Sports Medicine: Just the Facts

2 per 100,000 college participants, or an overall rate of

0.6 per 100,000 cheerleaders (Boden et al, in press).

• In 2000 the CPSC estimated a total of 1258 head
  injuries in cheerleaders of which 604 were recorded as
  concussions and 6 as skull fractures. In the same year
  there were 1814 neck injuries with 76 fractures in
  cheerleaders that initially presented to an emergency
  department in the United States (www.cpsc.gov).


• Compared with other sports, cheerleading has a low
  overall incidence of injuries, but a high risk of cata-
  strophic injuries.


• The majority of injuries occur in female athletes
  because there are more female than male cheerleaders
  and the women are usually at the top of the pyramid or
  being thrown into the air during basket tosses. The
  majority of injuries occur during the winter months,
  because cheerleaders perform on indoor hard surfaces.


• College athletes are five times more likely to sustain a
  catastrophic injury than their high school counterparts
  (Boden et al, in press). This finding is likely owing to
  the increased complexity of stunts at the college level.


• Catastrophic head injuries are twice as common as
  cervical injuries.

MECHANISMS

• The most common stunts resulting in catastrophic
  injury are the pyramid or the basket toss. The cheer-
  leader at the top of the pyramid is most frequently
  injured. A basket toss is a stunt where a cheerleader is
  thrown into the air, often between 6 and 20 ft, by
  either three or four tossers. Poor judgment or inade-
  quate training of the spotter is often the main problem
  leading to injury.


• Less common mechanisms include advanced floor
  tumbling routines, participating on a wet surface, or
  performing a mount. The majority of injuries occur
  when an athlete lands on an indoor hard gym surface
  (Boden et al, in press).

PREVENTION

• Height restrictions on pyramids are limited to two
  levels in high school and 2.5 body lengths in college
  (www.ncaa.org; http://www.nfhs.org)..) The top cheerleaders
  are required to be supported by one or more individu-
  als (base) who are in direct weight-bearing contact
  with the performing surface. The base cheerleaders
  must remain stationary and maintain constant contact
  with the suspended or top athlete. Spotters must be
  present for each person extended above shoulder level.
  The suspended person is not allowed to be inverted
  (head below horizontal) or to rotate on the dismount.
  Limiting the total number of cheerleaders in a pyramid
  as well as the quick transitions between pyramids and
  other complex stunts may also help reduce injuries.
  
  
  • Basket toss rules limit the stunt to four tossers, starting
    the toss from the ground level (no flips) and having
    one of the tossers behind the top person during the toss
    (www.ncaa.org; http://www.nfhs.org)..) The top person (flyer)
    is trained to be directed vertically and not allow the
    head to drop backward out of alignment with the torso
    or below a horizontal plane with the body. Other safety
    measures that may reduce the incidence of basket toss
    injuries include evaluating the height thrown, using
    mandatory landing mats for complex stunts, and
    improving the skills of the spotters.
  
  
  • All stunts should be restricted when wet conditions
    are present.
  
  
  • Injuries from floor tumbling routines can be prevented
    by proper supervision, progression to complex tum-
    bling only when simple maneuvers are mastered, and
    using spotters as necessary.
  
  
  • Minitrampolines, springboards, or any apparatus used
    to propel a participant have been prohibited since the
    late 1980s.
    •A landing mat should be employed during all complex
    stunts.
  
  
  • Cheerleading coaches need to place equal time and
    attention on the technique and attentiveness of spot-
    ters in practice compared with the athletes’ perform-
    ing the stunts.
  
  
  • Coaches are encouraged to complete a safety certifi-
    cation, especially for any teams that perform pyra-
    mids, basket tosses, and/or tumbling.
  
  
  • Pyramids and basket tosses should be limited to expe-
    rienced cheerleaders who have mastered all other
    skills and should not be performed without qualified
    spotters or landing mats.
  
  
  
  

BASEBALL

EPIDEMIOLOGY

• Baseball has a low rate of noncatastrophic injuries,
  but a high incidence of catastrophic injuries.


• Head injuries constitute the majority of catastrophic
  injuries.


• There are approximately two direct catastrophic injuries
  reported to the NCCSIR per year or 0.6 injuries per
  100,000 participants (Mueller and Cantu, 2000). The
  total incidence of catastrophic injuries and fatalities is 5
  and 13 times higher, respectively, at the college level
  than at the high school level (Boden et al, unpublished).

MECHANISMS

• The most common mechanism is a pitcher hit by a
  batted ball, followed by a collision of two fielders, and
  a collision of a runner and a fielder (Boden et al,
  unpublished). An area of controversy in baseball is the

28 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE