Cheerleading accidents may be responsible for a greater percentage of injuries among high school and college athletes than previously thought, according to an updated report on catastrophic injuries released last week.
Frederick Mueller, director of the National Center for Catastrophic Sports Injury in Chapel Hill, N.C., and lead author of the report, says additional catastrophic injury reports from the National Cheer Safety Foundation, when factored into his original figures, suggest that during the periods 1982-83 and 2006-07, 65.1 percent of all female high school sports catastrophic injuries and 66.7 percent of all college female sports catastrophic injuries are directly attributable to cheerleading.
Catastrophic injuries, as defined in Mueller's report, are those that range in severity from serious fractures to paralysis and death.
These serious injuries, Mueller says, often go unreported. And he says that because there are no established regulations for reporting cheerleading injuries, the number of these injuries directly attributable to cheerleading could be even higher.
"What [the report] tells us is that data collection for these injuries is difficult and that we may not be getting all of the cases that are out there," he said. "Cheerleading organizations need to take a serious look at this and make some important changes."
Not everyone agrees with Mueller's figures. Jim Lord, executive director of the American Association of Cheerleading Coaches and Advisors, contends that the participation figures in Mueller's report are far too low, and that this in turn makes catastrophic cheerleading injuries appear much more common.
"I think participation numbers are certainly higher," he said. "I think the injuries per 1,000 participants is lower than what is in the study."
Plus, he says that additional safety measures have made cheerleading safer than in years past.
"Over the last five years, we have seen a major change in safety awareness out there," he said. "We have also made, probably in the last two to three years, significant changes to safety rules that prohibit certain skills to be done on certain surfaces, such as basketball courts."
"From what we have seen, we have found that this has had an effect."
But others say the report brings to the forefront the continuing safety issues associated with the activity.
Kimberly Archie, executive director and founder of the National Cheer Safety Foundation, says that the fact that cheerleading is not regulated in the same way as high school and college sports creates a situation in which many injuries -- even catastrophic ones -- are never reported or recorded.
"Dr. Mueller's report only covers high school and college kids during the school year," she said. "If it happens in a summer camp, it is not on Dr. Mueller's report."
And she agrees with Mueller that the number of young athletes sustaining major injuries through cheerleading may be much higher than even the figures in the revised report.
"According to these numbers, 1 in 30,000 kids is going to have a catastrophic injury from cheerleading," Archie said. "And these injuries are not, 'Oh, Susie fell and now her back hurts.' These are dramatic and serious injuries."
"If anything, there are even more injuries... more like one in 10,000."
Tumbling Toward Tragedy
Archie is no stranger to the perils of cheerleading. Her daughter Tiffani Bright sustained a serious injury as a high school cheerleader; at age 15, she broke her arm in two places when a stunt went wrong.
Tiffani recovered completely, but not all high school cheerleaders have been so lucky. Three years ago, 14-year-old Ashley Burns of Medford, Mass., was practicing with her high school cheerleading squad when a high-flying stunt ended in her landing in the arms of her teammates on her stomach instead of on her back. Unbeknownst to her coaches and her teammates, the fall had ruptured her spleen. She soon fell ill, experienced convulsions and lost consciousness.
"She was pronounced dead before I could even get there," said Ashley's mother, Ruth Burns, through the National Cheer Safety Foundation in a statement. "The coaches waited until Ashley was really sick, like [vomiting blood], to call the ambulance."
She says she feels that if a proper emergency plan had been implemented and properly followed, her daughter might be alive today.
"It was the hardest day ever," she said in the statement. "It gets harder instead of easier. She was my only child."
"I hope that this new study opens people's eyes and they stop making excuses."
Archie agrees -- and she adds that cheerleading organizations and companies involved in promoting the activity must be more involved in implementing safety standards.
"We have to have the support of the cheerleading industry," she said. "Thus far, not one of the cheerleading organizations has volunteered to do anything with NCSF [the National Cheer Safety Foundation]."
And while American Association of Cheerleading Coaches and Advisors has promoted revised safety standards in recent years, Archie says the measures have largely failed to encourage preparedness among those supervising the young athletes.
"When we studied these, including the cases of Lauren Chang [another Massachusetts cheerleader who died during a cheerleading competition in April 2008] and Ashley Burns, we found a pattern of delayed emergency response," she says. "This is in direct respect to cheerleading's lackadaisical response to catastrophic injuries."
Making Cheering Safer
If there is a point on which all parties agree, it is that coaches and other supervisors must be properly trained and accredited.
"I think the first thing that parents of kids in cheerleading should do is to know who the coach is and what background experience they have," Mueller said. "It's still the case in many schools that the last teacher who is hired is assigned cheerleading coaching responsibilities, whether they know anything about it or not. That's a big problem."
"The biggest problem is uninformed consent," Archie said. "Parents don't know that their kids can break their necks doing this."
Lord adds that proper supervision would also ideally cut the risk associated with ill-advised stunts.
"The number-one reason people get injured is that they attempt a skill that they are not qualified to perform," he said. "If someone's not going to follow the rules, there's nothing we can do."
Part of the problem could also be the fact that regulations governing the activity and its requisite safety measures are a hodgepodge of guidelines that vary from place to place. Currently, cheerleading is regulated as a sport in some states, such as Arkansas and Georgia, while in other states like New York and California, it is classified as an athletic activity. Not all states require cheerleading injuries to be reported to a central database, further muddling its actual risks.
Mueller and Archie say that one of the best ways to correct this problem is for athletic organizations to begin regulating cheerleading as a sport, rather than simply an activity.
"Cheerleading is still not a sport in many schools and states, so these programs can do what they want without regulation from the athletic department," Mueller said.
Lord disagrees. He says he feels regulating cheerleading as a sport may have the unintended consequence of making the sport less safe, as it would limit the amount of organized off-season training that cheerleaders could use to practice.
"I don't think designation as a sport will have anything to do with safety," he said. "Safety is on the local level."
But Archie maintains that safety should be a top priority across all levels of the activity -- an activity, she says, both she and her daughter still love.
"It's a high to fly. It's an adrenaline rush," she said. "It's obvious why these girls would want to do it. But why can't we do it safer?"
"We don't want to stop cheerleading; we want to make it better and safer."