Last year, the National Association for Catastrophic Sports Injury Research surprised many by reporting that the most dangerous sport for young female athletes was not a contact sport like field or ice hockey, but in fact cheerleading. Indeed, cheerleading leads the nation in catastrophic injuries among all sports, male or female, accounting for a staggering 65.1 percent of all catastrophic injuries among female athletes over the past 25 years.
Meanwhile, the sport of mixed martial arts (MMA) has been increasingly popular over the past decade, having entered mainstream pop culture with reality television shows and matches broadcast on basic cable's Spike TV. And in recent years, gyms throughout the country have begun offering MMA training to athletes reportedly as young as 8 years old.
Michael O'Brien, MD, of the Division of Sports Medicine at Children's Hospital Boston, weighs in on cheerleading and MMA, and answers some of the more common questions parents are asking.
What is a catastrophic injury?
Catastrophic injuries are injuries to head or neck that lead to significant permanent impairment including paralysis and death. Unfortunately, most contact sports like hockey and football have these types of injuries, but based on participation, total number of athletes and hours played, cheerleading is most dangerous.
What makes cheerleading so dangerous?
The more complex and riskier maneuvers in cheerleading are called stunting, with performance moves similar to gymnastics. The big difference, however, is that gymnastics is done on padded surfaces, instead of the hardwood gym floors, school tracks or football fields where cheerleading is performed. Gymnastics floor routines are also individualistic. In cheerleading, teammates, usually males, help throw the performer high in the air, allowing them to do more flips and maneuvers. A minor miscue with the landing can lead to an extreme, catastrophic injury.
If stunting is so dangerous, why is it still being practiced?
At the high school level, most athletes are new to cheerleading and stunting, but there is a great deal of pressure to out perform the opponent's squad and create the most exciting routine. And even in college, with scholarships and access to staff trainers and doctors, the incidence of significant injury is still relatively high, likely because of increased pressure to wow audiences in college gymnasiums and stadiums. Yet, given the risks involved, there is not as much oversight in cheerleading as in other high school and college sports. And unless stunting techniques are closely monitored and instructed, the risk of catastrophic injury for these young female athletes will remain high.
What are the other common injuries seen in cheerleaders?
Some of the more common injuries we see are to the wrist and shoulder. And a growing trend is low back pain and stress fractures to the lower back, called spondylolysis. This is fairly prominent in cheerleading, particularly with tumbling on hard surfaces, back layouts and handsprings, all of which require the extension of the lower back. These are particularly unique to the adolescent athlete not just in cheerleading. Repetitive impact seen in most sports—gymnastics, dancing, cheerleading, ice skating—are associated with high rates of this injury, which is one of the more common seen in our clinic.
What can parents do?
Parents should be comfortable with the coach's approach to stunting and have an open discussion about how routines will be taught. Is it done in a slow, gradual fashion? Are there spotters, how are they being chosen and trained? Are the stunts being appropriately supported and instructed? They should also consider where the practices are being held: grass, padded mats, or gym floors.
What is mixed martial arts (MMA)? How is it different than karate and wrestling?
MMA combines of a number of different forms of martial arts—judo, karate, jujitsu and the like—that compete against one another. But unlike traditional karate matches and conventional wrestling, which rely on a point system, MMA emphasizes submission holds and tap outs. And whereas being flat on your back in wrestling is considered a pin and the end of the match, this can be a position of both strength and vulnerability in MMA.
What are the most common injuries associated with MMA that you're seeing?
The most common injuries are finger and hand sprains or dislocations. The more serious injuries include shoulder and elbow injuries affecting the humerus bone. These are often the result of submission maneuvers. In older athletes we also see rotator cuff strains and clavicle and sc joint injuries as well. People are also getting a lot of cuts that need to receive attention in emergency rooms. Even so, most of the young athletes participating in MMA are still growing, which makes them more vulnerable to unique and significant injuries that may have long-term implications like growth plate injuries. A fracture to a growth plate in the arm or leg can potentially affect how the bone grows and develops. Although this risk exists in other sports like wrestling, the growing popularity of MMA seems to warrant a closer look to ensure that the rate of serious injury is not significantly higher.
Are there any benefits MMA or other types of martial arts for kids and adolescents?
Absolutely. Like karate and other forms of organized sports, young athletes learn the importance of conditioning and exercise. In addition, it provides them with self confidence and discipline to become focused and organized, which can translate into other areas of their life, like school and work. And the good teachers, of course, make sure they do not use their skills outside the studio or gym.
What advice do you have for parents considering putting their kids in MMA?
Just like any sport or extracurricular activity, parents should find out everything they can about the instructors and teachers. I would also look at the overall tone of the gym, and how the matches and sparring are set up. These should always be supervised by the trainer, and should only be between athletes of similar build and experience. And as with all sports, it is important to see how this affects the child's daily living: sleep schedule, school work, etc. Young athletes are not small adults; they inherently have unique injury risks, and should be evaluated differently than adults.