Why Is It So Hard to Keep Cheerleaders Safe?

BrainLine talks with Krista Robinson, retired cheerleader and executive director of the National Cheer Safety Foundation

Krista Robinson had been cheering since 3rd grade — almost thirteen years. In 2003, at the age of 21 and captain of the cheerleading squad at the University of Memphis, she fell. Krista was the flyer — the girl on top of two to three tiers of other girls, the one who gets thrown as high as 20 feet in the air, the one who twists and twirls and wows the fans far below. As she was starting to launch a front flip, one of her teammates held onto her feet a second too long, and instead of soaring and then flipping mid-air, Krista plummeted to the ground. The ground was a 2-inch foam mat on top of concrete. Krista broke her neck in five places. She had blood clots in her brain and neck. She underwent three brain surgeries.

Today, at 27, Krista is a physical therapist’s assistant and executive director of the National Cheer Safety Foundation.

Krista talked with BrainLine about the state of cheerleading today, why cheerleading is still not considered a sport with the need for safety guidelines and trainers, and what parents, coaches, and athletes should know about safety in a sport that continues to become more risky and more competitive.

* * *

BrainLine: You had a terrible injury in college from falling during an advanced cheerleading stunt. What has your recovery been like?

Krista: Well, it has been a long road. I went from being 21, captain of the team, blond and cute to bald with a mullet and a huge scar running across my head. I had slurred speech and emotional problems like intense anger and temper tantrums due to the damage to my frontal lobe. And then I got hydrocephalus (swelling of the brain) during the first three days I was in the hospital and had holes drilled in my head and tubes running in and out to monitor the amount of fluid on my brain.

Once my physical injuries were healed, I was pretty much on my own. I didn’t get much therapy for my brain injury.

I have made a lot of progress in the last six years. I did finish and graduate from the University of Memphis, but I returned far too early; and being there and trying to be my old self was incredibly hard and frustrating. Not only could I not remember what I was reading, but sometimes I had to close the book and look at the cover to remember what subject I was working on. Also, I was ostracized by my team. I gathered that the coach and owner of the gym told my teammates not to talk to me for fear of a lawsuit. I was really lonely and disillusioned, especially by the loss of my friends. My parents have also had a tough time acknowledging the long-term effects I have from my TBI. They could understand the broken neck, the hydrocephalus … the physical symptoms. But with the brain injury, well, we don’t really talk about it, which is difficult.

I still have some memory issues. My short-term memory problems are minor now compared to how they were a few years ago, but I still have problems remembering some of my childhood memories. They come in flashes, with parts missing. I also suffer from PTSD and depression. I take antidepressants, which help.

I have definitely made a lot of progress. I’m not 100 percent, and I don’t think I ever will be. But my work as a physical therapist’s assistant and with the foundation has been good for me. It is gratifying to help others and to work on making safety standards better for all the young girls — and guys — who are in cheer now.

BrainLine: How has cheerleading changed in the last ten years?

Krista: Cheerleading has become more popular and more competitive. There are many more squads and camps — of kids starting at younger and younger ages — and competitions go on all year long. There is no “off season.” In addition to squads in elementary, middle, high school, and college, there are open squads, called all-star teams for cheerleaders who want to continue to compete after high school or college.

These teams, which have become incredibly popular in the last several years, are strictly for competition, they are not affiliated with a school or sports team. They are the ones you see on TV. For cheerleaders who are part of high school, college, or all-star squads, they could compete as many as three weekends a month and practice daily.

BrainLine: How has cheerleading’s reputation changed? How has public recognition of the sport changed?

Krista: I hate to say this, but the change has been minor. People who aren’t in cheerleading still have the idea that cheerleaders just smile, kick up their heels, and toss pom-poms in the air. Maybe because cheerleading has become more popular and more competitive, the awareness of it as a “real” sport that comes with real injuries has heightened, but not by much … Overall, cheerleading’s reputation is still ridiculously outdated.

BrainLine: What would get people to respect cheerleading as a serious athletic endeavor — and one that can come with serious injuries?

Krista: First and foremost, the cheer industry itself would have to take it more seriously and understand that it’s an athletic sport that needs safety guidelines and trainers. The cheer industry is made up of many branches under the same umbrella company, called Varsity, which is responsible for all aspects of cheerleading, including safety. It is also a clothing company responsible for selling camp clothes, uniforms, shoes, and so on, which is the majority of the sport’s revenue. It seems that the industry’s main concern is making money from the clothing, competitions, and the camps. If cheerleading were a sport and regulated likewise, it would limit the cheer season, practice, and competition times and distances, which would be a start to making it safer. It would also develop strict safety guidelines. In my opinion, the industry only makes changes that give an appearance of change. They are not working seriously toward a real sea change.

Whether certain stunts are covered by insurance has seemed like the only way the industry has paid attention. There was a high-profile case a few years ago when a girl — the flyer — was thrown up in a basket toss and fell, landing on her head on the wooden floor of a basketball court. She survived, but she sustained a serious, life-changing spinal injury. When the insurance companies involved said they would no longer cover these sorts of stunts — specifically basket tosses on wooden floors — the cheerleading industry backed it. But the industry didn’t go far enough and still allows basket tosses and other high-risk stunts on grass or other surfaces as hard as basketball courts.

The fact is that if cheerleading were treated as the sport that it is, with real risks and injuries, it would be more costly and the cheerleading industry would lose money. Major contributors who support an all-year season would pull out. And if athletic trainers were required on the sidelines that would also be a significant cost. I think the industry just wants to keep the money flowing and brush the safety issues under the rug.

BrainLine: What has helped people understand that cheerleading is a real sport with real injuries?

Krista: I think a lot depends on the leadership of the coaches and the parents. I have talked to some coaches who are incredibly proactive about keeping their squads safe. On the other end of the spectrum, there are coaches who don’t have any training and don’t even know what they don’t know. Many coaches are not trained in CPR or first response and many of them do not even know what a traumatic brain injury is or what to do if an athlete hits her head. It’s not uncommon, for example, for a middle or high school to appoint a new teacher to coach cheer, or to pick the person on the staff who cheered back in 1978 because she is the only one who knows anything about the sport. Then these coaches will try to do stuff they see on TV or YouTube … and in a gym on wrestling mats.

And most times, practices are closed to parents. They don’t see what goes on in practice, only at the competitions. They assume all is well and that the coaches are taking the necessary precautions to keep their athletes safe. We had a girl on a squad who ruptured her spleen after taking a serious fall. The coach told her she just got the wind knocked out of her and to walk around and keep her arms above her head. The girl died later that day. Had parents been present, or better yet, an athletic trainer, the outcome may have been different.

Cheerleading is even worse than sports like football and hockey in terms of awareness of the dangers of concussions and repeat concussions. I can’t tell you how many times I hear from coaches, parents, and the cheerleaders themselves: “If it’s not broken or bleeding, you’re fine.”

BrainLine: Why was the National Cheer Safety Foundation started? Who is involved?

Krista: The National Cheer Safety Foundation was founded in 2005 by Kimberly Archer, a mother whose daughter was injured cheerleading. She broke one of her arms — it was a compound fracture where the bone stuck through her skin. She had plates put in her arm and once she was through rehab she tried to return to cheer. That’s how crazy cheerleaders and cheer parents can be! It’s all about the competition with little attention paid to long-term consequences.

This mother began researching the safety issues around cheerleading and started the foundation to raise awareness about the risks of the sport and improve safety.

As the executive director of the foundation, I want to emphasize that we are not trying to ban cheerleading or any of the stunts. It’s an amazing sport and to compete is like nothing else. What we do want is to make sure that cheerleading is taught and performed as properly and safely as possible.

BrainLine: Are there safety guidelines? Who is developing them?

Krista: We are currently working on creating standard guidelines, which we believe will help our mission and, if adopted and promoted by the industry, will make a significant difference in keeping cheerleaders safe. We have been collaborating with sports medicine professionals — incorporating their knowledge and emergency plans and putting that together with ideas borrowed from other sports like gymnastics and ice skating.

BrainLine: What are the statistics for brain injuries — and other injuries — from cheerleading accidents?

Krista: Previously, cheerleading injuries were not tracked specifically. We have been working with the National Center for Catastrophic Sports Injury Research and over the last few years we have compiled the following statistics:

• Cheerleading is the #1 cause of catastrophic sports injuries in girls in high school and college — injuries that lead to permanent disabilities or death.
• 93 percent of cheer injuries occur on hard surfaces like gym floors, asphalt, grass, and concrete covered with thin mats.

We are just starting to look more closely at the statistics for brain injuries in cheerleading. We don’t have any hard numbers yet, but we know that concussions are not uncommon. You throw a girl 10-20 feet in the air to do twists and turns and then to be caught by girls her same size … well, serious falls that involve the head and neck don’t seem too far out of the realm of possibility.

BrainLine: What is the most common cheerleading injury?

Krista: Overuse injuries like ligament tears and muscle damage are the most common injuries because most cheer squads practice for several hours about 4-5 times a week.

Generally, the flyers are the ones who sustain the more catastrophic injuries like broken necks, spines, and traumatic brain injuries, while the bases and spotters tend to get more black eyes, knee problems, and back strain.

BrainLine: What changes do you think need to be made in cheerleading to keep cheerleaders safe?

Krista: As I mentioned, the big changes were only made when the insurance companies got involved. What should be addressed are issues around critical height, which basically addresses the fact that the higher you throw a cheerleader in the air, the better the landing surface should be. If a girl is getting thrown any higher than five feet, it should only be done on a spring floor, not on a hard surface like asphalt, wood, or grass. A spring floor is basically a floor that absorbs shocks giving it a softer feel. Most are made of some combination of springs, plywood, foam, and carpet. It’s what is used in gymnastics and for some martial arts. It’s what should always be used in cheerleading, too.

BrainLine: What strategies have you used to raise awareness about safety issues in cheerleading?

Krista: Our foundation has been working with sports medicine professionals to create an emergency plan, and we are trying to get coaches to use it. Besides the actual step-by-step plan in case of a catastrophic injury, the plan includes information about the serious injuries that can and do happen in cheerleading, how to be prepared, and what the coach and team members need to do.

BrainLine: What do parents need to know if their child wants to be or is already a cheerleader?

Krista: Most importantly, parents should know about the capabilities of the coach. Is the coach certified in CPR, first aid, first response? What is his or her background in cheer? What kind of stunts will he or she expect the team to perform?

Parents should also know about the facilities where the team practices and performs. What kind of surfaces and mats will they be using? How high is the ceiling? What kind of safety guidelines are in place?

I remember when I was in high school, we practiced in the cafeteria on wrestling mats. The ceiling was also pretty low. One girl was thrown for a “toe-touch basket toss.” She did her move and because the ceiling was low, she punched a hole in the ceiling with her foot on the way down. It could have been her head.

BrainLine: What do coaches and teachers need to know?

Krista: The biggest problem with coaches is that often they are not properly trained. Much of the time, they are chosen to be coach because they were a cheerleader. Their main credibility comes from the number of years they cheered instead of their safety training. For example, in addition to being trained in CPR and first response, a coach should also be trained in the body mechanics behind the stunts, tumbling, and critical height. And I bet a good 95 percent of coaches don’t even know what critical height is, and yet their flyers are thrown 10-20 feet in the air. Clearly, that is not safe.

Certification through the industry is not taken particularly seriously. Current certification is voluntary and involves only a three-hour course with an open-book exam and a score of 70 percent or higher to pass. Once you are certified, you are certified forever. There is no requirement for continuing education or re-certification.

BrainLine: If there was one message you could get out about safety and cheerleading, what would it be?

Krista: I would say that cheer needs to be taken seriously — as a competitive sport that comes with very real and serious risks. Just because we smile and make the moves look easy doesn’t mean that catastrophic injuries don’t happen and won’t continue to happen. People need to open their eyes and minds and keep these athletes safe.

Learn more about the National Cheer Safety Foundation.