Cheerleading is often overlooked as an injurious sport and scant studies have focused on the mechanisms and incidences of injuries.
But the reality is that cheerleading has evolved over the past century-and-a-half from a pep-group chanting in the bleachers to a competitive combination of high-impact dance and extreme-skill performance sport: filled with high-flying stunts and dangerous skills. Cheerleading has quickly become one of the most necessarily accurate professional sports due to the advancement of trick stunts and the subsequent improvements in training practices. In order to pull off those high-flying moves, athletes must train daily at intensities formerly reserved for the team sports they cheer for. Thus, they are subject to common over-training injuries which include ligamentous sprains, muscular strains, fractures, and contusions.
Dr. Jay Greenstein, CEO of Sport and Spine Companies in the Washington, DC area and a leader in the chiropractic industry at the national level offers his insight:
“Cheerleaders suffer lots of lower extremity injuries. A 2012 study published in the Journal of Trauma and Acute Care Surgery revealed that lower extremities injuries made up approximately 30% of all cheerleading injuries seen in the emergency room over a 5 year period. A study published in the American Journal of Emergency Medicine reported that an even higher rate of lower extremity sprains and strains at 42% of total injuries occurring.
Athletes should be aware that muscle compensations due to injuries of this nature create postural imbalances that can go unnoticed resulting in alignment issues that have a deeper affect on a person's performance and safety. An early evaluation for orthotic need can assist in reducing the risk of posterior tibial tendon, achilles tendon, and peroneal (fibularis) sprains and strains. In 2011, Franklyn-Miller, A,et.al. found the use of customized foot orthoses during training for those assessed as being at-risk resulted in a 20% reduction in lower limb overuse injury rate. Stabilizing the body through guided and controlled rehabilitation, skeletal manipulation, and orthotic use can keep the body aligned, improve sensorimotor control, and maintain better balance. Dr. Greenstein continues:"While functional elements of muscle imbalances, prior injury, and thus poor sensorimotor function are key variables of this epidemic, we also realize that there are anatomic variables that must be addressed. In a study published in the Clinical Journal of Sports Medicine, the application of a custom foot orthoses “have an immediate effect on (lower extremity) dynamics.” So, in thinking about prevention first, having a pre-emptive evaluation to determine the need for a custom orthoses to improve lower extremity dynamics and function, and reduce the risk of injury, is a worthwhile endeavor.”
A cheerleading-specific lower extremity evaluation will include objective measures of range of motion, strength, spinal alignment, pelvic obliquity, leg length discrepancy, knee alignment, hindfoot alignment, plantar fascia patentcy, sub-talar joint axis, navicular drop, flexor hallucis congruency, heel-ball ratio, and forefoot to hindfoot alignment during static and weightbearing sport maneuvers. In fact, these elements are necessary to fabricate the most appropriate device for any person seeking to improve their performance through balance and injury prevention.
Notes on Cheerleading injury incidence and prevention
In 2002, the Journal of Pediatrics published an epidemiological review of cheerleading injuries in children from 1990-2002. The authors found the body parts injured were lower extremity (37.2%), upper extremity (26.4%), head/neck (18.8%), trunk (16.8%), and other (0.8%). Injury diagnoses were strains/sprains (52.4%), soft tissue injuries (18.4%), fractures/dislocations (16.4%), lacerations/avulsions (3.8%), concussions/closed head injuries (3.5%), and other (5.5%). Children in the 12- to 18-year age group were more likely to sustain strains or sprains to the lower extremity than 5- to 11-year-olds (P < .01; RR: 1.62; 95% CI: 1.50–1.88). Since this land-mark paper was published, catastrophic injuries in cheerleading has continued to rise. The latest information (Oct 2012) shows the number of catastrophic injuries related to cheerleading has increased from 1.5 annually from 1982 to 1992 to 4.8 per year from 2003 to 2009 according to the American Academy of Pediatrics. Catastrophic injuries include closed-head injury, skull fractures and cervical spine injuries resulting in permanent brain injury, paralysis or death.
New recommendations in the guidelines of injury prevention in cheerleading have just been released and include:
Thank you to Dr. Jay Greenstein for his contribution to this article.
Council On Sports Medicine and Fitness. Pediatrics. 2012;doi:10.1542/peds.2012-2480.
J Physiother. 2011;57(3):193.
Foot orthoses can reduce lower limb overuse injury rate.Landorf KB.
SourceLa Trobe University, Australia.
PEDIATRICS Vol. 117 No. 1 January 1, 2006
pp. 122 -129
American Academy of PediatricsPolicy Statement: Cheerleading Injuries: Epidemiology and Recommendations for Prevention
Every shoe company has an idea of how thin a sole should be or what the heel to forefoot relationship should be and their guidelines are not well defined. What exactly is a "Minimalist" shoe? The parameters and features of a minimalist shoe vary greatly and even their marketed usages may differ widely, but the shoe industry continues to pursue persons willing to cough up a little extra money for a little less material under-foot. As in all life, the past repeats it's self often enough that we can find the answers in historical terminology. Shoes were once exclusively named for the type of sport they were meant for and later for the properties of their construction. "Trainers", "Field Cleats", "Tennies", and "Racing flats" were all an athlete needed to ask for 40-50 years ago when the mass marketing of shoes was in it's infancy. There were no large heeled, anti-pronation, asymmetric, multi-durometer, extruded soles on the market because designs were yet to be drawn, the machines had yet to be invented, the sports had yet to be integrated into society, and marketeers had yet to exploit the idea that running barefoot was somehow healthier for you. Later, as running took hold as a common sport and past-time, helpful terms such as "Half-Last", "Board-Last", "Straight or Curved Last" came into vogue as a means of better educating the consumer on selecting proper footwear. The term "Minimalist Running Shoe" is primarily used to group together styles of shoes with attributes that yield a walking or running experience similar to being barefoot without allowing the plantar surface of the foot to make direct contact with the ground. Minimalist running shoes (MRS) are lightweight, low to the ground, and flexible. They provide very little cushioning for the heel and forefoot. Additionally, compared to traditional running shoes, there is minimal slope from the heel to the forefoot in the MRS. This reduction in cushioning and decreased heel-to-toe drop forces the runner to land with a more anterior foot strike when running. While there are anecdotal stories of these MRS reducing injury and improving performance, there are still no conclusive research studies that confirm these claims. What does seem clear is that switching from a traditional running shoe to a MRS requires a proper transition period to avoid potential overuse injuries. There is no one right way to make the transition to MRS, but most programs require a period of 8-12 weeks. Running with MRS encourages a forefoot or midfoot strike when running. This type of foot strike means that rather than landing on your heel, you will land on the toes or mid part of the foot. This landing may lead to a reduced initial impact force on landing and relies on strong foot and leg muscles. A good transition program will focus on learning how to land on your forefoot or midfoot and will include strength exercises specifically for the foot and leg. Another important aspect of the transition is that you start with very short distances using the MRS – and build gradually over several weeks. This might be more easily said than done. While some studies show a reduction in vertical forces experienced in the joints, others suggest barefoot running requires more strength and has a greater metabolic cost on the body compared to shod running. Even the world's elite runners heel-strike; Meb Keflezighi and Usain Bolt both heel-strike as a primary method of running. Ankle and Tibial bone injuries are associated with heel-striking over use injuries while metatarsal fractures, posterior tibialis tears, plantar fasciitis and musculotendinous strains are associated with mid-foot strikers.
Whether you are for or against near-barefoot running, one thing is very clear: A persons body will tend to stand, sway, walk, and run in the most metabolically efficient way to bring about the most amount of comfort in any situation they encounter. Specialized shoes and conscious changes in running styles has the effect of increasing energy consumption which, in turn, causes earlier fatigue. There is no one way to run! In the absence of pathology, your natural gait and movement patterns are the ideal method of performance for you!
Graceyfeet insoles allow you to move within your preferred path of progression but lower the detrimental ground reaction forces that travel through the plantar surface of your foot an cause you injury and pain up the chain.
They are the perfect compliment to any minimalist shoe.
Lieberman DE, Venkadesan M, Werbel Wa, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature 2010;463(7280):531-535.: http://www.nature.com/nature/journal/v463/n7280/full/nature08723.html
Miller RH, Umberger BR, Hamill J, Caldwell GE. Evaluation of the minimum energy hypothesis and other potential optimality criteria for human running. Proc Biol Sci 2012;219(1733):1498-1505. : http://lowerextremityreview.com/issues/may/biomechanist-challenges-idea-that-forefoot-strike-pattern-reduces-runners-injury-rate
FOOT CONTACT PATTERNS AND JOINT DEMANDS IN NOVICE BAREFOOT
RUNNERS BEFORE AND AFTER EXERTION
Hashish R, Samarawickrame S, Powers C, Salem G
CSM 2012 Sports Physical Therapy Section Abstracts: Poster Presentations SPO1100-SPO1125J Orthop Sports Phys Ther 2012;42(1):A114-A124
Chris Gracey MPT, Cped