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Injury Occurrence in
Cheerleading (NCSF)
Cheerleading Injury
Prevention and Treatment
Bryce Compton, MS, LAT, ATC
Certified Athletic Trainer
High School Cheerleading Accounted for
65.1% of All Catastrophic Sports Injuries
Among High School Female Athletes Over the
Past 25 Years.
Between 1982 and 2007, There Have Been 103
Fatal, Disabling, or Serious Injuries in High
School Sports.
– 67 Occurred in Cheerleading (Most of All Sports).
Injury Occurrence in
Cheerleading (NCSF)
Among College Athletes, There Have Been 39
Severe Injuries.
– 26 Occurred in Cheerleading (Most of All Sports).
Children Ages 5-18 Admitted to Hospitals for
Cheerleading Injuries Jumped from 10,900 in
1990, to 22,900 in 2002.
Cheerleading Injuries
Traumatic
Overuse
Injury Occurrence in
Cheerleading (NCSF)
Sprains/Strains - 52.4%.
Soft Tissue Injuries - 18.4%.
Fractures/Dislocations - 16.4%.
Lacerations/Avulsions - 3.8%.
Concussion/Closed Head Injuries - 3.5%.
Other – 5.5%.
Traumatic Injuries
Sudden Onset of
Injury.
Mechanism of Injury
is Usually Known.
Usually a Clear
Indication of an
Inflammatory
Process.
1
Inflammatory Signs
Redness.
Heat.
Pain.
Swelling.
Loss of Function.
Grade 1 Concussions
Symptoms:
– Transient Confusion.
– No Loss of
Consciousness.
– No Headaches.
– No Neurological
Symptoms.
– Symptoms Resolve
in Less Than 15
Minutes.
Grade 2 Concussions
Symptoms:
– Transient Confusion.
– No Loss of
Consciousness.
– Mild Headache.
– Amnesia.
– LightLight-Headed.
– Unable to Concentrate or
Focus.
– Symptoms do Not
Resolve in Less Than 15
Minutes.
Common Traumatic
Injuries in Cheerleading
Head Injuries.
Hand and Wrist Injuries.
Low Back Injuries.
Leg Injuries.
Knee Injuries.
Ankle and Foot Injuries.
Grade 1 Concussions
Management:
– Remove from
Contest.
– Examine
Immediately and at
5-Minute Intervals.
– May Return if PostPostConcussive
Symptoms Resolve
Within 15 Minutes.
Grade 2 Concussions
Management:
– Remove From
Contest and Disallow
Return for That Day.
– Examine Frequently
for Signs of IntraIntraCranial Pathology.
– Physician
Management.
2
Grade 3 Concussions
Symptoms:
– Any Loss of
Consciousness.
Brief (Seconds).
Prolonged (Minutes).
– Severe Neurological
Symptoms.
– Beware of Second
Impact Syndrome.
Head Injury Take
Home Instructions
Head Injury Take Home Instructions
Head injuries are among the most feared of all sporting injuries. The vast majority of
head injuries are minor; however, the potential for serious injury is always present. The
following recommendations can help prevent a seemingly minor injury from becoming a
life threatening injury.
If any of the following symptoms are present 24-48 hours after a head injury, the athlete
should be taken immediately to your family physician or to an emergency room:
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Severe headaches (deep throbbing)
Dizziness or loss of coordination
Temporary loss of memory/mental confusion/disorientation
Ringing of the ears (tinnitus)
Blurred or double vision (diplopia)
Unequal pupil size
No pupil reaction to light
Nausea and/or vomiting
Slurred speech
Convulsions or tremors
Excessive sleepiness or grogginess
Clear fluid from the nose and/or ears
Decreased pulse rate
Gradual increase in blood pressure
Numbness or paralysis (partial or complete)
Difficulty being aroused
Management Instructions:
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Check breathing rate, heart rate, skin color and other symptoms every two
hours
Awaken the athlete every two hours to check their condition
Allow the athlete to consume only clear liquids for eight hours
Do not allow the athlete to take any medications in the initial 24 hours
following the injury unless directed by a physician. Certain medications
may thin the blood that could increase the severity of the injury. They may
also mask the symptoms of a serious head injury
If there is a question at any time concerning the well-being of the athlete,
seek medical attention immediately
Observe for 2424-48
Hours.
Symptoms to Be
Observed.
Management:
– Head Injury Take
Home Instructions.
Hand and Wrist Injuries
Mechanism:
Contact.
– Getting Hit Directly on
the Hand and Wrist.
– Catching Someone With
the Hand and Wrist in an
Awkward Position.
– Falling and Landing with
the Hand and Wrist in a
Awkward Position.
– Improper Form During a
Cartwheels, Handstands,
or Flips.
Grade 3 Concussions
Management:
– Transport to the
Nearest Emergency
by Ambulance if
Unconscious or if
Worrisome Signs are
Detected.
– Use Backboard and
Send to Emergency
Room.
Hand and Wrist Injuries
Types:
– Sprains.
– Fractures.
– Dislocations.
– Tendon Injuries.
– Dorsal Wrist
Impingement.
Hand and Wrist Injuries
Signs and Symptoms:
– Mild to Sharp Pain.
– Mild to Moderate
Swelling.
– Discoloration and
Bruising.
– Inability to Move the
Hand, Wrist, and/or
Fingers Properly,
Depending on Severity.
– Point Tender Over the
Injured Area.
3
Hand and Wrist Injuries
Hand and Wrist Injuries
Treatment:
NonNon-Surgical.
–
–
–
–
–
Brace or Cast.
Rest.
Control Inflammation.
Modalities.
Rehabilitation.
Surgical.
– Depending on Severity.
– Depending on Bone
Displacement with
Fractures.
Dorsal Wrist Impingement
Dorsal Wrist Impingement
One of the Most Common Injuries to a
Cheerleader’
Cheerleader’s Wrist.
Occurs When the Dorsal (Back) Edge of the
Radius Impinges on (Strikes) the Wrist Bones.
Dorsal Wrist Impingement
Mechanism:
– Repetitive Combination
of Hyperextension and
Axial Loading on the
Wrist.
– Walkovers.
– Handsprings.
– Cartwheels.
– Flips.
– Handstands.
Dorsal Wrist Impingement
Signs and Symptoms:
– Pain and Tenderness on
the Dorsal (Back) Aspect
of the Wrist.
– Pain Usually Subsides by
the End of the Routine.
4
Dorsal Wrist Impingement
Treatment:
NonNon-Surgical:
–
–
–
–
–
–
Rest.
Splint or Brace.
Control Inflammation.
Manual Therapy.
Modalities.
Rehabilitation.
Surgical:
– If Conservative
Treatment is Not
Successful.
Lumbar Strain
Mechanism:
Lumbar Strain
Muscles in the Lower Back
Gradually Tighten Over
Time Due to Overuse and
Improper Posture.
A Sudden Movement or
Twist May Cause the
Muscle Fibers to be
Stretched or Torn.
Causes Muscles to Go Into a
Spasm, and Lack of Oxygen
Causes Weakness.
Lumbar Strain
Predisposing Factors:
– A Sudden Movement or
Twisting May Cause a
Strain.
– Repetitive Flips and
Cartwheels With Added
Stress on the Spine.
– Improper Technique
When Lifting or
Throwing a Heavy
Object Into the Air.
Lumbar Strain
Classification:
– Grade I.
– Grade II.
– Grade III.
–
–
–
–
–
Muscle Tightness.
Muscle Imbalance.
Poor Conditioning.
Muscle Fatigue.
Improper WarmWarm-Up
Prior to Participation.
Lumbar Strain
Grade I:
– Stretching or Minor
Tearing Within the
Muscle.
– Mild Discomfort.
– Tightness in the Back.
– May be Able to Walk
Properly.
– Probably Won’
Won’t Have
Much Swelling.
5
Lumbar Strain
Grade II:
Grade III:
– Muscle is Partially Torn
But Still in Tact.
– Probably Cannot Walk
Properly.
– May Get Occasional
Sudden Twinges of Pain
During Activity.
– May Notice Swelling.
– Pressing the Area Causes
Pain.
– Can Limit Activity.
Lumbar Strain
Treatment:
NonNon-Surgical:
–
–
–
–
–
–
Lumbar Strain
–
–
–
–
Muscle is Completely Torn.
Unable to Walk Properly.
Severe Pain.
Severe Swelling and
Discoloration Immediately.
– Static Contraction will be
Painful and Might Produce
a Bulge in the Muscle.
– Expect to be Out of
Competition for 3 to 12
Weeks.
Lumbar Strain
Prevention:
Rest.
Back Brace.
Control Inflammation.
Manual Therapy.
Modalities.
Rehabilitation.
Surgical:
– Proper WarmWarm-Up.
– Proper Stretching
Techniques.
– Proper Strength Building
Techniques.
– Proper Condition Both
Before and During the
Season.
– Surgeon May Decide to
Operate with Grade III
Strain.
Leg Injuries
Hamstring Strains.
Quadriceps Strains.
Calf Strains.
Hamstring, Quadriceps,
and Calf Strain
Mechanism:
– Pushing Off or Slowing
Down While Running.
– Landing Incorrectly.
6
Hamstring, Quadriceps,
and Calf Strain
Predisposing Factors:
– Doing Too Much, Too Soon and Pushing Beyond
Your Limits.
– Poor Flexibility.
– Poor Muscle Strength.
– Muscle Imbalance.
– Muscle Fatigue that Leads to Exertion.
– Improper WarmWarm-Up.
– Leg Length Discrepancy.
Hamstring, Quadriceps,
and Calf Strain
Grade I:
– Stretching or Minor
Tearing Within the
Muscle.
– Stiffness, Soreness, and
Tightness in the Muscle.
– Little Noticeable
Swelling.
– Normal Walking Gait
and Range of Motion
with Some Discomfort.
Hamstring, Quadriceps,
and Calf Strain
Grade III:
– Muscle is Completely
Torn.
– May Hear an Audible
“Pop”
Pop” or “Snap”
Snap”.
– Pain During Rest Which
Becomes Severe With
Rest.
– Difficulty Walking
Without Assistance.
– Noticeable Swelling and
Bruising.
Hamstring, Quadriceps,
and Calf Strain
Classification:
– Grade I.
– Grade II.
– Grade III.
Hamstring, Quadriceps,
and Calf Strain
Grade II:
– Muscle is Partially Torn
But Still in Tact.
– Limp May be Present.
– Muscle Pain, Sharp
Twinges, and Tightness
in the Muscle.
– Noticeable Swelling and
Bruising.
– Painful to the Touch.
– Limited Range of
Motion and Pain When
Contracting Muscle.
Hamstring, Quadriceps,
and Calf Strain
Treatment:
NonNon-Surgical:
– Rest.
– Back Brace.
– Control Inflammation.
– Manual Therapy.
– Modalities.
– Rehabilitation.
Surgical:
– Surgeon May Decide to
Operate with Grade III
Strain.
7
Hamstring, Quadriceps,
and Calf Strain
Knee Injuries
Represents Approximately 60% of
Cheerleading Disorders.
Peak Vertical Ground Reaction Forces of
8-14 Times the Athlete’
Athlete’s Body Weight
Occurs in High Skill Tumbling Activities.
Knee Injuries
Ligament Injuries.
– Anterior Cruciate.
– Tibial (Medial)
Collateral.
Meniscal Injuries.
Patellar Dislocation.
Patellar Subluxation.
Anterior Cruciate
Ligament Injury
Mechanism:
Contact.
– Getting Hit in the Back
of the Knee While on
Full Body Weight.
NonNon-Contact.
– More Common.
– Usually Caused by a
Deceleration, Improper
Landing, or Pivoting
Motion.
Anterior Cruciate Ligament
Anatomy:
– Connection Between
Anterior Tibia and
Posterior Femur.
Function:
– Prevents Rotational
Movements About the
Knee.
– Prevents Anterior
Translation of the Tibia
on the Femur.
Anterior Cruciate
Ligament Injury
Signs and Symptoms:
– “Pop”
Pop” or “Snap”
Snap”.
– Immediate Swelling and
Pain.
– Unable to Continue
Participation.
– Requires Evaluation by a
Physician.
– Possible Surgery.
– Treatment.
8
Anterior Cruciate
Ligament Injury
Clinical Evaluation.
Anterior Cruciate
Ligament Injury
MRI Evaluation.
– Manual Muscle
Testing.
– Range of Motion
Testing.
– Special Tests.
– Functional Testing.
ACL Injuries in Females
Incidence:
– Rate of NonNon-Contact ACL Injuries
in Females Athletes is 2 to 1
Compared to Male Athletes.
Anterior Cruciate
Ligament Injury
Treatment:
NonNon-Surgical.
– Rest.
– Control Inflammation.
– Rehabilitation.
Surgical.
– ACL Reconstruction.
ACL Injuries in Females
Prevention:
Intrinsic Factors:
– Alignment.
Increased QQ-Angle.
– Joint Laxity.
– Hormonal Effects.
Extrinsic Factors:
– Muscle Strength.
Strengthen Hamstrings.
– Conditioning.
– Technique.
Anterior Cruciate
Ligament Injury
PostPost-Surgical
Rehabilitation.
– Strengthen Knee
Stabilizing Muscles.
– Correct Muscular
Imbalances.
– Functional Activity.
Bracing.
Return to Activity.
– 4-6 Months PostPost-Surgery.
9
Medial Collateral Ligament
Anatomy:
Medial Collateral
Ligament Injury
Mechanism:
– Made Up of 2 Bands.
– Deep Band – Connected
to the Medial Meniscus.
– Superficial Band.
– Getting Hit on the
Lateral (Outside) Aspect
of the Knee With the
Knee Slightly Bent.
– Landing Incorrectly With
the Knee Buckling
Inward.
– Deep Band is More
Prone to Injury First,
Which May Lead to
Medial Meniscal
Damage Also.
Function:
– Prevents Medial
Translation of the Knee.
– Prevents the Medial
(Inner) Aspect of the
Knee Joint from
Widening from Stress.
Medial Collateral
Ligament Injury
Classification:
– Grade I Sprain.
– Grade II Sprain.
– Grade III Sprain.
Medial Collateral
Ligament Injury
Grade II Sprain:
– Greater Than 10% of the
Ligament Fibers are
Torn.
– Significant Tenderness
on the Inside of the Knee
on the Medial Ligament.
– Some Swelling Seen
Over the Ligament.
– When the Knee is
Stressed as for Grade 1
Symptoms, There is Pain
and Moderate Laxity in
the Joint, Although
There is a Definite End
Point.
Medial Collateral
Ligament Injury
Grade I Sprain:
– Stretching of the
Ligament Fibers with Less
Than 10% Being Torn.
– Mild Tenderness on the
Inside of the Knee Over
the Ligament.
– Usually No Swelling.
– When the Knee is Bent to
30 Degrees and Force is
Applied to the Outside of
the Knee, Pain is Felt But
There is No Joint Laxity.
Medial Collateral
Ligament Injury
Grade III Sprain:
– This is a Complete Tear
of the Ligament.
– Pain can Vary and is
Sometimes Not as Bad
as That of a Grade 2
Sprain.
– When Stressing the Knee
There is Significant Joint
Laxity.
– The Athlete May
Complain of Having a
Very Wobbly or
Unstable Knee.
10
Medial Collateral
Ligament Injury
Clinical Evaluation.
Medial Collateral
Ligament Injury
Possible Referral for an MRI Evaluation.
– Manual Muscle
Testing.
– Range of Motion
Testing.
– Special Tests.
– Functional Testing.
Medial Collateral
Ligament Injury
Treatment:
NonNon-Surgical.
–
–
–
–
–
–
Medial Collateral
Ligament Injury
Return to Activity:
– Grade I: 1 - 2 Weeks.
– Grade II: 2 - 4 Weeks.
– Grade III: 4 - 6 Weeks.
Rest.
Control Inflammation.
Manual Therapy.
Modalities.
Brace.
Rehabilitation.
Surgical.
– Very Rare.
– Only for Severe
Instability.
Medial and Lateral Menisci
Anatomy:
– Small “C” Shaped Piece
of Cartilage Between the
Femur and Tibia.
– One on the Medial
Aspect and One on the
Lateral Aspect of the
Knee.
Function:
Medial and Lateral
Meniscal Injuries
Mechanism:
– Pieces of Cartilage Tear
and are Injured Usually
if an Athlete Quickly
Twists and Rotates the
Upper Leg While the
Foot is Firmly Planted.
– Gradual Degeneration.
– Primarily Acts as a
Cushion Between the
Two Bones.
11
Medial and Lateral
Meniscal Injuries
Medial and Lateral
Meniscal Injuries
Signs and Symptoms:
Classification:
Radial Tear.
– Usually an Audible
“Pop”
Pop” or “Snap”
Snap”.
– Mild to Severe Pain
Depending on the Extent
of the Tear.
– Swelling is Common,
But May Also Develop
After Several Hours.
– Knee May Lock or Feel
Weak.
– Unable to Continue
Participation.
– Requires Evaluation by a
Physician.
– Inside and Lateral Tear.
Flap Tear.
– Piece of the Torn
Cartilage Flips Upward.
Peripheral Tear.
– Around the Outer Edge.
Longitudinal Tear.
– Middle and Longitudinal
Tear.
Medial and Lateral
Meniscal Injuries
Clinical Evaluation.
Medial and Lateral
Meniscal Injuries
Possible Referral for an MRI Evaluation to See
the Extent of the Tear.
– Manual Muscle
Testing.
– Range of Motion
Testing.
– Special Tests.
– Functional Testing.
Medial and Lateral
Meniscal Injuries
Treatment:
NonNon-Surgical.
– For Very Minor Tears
with Little to No
Symptoms Present.
– Rest.
– Control Inflammation.
– Manual Therapy.
– Modalities.
– Brace.
– Rehabilitation.
Medial and Lateral
Meniscal Injuries
Surgical.
Partial Meniscectomy.
– Much More Common.
Repaired with Sutures.
– Occur Less Than 10% of
the Time.
12
Patellar Dislocation
Patella is a Protective
Bone That Lies in Front
of the Knee Joint.
The Patella is Attached
to the Quadriceps
Tendon and Acts to
Increase the Leverage
From This Muscle
Group When
Straightening the Knee.
Patellar Dislocation
Mechanism:
– Getting Hit on the
Lateral (Outside) Aspect
of the Knee.
– A Sudden Twisting
Action of the Knee.
Patellar Dislocation
Signs and Symptoms:
– Swelling in the Knee
Joint.
– Pain Around the Patella.
– Impaired Mobility in the
Knee.
– Obvious Displacement
of the Knee Joint.
Patellar Dislocation
The Patella Normally
Lies Within the
Patellofemoral Groove,
and is Designed to Only
Move Vertically Within
This Groove.
A Dislocation is When
the Patella Moves or is
Moved Outside of This
Groove Onto the Lateral
Femoral Condyle.
Patellar Dislocation
Predisposing Factors:
– Insufficient Vastus
Medialis Obliquus
Strength.
– Muscle Imbalance
Between the Medial and
Lateral Quadriceps
Muscles and IT Band.
– Excessive Foot
Pronation.
– Increased QQ-Angle.
Found in Women.
Patellar Dislocation
Possible Referral for
an MRI Evaluation
to See the Extent of
the Injury..
13
Patellar Dislocation
Patellar Dislocation
Treatment:
NonNon-Surgical.
–
–
–
–
–
–
Rest.
Brace or Knee Taping.
Control Inflammation.
Manual Therapy.
Modalities.
Rehabilitation.
VMO Strengthening.
Surgical.
– Loose Fragments of
Bone or Other Major
Structural Damage.
Patellar Subluxation
A Temporary, Partial
Dislocation of the
Patella From its Normal
Position Inside the
Patellofemoral Groove.
Occurs With Poor
Tracking of the Patella
Inside the
Patellofemoral Groove.
Patellar Subluxation
Predisposing Factors:
– Muscle Imbalance
Between the Medial
(VMO) and Lateral
Quadriceps Muscles and
IT Band.
– Patella Atla.
– Excessive Foot
Pronation.
– Increased QQ-Angle.
Found in Women.
Patellar Subluxation
Mechanism:
– Usually Occurs During
Forced Knee Extension ,
With the Patella Moving
Out of the Groove to the
Lateral Aspect of the
Knee.
Patellar Subluxation
Signs and Symptoms:
– Feel the Patella Moving
Out of Position.
– May Have Pain and
Swelling Behind the
Patella.
– May Have Pain or
Discomfort When
Bending and
Straightening the Knee.
14
Patellar Subluxation
Patellar Subluxation
Treatment:
NonNon-Surgical.
–
–
–
–
–
–
Rest.
Brace or Knee Taping.
Control Inflammation.
Manual Therapy.
Modalities.
Rehabilitation.
VMO Strengthening.
Surgical.
– If Conservative Treatment Does Not Fix Subluxation.
Ankle and Foot Injuries
Types:
– Sprains.
– Fractures.
Ankle Sprains
Most Common is an
Inversion or Inward
Stress.
Least Common is an
Eversion or Outward
Stress.
Can be Traumatic or a
Chronic, Reoccurring
Injury.
Ankle Sprains
Signs and Symptoms:
– Mild Aching to Sudden
Pain.
– Swelling.
– Discoloration.
– Inability to Move the
Ankle Properly.
– Pain in the Ankle Even
When You are Not
Putting Weight on It.
Ankle Sprains
Treatment:
NonNon-Surgical.
–
–
–
–
–
Rest.
Control Inflammation.
Manual Therapy.
Modalities.
Rehabilitation.
Surgical.
– In Recurrent Situations.
15
Ankle Sprains
Ankle and Foot Fractures
Mechanism:
Contact.
– Getting Stepped on the
Ankle or Foot.
– Jumping or Landing
Improperly.
– Sudden Twisting or
Pivoting Where the
Ankle Gives Out.
Ankle and Foot Fractures
Signs and Symptoms:
– Mild to Sharp Pain.
– Mild to Moderate
Swelling.
– Discoloration and
Bruising.
– Inability to Move the
Ankle, Foot, and/or Toes
Properly, Depending on
Severity.
– Point Tender Over the
Injured Area.
Ankle and Foot Fractures
Ankle and Foot Fractures
Treatment:
NonNon-Surgical.
– Brace or Cast.
– 4-6 Weeks of
Immobilization.
– Control Inflammation.
– Modalities.
– Rehabilitation.
Surgical.
– Depending on Severity.
– Depending on Bone
Displacement with
Fractures.
When to Seek Medical Attention
for a Traumatic Injury
Swelling About a
Joint.
Inability to Move a
Joint.
Decreased Joint
Motion.
ACL
16
When to Seek Medical Attention
for a Traumatic Injury
Obvious Deformity.
Inability to Walk or
Bear Weight on a
Joint.
Return to Competition
Following a Traumatic Injury
Pain Free.
Normal Range of
Motion.
Normal Strength.
Able to Run.
Able to Jump and Pivot.
Able to Perform Sport
Specific Activities.
Causes of Overuse
Injuries in Cheerleading
Strength Imbalances.
– Strength Deficits.
Flexibility Deficits.
Training Errors.
Treatment of Traumatic Injuries
Treat the
Inflammatory
Process:
– Rest.
– Ice.
– Compression.
– Elevation.
Seek Medical Help if
Necessary.
Characteristics of
Overuse Injuries
Gradual Insidious
Onset.
No History of Trauma.
Typically No Indication
of a Major
Inflammatory Process.
Usually the Result of
Repetitive Activity.
Progression of
Overuse Symptoms
Pain After Sporting Activities.
Pain with Sporting Activities but with No
Decrease in Performance.
Pain During Sporting Activities with
Decreased Performance.
Unable to Perform Sporting Activities.
Pain During Everyday Activities.
17
Common Overuse Injuries
Distal Radial Stress Fracture
Distal Radial Stress
Fracture.
Low Back Injuries.
Patellar Tendinitis
(“Jumper’
Jumper’s Knee”
Knee”).
Patellofemoral Pain
Syndrome.
Plica Syndrome.
Stress Fractures.
Achilles Tendinitis.
Caused by Repetitive
High Impact Forces that
Cause Compression on
the Wrist.
– Repetitive Microtrauma
Due to Axial Loading
and Extension of the
Wrist.
– Double Backward
Somersault.
This Can Lead to Small
Fractures in the Radius.
Distal Radial Stress Fracture
X-Ray Plays an Important Role in the Diagnosis of
This Injury.
This Injury Can Affect the Growth Plate in the Wrist.
This Can Cause the Radius and Ulna to Grow to
Different Lengths.
Therefore it is Important to Have the Injury Evaluated
When the Pain is First Felt.
Postponing a Visit to the Physician Can Lead to
Serious Complications.
Distal Radial Stress Fracture
Treatment:
NonNon-Surgical:
–
–
–
–
Distal Radial Stress Fracture
Signs and Symptoms:
– Pain and Tenderness are
Often Felt Around the
Entire Circumference of
the Radius Just Above
the Wrist.
– Pain is Experienced at
the Onset of
Participation and
Progresses as Activity
Continues.
Low Back Injuries
Spondylolysis.
Spondylolisthesis.
REST!!!
Brace or Splint.
Control Inflammation.
Rehabilitation.
Surgical:
– Not Necessary, However
Severity and Failure to
Seek Immediate Help
May Lead to Surgery.
18
Spondylolysis
The Most Common Cause
of Low Back Pain in
Adolescents.
Condition Where There is a
Stress Fracture in One or
Both Sides of the Lamina
(Pars Interarticularis) in a
Lumbar Vertebra.
Most Common at the
4th – 5th Lumbar.
5th Lumbar – 1st Sacrum.
Spondylolysis
Signs and Symptoms:
– May Have Low Back
Pain.
– May Have Spasms of the
Lumbar Muscles or
Hamstrings.
– May Have Pain All the
Time, or Only From
Time to Time.
– May Not Have Any
Symptoms at All.
Spondylolisthesis
Back Injury Involving
Forward Slipping of One
Vertebra Over Another.
– Usually at the 5th Lumbar
Over 1st Sacrum.
Most Common in
Children Between the
Ages of 9 and 14.
Spondylolysis
Mechanism:
– Caused by Repetitive
Extension of the Back
(Bending Backwards).
– Causes Weakness of the
Lamina (Bony Ring) of
the Vertebra, Eventually
Leading to a Break.
– May Also Result From a
Back Injury.
Less Common.
Spondylolysis
Treatment:
NonNon-Surgical:
– Rest.
– May Continue
Participation if Pain
Free.
– Avoid Stress on the
Back.
– Possible Back Brace.
– Manual Therapy.
– Rehabilitation.
Hamstring Flexibility.
Core Strengthening.
Spondylolisthesis
Often Seen in
Conjunction with a
Stress Fracture.
– Spondylolysis.
Stress Fracture Weakens
the Bone and Causes
Shifting of the Vertebra
With Repeated Stress.
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Spondylolisthesis
Mechanism:
– Most Commonly Occurs
in Sports That Have a
Lot of Strain on the
Back.
– Repetitive Stress, Strain,
and Hyperextension of
the Back.
Spondylolisthesis
Spondylolisthesis
Classification:
– Grade I.
– Grade II.
– Grade III.
– Grade IV.
Spondylolisthesis
Grade II:
Grade I:
– 25% Forward
Movement.
– There May be No
Symptoms at All and the
Patient May be Totally
Unaware They Have a
Defect in the Spine.
Spondylolisthesis
Grade III:
– Greater Than 50%
Forward Movement.
– Same Symptoms as
Grade II.
– Greater Than 25%
Forward Movement.
– Lower Back Pain Which
May or May Not Radiate
Into the Legs.
– Pain is Made Worse
With Extension
Activities.
– May Have a Palpable
Dip Where the Vertebra
Has Slipped Forward.
Spondylolisthesis
Grade IV:
– Greater Than 75%
Forward Movement.
– Same Symptoms as
Grade II and III, But
More Severe.
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Spondylolisthesis
Treatment:
NonNon-Surgical:
– Rest.
– Avoid Stress on the Back.
– Back Brace.
– Manual Therapy.
– Rehabilitation.
Hamstring Flexibility.
Core Strengthening.
Surgical:
– If Slip is Severe, May
Have to Fuse Vertebra.
Patellar Tendinitis
Classification:
Grade I.
– Pain Only After Training.
Grade II.
– Pain Before and After Training, But Eases Up Once
WarmedWarmed-Up.
Grade III.
– Pain During Training Which Limits Performance.
Grade IV.
– Pain During Everyday Activities.
Patellar Tendinitis
Treatment:
– Rest.
– AntiAnti-Inflammatory
Medication.
– Stretching.
– Cross Friction
Massage.
– Ice Treatments.
– ChoCho-Pat Straps and
Brace.
Patellar Tendinitis
Inflammation and Irritation
of the Patellar Tendon.
Overuse Injury that is
Usually Caused by Sports
that Involve Jumping
Activities and Changing
Directions.
With Repeated Strain,
MicroMicro-Tears and Collagen
Degeneration Occur in the
Tendon.
Patellar Tendinitis
Signs and Symptoms:
– Pain Directly Over the
Tendon.
– Point Tender Over the
Tendon.
– Pain with Activities,
Especially with Jumping
and Kneeling.
– Less Common, Swelling
Around the Tendon.
Patellofemoral Pain Syndrome
General Term Used to
Describe Anterior Knee
Pain.
Comes on Gradually, With
Symptoms Increasing Over
Time.
Occurs When the Patella
Does Not Track in a Correct
Fashion When Bending and
Straightening the Knee.
Can Lead to Damage of the
Surrounding Tissues.
Most Common in
Adolescent Girls.
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Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome
Predisposing Factors:
Signs and Symptoms:
– Aching Pain Around the Knee.
– Tenderness Along the Medial
Border of the Patella.
– Swelling After Activity.
– Pain is Worse When Walking
Up and Down Stairs.
– Possible Clicking or Cracking
in the Knee.
– Discomfort When Sitting for
Long Periods of Time.
– Quadriceps Atrophy in Long
Term Cases.
– Overloading the Knee.
Sports with Repeated
Weight Bearing.
Repetitive Landing
and Jumping.
– Feet Pronation.
– Weak Quadriceps.
– Chronic Tight Muscles.
– Previous Knee
Dislocation.
– Increased QQ-Angle.
Found in Women.
Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome
Treatment:
–
–
–
–
–
–
Rest.
Knee Brace or Support.
Control Inflammation.
Manual Therapy.
Rehabilitation.
Orthotics if Pronated
Feet are Present.
Plica Syndrome
Result of a Remnant
Fetal Tissue in the
Knee.
These Plica Usually
Diminish in Size During
the Second Trimester of
Fetal Development.
In Adults, They Exist as
Sleeves of Tissue Called
Plica or Synovial Folds.
Plica Syndrome
The Medial Plica is the
Synovial Tissue Most
Prone to Injury.
When the Knee Bends,
the Plica is Exposed to
Direct Injury, or Can be
an Overuse Injury.
When the Plica
Becomes Irritated and
Inflamed, the Condition
is Called
“Plica Syndrome”
Syndrome”.
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Plica Syndrome
Signs and Symptoms:
– “Snapping”
Snapping” and
“Popping”
Popping” Sounds as the
Knee Bends.
– Anterior Knee Pain with
Prolonged Knee Flexion.
Such as When Sitting
for Long Periods of
Time or When
Running Long
Distances.
Plica Syndrome
Treatment:
NonNon-Surgical:
–
–
–
–
–
Rest.
Control Inflammation.
Manual Therapy.
Rehabilitation.
Possible Cortisone
Injection.
Surgical:
– If Conservative
Treatment Fails to
Alleviate Symptoms.
– Removal of the Plica.
Stress Fractures
Stress Fractures
One of the Most Common
Injuries in Sports.
Overuse Injury.
Occurs When Muscles
Become Fatigued and are
Unable to Absorb Shock.
Eventually, the Fatigued
Muscle Transfers the
Overload of Stress to the
Bone Causing a Tiny Crack
Called a Stress Fracture.
Diagnosed with XX-Ray or
Bone Scan.
Signs and Symptoms:
– Pain with Activity and
When Putting Direct
Pressure Over the
Fracture Site.
– Pain Subsides with Rest.
– Swelling, Bruising, and
Discoloration May Also
Occur.
Stress Fractures
Treatment:
NonNon-Surgical:
– Rest – 6 to 8 Weeks.
– Cast, Brace, or Shoe
Inserts if Necessary.
– Pain Medication.
– Avoiding Activities that
Cause Pain or Discomfort.
Surgical:
– If Fracture Does Not Heal
Properly.
Stress Fractures
Prevention:
– Set Incremental Goals.
Increase Gradually.
– Cross Training.
– Maintain a Healthy Diet.
– Use Proper Equipment.
Proper Shoes.
– If Pain or Swelling Occurs, Discontinue Activity.
– Recognize Symptoms Early, and Treat Appropriately.
23
Achilles Tendinitis
Inflammation, Irritation,
and Swelling of the
Achilles Tendon.
Symptoms:
– Pain in the Heel When
Walking or Running.
– Achilles Tendon is Point
Tender.
– Tendon May be Swollen
and Warm.
Growth Injuries
in Young Athletes
Growth Plate
Considerations.
Injuries:
– “OsgoodOsgood-Schlatter’
Schlatter’s
Disease.”
Disease.”
– “Sever’
Sever’s Disease.”
Disease.”
Calcaneal
Apophysitis.
Osgood-Schlatter’s Disease
Occurs Due to a Period of
Rapid Growth, Combined
with High Levels of
Sporting Activity.
Results in the Patellar
Tendon Pulling on the
Tibial Tuberosity Causing
Inflammation of the Bone.
Calcium Forms on the
Tibial Tuberosity Causing a
Bony Growth.
Achilles Tendinitis
Treatment:
– Rest.
– AntiAnti-Inflammatory
Medication.
– Ice.
– Cross Friction
Massage.
– Rehabilitation.
Growth Injuries
in Young Athletes
OsgoodOsgood-Schlatter’
Schlatter’s
Disease.
Sever’
Sever’s Disease
Calcaneal
Apophysitis.
Osgood-Schlatter’s Disease
Symptoms:
– Pain at the Tibial
Tuberosity.
– Swollen or Inflamed
Bump on the Tibial
Tuberosity.
– Tenderness and Pain are
Worse During and After
Activity.
– Pain When Contracting
the Quadriceps.
24
Sever’s Disease
Calcaneal Apophysitis
Osgood-Schlatter’s Disease
Most Common Cause of
Heel Pain in Growing
Athletes.
Due to Overuse and
Repetitive Microtrauma
of Growth Plates of the
Calcaneus in the Heel.
Most Common in
Children 9 – 15 Years
Old.
Treatment:
– Rest.
– Ice.
– Stretching.
– Knee Brace.
Sever’s Disease
Calcaneal Apophysitis
Sever’s Disease
Calcaneal Apophysitis
Symptoms:
Treatment:
– Pain or Tenderness in the
Heel.
– Discomfort Upon
Awakening, or When
Squeezing the Heel.
– Limping.
– More Severe Pain After
Walking or Exercise, and
Difficulty Walking.
– Pain During Running
and Sporting Activities.
When to Seek Medical Attention
for an Overuse Injury
If Symptoms are Present
with Everyday Activities.
If Symptoms are Severe
Enough to Cause an Altered
Gait.
If the Symptoms Diminish
After a Week of Activity
Modification but Return
Soon After the Athlete
Resumes His or Her Sport.
–
–
–
–
–
–
Rest.
Ice.
Compression.
Elevation.
Elevate the Heel.
Stretch the Hamstring
and Calf Muscles 2 – 3
Times a Day.
– Foot Orthotics.
– Medication.
Treatment of Overuse Injuries
Relative Rest.
Treat the Inflammatory
Process.
–
–
–
–
Rest.
Ice.
Compression.
Elevation.
Correct the Underlying
Cause of the Injury!
25
Preventing Overuse
Injuries in Cheerleading
Utilize Proper
Training Techniques.
Improve Strength.
– Correct Muscular
Imbalances.
Improve Flexibility.
Rules of Strengthening
Proper Training Techniques
Begin Slowly.
Progress Gradually.
The #1 Cause of Injury
is Doing Too Much,
Too Soon.
The Tissues of the Body
can Adapt if Change is
Gradual.
Strengthening Exercises
Weight Training Should Not
be Performed Until the
Athlete is 14 or Older.
Emphasis in Cheerleading
Should be on the Shoulder
Girdle, Trunk, Core, and the
Stabilizers of the Knee and
Ankle.
See Cheerleading
Strengthening Hand Outs.
Light Resistance.
High Repetition.
Emphasis on Endurance and Balance.
* Refer to Strengthening Exercise Hand Outs.
Strengthening Exercises
When is it Safe for Kids
to Perform Strengthening?
Free Weights and
Machines – Not Until
14 or Older.
Strength Training Using
Own Body Weight or
Resistance Tubing.
Emphasize Proper
Technique and Safety.
Make Exercises Sport
Specific.
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Benefits of Strength
Training For Kids
Increase Your Child's Muscle Strength and Endurance.
Help Protect Your Child's Muscles and Joints From Injury.
Improve Your Child's Performance in Nearly Any Sport.
Strengthen Your Child’
Child’s Bones.
Help Promote Healthy Blood Pressure and Cholesterol Levels.
Boost Your Child's Metabolism.
Help Your Child Maintain a Healthy Weight.
Improve Your Child's SelfSelf-Esteem.
Stretching Guidelines
Precede Stretching Program
with a General WarmWarm-Up.
Perform Static Stretching
Holding Each Stretch for
1515-20 Seconds.
Perform Each Stretch 33-5
Times.
Do Not Bounce.
See Cheerleading Stretching
Hand Out.
Stretching Exercises
Flexibility
Ability to Move a Body Part Through
Normal Motion Against Minimal
Resistance.
A Stretching Program is Important in
Injury Prevention.
Cheerleading Warm-Up
The Purpose of a Proper WarmWarm-Up is to Prepare for
the Sport by Raising the Body Temperature,
Optimizing Performance, and Preventing Injury.
WarmWarm-up Activities Consist of General Running
Activities and Stretching Exercises.
As the Participant’
Participant’s Skill Requirements Increase, the
Time Allotted for WarmWarm-Up Activities Increases and
the Exercises are More Specific.
Stretching Exercises
27
Thank You
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