Jamie Woode raises her hands to show the crowd she’s okay.

When Orlando Magic cheerleader Jamie Woode fell on her head last November in front of a packed crowd at Amway Center, the accident caused shockwaves throughout not only the audience, but the cheer world at large. In light of Woode’s injuries (which included three fractured vertebrae and a broken rib), the University of Florida decided to ground-bound its own collegiate cheer squad—a decision that has since only been partially reversed to allow very basic stunting.

They’re not the only ones making headlines. In February, ABC News reported that the University of Georgia’s cheer squad had incurred a higher percentage of head injuries than its football team—with eight of 52 cheerleaders getting concussions, as opposed to nine of 152 football players.

The incidents coincided with a highly publicized American Academy of Pediatrics (AAP) report that urged classifying cheerleading as a sport. Its argument was that doing so would help provide better resources comparable to other sports, such as more qualified coaches, better facilities, access to athletic trainers and improved injury prevention methods.

AAP’s report also provided some eye-opening statistics culled from multiple studies. Among the findings: cheerleading has accounted for about 66 percent of all catastrophic injuries in female high school athletes over the last 25 years, and cheer injuries have steadily increased in both severity and number. College squads had the highest injury rate, followed by elementary school, high school, all-star, middle school and rec cheerleaders, respectively. Across the board, the most likely causes of injury were basing and spotting (23 percent), tumbling (14 to 26 percent) and falls from heights (14 to 25 percent).

Concussions accounted for between four and six percent of all cheer injuries—a number that, though lower than other sports, had increased by 26 percent every year from 1998 to 2008. The vast majority (96 percent) of those concussions happened during stunting, and pyramids were responsible for the majority of head and neck injuries.

Though the AAP study focused primarily on school-based cheerleading, experts say the issues are the same: safety must come first. “In order for cheerleading to continue in a form we all know it to be, I think safety has to be taken very seriously,” says The Spirit Consultants’ Dave Kirschner, citing the rising number of concussions and emergency room visits as chief concerns. “Coaches have to have a very close look at what they’re doing to keep their kids safe.”

Taking Action

Cheerleading isn’t the only activity experiencing a rash of concussions.  “All of the sports we deal with [as athletic trainers] have seen an increase in head injury rates—it’s been our most pressing issue,” says Karen Lew, a University of Miami athletic trainer who often works at Varsity-branded events. “Our goal is to try and reverse these trends.”

Lew and her colleagues set out to do just that by creating a protocol that could help coaches and gym owners determine when an athlete was ready to resume competing. “There was no previous [formal] reintegration process for cheerleaders,” shares Lew. “Rather than recreating research that has already been done, we wanted to develop a guideline for medical management of concussion as it applies to cheerleading.”

The result? Step-by-step guidelines to help coaches implement various levels of rehabilitation—based on five stages of incremental activity. (The minimum criteria they set for returning an athlete to the mat was being symptom-free for at least 24 hours and having physician clearance.) “Coaches need to understand the inherent risk they face by not following the appropriate progression,” says Lew.

Jessica Funke, an athletic trainer with Adventist Health System, agrees. She says that when athletes are injured, there is often a natural inclination to return them to competition right away—but that may be a dangerous proposition. When consulting for gyms like Wauconda, IL-based Ultimate Athletics, Funke uses a baseline assessment test called ImPACT. The purpose of the computer-based test is to assess athletes after they suffer concussions, and Funke says it is used by doctors and psychologists around the country. “It’s a really great objective test for concussions, one of the best that I’ve seen on the market,” Funke says.

Funke uses the test as a preventive measure, typically testing athletes before they even face an injury. The screening takes about 20 minutes, during which it tests both verbal and visual memory; athletes are also tested on their reaction time after an injury, compared to their normal reaction time. “The baseline test is performed when they have no symptoms and no concussion, so that when they do have a concussion, we know what their ‘normal’ is,” Funke says. “It basically lets us know what their brain function is like before they become injured.”

If an athlete suffers a concussion, Funke tests him or her again using ImPACT. She also uses her own set of tests such as checking the reflexes, vision, cranial nerve and cognitive functioning. She then makes injured athletes perform jumping jacks, sit-ups and push-ups to test their physical exertion, all in an effort to keep them safe.

“When the parents or athletes get upset because I’m not letting them practice, I remind them that ‘Cheerleading is wonderful, and I want you to be able to do it for a very long time, but if you don’t listen to me now, this might be it,’” Funke says.

Along with advanced assessment and testing, new equipment is being introduced to help prevent concussions. Case in point: Cheercussion, a rubber foam safety headpiece currently in development that aims to prevent concussions and is designed for use mainly during practices. However, Lew says she believes that the main emphasis should be on proactive prevention. “I would rather train the industry’s focus on having higher quality coaching and development of action plans,” says Lew. “Injury prevention is the key to any sport, so we have to be smart about it.”

–Karen Jordan