There is no skill in manual therapy…?

Physical therapists have a vast toolbox of skills to help improve someone’s ability to move. Within that toolbox may be exercise techniques, Pilates, Redcord Neurac, dry needling, other manual therapy techniques, taping, tapping, yelling, cheerleading, lecturing, parenting, inspiring, and mentoring. The truth is, despite what any studies say or any expert will tell you, there is probably not ONE best treatment for any young athlete. I will say no more because Adam (@thesportsphysio) who I follow on twitter really just summed it up best. I’ll let him do the rest of the talking…

The Sports Physio

I’m guessing if you are reading this then you are probably a manual therapist, and probably a little pissed off with the title of my blog that’s just called into question your skill, training and experience! But before you ‘blow a fuse‘ and decide to get all ‘medieval on my arse‘ in the comments section, please hear me out and continue to read on a little further!

So a few weeks ago, just for a change, I posted a controversial tweet that said “There is NO technical skill needed in ANY manual therapy. Except for red flag/safe application”

It had a mixed response, some agreeing, some disagreeing and the odd smart arsed remark. So I thought I would expand on this a bit more and explain my reasons for saying this, why I think this way and of course, as always, some evidence to back…

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How young is too young for dry needling?

As a physical therapist practicing in Georgia, I have the privilege of being able to use the skill of trigger point dry needling to help patients with myofascial pain and dysfunction, joint stiffness issues, acute and chronic injuries, tendon problems…the list goes on.

Working with a majority of younger patients, I often get questions like “Do you dry needle kids? What’s the youngest patient you have needled? Will my 10 year old benefit from needling like I have?” Those are all good questions. Before I answer them, I think we should cover a little background on this whole needling thing.

What is trigger point dry needling?

In a nutshell, dry needling is a form of manual therapy where the physical therapist or other trained practitioner inserts a solid filament needle into a trigger point in a muscle. This may stimulate a local twitch response in the area, creating a cascade response that ultimately results in a release of the trigger point…or at least that is what we believe happens.

While there is growing evidence for the effectiveness of trigger point dry needling and several studies on what is happening during the technique, the reality is that nobody knows exactly what happens during each treatment in each person. We just know it works and have seen it work time and time again. We believe that the response may be chemical, neurological, mechanical, all of the above, or some of the above. This may vary from place to place between patients or even in various locations within the same patient. Or perhaps it’s a higher order sensorimotor experience change in the brain’s cortex–which I suppose would technically be all of the above depending on who you ask. Either way, there can be great changes that when used in adjunct with other physical therapy tools, pave the way for the patient to see outstanding functional changes.

If you’re still not sure what dry needling is, I recommend you visit these websites for some information:

Back 2 Motion Physical Therapy Patient flyer

Kinetacore Physical Therapy Education

Myopain Seminars

MoveForwardPT.com

Is dry needling the hot new thing in physical therapy? Why have I never heard of it?

In some places and in some schools of thought—yes or no. In the grand scheme of the constantly-evolving practice of physical therapy, dry needling is the new kid on the block in many states and in many areas of PT practice. You may not have heard of it because while most physical therapists possess the skills to do it, not all 50 states allow them to do it yet.

Where is dry needling performed by physical therapists?

What physical therapists can perform trigger point dry needling?

Currently, dry needling requires advanced training beyond the realm of entry-level doctorate level physical therapy education. It is recommended that new graduates wait a year or so to begin training in this practice as good performance of dry needling requires more advanced skills. While new graduates have many excellent skills, the decision-making and safety behind dry needling takes extra time to develop the “finesse” of performance.

Is dry needling the best physical therapy treatment out there?

That is all a matter of opinion. But generally-the answer is probably that there is not one BEST physical therapy treatment out there. Don’t get me wrong-dry needling is one very helpful tool for many patients, but it is not THE tool. In states where dry needling is not legal for PTs to perform, patients see great results with a plethora of other treatment options. Not being able to perform dry needling does not make a clinician any less skilled; likewise, being able to perform dry needling does not necessarily make someone more skilled. It’s just an additional skill to add to the “PT skill toolbox.”

What’s most important are the “above the neck” skills of decision making, assessment, clinical reasoning, and finding the BEST treatment option for EACH patient that allows him or her to optimize the ability to move. See great recent blog about this here. This ability requires a good balance between manual therapy/dry needling, functional movement assessment and re-education, strengthening, stretching, and the good old fashioned teaching and learning interventions my patients lovingly call “Julie’s Sermons.”

So now that we’ve established what it is, where it is, who can do it, and how it fits into PT practice, I can move on to the question I know you’ve all been asking…

But Julie…do you needle KIDS?

My answer is usually something along the lines of “Well, it depends on your definition of kid.See my first post in this blog to understand my definition of kid. Some “kids” are 44 year old elite athletes who cry like babies when I so much as mention the word “needle.” Some kids are 11 year old elite gymnasts who come in begging for needling and swear it is the one thing that keeps them competing at Level 9.

In general, I tend to look not at chronological age, but a plethora of other contributing factors. This requires the need to use all of my senses to determine just who is the right candidate. One could argue that this rule applies to any patient of any age. Chronological age is one factor. Other factors include emotional stability, emotional and cognitive maturity, education level, personal pain experience, activity level, overall/general health, and tendency to faint or scream at the topic of needles.

So, it’s complicated. If you’re looking for an age “limit” recommendation on dry needling, you’re reading the wrong blog. What I can definitively tell you is maybe you want to steer clear of the super young children. Maybe under 6. Then again, I’ve heard from colleagues that it’s been done on younger kids before, as have trigger point injections performed by some of my physician colleagues. It’s just not black and white.

What I can also tell you is that as of this blog posting date, the oldest patient I have needled is 82 and the youngest is 11.

See this resource from a few pediatric and adolescent sports medicine experts on the practice of dry needling in this population.

Let’s dissect a few of these factors to determine which kid is the right needling candidate.

Emotional stability and maturity

I am not going to lie to anyone. Dry needling can be a little uncomfortable. In general I find that anyone who is not in an emotional place where some discomfort can be tolerated may not be the best candidate. On the other hand-some patients can be fearful of movement/exercise and prefer the security and relief that needling brings after treatment, despite discomfort. Sometimes it’s just emotionally easier when passive treatment is performed on them. They can get a little emotionally attached to the technique. This can be a problem too.

Kids and teenagers—and even adults–can be afraid when it comes to medical interventions. Fear and anxiety can sometimes improve with some coaching and the patient will eventually agree to try dry needling. Others are totally emotionally on board, and then it maybe didn’t live up to their expectations—so they jump ship and ask to not have it performed again. See what I mean? It’s complicated.

Cognitive Maturity

“Wait so, you’re telling me this may be uncomfortable. Remind me again how doing something that’s uncomfortable is going to make me feel better?” To some kids, particularly younger kids—this concept is not even an approachable topic of conversation for me. From a cognitive maturity standpoint, some kids just haven’t developed the ability to discern the “later” benefit of doing an uncomfortable “now” treatment. I general I see that in many kids this improves from age 9-11. But then again-it really just depends on the kid.

I also find—and this is my TOTAL anecdotal experience—that sometimes the more the parent is on board with the kid having the technique done, the less the kid is willing to try it. There are many exceptions to this. Some kids and teens do exactly the opposite of what the parents recommend. Most parents would probably agree this concept isn’t exclusive to physical therapy sessions! In other cases, the parent says “poke him” and the kid says “let’s do it!”

But—I use some definite discretion here. Bottom line: I have a strict rule that I must get a resounding YES from the kid or teen before I glove up and pull out the needles. An “I guess” or “Whatever my mom says” just won’t cut it. Sometimes it takes kids a few sessions to warm up to it. Sometimes we try it and it doesn’t really seem to help—largely because I don’t believe they truly understand what I’m doing. The good news is we have so many other interventions we can use that sometimes we don’t even need to go through with needling.

Education level

It’s important any patient be at an education level that they can understand the basic concepts of benefits, risks, alternatives, and outcomes required of an informed consent. Generally, most kids at about 8th or 9th grade can handle a mature discussion on the pros and cons needling without a lot of parental intervention.

What I find often is that the patient who is not WELL educated on medical procedures, but ALMOST well educated is the biggest threat to dry needling candidacy. These are kids who are super smart and have done a little research on their own. Perhaps they have consulted Google, their high school anatomy class, or just talked to friends. Needless to say—they thought that because they knew the name of one muscle in the vicinity of their injury or pain, that it MUST be the muscle that needed to be dry needled.

And kids can be very black and white about it—believing dry needling is the only thing that will fix it. Kids can be very smart, but let me remind you about cognitive and emotional maturity. They generally don’t develop their higher level processing and abstract thinking skills until late high school, college, or even mid adulthood. Some people never develop it. So they firmly believe that putting a needle in the muscle will immediately fix their problem that has been going on for months.

Anyone who knows me knows that this is not quite how I operate, nor how I believe humans operate. I am not a one-and-done type of physical therapist. I get down to the source of WHY that muscle is affected due to how the patient moves or how the patient believes he or she should move. Address that first and see if the trigger point is still there later. Then we’ll talk about putting needles in the serratus posterior inferior. Yes, someone asked me to specifically do that and no, I’m not trained to put a needle there.

(End rant)

Personal pain experience

Someone call Lorimer and David. They can explain this part way better than me, but I’ll take a stab at it (pun intended). I could probably go on for days about how a person’s experience with pain is highly individualized. Some people get a hangnail and it is the most painful thing they’ll ever describe. My good friend just gave birth to a nearly 9 pound kiddo without the use of drugs or any intervention. She didn’t say it wasn’t painful, but she certainly lived to tell about it with a smile on her face. I’ve seen 15 year olds burst into tears when I told them I was not going to needle the tiny knot in their back muscle because I did not believe it would be beneficial.

Pain is emotional.

Pain is an output from the brain. See this post to explain that further or the video below to understand pain better.

For some, dry needling is a valuable tool to help people navigate through nociception, central sensitivity, blurred sensorimotor maps, freaked out “protectometers,” or any other great descriptions for that thing we call “pain.” Some people look at you like you have 10 heads when you recommend dry needling. Some are completely convinced it will not help them, while others call themselves “dry needling evangelists.”

For kids, a large part of why I haven’t gone younger than 11 years old is that GENERALLY (not the bold and italics there please) speaking, most kids are healthy and do not have a lot of experience with pain. Generally, pain at this age is highly driven by emotion, fear, and a lot of internalizing of parents’ experiences with pain. Simply put-most kids learn how to cope with pain based on how other family members and their culture breeds them to cope with pain.

Having said all of that—in any person who has very little experience with pain, an injury is often treatable without a lot of passive or manual intervention. I’m not knocking the value of these therapies, but most of these people have not yet learned that “someone else can fix this for me.” They’re open to doing exercises and not afraid of moving. For a few fearful patients, a lot of times we may do manual therapy and/or needling to coax them back into movement. They’ve had pain for so long or on so many instances that they no longer know “which way is up” so to speak. They don’t know what helps or what hurts them, so they just assume avoid all movement and opt for passive treatment.

Needless to say, pain can be very individualized. Even in kids. We have to determine who is the right candidate based on our interpretation of his or her individual pain experience.

What other factors might a PT consider?

Generally, I encourage all patients to start or maintain a level of physical activity. I try and minimize the amount of time that I perform treatments on the patient. The patient is with me maybe 2 hours a week and with themselves (7 X 24)-2 hours. That’s a lot of hours out in the world by themselves. I tell all patients that “movement is medicine.” I’m not expecting my patients to go run a marathon, but everyone has to do something. Kids included. Most kids are pretty active, but some aren’t. I find that age is not a factor here. If a kid is not active, he or she will probably not respond well in the long run to dry needling or to any other interventions. They must learn to take an active approach to caring for themselves.

As for fear of needles: if someone is legitimately terrified of needles-we don’t even go there. This is a screening question I ask all patients when approaching the topic. This can be an issue in kids, though I often find that adults are more afraid of needles than kids. Kids have to get shots all the time for school and have yearly well checks, so they aren’t strangers to needles. Some people just need a little coaching to be ok with needling, while others will tell me the second they find out that we do dry needling that we will NOT be trying this.

Lastly…what caused the trigger point in the first place? Are trigger points really all that bad?

NO! Trigger points happen in everyone. They can be angry little creatures, but they don’t always have to be the problem. Oftentimes they are the result of poor movement strategy. I know several physicians who have learned that dry needling can help patients and refer patients to PT “Just for dry needling.” They are shortchanging the patient when they tell them this. The patient comes in with the understanding that dry needling will fix their problem. What most physicians aren’t trained to do is analyze and retrain movement. And that’s not anything against their exceptional skills. That’s just not a huge part of medical school, residency, and fellowship. That’s part of PT school and advanced PT training.

So, does my kid need dry needling or not?

While there may be exceptions, typically the younger patients (7-13) do not necessarily need dry needling as the first line of defense. Typically, even with the elite young athlete, we do all sorts of kid-friendly and sports-friendly therapy and the kids get better quickly. Sometimes it’s just a matter of quelling their fears and showing them that a little heel or knee pain can get better with some education, strengthening, and proper retraining.’

National Cheerleading Safety Month: Why it Matters (Part 2)

Now that we’ve established cheerleading as a sport, why does it matter to sports medicine?

My point in painting this picture in Part 1 of cheerleading-as-a-sport is not because I want to see cheerleading in the Olympics. It has nothing to do with my former 6th grade dreams to become a cheerleader. There is the bigger issue. At the end of the day, as with all other sports, cheerleaders get injured. The more participants and complex skills that are required for participation, the more kids will get hurt.

Just as with any other athlete, we are all faced with having to understand cheerleading so that we can rehabilitate them back to their sport. Or better yet—prevent the injuries in the first place. Part of understanding a sport you’ve never done is taking the time to learn about it. So I’ve been to cheer practice, a competition, got the team t-shirt, and have been doing some bedtime reading. I’ve been completely out-tumbled by a 6 year old, too.

According to Shields & Smith (2009 and 2010), some of the most common injuries in cheerleaders (of any variety) are ankle injuries, knee injuries, and low back injuries. When humans have to lift other humans overhead, there is going to be a risk of falling. Either the lifter (known as the “base”) or liftee (known as the “flyer”) could be injured as a result of a flying human failure (that’s a technical term, by the way). Shields & Smith showed that up to 52% of all injuries in competitive cheerleading happen during stunts, up to 24% occur specifically to the base/spotter, 15% from tumbling and 14% from traumatic falls of the flyer. That’s a lot of flying human failure.

In addition to stunting and tumbling skills, the surface on which these athletes cheer may vary from grass to spring floor, resilite (foam) to hardwood floor. The same 2009 study mentioned above showed that 34% of competitive cheerleading injuries occurred on foam floor and 30% on spring floor. The diversity in competition/performance surface literally impacts an athlete’s ability to perform certain skills and has the potential to place undue strain on certain areas—putting them at greater risk for injury. A different study by the same researchers showed marked differences in risk for head injury in cheerleading stunts performed on various surfaces, with higher height of stunt and lower impact-absorbing surfaces leading to greater risk for injury.

Patients of mine have ranged from the competitive cheerleader with a traumatic ACL tear or ankle sprain, to the sideline cheerleader with a stress fracture in the back from improper base and tumbling mechanics. I’ve seen flyers who have fallen from a stunt with severe concussions. I wrote about concussion in cheerleading last month, and the CDC has some great educational information and athlete stories out to spread the word, too.

Last month I began working with a 15 year old high school cheerleader/tumbler who very eloquently told me the reason for her injury was “because I don’t tumble or base with the right form.” Not only was I impressed that a 15 year old identified the root of her problem, but she identified a risk factor that Shields & Smith (2009 and 2010) have shown to be the biggest predictor for injuries in bases. Remember how I mentioned in Part 1 how impressed I was with the University of Kentucky base body mechanics? I take notes for my patients. This is part of what we make sure our bases can do before they can return to cheerleading after injuries. Check out this photo of great base mechanics being taught in 4-6 year olds. Great coaching from an early age instills great injury prevention for the future.

Great body mechanics, coaching & spotting at Stingray All Stars (4-6 year olds) in Marietta, GA

Great body mechanics, coaching & spotting at Stingray All Stars (4-6 year olds) in Marietta, GA

So what do we do in PT? I find that generally for all cheerleaders, no matter what their position or role, the treatment plan mirrors the same plans that I use for gymnasts, divers, or even pole vaulters with similar injuries. The only difference is that for several sideline and all star cheerleaders, we also have to train the skill of avoiding flying human failures.

It is unfortunate to be injured, but fortunate when a young cheerleader ends up in physical therapy. I see it as a great educational, rehabilitative and prevention opportunity to keep a young athlete active and engaged in the sport he or she loves so that he or she can move into a healthy and active adulthood. I love a good challenge and love being creative with my PT skills to develop cheerleading-specific programs to help these young athletes get back to their sports.

I use some cool tools like Pilates apparatus and Redcord Neurac to design kid-friendly and cheer-specific exercises while educating on alignment, spinal mechanics, central stability, breathing mechanics, and all other “typical” concepts I teach to other tumbling and flying patients. If you want to read more about other “core” ideas I incorporate into my young tumbling and stunting athletes, visit this blog or check out this video from my PT colleague Julie Wiebe in Los Angeles.

Unfortunately, many young and even collegiate level cheerleaders do not often make it to a medical provider. In fact, the same 15 year old I mentioned above was injured then immobilized for 6 weeks. That’s a long time to not move a body part, folks. Had her mother not brought it up in conversation with me one day, she would have returned to cheerleading without correcting the imbalances and poor mechanics that likely led to the injury in the first place. As I mentioned, even she knew her mechanics were an issue. They had to ask to be referred to physical therapy. It shouldn’t happen that way.

The disconnect in sports medicine: why cheerleaders don’t get the right care

Why is it that cheerleaders do not regularly receive medical attention? Due to the fact that several sport governing bodies like the NCAA, AAU and sports medicine governing bodies like the ACSM and NATA do not always recognize cheerleading as a sport, cheerleading does not receive money nor sanctions to create a standard set of rules and standards of medical care. It is not heavily researched, though several small groups of researchers have begun to explore this concept. The American Academy of Pediatrics released a position statement on cheerleading. The STOP Sports Injuries campaign also has begun with cheerleading advocacy & safety campaigns.

Most cheerleading competitions are not held in traditional athletic venues; rather they may be held in large convention centers which may not be designed to support emergency medical needs. It is rare to hear of athletic trainers covering cheerleading events and competitions, or for a cheerleading squad to have their own team physician. Without recognition by national and/or international sports and sports medicine governing bodies, there is no requirement for standardization of safety and care.

Enter several of the national cheerleading safety organizations which have formed over the years. Some have been formed by parents who see the need for awareness and advocacy for their young athletes.  It’s not perfect, but it’s definitely a start. See links to some major cheerleading safety organizations below:

American Association of Cheerleading Coaches and Administrators (AACCA)

National Cheer Safety Foundation (NCSF)

United States All Star Federation (USASF)

These organizations are not necessarily unified. Each has different rules and standards for competition and performance and they have different governing “roles” for each type of cheerleading. The spread of leadership and rules contributes to confusion of “who’s in charge” and requires a very diverse skill set in coaches and in athletes.

As we move along the chain from national organizations into the various forms of more “local” cheerleading, including high school, middle school and recreational leagues-there is even less organization. Some school systems include cheerleading as a varsity sport, while others call it a “club.” In college, some schools offer varsity scholarships for competitive cheerleading, while at others it is not recognized as a varsity sport. The NCAA Injury Surveillance survey, an ongoing project chronicling incidence and risk factors for injuries in 16 collegiate sports does not include cheerleading in its study of collegiate sports. This means that these athletes may not be covered nor managed by the school’s athletic training and medical team. They may not be required to undergo preseason physicals or baseline concussion testing, two key injury prevention checkreins. At the end of the day—there is no standardization of rules and care. This leads to an overall problem of funding for research, prevention programs, and management.

In summary, without all of this information, people just don’t know the right way to handle cheerleaders. It’s a safety issue.

What do we do about this?

So what do we do about this? We have to change our language and understanding. There is no use in denying it as a sport. What does one gain from doing this? Does it make one feel like more of an athlete to say that someone else isn’t an athlete? A 2004 study showed that the Vo2 max, body composition, strength & endurance of collegiate cheerleaders rivals that of other collegiate athletes. They’re in shape, they are performing feats that require a high level of athletic skill, and they deserve the same wellness and prevention attention of other athletes. With the number of cheer-related concussions and injuries on the rise, it’s just not worth the risk of ignoring it at this point.

anna-watson-11

To be fair, the cheerleader on the right is a competitive body builder. Impressive! http://nationalconfidential.com/2014/02/anna-watson-photos/

The AACCA is one of several organizations offering a credentialing process for cheerleading coaches. While there are likely many non-credentialed skilled and talented coaches out there, it is generally accepted credentialing protects the consumer—in this case the athlete and family. It improves safety awareness, injury prevention/management, and standardization of coaching and level progression protocols. While there has been conflicting evidence to show the relationship between coaching credential and injuries, a 2004 study in North Carolina high school competitive cheerleaders showed a 40% decrease in cheerleading injuries when credentialed coaches were present. I am a firm believer that a credential does not guarantee skill. However, it does show a commitment to the betterment of a profession and a sport. Find a credentialed coach near you.

In the case of the young cheerleader, this is something that runs rampant on my caseload—and I blogged earlier this year about how am seeing injuries and early specialization in sports from increasingly younger ages. Some of that is parent-driven, as described in this post, but some of it is culture-driven. Early specialization leads to injuries. It’s a problem. But on the flip side-there has to be a balance. Our kids need to stay healthy and active, and sometimes early participation and specialization in a sport is a way to do that.

Ride the cheerleading safety and prevention wave with me! You just might get to wear a cool shirt like the one below and support one of the fastest-growing athletic activities for young athletes.

Disclaimer:

Out of respect for all sports, the comparisons made in this post were not meant to downplay or discount the hard work or dedication of athletes in any other sport or activity. In addition, this was not meant to be an exhaustive post about all factors which contribute to sports injuries in cheerleaders. Be on the lookout for future posts that highlight additional issues in these and other athletes. I welcome your feedback and thoughts for future ideas.

 

Rah! Rah! It’s National Cheerleading Safety Month! (Part 1)

Welcome to National Cheerleading Safety Month!

Wave your pom poms, do a few jumps and leaps, and get excited for this marvelous awareness campaign!

duke cheerleader

Photo credit: goduke.com

For anyone who knows me, you may wonder why in the world I’ve decided to blog about cheerleading safety. I’ve never been a cheerleader. In 6th grade when every single one of my female friends was signing up for recreational cheerleading—the penultimate way to become popular and gain friends in middle school—I was qualifying for travel swim meets to California and Orlando. I went to Disney on both coasts in one summer. Let me tell you, I really suffered at making friends. Regardless of that, I still felt a little left out at the time from this seeming rite-of-passage activity for many young ‘tweens. Nowadays we call this a #firstworldproblem.

So why do I care? Perhaps it’s because a friend of mine has a high-flying-tumbling-and-stunting fanatic 6 year old who can pull off some pretty fancy skills. Or maybe it’s the plethora of cheerleaders I have treated over the past few years for a plethora of injuries and problems. While I’ve learned there are many types of cheerleading, there always seems to be a common denominator among their injuries: no one definition for the sport, leading to no unified standards for safety, and subsequently increased risks for injury.

So let’s just start with one fact: Cheerleading is a Sport.

There. I said it. Did you agree with me? Roll your eyes or shudder at the thought of considering it a sport? Vehemently disagree? Still on the fence? If you answered yes to any of those, then please humor me and proceed.

By calling cheerleading a sport, it would imply that I’m lumping all types of cheerleading into the same category. Yes, I do realize there are differences. Keep reading.

The cheerleading “purists” out there might argue that sideline cheerleading is not the same as all star or competitive cheerleading. You may be thinking “well MY KID does the athletic type of cheerleading. Those other kids who stand on the sideline: that’s not a sport.” Some types of cheerleading require higher levels of athletic skill and teamwork than others. But for the sake of argument and keeping me from writing 4 separate blog posts, let’s just put them all together.

On the contrary, some cheer “haters” would throw out every excuse and argument in the book to support the “cheerleading is NOT a sport” campaign. Some have even blogged about it, asking “how dare cheerleaders compare themselves to LeBron James?” I’m not sure anyone is actually comparing cheerleading to LeBron, except perhaps the author of that post. That’s like apples and oranges. Both are fruit, yes, but there really is no comparison. Both cheerleaders and basketball players are athletes, yes, but comparing is futile. If I could figure out the reason anyone would spend his or her time arguing against cheerleading as a sport, I think it would solve the meaning to life. Did cheerleading wrong you in some way? Did it trip you in middle school or steal your lunch?

I’ve heard that girls (and guys!) who jump and clap for another sport are not, in fact, participating in their own sport. Who cares if the sport is in support of another sport? Take cheerleaders who cheer on football players, for example. They jump for 2-3 hours, dance, lift each other up overhead, tumble, and perhaps perform a well-choreographed routine for several minutes at halftime. A casual observation would see that some cheerleaders—even the sideline ones—do more on their feet than the 4th string benchwarmer. I’m not knocking the freshman who is anxiously waiting for play time, but I’m just sayin’…the cheerleader is burning more calories than you dude.

Let’s look at it another way. How great it is that two sports are put together for an overall end result of everyone-gets-a-workout and everyone-works-as-a-team? What a marvelous concept! You go to a football game and also get to watch cheerleading. That’s two-for-the-price-of-one, folks. And who doesn’t like a good BOGO deal? Perhaps we should rephrase and say you’re watching cheerleading and as an added bonus, there are guys in funny padded costumes knocking each other over in the background. Depending on how your favorite football team’s season is going (or not going), you may prefer to spend your season ticket money watching those tumblers and stunters.

Then there’s the “costume” argument. I’m going to just call it like it is. If you’re going to argue anything about the appearance of a cheerleader having anything to do with it being a sport or not, I’d urge you to reconsider. I’ve heard the phrase “Girls who wear barely any clothes, wear makeup and glitter are not athletes.” So how do you explain gymnastics? Have you SEEN the hair spray, makeup, glitter, and lack of clothing in gymnastics? If you haven’t, take a look at the photos below.

Have you been to a swim meet lately? We all used to joke about girls who curled their hair and put on make up just to dive in the pool and mess it all up. Then they’d go re-do their makeup in between events. And last time I checked—swimmers don’t wear ANY clothing. Don’t even get me started on the “acceptable” amount of swimsuit wedgie. Let’s just say that we all knew who THAT girl was who crossed the line (literally) in her Arena suit. She always swore that’s how they’re worn in Europe. And we won’t even discuss guys in racing Speedos.

Skilled runners all over the world wear spandex shorts that barely cover their bums and sometimes up top they wear only a sports bra. Last time I watched the Olympics even the male runners had on jewelry and the female runners had beautiful hairstyles and wore makeup. Don’t believe me? Check out this blog on “What Professional Runners and Prom Queens Have in Common”.

Mackey-Trailing-Rowbury-Trials

Shout out to Duke ’06 runner & 2008, 2012 Olympian Shannon Rowbury! Photo credit: http://www.donidexter.com/blog/2012/07/02/womens-1500-meter-semi-finals-olympic-trials/

Makeup, glitter, and barely any clothes are just part of the pedagogy in most of these activities. It’s what helps them function in their roles. Visualize an Olympic sprinter in full football gear, or a gymnast in a helmet or elbow pads. Gotten a good mental image down? Just wouldn’t have the same effect, now would it?

Next argument. If an activity has organized practice, requires conditioning, stretching, strengthening, coaching, hydration in between exercises, stresses someone’s cardiovascular reserve—is that not an athletic activity by any other name? Then you add the judging and scoring associated with all star cheerleading—and now you have an athletic competition.

There are the artistic and skill components of choreography and tumbling in cheerleading. Wait! Gymnastics has choreography and tumbling in the floor routine! Interesting! Some may argue that a “subjective” activity like gymnastics or diving with a scoring system is not really a sport or game. I’d like to see you practice gymnastics for 20+ hours per week and tell me you’re not doing a sport. Tell Gabby Douglas she’s not an athlete. Let me know how that goes for you.

In addition, there’s synchronized swimming and one of my favorites- the new Olympic sport of synchronized diving (shout out to Duke Women’s Diving Olympic Silver Medalist Abby Johnston, by the way!). Both have choreographed tumbling-esque components. Oh, and check out the makeup and costumes in synchronized swimmers. Minus the whole don’t-drown-while-dancing-upside-down-underwater part, how is synchronized tumbling in cheerleading any different?

Let’s layer on teamwork. The amount of teamwork required for cheerleading stunts is impressive if you have ever seen a competitive cheerleading routine. This level of teamwork and coordination is present in other activities we call “sports” including rowing, soccer, basketball, and football. And no, if you think I’m being the pot calling the kettle black– I’m not comparing University of Kentucky Cheerleading to the Miami Heat. I’m just making a point on teamwork. So, if sports require teamwork, then I would presume that cheerleading should fall into the sports category, correct?

But wait! Some of those sports I mentioned are games. Cheerleading is NOT a game, right? So what is a game? According to the University of Google, a game is a “form of play or sport, esp. a competitive one played according to rules and decided by skill, strength, or luck.” By that definition, I think we can call cheerleading a sport, athletic activity, and I would go so far as to call it a (gasp!) game.

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Stingray All Stars Grape Rays. Photo credit: https://twitter.com/Grape_Rays/status/348063948752449537/photo/1

Unlike the similar activities of gymnastics and diving that I already mentioned, there is one element of cheerleading that makes it unique. Weight lifting. Let me clarify. This is not CrossFit Cheerleading. By “weights” I mean humans. Now that’s some high-risk weight lifting. While I completely respect (and love!) diving and gymnastics, neither of those sports requires humans to lift other humans in a completely well-timed choreographed routine. Then there is the comparison we could draw with weight lifting and throwing. Do you see Olympic weight lifters dead lifting another weight lifter? No. Do you see the javelin thrower launching another human into the air? No. Come to think of it, the entertainment behind both of those ideas might actually get me to watch them on TV.

So in summary—if cheerleading is not an athletic pursuit, sport, game, or whatever term you’d like to use, then I feel I’ve been misinformed for 30 years about what IS a sport.

Still not convinced? Check out this video. These collegiate cheerleaders (arguably the best in the nation) have earned the title of “sport” in my book. I might also add that I’m ridiculously impressed with the body mechanics of the bases. They make it look easy. Read on to Part 2 to find out why basing body mechanics are important and why cheerleaders, like all athletes, need good safety awareness, sports medicine care, and research.