By Lisa Ellis
InteliHealth News Service

BOSTON — In many schools, the cheerleaders still may be the perky glamour queens who perch — literally and figuratively — at the top of the pyramid in the social pecking order.

But cheerleaders today also face a growing risk of injury — with little protection or support from their schools — as competition in their sport requires more and more challenging stunts such as pyramid building, lifts and throws, a California pediatrician says.

The sport, which exists largely as a club phenomenon only loosely affiliated with schools, urgently needs to adopt safeguards to protect cheerleaders, Sally S. Harris, M.D., M.P.H., told fellow doctors at the annual meeting of the American Academy of Pediatrics (AAP).

Cheerleading has been growing rapidly and now enrolls 3 million to 5 million participants — the vast majority girls — from age 5 through college, said Dr. Harris, an assistant clinical professor of pediatrics at Stanford University and former chairperson of the AAP's Section on Sports Medicine.

The injuries also have multiplied, she said, from fewer than 5,000 emergency room visits in 1980 to nearly 25,000 in 2001.

Studies show that the injury rates are lower in cheerleading than in many other sports, but they are often more severe, Dr. Harris said in a news conference before her presentation to the doctors. Cheerleading causes more than half of the catastrophic injuries (those involving paralysis or death) suffered by all girls competing in sports in the United States, she said.

Combining the maneuvers — and the injury patterns — of gymnastics, dance and acrobatic stunts, cheerleading is "incredibly demanding on all body parts," Dr. Harris said. "It's very high-impact."

She said many of the most serious injuries are tied to the stunts that cheerleaders perform in local, state and national competitions. Rather than just supporting a school’s traditional athletic teams, cheerleaders spend most of their energies year-round preparing for and participating in these competitions, the heart of their sport, she said.

A 1993 study found that 3 out of 10 injuries occurred during stunts involving partners. Many falls occur, she said, during pyramid building and stunts in which one girl is tossed through the air and, if all goes well, caught by her partners.

Ankle injuries are the most frequent (22 percent), but head and neck injuries (7 percent) are the most severe, according to a 1997 study, she said.

Despite these risks, cheerleading squads often operate with inadequate medical screening and conditioning, inappropriate practice surfaces and equipment, and poorly trained coaches, she said.

"Cheerleading is not recognized in most schools as an official school sport, so the majority have girls doing these very risky maneuvers, but they don't get the support the other athletes do," she said.

Dr. Harris said some states have attempted to regulate the sport by banning the more dangerous stunts. But this approach is controversial, she said, because it puts teams from those states at a disadvantage in national competitions.

She urged widespread adoption of guidelines developed by the NCAA and the National Center for Catastrophic Sports Injury Research.

The guidelines include the following recommendations: