Cheerleading and Chiropractic – A Natural Choice!
Dr. Jay Greenstein, DC, CCSP, CGFI-L1, CKTP

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The Facts on Injury Rates:

Cheerleading injuries are among the leading cause of injuries for adolescent females, and over the past 26 years, have accounted for the majority of catastrophic injuries to female athletes (1). Further, in a recent study published in the American Journal of Emergency Medicine, they found the most common injuries to be sprain/strains, (53% of all injuries). Of those sprain/strains, 42% occurred in the lower extremity, 28% being sprained ankles. Strains/Sprains occurred most frequently while attempting a stunt (34%) or while tumbling (32%).  In addition, low back pain was a very common injury and occurred most commonly (19%) when the cheerleader was spotting/basing other cheerleaders (2). The cost of these associated injuries is significant. Furthermore the toll it takes on the individual athlete and their family can be considerable. Time off from practice and/or competition due to musculoskeletal injuries can be devastating in a competitive environment.

Discovering Inherent Risk Factors:

Why do these injuries occur? While we can see that specific injuries are more likely to occur with specific cheerleading activities, there are also inherent characteristics of the individual cheerleader that may increase their risk. Mitigating these risk factors is one way of preventing future injuries. This can be done by performing comprehensive pre-participation screenings and examinations to identify articular (joint) dysfunction, muscular imbalances and poor muscular strength, endurance and activation which can lead to significant injury. Another important way to reduce risk is to provide the cheerleading athlete with a preventative conditioning program that tie to specific areas of the body (ankle, lower back) to reduce injury occurrence. For instance, a landmark study in 2007 found that balance training had a statistically and clinically significant reduction in the occurrence of ankle sprains in the high school football player(3). Balance training protocols can easily be implemented and performed by the competitive cheerleader in their conditioning regimen.

Injury Treatment – The Key to Preventing Future Injury:

So when a cheerleader gets injured, where does one turn for the best possible outcomes? How does a young athlete, parent, coach etc. not only figure out how to get the athlete "better" as fast as possible, but also how do they figure out how to prevent both re-injury and/or new injuries? One evidence-based alternative is the Doctor of Chiropractic. The modern-day profession of Chiropractic, through the advancement of both basic science and clinical research, has evolved into a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Doctors of chiropractic practice a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment. Doctors of chiropractic have broad diagnostic skills and are also trained to recommend and implement therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling. Many doctors of chiropractic are experts in all aspects of conservative musculoskeletal care for athletes of all ages. In fact, there are three different post graduate sports degrees in chiropractic today – the Certified Chiropractic Sports Physician (CCSP), the Diplomate of the American Chiropractic Board of Sports Physicians (DACBSP) and the Masters in Sports (MSc.) degree. Doctors of chiropractic are the most thoroughly trained healthcare providers in spinal adjustments/manipulation. Spinal adjustments/manipulation, especially in conjunction with exercises, has consistently been shown to be highly effective, and in some populations, the most effective treatment, for patients with low back pain.

Why does it work so well for low back pain? It's simple actually. Acute trauma and chronic repetitive stress cause inflammation. Inflammation leads to scar tissue (fibrosis) around those joints which limit motion. Further, muscles tighten to protect the region which limits motion more. Limited motion in joints and spasms in muscle cause pain.  In addition, the doctor of chiropractic they are highly trained and skilled in physiotherapy modalities (electrical stimulation, ultrasound, low-level laser therapy), rehabilitative exercises (balance training), manual joint and soft tissue techniques such as Active Release Technique® and Graston Technique®, as well as kinesiology taping. Doctors of Chiropractic have multiple "tools in the toolbox" to apply a natural, multi-modal, and holistic approach to treating, rehabilitating and preventing cheerleading injuries.

Table 1 below illustrates the approach that a doctor of chiropractic may take in the treatment, rehabilitation and performance enhancement program for the cheerleader athlete 

Athletes can take all the medications (chemicals) they want, but chemicals can't fix mechanical problems. In addition to the many side effects of pain relievers and non-steroidal anti-inflammatory medications which are widely know, these treatments do nothing to prevent future injuries. The sports injury literature is clear that the most common predictor of future injury is past injury because historically the treatment has been about controlling the symptoms. Doctors of chiropractic are focused not just on helping to relieve pain and inflammation for the injured athlete, but more importantly to restore function, fitness and health.

Rules for finding a highly skilled doctor of chiropractic:

1. Seek doctors of chiropractic out that have experience with the cheerleading/athletic population and/or have a post graduate degree in sports chiropractic.
2. Seek out doctors of chiropractic that are evidence-based and use a multi-modal approach to patient management.
3. Ask for recommendations from others in the cheerleading world that have utilized chiropractic services and have had excellent long term outcomes.
4. Ask for recommendations from your pediatrician, primary care physician or orthopedist that has a good working relationship with a doctor of chiropractic.

It's important for any athlete, parent or coach to understand that typically a TEAM approach is what will benefit the athlete most. It's the medical doctor, doctor of chiropractic and the coach all coordinating efforts to get the best outcome.

1. NCCIR Annual Report (www.unc.edu/depts/nccsi)
2. Am J Emerg Med. 2010 Aug 12. Epidemiology of strain/sprain injuries among cheerleaders in the United States. Shields BJ, Smith GA.
3. Am J Sports Med. 2007 Aug;35(8):1289-94. Epub 2007 Mar 29. The effectiveness of a balance training intervention in reducing the incidence of noncontact ankle sprains in high school football players. McHugh MP, Tyler TF, Mirabella MR, Mullaney MJ, Nicholas SJ.