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St. Scholastica cheerleaders Carly Sandmann (left) and Caitlin Hare stretch during a recent practice at Reif Gymnasium at the College of St. Scholastica in Duluth. Clint Austin / Forum News Service

'A risk you take': Cheerleaders face possibility of catastrophic injuries

DULUTH—Carly Sandmann was practicing with her teammates when something went awry.

"I got a concussion," the 21-year-old College of St. Scholastica senior said. "That's a risk you take."

Sandmann's sport is not basketball or hockey; it's cheerleading. And the risk she and her 27 fellow CSS cheerleaders take is real.

"There are a few things that are real common in cheerleaders," said Dr. Janus Butcher, an orthopedics and sports medicine specialist at Essentia Health. "And, believe it or not, head injuries are very common."

The risk of what experts refer to as catastrophic injuries also is real.

"Those are mostly injuries to the head and neck area that can involve serious or permanent impairment, spinal cord injuries, paralysis or even death," said Dr. David Rust, an orthopedic and sports medicine specialist at St. Luke's Hospital.

Cheerleaders know that.

"You could break your neck," Sandmann said.

Added fellow Scholastica cheerleader Caitlin Hare, "You could die. We have to sign a paper that says if you die, it's not St. Scholastica's fault."

Although deaths are extremely rare, the data points to a small but noticeable risk of severe injuries. In a 2012 report, the American Academy of Pediatrics cited data showing that, among female high school athletes, cheerleaders are at the lowest overall injury rate from seven sports that were surveyed. But they had the highest catastrophic injury rate: 1.62 per 1,000 exposures (an exposure being one athlete participating in one practice or competition) for competitive cheerleading. The rate was 0.50 when sideline cheering was included — still higher than the other sports in which female athletes participate.

The injury rate is higher at the collegiate level than at the high school level, the American Orthopaedic Society for Sports Medicine noted in a report last fall.

And the number is growing. The U.S. Consumer Product Safety Commission reported 4,954 hospital emergency department visits for cheerleaders in 1980, the American Academy of Pediatrics report noted. By 2007, it had risen more than 400 percent to 26,786.

Competitive sport

Cheerleading has come a long way since a University of Minnesota medical student assembled a group to cheer on the football team in 1898, according to the cheerleading magazine Varsity. Now, cheerleaders don't just lead the crowd in supporting their team. They compete against other squads.

The sports medicine doctors interviewed for this story say a factor in cheerleading injuries may be a lack of coaching, a consequence of not catching up to the idea that cheerleading is a sport.

"If you don't have good organization, if you don't have coaches that can monitor their athletes to make sure that they're physically able to do the necessary tasks to be able to do a certain stunt or tumbling routine, then these athletes might be putting themselves at risk because they're not being properly monitored," Rust said.

Butcher said he works the sideline at a couple of University of Minnesota Duluth football games each season, and he's impressed by the "safety-mindedness" and skill of the UMD cheerleaders.

"They're very well choreographed," Butcher said. "If they don't have a coach, someone is acting as their coach."

But no one is.

"We don't have coaches; we don't have advisers," said Rachel Brown, 20, a junior who is co-captain for UMD football, basketball and competition cheerleaders. "Since we don't have a coach or a supervisor, we really all look out for each other."

Earlier this year, for the first time in Brown's three years on the squad, the UMD cheerleaders used money from fundraisers to hire a choreographer for one day of training. The purpose was to prepare for competition in Minneapolis later this month. Last year, UMD cheerleaders competed for the first time, and they won first place in their division.

It's quite a contrast from Brown's experience at Jefferson High School in Bloomington, Minn., which has one of the top cheerleading programs in the country. The school had two coaches for its varsity team, one for its JV team and one for its middle school team. Cheerleaders had the same access to the school's athletic trainers as any other athletes.

Stunt goes awry

But it was high school, not college, that proved to be more perilous for Brown. Injuries in general have been infrequent during her time as a UMD cheerleader, Brown said. She counts two concussions as the most serious injuries suffered by her fellow athletes, and none for herself that she considers worth mentioning.

High school was different.

"My knee, my stress fracture in my foot, my broken wrist and my bruised ribs," she said, ticking off her high school injury list. "And there were smaller things."

The knee injury, which affects Brown to this day, occurred when she was still in eighth grade, though on the junior varsity team.

Brown is a flyer, meaning she is tossed in the air and caught by her teammates during stunts. But during a practice, a stunt "went wrong," and her teammates didn't catch her. Brown landed with her full weight on her right knee.

Her coach wasn't sympathetic.

"I was immediately sobbing because it was so much pain," she related. "And he flipped me over and said, 'There's no bone sticking out. You're fine.'"

She wasn't. The trainer taped her knee and gave her crutches. Her mother took her to the doctor the next day, where she was diagnosed with torn ligaments and a bone bruise.

She was on crutches and wore a brace for two months, but the injury never fully healed, Brown said. A few years later, she was diagnosed with patellofemoral pain syndrome and told that her kneecap didn't align well with her femoral bone, a consequence of the cheerleading injury. She has been told to wear a brace when it acts up, and she will need knee surgery within the next 10 years.

'An elbow to the temple'

Sandmann's injury occurred at the other end of a stunt, and much more recently. The Scholastica cheerleaders were participating in a two-day stunt camp in August with the University of Minnesota-Twin Cities cheerleading squad. Sandmann, from Silver Bay, is a "base," one of those who does the tossing and the catching.

"I was catching my flyer, and I got an elbow to the temple," she reported, pointing to the right side of her head. "Her forearm or elbow area to the side of my head, right here, the soft spot."

Stunned, Sandmann quickly made her way to the restroom. "You don't cry in front of U of M people," she said.

Sandmann threw up. She experienced blurred vision and what she describes as "fogginess."

As at UMD, cheerleading is considered a club sport at Scholastica, but the Scholastica team has an adviser in Becky Brenna. She didn't see Sandmann get hurt, Brenna said, but she went to check on her when Sandmann didn't quickly return from the restroom.

"She was kind of panicking," Brenna recalled. "We were talking about did she have a concussion, or was she panicking over the thought of being hurt?"

It was late in the second day of the camp, so Brenna had Sandmann sit out the rest of the training. Sandmann didn't seek immediate medical treatment, but when she still wasn't feeling well after returning to Duluth, she went to a doctor who determined she had a concussion and needed to sit out of training for a while.

"I was out for a week or so, week and a half, and I got cleared by a sports doctor," Sandmann said. "He wasn't super happy about letting me stunt again. ... Which, none of them are super happy about letting any of them stunt again."

Coaching desired

Hare, a 20-year-old junior, fills the third role in the cheerleading triumvirate, that of back spotter. "They're in charge of the flyer and the whole stunt and what's going on," the junior from St. Paul explained. "You're in charge of their head. If anybody comes down, you go for the head."

Added Sandmann, "And you really notice it if you don't have a back spot."

Brenna, an administrative assistant at St. Scholastica, was a cheerleader at Proctor High School. She's an enthusiastic advocate for the team, but freely admits she doesn't have the credentials to coach them. The cheerleaders are peer-trained, she said.

If the school were hired a coach, she'd gladly step aside, Brenna said.

"If that means that these guys and the people who come after them get to do their cheerleading, which is a sport that they love to do, and get to do it safely?" she asked rhetorically. "Absolutely. I'll go in the stands and watch."

UMD cheerleaders serve as their own coaches by necessity, not by choice.

"I would love to have a coach," Brown said.

'So much pressure'

Both the UMD and Scholastica squads are entirely female, although both are open to men. To compete at the highest levels, a team has to be co-ed, Brown said. The gold standard among those teams is the University of Kentucky, which last month won its 23rd—and third straight—national championship.

From Kentucky to UMD and Scholastica, teams always try to top themselves, Brown said.

"There's so much pressure to have the best stunt, the coolest stunt, the gravity-defying, jaw-dropping, everyone-look-at-us stunt," she said. "Every year you're competing, and you're trying to not only one-up other people, but you have to one-up yourself."

Although he said the premium should be on safety, Rust doesn't think that means trying to limit the jaw-dropping element in the stunts.

"I think advancing the level of skill is just a natural part of any sport," he said. "I don't know that you can try to scale back or reverse what people are trying to do."

All of the people interviewed for this story stressed the positives. Cheerleading is a team-building sport; it's a good way to stay active and in shape. They all put a premium on safety. Brown noted that the UMD captains agreed to discontinue a stunt this year out of safety concerns. As it happens, it was the same stunt that caused her knee injury as an eighth-grader.

"Our goal always is to never let the top girl touch the ground," she said. "Always."

Despite the precautions, is it ever scary?

"Yeah," Brown said. "Like group stunts, when you have pyramids of multiple groups, and you're kind of building on each other, those can get scary. ... (But) the thrill and excitement outweighs the scariness or the fear."