The evolution of cheering

Some health professionals are pushing to sanction cheerleading as a sport

Read the recommendation:
To learn more about the American Academy of Pediatrics’ guidelines for cheerleading, go to and enter “cheerleading injuries” in the search box.

Over the 30 years she’s been a physical therapist, Mary Kay Genzlinger has seen significant changes in cheerleading. Teens don’t just shake pom-poms and exhort the home crowd to chant “L-E-T-S G-O, let’s go, let’s go!”—they also perform acrobatic stunts that rival routines in competitive gymnastics.

“It’s even more competitive and high profile than it was 10 years ago,” Genzlinger observed during a recent phone interview. “They’re doing gymnastic maneuvers.”

Yet there is a key distinction between gymnastics and cheerleading.

Gymnastics is a sport, and gymnasts are treated as athletes. But, neither the National Collegiate Athletic Association (NCAA), collegiate athletics’ governing body, nor the California Interscholastic Federation (CIF), the state’s high-school athletics governing body, considers cheerleading a sport.

Twenty-nine states do sanction cheerleading as a high-school sport, providing set standards for medical and competitive oversight. If the American Academy of Pediatrics (AAP) has its way, so will the remainder.

On Oct. 22, the AAP issued guidelines for preventing injuries in cheerleading. Atop the list of recommendations: sanctioning cheerleading as a sport. The AAP considers this important, its report says, “because being classified as a sport gives athletes valuable protection including qualified coaches, well-maintained practice facilities, access to certified athletic trainers, mandated sports physicals and surveillance of injuries.”

Genzlinger, who treats athletes (including cheerleaders) at the Feather River Hospital Rehabilitation clinic, wholeheartedly agrees. So does Dr. Baran Onder, a sports medicine specialist at the Argyll Medical Group in Chico. Both see the recommendation as a natural offshoot of cheerleading’s evolution.

“Cheerleaders are definitely athletes,” Onder wrote in an email. “They practice regularly, have competitions, and have tryouts for the team. I really don’t think there is much room for debate on this question.”

Said Genzlinger: “They can have some horrible injuries, much like athletes do, so they should be treated like athletes.”

Whether the AAP makes headway remains to be seen. Kelly Staley, superintendent of the Chico Unified School District, wrote in an email that California schools work under the guidelines of the CIF, and “they do not recognize cheerleading as a sport. This may change in the future, but it has not yet hit California.” The CN&R contacted the CIF’s state office and Northern Section office, but did not receive a response by publication deadline.

Mary Kay Genzlinger says cheerleaders are athletes.

Photo By Kyle Emery

In the meantime, regardless of sanctioning, cheerleaders at North State schools will continue to perform—and some will get injured.

“Relatively speaking, the injury rate is low compared to other sports, but despite the overall lower rate, the number of catastrophic injuries continues to climb,” Dr. Cynthia LaBella of the AAP wrote in the report. “That is an area of concern and needs attention for improving safety.”

Genzlinger has overseen the rehabilitation of cheerleaders with an assortment of ailments—head, neck, spinal, joint. Onder said the spectrum includes “the same sort of injuries you would see in many other forms of land-based athletic activities, ranging from minor sprains, strains and overuse injuries, to more severe such as fractures, ACL [knee ligament] injuries, and concussions.

“They are also variable depending on the individual. With ‘flyers’ you are more concerned with more high-impact devastating injuries if they get dropped. Tumblers have a higher incidence of shoulder, hand and wrist injuries, and lower-extremity injuries as well, depending on how good their landing technique is. Male cheerleaders who throw may have a higher incidence of overuse shoulder injuries.”

As a result, it’s not uncommon to see cheerleaders on crutches or with an arm in a sling. Some injuries require months of healing and rehabilitation.

“It’s pretty devastating for the cheerleader, the team, the coach—everybody who’s involved,” Genzlinger said.

The AAP recommends more than sanctioning. Its guidelines, released in a policy statement titled “Cheerleading Injuries: Epidemiology and Recommendations for Prevention,” also include:

preseason physical examinations;

access to strength and conditioning coaches;

training in techniques for “spotting”;

performing stunts only on spring/foam floors or turf (never on hard, wet or uneven surfaces);

limiting pyramids to two athletes high;

removing athletes suspected of head injuries from practice or competition, and not letting him/her return until cleared by a medical professional.

Onder offered some additional recommendations.

“Seeking medical attention promptly for injuries or other medical issues—whether it be from the athletic trainer or team physician—so that the issue can be evaluated in a timely manner is also a good idea,” he said. “For the coaches, there should be a strong emphasis on core and hip-stabilizer strengthening exercises during the preseason and offseason for a conditioning regime.

“There has recently been a lot of research done that provides evidence that neuromuscular training programs—focusing on balance, landing mechanics, plyometrics, and strengthening specific muscle groups—help prevent devastating knee injuries such as ACL tears in this population of athletes, which is a concern since female athletes are six times more likely to tear their ACL during sports participation than their male counterparts.”

Like Onder, Genzlinger stresses the importance of preparing cheerleaders for the physical demands of their specific activities.

“If they’re doing lifts, they need to have good upper-extremity and scapular [shoulder] strength,” she said. “They need to have good core control if they’re doing pyramids or jumps. They need to practice on different surfaces—there’s a difference between performing on a basketball court as opposed to a football field.

“Just be more informed—I think that’s true of a lot of athletic trainers and coaches. They need to be more aware of the type of injuries that can happen and assess them as soon as you can. You have to have a sharp eye for that, because a lot of these kids don’t let you know when they’re hurting, so you have to see what their movement patterns are.”

Sanctioning cheerleading as a sport won’t prevent all injuries, but health-care professionals see it as a step in the right direction.

“From a medical standpoint, I really don’t see any obstacles in treating cheerleaders like one would any other athlete,” Onder said. “[But] from a school/organizational standpoint, the issue is always going to be one of funding and support for the program.

“Since the passage of Title IX there has been an explosion in female athletic participation in sports across the board, and more athletes require more funding. Ideally there would be sufficient funds to support every sport equally, but this typically is not the case, so there will always be controversy as to which programs should be cut at the expense of others.”