Saturday, November 10, 2012

More dangerous than football...

A group of U.S. pediatricians last week recommended that cheerleading be designated an official sport, mainly to help prevent injuries, which the doctors say can be catastrophic.

Some of the group's other recommendations include requiring cheerleaders to pass pre-season physicals, to have access to strength and conditioning coaches and to be removed from competing or performing if they have a head injury.

"We felt that there needed to be some guidelines out there on how to make it safer for these girls," said Dr. Cynthia LaBella, co-author of the recommendations that were issued by the American Academy of Pediatrics (AAP).

In the realm of high school athletics, cheerleading accounts for less than 1 injury per 1,000 "athletic exposures" in girls, according to the AAP. That's far less than the 8.5 injuries per 1,000 exposures for gymnastics or the 5.3 per 1,000 exposures for soccer.

However, research has shown that cheerleaders are at a disproportionately high risk for catastrophic injuries, which include skull fractures and spine injuries.

According to the AAP, cheerleading accounted for 65 percent of all catastrophic injuries in high school girl athletes and about 71 percent in college women between 1982 and 2009.

"In many states and at the college level, cheerleading isn't officially recognized as a sport. And because of that there are quite a few safety mechanisms they miss out on," said LaBella, an associate professor at Northwestern University's Feinberg School of Medicine in Chicago.

Those safety mechanisms, according to the AAP, include access to trainers and medical care, better facilities and practice times and certified coaches. [1]

Most of us have an image of cheerleaders as possessing high energy and bright smile and glowing personality.  While this is for the most part true these qualities may also serve to mask the fact that these young ladies (I know males do cheer but 96% of participants are female) beat their still developing bodies up pretty good.

Scan the sidelines of your local high school football team and you will undoubtedly see girls with their knees, ankles, and wrists taped or braced.  What we can’t see is that they are also very likely to suffer from some sort of lower back pain.

My 13-year old niece competes in competitive cheer and I always ask how she’s feeling because I have a pretty good sense her body is banged up.  She tells me that her knees hurt all the time and her lower back hurts most of the time.  Last week I worked with a high school girl’s gymnastics team.  After watching them perform their routine and observing similar issues with cheerleading I felt compelled to highlight these two populations particularly in light of the recommendations above.

For the most part girls don’t train to play/participate in their sport.  They use the sport to prepare them to play.  This would be akin to trying to prepare a meal and serve it at the same time; you’re always going to be behind.  However if you do the work ahead of time (prepare the meal) when it comes time to perform (serve the meal) you are set up for success.  Then it’s just a matter of whether or not the judges (diners) like your routine (food).  The foundation of general fitness and strength does not exist in this population yet they are still called upon to hoist each other up and do hand springs off a vault and stick a high velocity landing.  These activities are just as demanding as anything you will find in most boys sports but the level of commitment by girls to strength and conditioning falls far short of what should be required to minimize the risk of injury and to ensure optimal performance.

Another issue is strictly due to the competitive demands of these activities.  Form, the way movement or the routine looks is very important in cheerleading and gymnastics.  Due to this nature the girls are required to have tremendous “flexibility.”  As a result these young athletes spend a disproportionate amount of time taking their joints to end range of motion and holding a stretch for long periods of time to improve muscle length.  In the essence of time I won’t get into whether or not this method of stretching is having the intended affect but this extreme stretching definitely has negative implications.  These athletes also perform high velocity movements with extreme joint range of motion such as a back bend to handstand.  If you’ve ever seen that move it will make you cringe just watching it (ugh that poor spine). 

Our muscles provide our bodies with active restraints.  When our muscles fire they not only provide movement but also help to stabilize and control joints.  Joints and ligaments are more passive in nature; they provide stability when the muscle fails for whatever reason.  When a muscle is stretched to it’s full capacity repeatedly and over a long duration it begins to lose it’s resiliency and their protective nature is delayed.  Imagine a rubber band that is stretched maximally and held at that length for long periods of time.  Eventually it becomes very loose and loses its elasticity. When the muscles aren’t providing adequate stability these young athletes have to find it somewhere and it very often results in hanging on a passive restraint like a joint.

Young athletes will lockout their knees and/or hyperextend their lower back to create stability to support their bodies while executing the required movements or routines.  In this case imagine a credit card that is repeatedly being flexed back and forth so that both ends touch.  Eventually the card snaps in half, analogous to a stress fracture for a young athlete.

And while I use cheerleading and gymnastics as examples it should also be understood that in all sports there are certain competitive demands inherent within them that can lead to pain and injury if it’s not counteracted.  For example basketball players often get their ankles taped and/or wear hi-top sneakers for added support of the ankle joint.  While on the surface this seems logical it can also be problematic.  The ankle is a very mobile joint and if some sort of brace restricts it the body will compensate in an attempt to find that lost mobility somewhere else.  Frequently that movement will come from the less mobile knee joint and this is likely why serious knee injuries are fairly common in basketball players while catastrophic ankle injuries strangely enough are pretty rare.  That said, I wouldn’t advise basketball players to throw away the hi-tops or stop taping, it clearly proves advantageous in the prevention of ankle sprains.  What I am saying is that training must be adapted with the knowledge that ankle mobility must be maintained while concurrently improving knee stability and hip mobility (hip mobility is a very good thing) to prevent injury and ensure optimal performance.

The message that should not be missed within all of these examples is the importance off some type of pre-competition training program to improve athlete safety and injury reduction.  The main benefit of safe, healthy athletes is that they perform better and when they perform better it’s more fun.  The most effective tool to prevent youth sport injuries is a balanced athletic development foundation.  This used to be easy to attain through free play and seasonal sport participation.  Now due to the rise of sport specialization and travel teams kids lack that broad foundation that will ensure their durability. Sensible and anti-specific training programs have become a necessity for the current youth sport culture.  The sooner this approach is adopted the better off our young athletes will be.

Cheerleading Injury Prevention Resource

Gymnastics Injury Prevention Resource

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