Concussions in Cheerleaders: Symptoms and Treatment

By Tara Hackney, PT, DPT, OCS, KTTP for Athletico Physical Therapy

Cheerleaders are commonly seen on the sidelines of school and professional sporting events, but the sport is no longer reserved for the sidelines. Cheerleaders have their own competitions where they are in the spotlight. Competitive cheerleading participation is on the rise with teams ranging in age from 5 years old through college.

All-Star cheerleading is the name used to refer to cheer groups created for competition and not associated with any school or team. Competitive cheerleading is divided into groups according to age and each group has different levels according to experience. Cheerleaders perform tumbling, stunting and pyramids as part of their routines. As with any sport, injuries can occur.

Did you know that the most common injury in competitive cheerleading is concussions? The overall injury rate in cheerleading is low; however of those injuries, concussions account for 31.1 percent.1 You may be thinking this high rate of concussions would be from cheerleaders falling and landing on their heads. However, the cheerleading position that suffers the most concussions are the bases, the athletes who support the flyers in the air by holding them up and catching them. This position is at risk for concussions as a flyer may fall on top of them, or from a foot or elbow hitting them in the head as the flyer comes down from a stunt. In fact, it is more likely in cheerleading for a concussion to occur after contact with another athlete than with contact with the floor.

Concussion Symptoms

Any one or more of the following signs and symptoms may indicate a head injury:

  • Headache
  • Nausea or vomiting
  • Dizziness
  • Coordination or balance issues
  • Blurred or double vision
  • Light and noise sensitivity
  • Feelings of sluggishness
  • Memory or concentration problems
  • Altered sleep patterns

Signs observed by coaches or other team members that may indicate a concussion has occurred:

  • Stunned or confused appearance
  • Forgets arm motions or cheers
  • Confused about formations in routines
  • Unsure of surroundings
  • Moves clumsily
  • Loss of consciousness (long or short)
  • Personality or behavior changes
  • Forgets events right before or after a blow to the head

If a head injury or concussion is suspected, the athlete should not return to play prior to 24 hours after the initial incident and should be cleared by a physician prior to returning to sport.

Concussion Management

Concussion management is evolving through research. There is strong evidence to support an active approach to rehabilitation of concussions. Physical therapy is one way to help manage the symptoms following a concussion. Physical therapy can include management of neck pain and headaches, balance exercises, progression of exercise tolerance and cardiovascular activities, and vision training. Ideally, an athlete will complete a graded exposure program that starts with symptom limited activity, progress through light aerobic activity, and transition to sport-specific incremental intensity training. Finally, the athlete will be cleared to practice prior to being cleared to compete.

Speed of recovery after concussion is individualistic for each athlete and may be affected by severity of trauma, area of the brain injured, age, gender, past medical history, and previous history of concussions.

Please visit our Concussion Page to learn more about our services.

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Ask the Doctor!

This regular segment of ‘Ask the Doctor’ addresses questions submitted by Sports Medicine Weekly followers. Dr. Charles Bush-Joseph is sitting in for Dr. Brian Cole from Midwest Orthopaedics at Rush and will be discussing

  • Young Female Athletes and the Risk of Knee injuries 
  • Failure Rates Post ACL Surgery as well as Re-tear Rates

Sports Medicine Weekly on 670 The Score

If you have a question to be addressed on an upcoming show, please click here to submit your question.

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Ski Holidays and Head Injuries

Image result for skiing head injury

In this segment Dr. Brian Cole of Midwest Orthopedics at Rush, Steve Kashul & Dr. Jeremy Alland discuss Holiday ski trips and what parents (and adults!) should know about concussion.

Dr. Jeremy Alland graduated from Rush Medical College in Chicago, IL, where he was awarded the prestigious William H. Harrison, PhD Award for selfless leadership, aspiration and collaboration. He went on to complete a Family Medicine residency at UPMC St. Margaret Hospital in Pittsburgh, PA, where he served as Chief Resident and was peer-selected as the best resident teacher. After residency, he returned to Rush and his hometown of Chicago to complete a fellowship in sports medicine.

During his training, Dr. Alland served as a team physician for the Chicago White Sox, Chicago Bulls, Chicago Fire Soccer Club, DePaul University and multiple high school football, basketball and wrestling teams. Additionally, he has been a part of the finish line medical team at both the Chicago and Pittsburgh marathons. He is board certified by the American Board of Family Medicine and is a member of the American Medical Society of Sports Medicine, American College of Sports Medicine and American Academy of Family Physicians. Jeremy Alland

As a former collegiate baseball pitcher, Jeremy A. Alland, M.D. has a strong passion for sports and medicine. He finds pride in his ability to relate to his patients and strives to help his patients remain active. He specializes in the care of the entire athlete with special interests in the throwing athlete, the golfing athlete, sports performance, and ultrasound-guided procedures.

Dr. Alland is a team physician for the Chicago White Sox, Chicago Fire Soccer Club, Windy City Bulls (Chicago Bulls NBA D-League team), Chicago Dogs, Chicago Blaze and Mount Carmel High School. He previously served as a team physician for DePaul University. He is an active researcher and has authored numerous papers on topics in sports medicine. He also serves as a peer-reviewer for The Journal of Family Practice.

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Shoulder Instability Surgery- Reliable Results For Most Athletes

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Many young athletes with a shoulder dislocation from sports activity will choose to have shoulder stabilization surgery
  • Modern arthroscopic surgery techniques generally result in extremely stable shoulders for 90% of athletes and high satisfaction

I wrote last week about improvements in ACL surgery over the last 25 years and this week I’d like to explore improved results from another commonly performed sports medicine surgery- stabilization surgery for the dislocating shoulder. The results here mirror those of ACL surgery in many ways.

Many young athletes dislocate a shoulder from trauma, typically a dive with the arm outstretched overhead. This can happen in any sport involving that kind of motion, and any contact sport.

Most surgeries were performed through a large “open” incision 25 years ago, but nowadays can be performed arthroscopically in most cases. For uncomplicated stabilization of shoulders that have had a small number of dislocations from trauma, we should expect 90% of shoulders to remain stable and satisfaction rates upwards of 80% out to about 5 years with current methods, for recreational athletes.

Early Open Surgery Methods- Very Good At Stabilizing, Not So Good At Retaining Motion

Historically, the open surgery was for an unstable shoulder was reported in the early 1900s. A surgeon named “Bankart” first described the essential anatomy of the torn ligament and labrum stabilizing the shoulder in 1923, and for the most part we still generically refer to a shoulder stabilization as a “Bankart repair”.

Over the decades as additional knowledge was gained, modifications to the original procedures were developed. A key component surrounded understanding why surgeries on shoulders with many dislocations tended to do poorly compared to ones with only a few dislocations. While there are many factors, restoring bone loss that resulted from the dislocations was a major advancement.

As it turned out, open stabilization was extremely effective at providing excellent stabilization, with low re-dislocation rates.  But it came at a price. The rehabilitation was difficult and often resulted in permanent motion loss. Some techniques had unacceptably high rates of early arthrits. The end result was that many folks ended up with a stable shoulder but were unhappy about the result.

Arthroscopic Stabilization- Much Better At Retaining Motion With Excellent Stability

 “Arthroscopy” involves small incisions, with the surgeon visualizing and performing repairs through the small incisions. There are numerous advantages over open surgery.  Arthroscopy avoids some complications of open incisions, is generally faster, has minimal blood loss, is more comfortable after surgery, and generally leads to a faster return to sports with excllent joint motion.

And yet, in its earliest years, arthroscopic stabilization had a higher dislocation rate than open surgery. As it has been with ACL reconstruction surgery, arthroscopic shoulder stabilization has improved substantially over the years. Better surgical technique, improved surgical implants, and cutting-edge rehabilitation all play a role.

Measuring the ultimate outcome from arthroscopic shoulder stabilization surgery can involve many factors. Is there another dislocation after surgery? How is the range of motion? What’s the patient’s level of sport activity? How does the patient feel about their result?

If you’re a young athlete with an unstable shoulder, and you have a strong desire to resume a contact or collision sport you’ll likely want to consider shoulder stabilization surgery. Find an experienced shoulder surgeon and have a thorough discussion. You’ll have to work hard on your rehab and be patient but you should generally end up with an excellent result.

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