Written by Gregory B. Gullung, M.D., of OrthoAlabama Spine & Sports
Cheerleading and gymnastics are high-intensity, high-stakes sports that require an immense amount of strength and flexibility to successfully execute stunts. Taking these factors into consideration, it is not surprising that gymnasts and cheerleaders get injured as often as they do. We see a range of orthopedic injuries in these athletes that can keep them off the mat.
Muscle Strains
Muscle strains are stretches in the tendon or muscle that can result in a spasm. Typically, strains are caused by a sudden and forceful motion and can occur in the ankle, knee, wrist, lower back and neck. A cervical strain, such as whiplash, is one example of a common strain found in the neck. For cheerleaders and gymnasts, much of their activity requires a certain amount of flexibility, and the twists and turns in the air can also play a role in lower back strains.
Getting a muscle strain can keep you from your sport for weeks. Taking a few extra minutes to stretch and warm up can make a difference. Other prevention habits include cross-training to strengthen muscles, eating foods high in potassium before a workout and proper hydration during exercise.
If a muscle strain does occur, treatments for this type of injury include rest, gentle stretching and alternating heat and ice at the location of the injury. Physical therapy may also be an option to identify weaknesses and muscle tightness that could affect capabilities during your sport. After identifying these issues, a therapist can then work with the athlete to strengthen their core muscles and directly target potential concerns. Alternatively, some back issues for cheerleaders and gymnasts can happen over time, including lumbar hyperextension.
Lumbar Hyperextension
Lumbar hyperextension is a common overuse injury that can affect athletes who frequently do backbends, back handsprings, flips and other related activities. When an athlete has lumbar hyperextension, the lower spine is bent backwards or arched beyond the normal anatomical position. This kind of injury can damage the bones and nerves in the back, leading to other complications.
To prevent this condition, stretch the hamstrings before and after activity, allow for adequate warm-up and cool-down time, and when learning new skills, take it slow and ease into the full speed of your new skill. Having an overall awareness of your body and staying proactive can have a major impact on avoiding lumbar hyperextension.
The severity of this injury can vary, so the approach and type of treatment will depend on the specific situation. If recognized early, simply icing the area, getting plenty of rest and immobilizing your spine will help relieve the pain. If you are experiencing back pain, it is time to stop. Do not continue until you have had rest; otherwise, more serious issues can arise. Athletes who do not take this advice can develop a more serious issue called spondylolysis.
Spondylolysis
Spondylolysis is a type of fracture that happens in the lower spine. More specifically, it is a stress fracture in a section called the pars interarticular in the lowest vertebra. The pars interarticular is the segment of bone that connects the sacrum (the bone that stabilizes the pelvis) to the disc at the bottom of the spine. It plays a key role in keeping your entire body aligned.
This condition is typically caused by overuse or hyperextension, but genetics may also play a role. It is very common, occurring once in every 20 people, and does not always show symptoms or symptoms may be minor. If this is the case, the only symptom is lower back pain that gets worse with exercise and leaning backward, but it does not affect daily activity. Athletes experiencing lower back pain for more than two weeks should see a doctor, as this condition could be even more serious than perceived.
To prevent this lower spine fracture, limit participation in sports, keep your back and abdominal muscles strong, use proper equipment and techniques and warm up before activity.
Treatment for spondylolysis includes refraining from bending back for several weeks or months, physical therapy, wearing a back brace and pain medication. When these treatment methods have been exhausted or if there is injury to a nerve, surgery may also be an option. When spondylolysis goes untreated and unacknowledged, it can cause a vertebra slippage referred to as spondylolisthesis.
Spondylolisthesis
For spondylolisthesis, the pars interarticular fractures so badly that it breaks and causes the vertebra to slip forward. The broken bone is called a pars defect. Over time, spondylolisthesis can result in developing a narrower spinal canal, chronic pain or spinal deformity.
The most common causes of this condition are severe fractures, congenital or developmental anomalies at birth, degenerative changes and bone disease.
Preventing spondylolisthesis is similar to preventing spondylolysis. Rest when you need to, do exercises to keep your core strong, warm up adequately and use the correct equipment and techniques.
If you do get spondylolisthesis, there are various nonsurgical and surgical treatment options based on the situation. The patient’s age, overall health, the severity of symptoms and degree of spinal slip could have an effect. For some, nonsteroidal anti-inflammatory medication, back support with a brace and physiotherapy are ideal. For others, surgical treatment is necessary.
Typically, two operations are performed to treat spondylolisthesis: decompression laminectomy and spinal fusion. During decompression laminectomy, a surgeon will relieve nerve pressure by removing the bone. Spinal fusion is when a surgeon joins two or more vertebrae together, stopping the vertebra from further slippage.
Though common in gymnastics and cheerleading, hyperextension-related pain is not the only condition causing low-back pain—sacroiliac joint dysfunction also plays a role.
SIJ Dysfunction
Dysfunction in the sacroiliac joint, or SIJ dysfunction, is known to cause low-back pain, leg pain and inflammation due to overuse. Pain can affect one side or both sides and may be accompanied by numbness, weakness, tingling and feelings of leg instability. The sacroiliac joint sits toward the bottom of the spine, connecting the ilium bones (hip bones) to the sacrum.
For athletes, this condition is caused by unconditioned low-back and/or pelvic muscles, landing on one leg, falling, landing a tumbling pass short or prior low-back surgery.
The prevention of SIJ dysfunction starts with good posture and a neutral spine position. Athletes should also focus on exercises that strengthen their core and hips. Check in with other cheerleaders or gymnasts to have them observe your technique on various stunts. Good technique from the start can prevent falls and, in turn, prevent injury.
Some cases of SIJ dysfunction will get better with time, rest and alternating heat and ice. Other situations may need more attention with anti-inflammatory medication, sacroiliac joint injections or treatments for hypermobility. A sacroiliac joint that is hypermobile, or stretches further than normal, may require treatments like supports or braces, gradual physical therapy, low-impact aerobic exercise, water therapy or manual manipulation from a chiropractor or other qualified practitioner.
In both gymnastics and cheerleading, athletes can reach new heights with careful training and consideration of their sport’s long-term effects. By taking preventive measures, listening to your body and seeking appropriate medical care when necessary, you can stay in winning shape and compete at your best while avoiding lasting injuries.