Dear Cheerleaders: Here's What You Need To Know About Your Back Pain

By Eleanor Au

Introduction

Spotting, Lifting, Landing, Stunts, Tumbles... most of these cheer routine components can cause back pain. Back pain is the third most common musculoskeletal injury in the cheer world. Depending on the diagnosis, back pain can become tricky and debilitating if not treated well. So, how can we avoid it or prevent it from getting worse?

Common Types of Back Pain In Cheer

1. Strain Strain means pulling a muscle in the back. It can result from a sudden injury or overuse, which involves repeatedly extending, flexing, or rotating the back during training. Symptoms of a strain would include: - pain across the lower back, sometimes referring to the buttock or leg - reduced range of movement in the spine - spasms with activity or rest
   

2. Pars Interarticularis Defect (spondylolysis) This contributes to 47% of low back pain in young athletes. It is a stress fracture in the pars interarticulars of a spinal vertebra (see image below), commonly in the bottom 2 levels of the lumbar spine (L4/ L5). Complete fractures can lead to spondylolisthesis, which means forward slipping of the vertebrae to the one below it. Back pain in spondylolysis is progressive and is usually worse on bending backwards and twisting movements of the spine.
   

Ways To Manage Back Pain

1. Strains: For acute strains, taking NSAIDs, applying heat/ice, and adequate resting can alleviate symptoms. Adaptations should be made to ensure comfort and pain-free during training. Core strengthening is needed to improve pain and spine function.
   

2. Pars Interarticularis Defects: Spondylolysis usually responds well to non-operative management. Again, taking NSAIDs, resting and adapting training routines can help with symptoms. Physiotherapy often includes core strengthening, hamstring stretches, and cheer-specific rehab to identify muscle weakness/ imbalance. You should always consult a medical professional for the diagnosis. Depending on the severity of the injury, you might be asked to stop training for 6-12 weeks and will be offloaded in a brace. In severe cases, surgery might be required to provide spinal stability.
   

Injury Prevention

Prevention is always better than cure. Here are a few ways to equip yourself to withstand unforeseeable accidents.

1. Warm Ups. I cannot stress enough how crucial warm-up is! Warm-up is not about static stretches but about preparing your body for the high physical demands during training. A good warm-up routine should look like: cardiovascular exercises to increase heart rate (jumping jacks, light jogs) + functional exercises (for bases, it could be squats + overhead lifts; for tumblers--handstands/ planks to prepare your shoulders and core!)
   

2. Techniques and Safety. Don't arch your back as you lift; keep your arms and legs close to the body as you fall. Mastering the basics is the first step to injury prevention. Furthermore, breaking down complex skills into simple steps with gradual advancement and practising new stunts on a thick mat with more spotters—all these safety measures can help injury prevention, too.
   

3. Conditioning. Back injuries happen when the load > capacity of muscles/ bones. Increasing the muscles' loading capacity, strength, and conditioning, especially in the core muscles, can reduce back injuries. Here are some exercise ideas: Bird Dog Start on your hands and knees, with your hands under your shoulders and knees under your hips. Tighten the abdominal core muscles. Extend the opposite leg and arm simultaneously, ensuring you maintain reasonable control of your torso. Do not allow your body or hips to rotate. Repeat on the other side. Alternatively, you can try this on a gym ball to challenge your core even more!
   

Dead Bug

Lie on your back and bring your legs to the table-top position with your hips and knees at 90 degrees.

Raise your arms straight up vertically over your head.

Keep your back flat, and lower the opposite arm and leg away from one another towards the floor.

Return to the start position and repeat with the other pair.

Side Plank Hip Abduction

Lie on your side and prop yourself up on your elbow.

Tie a tensioned resistance band around your thighs, just above your knees.

Bend your knees and lift your hips off the mat until you have a straight line from your knees to the top of your head.

Straighten your top leg and lift it directly towards the ceiling.

Ensure this leg does not travel forward.

Control the movement as you lower the leg back down and then repeat.

Take Home Messages:

1. There are 2 common causes of back pain in cheerleading- strain and Pars Interarticularis Defects.

2. Back pain often responds well to conservative management--NSAIDs, ice/heat, core strengthening, physiotherapy, etc.

3. Warm-ups, good techniques, safety awareness and body conditioning can help reduce the risk of injuries.
   

References

Duarte, M. P., & Willhuber, G. O. C. (2023). Pars Interarticularis Injury. In StatPearls [Internet]. StatPearls Publishing.

Shields, B. J., & Smith, G. A. (2011). Epidemiology of strain/sprain injuries among cheerleaders in the United States. The American journal of emergency medicine, 29(9), 1003–1012.

Xu, A. L., Beck, J. J., Sweeney, E. A., Severson, M. N., Page, A. S., & Lee, R. J. (2022). Understanding the cheerleader as an orthopaedic patient: an evidence-based review of the literature. Orthopaedic journal of sports medicine, 10(1), 23259671211067222.

Waters, N., 2013. What goes up must come down! A primary care approach to preventing injuries amongst highflying cheerleaders. Journal of the American Academy of Nurse Practitioners, 25(2), pp.55-64.

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Our blogs and articles are not designed to replace medical advice. If you have an injury, we recommend seeing a qualified health professional. We offer both in-person assessments and online consultations.