Concussions are in the news every week these days. Former pro football players are suing the NFL, claiming that they were never warned of the dangerous, sometimes life-threatening effects of concussion. New helmets are being developed to protect brains better after hard hits. And coaches and players alike are receiving training in how to recognize and treat head injuries.

Concussions can happen anytime there is a blow to the head, causing a jarring or shaking that disturbs brain function.

“The brain is like jello, when jello is impacted it’s going to move within the bowl. The same thing applies for a brain; even if it’s the slightest impact the brain is affected,” said Carrie Jaworski, MD, head team physician for Northwestern University Athletics.

It’s easy to see why prevention and protection are so important—imagine trying to use a helmet to protect a bowl of Jell-O. Even the best helmet won’t keep the Jell-O from getting shaken up. And without a helmet, impacts can do even greater damage. Football players’ heads have at least some protection from those giant helmets; gymnasts’ and cheerleaders’ heads do not.

“Concussions aren’t discriminatory; they affect people of all ages and all activities, even in non-contact sports such as gymnastics or cheerleading,” said Hunt Batjer, MD, chair of the department of neurological surgery at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine. “In fact, young girls may be at a higher risk than boys when it comes to concussions.”

Tips From the Concussion Symposium

Along with the usual academic discussions, the symposium provided some useful tips, too. Some of the information you may find helpful:

• Black outs. You don’t have to black out to have a serious concussion. In fact, most concussions don’t result in any black out, of any length.
• Game-specific signs of concussion. We know the general symptoms of dizziness, confusion, etc. But doctors at the symposium gave specific signs to watch for, which include appearing dazed or stunned; confusion about an assignment or position; forgetting a play; uncertainty of game, score, or opponent; moving clumsily; answering questions slowly; losing consciousness (even briefly); behavior or personality changes; and the inability to recall events before or after a hit or fall.

“If an outgoing and boisterous athlete on your team suddenly becomes quiet or withdrawn, this is a cue that the player needs to be taken out and evaluated. The signs can be very subtle, but if you feel like something is wrong, you need to assume it is,” said Adam Bennett, MD, sports medicine physician at Northwestern Memorial and assistant professor of family and community medicine at the Feinberg School.

• Second Impact Syndrome. Athletes who resume playing too soon after a concussion are at a greater risk for second impact syndrome, which can cause the brain to swell rapidly—a serious medical emergency. This occurs when a second head injury happens before the child recovers from the first concussion. Because the second hit happens when the brain is still injured, it is more vulnerable to additional injury…perhaps permanent, serious, irreversible injury.
• Encourage open dialog. Players need to know that talking about their symptoms is “safe”—that they will be respected for being open about their injury, and rewarded for taking time to heal. According to Dr. Batier:  “Players can shake off pain in the leg, but they should understand that they should never shake off a head injury.”
• Sidelining players. All players need to be sidelined until all symptoms have disappeared—that means not only the obvious physical symptoms of headache or blurred vision, but also normal concentration and resuming normal patterns of eating and sleeping. This could take three weeks…it could take three months or longer. For coaches and parents of youth athletes, this translates to a simple rule:  When in doubt, sit them out.

Also highlighted at the symposium were concussion war stories, such as this one from former football great Dan Hampton, from his years playing professional sports:

“I played during what I call the ‘crash-test for dummies’ period. Players would get hit so hard they wouldn’t even know how to walk off the field,” said Hampton. “I wish these discussions happened back when I played. Today most people are aware of the effects of a concussion, that wasn’t the case when I played.”

That sure sounds like a sport to me. What would you call it?

Well, officially, cheer is not a sport. (And by the way, advocates now prefer the term “cheer” to “cheerleading,” mainly because the nature of the activity has changed almost to the point of being unrecognizable since the early days of pom-poms and calls of S-U-C-C-E-S-S.)  But in July 2010, U.S. District Judge Stefan Underhill ruled that cheer is not a sport because it is “too underdeveloped and disorganized.” I’m not sure what he looked at to make his decision, but cheer is one of the most organized activities around–there are cheer squads in nearly every middle school, high school, and college…participants are taught and coached in standard moves…and the competition circuit is big business.

Why definitions are important

Whether cheer is defined as a sport or as merely an athletic activity has repercussions that go beyond ego. Sometimes it’s a question of available funding from colleges or sponsors, and sometimes it’s about reputation and respect–cheerleaders are admired, but rarely honored for their combination of brains and athleticism.

But even more important is how defining cheer as a sport would affect safety of the participants. A true sport requires coaches to have a certain level of training and certification; a “sport” puts limits on the risks required of the participants; and a “sport” makes training and safety an integral part of practice and performance. Unfortunately, in most schools, cheering lacks safety, limits, and trained coaches. That’s why cheer accounts for more than 65% of of all high school catastrophic injuries, and more than 70% of all collegiate catastrophic injuries. (For the record, “catastrophic injuries” are life changing events, including traumatic brain injury, paralysis, and death.)  Less severe injuries are also common–each year, this sport sends more than 25,000 female students to hospital emergency rooms.

A Cheer Advocate Speaks Out

In June 2010, we posted a blog that listed guidelines to help prevent cheer injuries, as recommended by Frederick O. Mueller, Ph.D., Director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill (UNC-CH). It’s a long list, so we won’t repeat it now, but you can read the full blog here: When Is a Sport Not a Sport?

After it was posted, we heard from one of the all-time great cheer coaches, Rusty McKinley. In his career, McKinley was Spirit Director at the University of Southern Mississippi, followed by eight years as Cheer Advisor/Coach at the University of Memphis. He authored two books:  The Complete Partner Stunt Book and NCA Pyramids. Currently, he is a nationally known and respected expert in the area of cheer safety. (I know he’s going to be embarrassed that I put it that way.) He was even one of the featured interviews in the cheer safety episode of the Emmy-nominated television show Penn & Teller: Bullshit! (season 8, episode 1: Cheerleading).

McKinley reports that the state of cheer safety is worse than most people think. He recently obtained the AACCA Certification–a safety certification from the American Association of Cheerleading Coaches and Administrators. Sounds impressive, right? As McKinley said:

The entire course, 2.5 hours, is dedicated to walking you through the AACCA Manual and highlighting the areas that will be on the Open Book test that follows. No “hands on” experiences are required or tested in any fashion.  The periodic update requires 20 minutes online, again without hands on training or demonstrations.

McKinley has given us a wealth of information about the state of cheer safety, as well as some solid suggestions for how parents, schools, coaches and all the rest of us can help keep these athletes safe from traumatic brain injury and other catastrophes.

This is the first of a 3-part series we’re writing on cheer safety. Part 2 will be posted May 2, 2011 and Part 3 will be posted on May 9, 2011.

Meanwhile, if you have questions about cheer safety, please send them to our researcher, carol@lawmed.com. We’ll do our best to answer them online.

If someone you know has a cheer injury…

To report a cheerleading injury to make statistical reporting more accurate, go to www.cheerinjuryreport.com, sponsored by the National Cheer Safety Foundation. For more information about traumatic brain injury, or to request a legal consultation for a cheer injury, visit our dedicated web page.

If you have questions, HensonFuerst has answers.

1. According to the U.S. Centers for Disease Control and Prevention (CDC), how many people in the United States receive treatment for brain injury every year?

• (a)  1,700
• (b)  17,000
• (c)  170,000
• (d)  1,700,000

ANSWER: (d) And that doesn’t even include all the people who receive a head injury but don’t seek treatment.

2. Is a concussion considered a brain injury?

• (a)  yes
• (b)  no

ANSWER: (a) Anyone who reads this blog knows that concussion is definitely a form of brain injury. In fact, some experts are trying to have concussion called by a more accurately descriptive name: mild traumatic brain injury, or MTBI.

3. Which of the following is NOT a possible symptom of brain injury?

• (a)  moodiness
• (b)  loss of sexual interest
• (c)  slurred speech
• (d)  hallucination
• (e)  difficulty doing math
• (f)  inability to multitask
• (g)  not recognizing your own arm
• (h)  color blindness
• (i)  insomnia

ANSWER: This was a trick question…they are all possible symptoms of brain injury.

4. Which of the following is NOT an appropriate member of a brain injury treatment team?

• (a)  neurologist
• (b)  psychologist
• (c)  physical therapist
• (d)  job coach
• (e)  attorney

ANSWER: Another trick question…all of these professionals are important for improving the medical, psychological, and financial situation of a person with brain injury.

5. According to the National Center for Catastrophic Sports Injury Research, which sport is the number-one cause of brain injury among high school and college female athletes?

• (a)  Gymnastics
• (b)  Field Hockey
• (c)  Cheerleading
• (d)  Soccer

ANSWER: (c) It’s not even close. Cheerleading injuries accounts for about 65% of serious catastrophic injuries.

6. What is the leading cause of traumatic brain injury among all age groups?

• (a)  Motor vehicle wrecks
• (b)  Falls
• (c)  Sports injuries
• (d)  Assault

ANSWER: (b) Falls are the cause of about 35% of all brain injuries for all age groups. Motor vehicle wrecks are the second leading cause of traumatic brain injury.

7. According to the National Institute of Neurological Disorders and Stroke (NINDS), about how much is the lifetime cost for one person surviving a severe traumatic brain injury?

• (a)  about $1 million
• (b)  about $2 million
• (c)  about $3 million
• (d)  about $4 million
• (e)  more than $4 million

ANSWER: (e) The great cost of taking care of a person with severe brain injury is one reason why it is so important to talk with a lawyer who is experienced in handling brain injury cases. You want to make sure the injured person gets all the compensation he or she is entitled to. Covering the costs is next to impossible without financial help. injury.

8. Which of the following are good ways to prevent head and brain injury?

• (a)  Wearing a helmet while riding a bicycle
• (b)  Wearing a helmet while riding a motorcycle
• (c)  Wearing a seatbelt while driving or riding in a motor vehicle
• (d)  Removing or securing throw-rugs in a house
• (e)  Removing snow and ice from walkways, driveways, and outdoor steps
• (f)  all of the above

ANSWER: (f) You knew that would be the answer! Preventing brain injury means being aware of potential trouble areas, taking an abundance of care to keep areas free from fall hazards, and protecting your head while engaging in high-risk activities.

So, how did you do?

If you want more information, feel free to visit our traumatic brain injury page on the HensonFuerst website at http://www.lawmed.com/. Stay safe!

The sport?  Cheerleading.  And compounding the tragedy of injury is the fact that only 20-25 states list high school cheerleading as a sport… the NCAA doesn’t recognize cheering as a championship sport… and unless the number has changed since December 2009, only 3 colleges consider cheering a sport–none in North Carolina. (Statistics from Journal of Athletic Training 2009)

Call a Sport a Sport.

While “recognition” might seem like a minor point, it has major ramifications for safety.  A “sport,” performed competitively and for entertainment, requires strict guidelines to ensure the safety of athletes. In 1980, when cheering was still primarily about leading the crowd in cheers, there were fewer than 5,000 emergency room visits. Today, cheering involves highly skilled gymnastics (as well as being tossed in the air and trusting that someone will be there to catch you).

Without the sanction of being a sport, cheerleaders often have to practice in areas that make injuries more likely, such as an asphalt parking lot or a team member’s backyard.  A “sport” requires coaches to have a certain level of training and certification; a “sport” puts limits on the risks required of the participants; and a “sport” makes training and safety an integral part of practice and performance. Unfortunately, in most schools, cheering lacks safety, limits, and trained coaches.

Gimme an A-C-T-I-O-N.

One of cheering biggest and most vocal supporters is Frederick O. Mueller, Ph.D., Director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill (UNC-CH). The group’s 26th annual report devotes a special section to cheerleading injuries, which describes the current state of cheering as a sport, details specific catastrophic injuries and how they occurred, and suggests sample guidelines that could help prevent cheerleading injuries. As quoted from the report (available here):

“Is cheerleading an activity that leads the spectators in cheers or is it a sport? If the answer is to entertain the crowd and to be in competition with other cheerleading squads, then there must be safety guidelines initiated. The authors of this research question why it is called cheerleading, when competitive cheer has nothing to do with leading the crowds at athletic events in cheering for the athletic teams on the playing field. Following are a list of sample guidelines that may help prevent cheerleading injuries:

1. Cheerleaders should have medical examinations before they are allowed to participate. Included would be a complete medical history.
2. Cheerleaders should be trained by a qualified coach with training in gymnastics and partner stunting. This person should also be trained in the proper methods for spotting and other safety factors.
3. Cheerleaders should be exposed to proper conditioning programs and trained in proper spotting techniques.
4. Cheerleaders should receive proper training before attempting gymnastic and partner type stunts and should not attempt stunts they are not capable of completing. A qualification system demonstrating mastery of stunts is recommended.
5. Coaches should supervise all practice sessions in a safe facility.
6. Mini-trampolines and flips or falls off of pyramids and shoulders should be prohibited.
7. Pyramids over two high should not be performed. Two high pyramids should not be performed without mats and other safety precautions.
8. If it is not possible to have a physician or certified athletic trainer at games and practice sessions, emergency procedures must be provided. The emergency procedure should be in writing and available to all staff and athletes.
9. There should be continued research concerning safety in cheerleading.
10. When a cheerleader has experienced or shown signs of head trauma (loss of consciousness, visual disturbances, headache, inability to walk correctly, obvious disorientation, memory loss) she/he should receive immediate medical attention and should not be allowed to practice or cheer without permission from a physician.
11. Cheerleading coaches should have some type of safety certification. The American Association of Cheerleading Coaches and Advisors offers this certification.
12. The NFHS should make cheerleading a sport, which will place cheerleading under the same restrictions and safety rules as all other high school sports. The NCAA should follow this same recommendation.”

HensonFuerst commends the research and activist efforts of Dr. Mueller and his team. We represent the interests of far too many children and young adults whose lives have been shattered due to head trauma or other catastrophic injury. There are few things in life as heartbreaking as broken potential. We agree that it is time to let recognition and regulations catch up to this fast-moving, physically demanding sport. Yes, sport. Let’s at least make an effort to stop the hemorrhage of young, enthusiastic lives.

To report a cheerleading injury to make statistical reporting more accurate, go to www.cheerinjuryreport.com, sponsored by the National Cheer Safety Foundation. For more information about traumatic brain injury, or to request a legal consultation for a cheer injury, visit our dedicated web page. If you have questions, HensonFuerst has answers.

(Related and interesting articles can be found here: Flying without a net: Cheer injuries on rise. MSNBC and Cheerleading is leading cause of catastrophic injury in young women, ScienceDaily.)

According to an article from the University of California, San Diego Health System:

Sports concussions are especially problematic in those under 18 years of age because of “second-hit” or “second-impact” syndrome. If an athlete returns to play too soon and has not allowed the brain to fully heal, then a second blow to the head could result in a life-threatening situation.

There is an organization that has launched an educational campaign to raise awareness and promote prevention of injuries in young athletes. STOP Sports Injuries was created by a coalition of organizations, corporations, and medical professionals. (The all-volunteer medical steering committee includes Dr. David Martin of Wake Forest School of Medicine in Winston-Salem, NC.)

The website offers educational tools for parents, coaches, athletes, and healthcare providers…concussion and injury-specific information…and injury prevention resources for specific sports, including baseball, basketball, cheerleading, dance, running, soccer, and many others.

Check out the site: http://stopsportsinjuries.org. The brain you save could be your own… or your child’s.

HensonFuerst Attorneys remain committed to combating brain injury. We are proud supporters of the Brain Injury Association of North Carolina (BIANC). If someone you love has suffered a brain injury and you are wondering what to do next, give us a call. If you have legal questions, HensonFuerst has answers.