TABLE A2.
Common Cheerleading Injuries a
| Injury | Cause/Description | Treatment | Return to Sport |
|---|---|---|---|
| Head | |||
| Concussion | Although contact is not necessary, most concussions occur by head impact from contact with the ground or another athlete. Most commonly results from stunts. 132,133 | At least 24 h of rest followed by graduated 6-phase return-to-play protocol. 143,155 | 10 d to 3 wk 78,89 |
| Upper Extremity | |||
| Glenohumeral instability | Can result from forces on the shoulder during weightbearing maneuvers, 42 including basing and tumbling, which can cause glenohumeral sprains that may increase joint laxity and decrease stiffness, leading to instability. | Nonoperative treatment (rest, activity modification, and NSAIDs) and PT. Surgery may be warranted after recurrent dislocations or first-time dislocation in young, active patients at high risk for recurrence. 161 | 3 wk 12 b to 6 mo 91 c |
| Subacromial impingement | Can result from the forces on the shoulder during weightbearing maneuvers. 4,60,113 Abnormal distribution of stress can compress the rotator cuff tendons, leading to chronic impingement syndrome with subacromial bursitis. | PT (with or without subacromial steroid injections) and NSAIDs, or surgery if unresponsive. 70%-90% of cases resolve with nonoperative treatment. 18,43 If untreated, subacromial impingement can lead to partial or complete tear of the rotator cuff. 146 | 4 wk 36 b to 6 mo 168 c |
| Distal radius epiphysiolysis (“gymnast’s wrist”) | Can result from repetitive compression loading and shearing forces on an extended wrist, such as when basing or performing handsprings or walkovers. Presents with physeal stress reactions on radiographic evaluation. 32,86 | Nonoperative treatment (rest, activity modification, and NSAIDs), period of immobilization, and then PT. Consider monitoring for growth disturbance. | 6-8 wk 72 |
| Wrist sprain or strain | Skills (eg, basing and tumbling) often require transmission of loads exceeding body weight through the wrist while dorsiflexed. Often presents with chronic, insidious pain. 32,33 | Nonoperative treatment (rest, activity modification, and NSAIDs). | Regain full ROM d |
| Back | |||
| Lower back strain | Repetitive hyperextension, flexion overload, forced rotation, and unbalanced shear forces from tumbling, jump landings, and stunts. Often presents with chronic, insidious pain. 11,44 | Nonoperative treatment (rest, activity modification, and NSAIDs) with or without lumbar bracing. 84 | Regain full ROM d |
| Pars interarticularis stress reaction (spondylolysis or spondylolisthesis) | Repetitive hyperextension, flexion overload, forced rotation, and unbalanced shear forces from tumbling, jump landings, and stunts can result in lumbar vertebral injury progressing from stress reaction to spondylolisthesis with time and continued high-impact activity. Poor technique can further contribute. 75,108 | Nonoperative treatment (rest, activity modification, and NSAIDs) and PT with or without antilordotic bracing. Rarely requires surgical pars repair or spinal arthrodesis, 48,109 because 92% of injuries respond well to nonoperative therapy. | 4 wk 98 b to 12 mo 52 c |
| Lower Extremity | |||
| Femoroacetabular instability or impingement | Can result from repetitive training and compensatory soft tissue laxity, likely caused by strategic landings after jumps and tumbling skills. The extremes of ROM can lead to labral damage and cause intra-articular impingement (at posterior-superior acetabulum) or extra-articular impingement (between AIIS and distal femoral neck). 19,140,164 | Nonoperative treatment (rest, activity modification, and NSAIDs) and PT. Symptomatic patients can be treated with labral repair, resection of arthroscopic cam deformity if present, and periacetabular osteotomy for symptoms associated with hip dysplasia. | 6 wk 171 b to 8 mo 41 c |
| ACL or PCL injury | Extensive training increases anterior knee laxity, leading to diminished postural stability and increased risk of ligament damage. 120 ACL injury most often occurs with twisting, valgus, and hyperextension or when landing skills are “short” or off-balance. 8,61 PCL injury can result from force applied to the lower leg while the knee is at a 90° angle, such as impact while basing. 77 | Surgical ACL reconstruction is favored for young athletes hoping to return to sport after injury. 88 PCL tears often can be treated nonoperatively. 65,112,130 | |
| Patellar tendonitis or Osgood-Schlatter disease | Repetitive high-impact movements, particularly jumping, can cause inflammation about the patellar tendon and tibial tubercle. 37,59,160 | Nonoperative treatment (rest, activity modification, and NSAIDs) and PT with or without bracing. Rarely requires surgical excision of symptomatic, unfused ossicle after skeletal maturity. 165 | 8-12 wk 124 |
| Patellofemoral syndrome | Pressure up to 7 times the body weight can be transmitted through the knee with squatting and other high-impact positions involved in stunts, tumbling, and jumps. Presents with anterior knee pain. 10 | Nonoperative treatment (rest, activity modification, and NSAIDs) and PT with or without bracing. 116 Surgery for select, recalcitrant cases if alignment issues are present. | 6-8 wk 56,71 |
| Talar osteochondral lesions | In addition to resulting from recurrent ankle sprains, these lesions also occur from short landings from underrotation while tumbling, in which the athlete impacts the floor with the ankle in hyperdorsiflexion. Lesions result from repetitive driving of the talus into the distal tibia. 110,159 | Nonoperative treatment (rest, activity modification, and NSAIDs) with or without CAM boot or crutches. Surgery should be considered if lesion is unstable. 59,107 | 5 wk to 6 mo 79,142 c |
| Ankle sprain or strain | Can be sustained from landing in an inverted or plantarflexed position, decreasing ability to absorb ground reaction forces on impact. Lateral ankle ligaments are most commonly affected. 29,136 | Nonoperative treatment (rest, activity modification, and NSAIDs) and PT with or without bracing. Surgery is an option for recurrent instability. | Regain full ROM, strength, and function d |
a ACL, anterior cruciate ligament; AIIS, anterior inferior iliac spine; CAM, controlled ankle movement; NSAIDs, nonsteroidal anti-inflammatory drugs; PCL, posterior cruciate ligament; PT, physical therapy; ROM, range of motion.
b Least conservative estimation of return-to-sport time with nonoperative treatment.
c Most conservative estimation of return-to-sport time with operative treatment.
d Return-to-sport time varies depending on severity of injury and specific component injured. Radiographs should be obtained to rule out fractures.