Dr. Bashir Zikria, an assistant professor of sports medicine at Johns Hopkins, never will forget the first time he came face to face with a teenager whose life had been forever changed by an acrobatic flip that landed way out of control.
“Horrible,” said Zikria, as he recalled — while an intern at Children’s Hospital in Boston — the heart-breaking aftermath of a 16-year-old boy’s head-first landing. He had been held in the air and was supposed to perform a forward flip. But instead of landing on his feet, he landed on his head and fractured a cervical vertebra. He’ll never walk again. “Breaking your neck at 16,” Zikria said, “it’s almost like losing your life.”
The danger is realAmy Kennedy was whirling sideways when she felt her ankle rip apart. The pain was agonizing.
She was practicing a cheerleading routine for the University of Maryland, College Park team, when she launched herself from a roundoff — sort of a cartwheel where her feet are kept together — into a back flip.
As she landed on the mat at the campus’s Health and Human Performance building, her foot came down with such force that she severely strained the ligaments in her ankle. Doctors told her it would have been better had she broken it.
The injury, which kept Kennedy sidelined for a month, is common in one of the most dangerous athletic activity for females.
“A lot of people think that cheerleading is just rah-rah, pompoms,” Kennedy said. “But in a competition, it’s very serious, and stunts and tricks and tumbling passages, they’re really dangerous.”
And with no protective gear.
“We’re out there without pads, without a helmet, so it’s much easier to get a concussion,” Kennedy added. “We get concussions, we get broken bones. We get the same injuries as football players.”
The National Center for Catastrophic Sports Injury Research has made several recommendations for improving cheerleaders’ safety, including limiting pyramids to two levels, prohibiting mini-trampolines, abolishing flips or falls off pyramids, and requiring that cheerleaders have medical examinations before they participate.
All cheerleaders — not just those in college — Zikria said, should use a strength and conditioning program because the glitzy stunts they attempt require far more strength than most people think.
“The first thing you should do is determine what you can do,” he said. “Just don’t look at TV and decide, ‘I’m going to do that.’”
‘It’s a scary thing’CBS televised the first cheerleading competition in 1978. The first basket toss — where a cheerleader is launched into the air and caught on her way down — was performed in 1984 at the University of Michigan, and the its popularity has soared ever since.
Reports estimate that nearly four million Americans participate in cheerleading.
But as its popularity thrives, cheerleading has evolved into feats of complex maneuvers, lofty basket tosses and human pyramids as tall as some small buildings. Safety regulations can limit the dangers, but only if they’re followed, and while many schools still do not consider it a sport or follow the regulations, experts say it is the country’s most dangerous athletic activity.
“When a parent sends a kid to cheerleading, a lot of people don’t really understand what’s going on,” said Fred Mueller, a University of North Carolina professor and head of the National Center for Catastrophic Sports Injury Research. “They still think you’re jumping up and down and shaking pompoms. They still do that, but they’re doing a lot more.”
Cheerleading causes about 65 percent of all catastrophic injuries for high school girls. A catastrophic injury is defined as one that is fatal or potentially life-altering, according to the center.
Injuries most often come from tall pyramids or basket tosses.
At a recent practice in Joppa, Shelby Cannon, 17, was working on stunts for the Baltimore Sharks All-Stars. She was thrust up in the air and held up by one leg. Several times she teetered, desperately calling to “let me down” after struggling to reach her leg up to her head.
“It is a scary thing,” she said. “If I fall, I would get hurt.”
“But,” she was quick to add. “I do it because I like it so much.”
Cannon and Molly Robinson, 17, have been cheering together for years. They say they’ve grown comfortable with flying through the air, even though Robinson comes home with more bruises than her football-playing brother.
“It’s the inexperienced ones [who concern me],” Robinson said. “I’m more worried for them than I am about myself.”
One of their newest teammates, Mike Conneely,18, knows the pain of inexperience. While new to the sport a few years ago, “I was working on a back flip when I landed on my shoulder and broke my collarbone.”
“But once you start doing it [cheerleading],” he added, “you just get into it.”
A full-contact sportBut beyond the broken bones and torn ligaments, there is a deadly side to cheerleading.
Shauna Stuewe, 14, a cheerleader at Esperanza High School in San Diego, suffered cardiac arrest and died after she was thrown in the air on a basket toss in February 2006.
Lauren Chang, 20, a cheerleader for Newton (Mass.) High School and the Energy All Stars, was kicked in the chest during a cheerleading competition this past April. Her lungs collapsed, and she died.
“You can’t put a price on a child’s life, ever,” said Ruth Burns, a Medford, Mass., resident whose daughter died while cheerleading in 2005.
Ashley Burns, 14, was thrown in the air during practice to perform a stunt she had completed perfectly many time before. But this time, she wasn’t able to finish a second twist and was caught stomach down. She ruptured her spleen and died.
“I knew being a flier would be more dangerous than being a base or back spot, but I never thought she would die doing it,” Burns said. “I feel like a fool for just assuming that these organizations actually cared about [cheerleader] safety when clearly they do not.”
Emergency room visits for cheerleaders more than doubled in the 1990s, and in the past three decades, they have increased nearly six-fold, from 5,000 to 28,400, according to the sports injury center. Mueller said the increase is partly because so many more people participate in cheerleading, but it’s also because the stunts are more perilous.
Burns said her daughter’s cheerleading squads at Medford High and the North East All-Stars were similar to many. They did not keep medical personnel or equipment on hand. Had she known how dangerous the activity can be, she said, she would not have allowed Ashley to take part.
“She always asked me why it isn’t a sport,” Burns said. “In fact, it is a full-contact, extreme sport.”
If a school or group considers cheerleading a sport, it is subject to strict safety regulations that can limit the dangers, such as the height of pyramids. Medical personnel would also be required to monitor the activity, similar to the way they stand guard at sports such as football.
The University of Maryland became the first college or university in the country — in July 2004 — to call cheerleading a sport. The competitive cheer squad at the school participates exclusively in competitions. A separate group of cheerleaders rallies the crowds at football and basketball games.
A year before it became a sport, injuries decimated the squad, sidelining every cheerleader at some point, members said.
Kimberly Archie, president of the National Cheer Safety Foundation, applauded the school for recognizing the dangers and establishing regulations to take control.
“Cheerleading is an example of what can go wrong in youth sports in America,” she said. “In cheerleading, injuries are a no-no. You don’t talk about them. It’s secrecy. You’re not supposed to talk about injuries because if you do, they say you’ll stop cheerleading. So the girls are afraid.”
Archie’s daughter, Tiffani Bright, of Medford, Ore., broke her arm five years ago when a coach allowed another girl to practice on the same trampoline. Bright, then 15, was bringing her hands down for a handspring as the other girl snapped the springs back up. Bright suffered a double compound fracture. To keep cheering, she opted to have a metal plate screwed into her arm.
‘Truly a spectacle, when done right'Allison Stangle has coached cheerleading for 17 years, and she’s suffered the broken noses, contusions and shoulder dislocations to prove it.
“The injuries are overwhelming,” said Stangle, who represents Harford County on a state cheerleading board and has also judged national competitions. “It’s better for a coach to get hurt than a girl, because they’re just learning.”
In the three decades in which she’s been a cheerleader, judge and coach, Stangle has seen it all, from snapped legs to ACL tears to concussions. But despite the carnage, she keeps coming back because, she says, there is no sport more beautiful when done right.
And to do it right, she says, cheerleaders need qualified coaches.
“There’s not as many cheerleading coaches out there, so schools are just happy to have anyone do it,” Stangle said. “Often, it’s just a teacher who’s doing it.”
Gymnastics coaches are often required to get certification, and while competitive national association All-Star coaches must pass a safety test, for many others, there’s no such requirement, Stangle said. Making coaches go through training and get certified is the best way to ensure the girls’ safety. “It’s scary that there’s no training required,” she said.
But, she added, when coaches know what they’re doing and teach girls to progress slowly, first mastering basic moves before they move on to more glamorous and intricate stunts, there’s no sport quite like it.
“It’s one of the most exciting, entertaining, energetic sports out there,” Stangle said. “It’s truly a spectacle — when it’s done right.”
BY THE NUMBERS
High school cheerleading injuries over the past 25 years
College cheerleading injuries over the past 25 years
High school female catastrophic injuries over the past 25 years
Ice hockey: 2
College female catastrophic injuries over the past 25 years
Field hockey: 3
Ice hockey: 1
Source: National Center for Catastrophic Sports Injury Research