 direct injuries, 117 were sustained by high school and 48 by college girls. Seventy-six (65%) of the 117 high school direct injuries were sustained by cheerleaders, nine by gymnasts, nine by track athletes, and the remainder spread over eight other sports. Thirty-four (70. 8%) of the 48 college direct injuries were sustained by cheerleaders, three in field hockey, two by gymnasts, and the remainder spread over seven other sports. These statistics suggested that cheerleading may be an area in need of closer monitoring.

The major issues involved in the safety of cheerleaders include the conditioning of the cheerleaders; the types of maneuvers being performed; the type of surfacing on which cheerleaders practice and perform; the appropriate use of properly trained spotters; and the supervision present during practice sessions and performances). demonstrated that the level of education and experience of the cheerleading head coach, and whether or not this individual had specific training on injury prevention, had a significant impact on occurrence of injuries.

They also noted that since the relatively recent inclusion of gymnastic elements in cheerleading, along with partner stunts and pyramids, these elements have been involved in a high proportion of cheerleader injuries. These stunts are performed at games and pep rallies, as well as competitions. Sometimes competition routines are focused solely around the use of difficult and risky stunts. These stunts usually include a flyer (the person on top), along with one or two bases (the people on the bottom) and, one or two spotters in the front and back on the bottom.

Like gymnasts, cheerleaders land from heights while twisting and rotating and place a considerable amount of stress on their lower back as a result of repetitive flexion, hyperextension, rotation, and compressive loading of the spine on landings. In addition, a unique aspect of cheerleading is that both male and female cheerleaders lift other cheerleaders above their heads during cheerleading routines, which may result in compressive loading of the spine and weight-bearing related injuries to the upper and lower extremities, as well as the lower back. . Boden, Tacchetti, and Muller found that cheerleading had a significant number of direct catastrophic injuries resulting from direct contact of the head with the floor (most often without protective mats) or ground, resulting from falls (or failure of other cheerleaders to properly catch) as the individual was dismounting from a pyramid or from a basket toss. Other mechanisms also occurred, such as contact with another cheerleader’s head or knee, or with a wall.

They also found that of the most common stunts performed at the time of 29 cheerleading catastrophic injuries, nine were pyramids and eight involved the basket toss. Among the 29 catastrophic injuries, 17 were severe head injuries, resulting in 13 skull fractures and two deaths, and eight were cervical fractures. The types of cheerleading-related injuries are strain or sprain, fracture or dislocation, concussion or closed head injury (CHI), and abrasion.

Shields and Smith in 2006 reported that the number of cheerleaders suffering from broken bones, concussions, and sprains has increased by over 100 % between the years of 1990 and 2002, and that in 2001 there were 25,000 hospital visits reported for cheerleading injuries dealing with the shoulder, ankle, head, and neck. In the recent research, the most three common injuries are ankle strain or sprain, neck strain or sprain, and concussion. Injury Surveillance As the sport has evolved, so have its safety training and regulations.

The AACCA has initiated a safety certification program that as of 1999 had been adopted by the state of Vermont and the following NCAA athletic conferences: the Big Ten, Southwest, Southeast, and the Western Athletic Conferences. Other organizations such as the National Federation of State High School Associations (NFHS), the National Council for Spirit Rules and Education, Cheer Ltd, and the National Cheer Safety Foundation (NCSF) also have worked on safety management). Preventing catastrophic injuries in competitive cheerleading is somewhat more problematic, since it is a relatively new sport, and rules are still in the developmental stage.

There have been recent rules limiting the height of pyramids and putting limits on the basket toss, two of the riskiest activities. As with other sports, there is a definite need for education and certification of coaches, and education of participants and parents about the risks of the sport and how injuries can be prevented. Not attempting tricks or routines for which everyone is adequately prepared and trained, including the spotters, is important. Mandating adequate floor mats for complex stunts is another important recommendation.

Given the changes in the nature of cheerleading, its popularity, and the injury prevention interventions being undertaken in the sport, it is essential that cheerleading injuries and injury rates be described and risk factors quantified. According to the survey (NFHS, 2010), it indicated that the number of girls’ participation in competitive spirit squads in Florida was 5,226 which ranked 7th in the United States. The purpose of this research is to randomly sample high school cheerleading squads in order to collect and compile selected injury information and to compare this information with previously published literature.


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