HighSchool%Cheerleading% InjuriesandtheFunctional Movement ... · Hopper,!Spring!2014! 1!! Introduction! Injurypreventionisamainstayintheathletictrainingprofessionandsomethingthatwe!

High School Cheerleading Injuries and the Functional

Movement Screen as an Injury Predictor

Capstone Project, Spring 2014

Mike Hopper, ATC, FMS

Mentors Carlen Mulholland, PhD, ATC

Adjunct Professor Southeast Missouri State University

Ashley Rockey, MS, ATC Twin Cities Orthopedics

Rebecca Lopez, PhD, ATC, CSCS

Director of Graduate Athletic Training Program University of South Florida

Peer Reviewer

Sara Crawford, ATC

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Introduction Injury prevention is a mainstay in the athletic training profession and something that we

attempt to achieve on a daily basis. Identifying exactly why and how the injury rates can be improved

must be a priority. National injury surveillance programs have been developed that help researchers to

track these injury rates if that sport is included in the particular interests of the study.

Cheerleading has long fought to be recognized as a sport, which caused it to be excluded from

national sports injury surveillance programs for many years. Additionally, rules and regulations have

long lagged behind the sport itself in terms of safety. There are national associations such as the

National Cheer Safety Foundation and the National Cheer Association who have attempted to improve

the safety of the sport, but much work remains. Cheerleading is no longer the cheerleading mothers and

grandmothers grew up with girls on the sideline leading the cheers of victory. Instead, the sport has

become a competitive activity with similarities to gymnastics combined with team spirit1. Many

cheerleaders were at one time gymnasts and these girls have brought those skills and experiences to the

cheerleading competition mat. Competitive cheer and gymnastics share many risks and rewards. One of

these risks is the increased opportunity for serious injury. Absent serious injury, cheerleading also

causes numerous less severe injuries such as sprains and strains on a regular basis. It has been noted

that while cheerleaders do not suffer injuries at the same rate as other athletes, the percentage of

catastrophic injury is much higher than other female sports at the high school level1,2.

Sports medicine providers should attempt to identify potential injury risks and alleviate those

through training and conditioning. However simply training the body is of little use if one does not first

identify weaknesses and strengths for which to further develop. Data that can be re-‐tested and repeated

is necessary for both improving function and for personal gratification. There are various tests and

screenings that can be done which may shed light onto particular issues to be investigated. Some tests

done in the past have included the Cooper Test for aerobic capacity, the YMCA bench press test, or 1-‐

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rep maximums testing with various strength movements. The Functional Movement Screen is one such

screen that has been hypothesized as a potential injury prevention tool.

The Functional Movement Screen (FMS) was developed by Gray Cook and Lee Burton in 1997 as

a mechanism theorized to predict injury and help clinicians communicate regarding deficiencies in

movement that may be detrimental to the individual3. The FMS has been used by athletes and clinicians

around the world and is a popular tool in professional sports. Adolescents may be ideal candidates for

this testing, but that data is currently limited4. The FMS emphasizes the correction of movement

dysfunctions that are said to be detrimental to healthy and efficient movement. The body will often

move in whatever way is necessary to complete a task, but that may not be the most ideal way for the

body to do so. If the body is moving incorrectly, then it may predispose that individual to injury

eventually. This is why identification of incorrect movement patterns at an earlier age is so important

not only for athletics, but for later life as well. Additionally, much of the research of the FMS has been

conducted on male athletes. Paszkewicz et al and Schneiders et al both found that there were statistical

differences in composite scores between genders4, 5. However it was noted by Schneiders et al that

females scored higher on the active straight leg raise and on the shoulder mobility5. This is associated

with greater flexibility. Additionally, concerns about applying studies conducted on professional athletes

are important to consider as their movement patterns are more defined than that of an adolescent

athlete. This data can be useful, but must be considered carefully. Ideally, new research will continue to

focus on the adolescent individual.

The purpose of this project is two-‐fold. First, I wanted to investigate the incidence and severity

of cheerleading injuries at the high school level. Secondly, I wanted to use the Functional Movement

Screen to evaluate its usefulness as an injury predictor in high school cheerleading. There is research

already available on the FMS with regards to professional athletes, but its usefulness with adolescents

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remains largely unknown. It is my hope that, by combining these two subjects, we can work to prevent

more injuries in high school cheerleading.

Methods 20 cheerleaders from Waterloo High School participated in the Capstone Project. They were all

female ranging in age from 14-‐18 years of age. This comprised the entirety of the cheerleading squad

during the 2013-‐2014 basketball/competition season. No cheerleader was excluded due to previous

injury. This group was selected as a sampling of convenience in order to test the idea of the Functional

Movement Screen as an injury predictor in high school cheerleading injuries. Testing was completed in

the high school Athletic Training Room or at cheerleading practice.

The Capstone Project initially entailed screening high school female cheerleaders using the

Functional Movement Screen. This required the use of the Functional Movement Screen Test Kit (Figure

1). This kit was purchased from Perform Better and consisted of a dowel rod, a 2x6 plastic piece with

measurements marked, two upright pieces with measurements, and a piece of rubber tubing. This was

recorded on an individual scoring sheet with the cheerleader’s name for identification and then a

participant number was assigned for further record. This data was then transferred into a Microsoft

Excel spreadsheet using the participant number to identify the cheerleader. Injuries were recorded using

the Injury Consultation form used by the company (Figure 2) and that data was also input into the

spreadsheet.

The Functional Movement Screen consisted of seven tests: the overhead squat, inline lunge,

rotary stability, shoulder mobility, active straight leg raise, hurdle step, and trunk stability push-‐up6, 7.

These tests were scored, on a scale from zero to three, in order to determine raw scores of each test as

well as a composite score. The instructions for each test were verbally given to each cheerleader prior to

performing the test. Based on the findings of Frost et al, the criteria for scoring were not provided to the

cheerleaders8. This study found that subjects performed better on the screening tests if they knew what

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criteria they were being tested. Visual demonstrations were provided as needed. The cheerleader was

asked if she experienced pain with each movement and with each clearing test. Pain with a specific

movement resulted in a score of zero being assigned for that test.

The first movement was the overhead squat (Figure 3)6. In the overhead squat, the individual

held the dowel over the head and attempted to squat with the knees and toes aligned with the femurs

getting below parallel in the down position. The dowel should remain overhead or slightly behind the

head. If she completed the movement as described above, a score of 3 was recorded. She scored a 2 if

she was unable to complete this movement standing flat-‐footed, but was able to do so with her heels

elevated by the 2-‐inch test kit. She scored a 1 if she was unable to complete the movement even with

modification. Pain overruled all scoring if it was present.

The second movement was the hurdle step (Figure 4)6. The individual held the dowel across her

shoulders with her toes touching the back of the test kit. The elastic band created a hurdle located at

the tibial tuberosities. One at a time, the individual stepped over the hurdle, tapped her heel on the

front of the board, and returned to the starting position. The goal is to complete the movement while

keeping the hip, knee, and toes in a line without losing balance. This is completed bilaterally. If she

completed the movement perfectly, then a score of 3 was assigned. If she was unable to maintain this

alignment, had lumbar flexion, or was unable to maintain the dowel parallel to the string, then a score

of 2 was assigned. A score of 1 was assigned if contact between the foot and the string occurred or if she

lost her balance. Pain negated all movement testing and a score of 0 was assigned. This test was scored

both with a raw score for each individual side, but also a final score was recorded which was the lower

of the two sides.

The third test in the series was the Inline Lunge (Figure 5)6. The cheerleader stood on the test kit

with the dowel vertical along the spine. The feet were spread approximately the same distance as the

height of the hurdle step which was measured at the height of her tibial tuberosities. She then knelt

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down taking the back knee to the back heel of the front foot while keeping her torso upright. This test

was also completed bilaterally. If she was able to maintain alignment of knee and foot as well as

maintaining an upright torso, she was awarded a score of 3. If there was torso movement, malalignment

of knees and toes, or her knee did not touch behind the heel of her front foot, then she was awarded a

score of 2. She was awarded a score of 1 if she lost her balance. Reported pain resulted in a score of 0

for that movement. The raw score was recorded for each side as well as the final score.

The Shoulder Mobility test (Figure 6) was the next test7. The cheerleader reached overhead in

external rotation, flexion, and horizontal adduction with one hand while the other hand was in internal

rotation and extension with the goal of the two hands interlocking behind the back. Then she reversed

her hand placement to record the other side. A score of 3 was recorded when her hands met behind her

back. She was given a score of 2 if her hands were within one and a half hand’s length and she scored a

1 if her hands were outside that distance. The Shoulder Mobility test also has a clearing test called the

Impingement Clearing Test7. This clearance test was unscored but instead was pain-‐free or not. The girl

placed her hand on her opposite shoulder and lifted her elbow as high as she could. Pain with this test

negated whatever score she attained on the Shoulder Mobility and resulted in a zero. Scores were

recorded for each side as well as a final score.

The Active Straight Leg Raise was tested next (Figure 7)7. The cheerleader laid supine with her

legs perpendicular to the test kit board which rested below her knees. The midpoint between her ASIS

and her midpoint of her patella was identified and the dowel was placed perpendicular to the floor at

this point. Next, she flexed her hip with an extended knee and dorsiflexed foot as far as possible while

she maintained the other leg in hip extension against the board. She scored a 3 if her foot went past the

dowel. If the foot was between the dowel and her midpoint of the patella, she was awarded a 2. If her

foot was below the patellar midpoint, she scored a 1. Pain negated any movement score and resulted in

a 0. This was scored as a raw score on each side as well as a final score.

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The Trunk Stability Pushup Test was the sixth test (Figure 8)7. For this test, she began in a push

up position with her thumbs even with her chin. Completion of a push up in this position resulted in a

score of 3 being assigned. A score of 2 was recorded if she completed the push up with her thumbs

aligned with her clavicles and a score of 1 was recorded if she was unable to complete a push up. Pain

negated movement scores and resulted in a zero. Additionally, she performed the Spinal Extension

Clearing Test which was scored as pain-‐free or painful. Pain with this clearance test negated movement

scores and resulted in a 0 recorded7.

Lastly, the Rotary Stability test was another bilateral test (Figure 9)7. She began in a quadruped

position straddling the test kit. A score of 3 was recorded if she completed a unilateral repetition

keeping the spine parallel to the floor and the knee and elbow touched. She received a score of 2 if she

completed a diagonal repetition where the knee and elbow touched underneath the body and she

scored a 1 if she was unable to complete the diagonal movement. This test also has a clearing test

known as the Posterior Rocking Clearing Test7. Again in the prone position, she will rock back taking her

buttocks to her feet. Pain here results in the Rotary Stability Test becoming a zero.

Upon completion of the Functional Movement Screen, the next step in the study was to simply

observe for injuries throughout the course of the season. I did not make any significant changes to the

injury recording process, but instead evaluated injuries as they occurred and in the same manner I

would evaluate any injury that occurred at Waterloo High School during this time.

Results Test scores were recorded in both raw data and as composite scores. It is important that both

be considered when analyzing the data. The following tables will show scores in many different forms.

First the Deep Squat was evaluated. Many of the cheerleaders scored 2s, one cheerleader

scored a 1 and six cheerleaders scored perfect 3s. No pain was reported during this test so no 0s were

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recorded. The average score for this test was 2.25 which shows that the majority of the cheerleaders

were able to complete this test with little to no difficulty.

The second test to be evaluated was the Hurdle Step. This test will be shown in Table 2 with raw

scores and then also in Table 3 with the final score. The final score is determined by taking the lowest of

the two raw scores. The average score, as noted both in Table 2 and Table 3, are much lower. The final

score for the Hurdle Step has an average of 1.5 which means that there were several of the cheerleaders

unable to successfully complete this test. There are minor asymmetries present, however looking side-‐

by-‐side, the only big gap is with cheerleader #15 who experienced pain on the left side. This resulted in

an automatic 0.

Next the Inline Lunge was evaluated. This is another test that was completed on each side so

there is both the raw score and the final score to be determined. Table 4 shows the raw scores on each

side while Table 5 shows the final score. Many of the cheerleaders were able to complete this test with

minor deviations which resulted in a score of 2. Again, there were no reports of pain with this test.

Minor asymmetries noted, but the scores are close. Because the final score is the smaller of the two raw

scores, it makes sense that the average final score is also slightly lower.

Shoulder Mobility was next examined. This test is also scored bilaterally. Table 6 demonstrates

the raw scores while Table 7 demonstrates the final score. With the exception of cheerleader #10 and

cheerleader #14, scores were very high on this test. Cheerleader #10 scored a 1 while cheerleader #14

experienced pain while completing the movement warranting a score of 0. There was also very little in

the way of asymmetries with this particular test. Again, the largest difference is associated with pain

rather than necessarily with the movement itself.

The Active Straight Leg Raise is the next test in the Screen. Again, tested bilaterally so Table 8

shows the raw scores on each side while Table 9 has the final scores for this test. This test was an oddity

in that every single cheerleader scored perfect 3s on it. Most would not find that odd as there is a

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common belief that cheerleaders and gymnastics are very flexible. With that in mind, it makes good

sense that this mobility test would be scored so highly.

The next score is only one score so there is only the final score. The Trunk Stability Push Up is

where most of the pain was reported and that was still only two individuals. They both reported pain

with the clearing test. These were all scored 2s or 3s with the exception of the two with pain. Nobody

was unable to complete the test which would have resulted in the 1. These scores are illustrated in

Table 10.

Lastly, the Rotary Stability Test is illustrated in Table 11 with raw scores and Table 12 with final

scores. No pain was reported during this test so there were no 0 scores. There were some asymmetries

when compared side by side which demonstrates weakness of the core stabilizers with asymmetric

strengths. The average scores were a 2 or greater for both sides and for the final score.

The next table is the composite scores. This score includes each of the final scores illustrated

above in Tables 1, 3, 5, 7, 9, 10, and 12. This is totaled up to give us the composite score. FMS says that

this composite score should be 14 or greater in order to prevent injuries. This is shown in Table 13.

Injuries were documented in Table 14. There were nine injuries recorded during this

cheerleading season. These consisted of one head injury, one back injury, one foot injury, one hand

injury, one wrist injury, two knee injuries, and two ankle injuries.

Discussion Cheerleading has been a sport largely associated with school spirit and less to do with

competition. That has changed. With this change, injuries have increased resulting from various causes9.

This project illustrated that as well. Of these nine injuries documented during this study period, only one

of them would be considered serious in nature. That was a concussion suffered as the result of a fall

from a stunt. This stunt, by admission of the coach, was not properly supervised and therefore should

have never taken place. The stunt was completed on a hardwood gym floor without the head coach

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present. Because of this, the girls were instructed to not attempt said stunt, but did so anyway. This

resulted in the flyer hitting her head on the gym floor. This illustrates concern that has been expressed

in the literature of improper techniques with improper supervision leading to injuries1, 9-‐12. Shields and

Smith associated 14% of injuries in their study to falls10. They also described stunting injuries as

accounting for 60% of their data10. Stunting injuries during the 2013-‐2014 season accounted for

approximately 44% of injuries while tumbling accounted for 11%. The other four injuries were not

traumatic in nature and therefore could not be pinpointed as to cause of injury. No injuries this year

resulted in disqualification for greater than two weeks. Most injuries did warrant further evaluation by

additional medical personnel. Three injuries were treated by a chiropractor, one injury was seen in

physical therapy, and two other injuries were cleared by physicians.

The Functional Movement Screen was inconclusive in its prediction of injury. Two individuals

suffered two injuries apiece and each of them had scored less than a 14 on the FMS. One girl who had

scored a 12 also suffered one injury. The other four injuries occurred on girls who had scored 14 or

better. Three individuals who scored less than a 14 suffered injury during the cheerleading season. The

team averaged a 15.3 on the FMS for a total composite score with one score as high as 20 and one score

as low as 12. The team average of 15.3 compares favorably with the study conducted by Paszkewicz et al

who had an average score of 15.16. That study also found that the composite scores improved from

prepubescent to postpubescent maturity4. This Capstone Project did not attempt to determine the

maturity of the individuals therefore this cannot be compared. Based on the average composite score,

that would lead us to believe that few injuries would occur over the course of the season3. I would

suspect that is this normal in studies because not all injuries can be accurately predicted based on

simple movements such as conducted in the FMS. Movement deficiencies cannot be expected to be the

only cause for injury in any sport. Cheerleading, like so many others, often involves contact with other

individuals as well as with the floor. With this in mind, contact with the other cheerleaders is often one

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reason for an injury. This season three of the injuries were the result of collision with another

cheerleader. Another three injuries were the result of overuse that could be potentially corrected by the

use of movement corrections. The final three injuries documented had unknown origins.

Looking back at raw scores and composite scores, several injuries and scores correlated.

Cheerleader #5 scored a 0 on the Trunk Stability Push Up because she reported pain with the clearing

test. This makes sense because the testing was done after she had suffered a back injury. Back extension

as a part of the clearing test elicited pain. Cheerleader #15 has battled plantar fasciitis and a flattening

of her arch for most of the season. She occasionally had pain with bearing weight on that foot so it made

sense that she reported pain in a single leg stance during the Hurdle Step. Cheerleader #14 reported

pain with Shoulder Mobility. She had suffered a previous AC sprain about seven months ago, so it

seemed normal that she had pain with the clearing test. Another consideration, as illustrated in this

paragraph, is that previous injury does affect the Functional Movement Screening scoring as well as the

risk of future injury. With the exception of one 0 score, I was able to look back and identify why that

individual had pain. Gray Cook has said before that whether we in the rehabilitation world like it or not,

previous injury is a predictor for future injury13.

The idea was to test each cheerleader to obtain the FMS score for each of them. This is said to

determine whether that individual cheerleader is at increased risk for injury or not. The next component

was to observe injuries as they took place and then compare that information with the FMS scores. Nine

injuries were recorded over the 2013-‐2014 cheerleading season. Cheerleader #3 and Cheerleader #5

both reported two injuries apiece. Cheerleader #3 suffered a knee injury in their final competition of the

season and also suffered an ankle injury during tumbling practice near the end of the season. She had

scored a 13 for a composite score which meant she was at increased risk of injury and it finally caught up

with her nearing the conclusion of the season. Neither injury was significant. Her knee injury required no

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missed activities while the ankle injury sidelined her for 8 days. Cheerleader #5 suffered a back injury

early in the season causing her to miss a competition, which ended up meaning the team had to also

miss that competition. She sat out of cheerleading for a few days before working back into it and

completing a stint of physical therapy. This girl also missed 9 days after suffering a concussion during a

basketball game. She had scored a 12 on the FMS which meant she was also at risk for injury.

Cheerleader #14 was the last girl to have scored below the 14 threshold. She suffered a minor ankle

injury in the middle of the season, but missed no time due to injury. There were 4 other injuries

reported during the course of the season but none of these resulted in time lost.

As a group, the cheerleaders scored lowest on the Hurdle Step (1.5) and the Inline Lunge (1.85).

The Active Straight Leg Raise resulted in perfect scores (3) for every individual while the Shoulder

Mobility (2.45) also resulted in a high score. Schneiders found that 46.3% of their female participants

scored a 3 on the ASLR while approximately 80% of their female participants scored 3s on the Shoulder

Mobility5. 12 cheerleaders scored a 3 on Shoulder Mobility which is 60%. The Trunk Stability Push Up

also scored higher (2.5) than in Schneiders’ study. 58.3% of the females in that study scored a 1 while all

but two of the cheerleaders scored a 2 or a 3. Those two cheerleaders scored a 0 due to pain. The Deep

Squat (2.25) and the Rotary Stability (2) were both scores that FMS says are adequate for training. The

Deep Squat compares to that of the Schneiders study while the Rotary Stability was much higher among

these cheerleaders.

Injuries occurred in various settings within the sport. Although four of the injuries could not be

determined as to where they took place, the other five can. One happened in a competition, one

happened during a game, and the other three occurred in practice. This coincides with Shields and Smith

who found that most injuries occurred in practice2. The rate of injury was lower in practice but due to

the overall number of exposures that number still remains higher. Competitions resulted in fewer

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exposures, but injuries do still occur there. This project did not calculate exposure rates so we cannot

directly relate that information to the Shields study, but we can highlight what the numbers do show us.

Conclusions Research has shown that cheerleading injuries have risen significantly in the last 30 years1, 12.

Fortunately, the Waterloo High School cheerleaders did not experience significant or severe injuries this

year over the course of the season. The worst injury suffered this year was a concussion. Last year, three

WHS cheerleaders underwent surgeries related to cheerleading injuries. Injuries were more chronic in

nature for the girls this year and some of that is due to previous injury. Improvements in the recording

of cheerleading injury incidence could include better documentation of minor injuries as well as

recording athletic exposures. This would be the best way to compare to the studies conducted by

Shields and Smith.

I cannot correlate last year’s misfortunes with a lack of FMS scores, but I can look at the scores

from this year as a potential indicator of why there were not significant injuries this year. With three

individuals scoring below the threshold and each of them suffering at least one injury during this limited

project, I am confident that the FMS can predict many injuries. These results correlated with the

prediction made by Kiesel et al in that scoring under 14 on the FMS predisposed an athlete to injury

(Kiesel). It is not a perfect system and no system will be able to predict all injuries with complete

certainty.

The Functional Movement Screen has a place in predicting injuries in high school athletics. This

project was conducted solely with high school cheerleaders, but it could certainly be expanded to

include other sports as well. For schools that have the resources, I would certainly recommend its

inclusion into a strength and conditioning program and injury prevention programs. One of the benefits

of the FMS is that most strength and conditioning coaches or athletic trainers attain the skills needed to

screen the athletes without too much difficulty.

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Previously mentioned rehabilitation and treatments were for specific injuries as documented.

No corrective actions were taken based solely on the FMS scores recorded as a part of this project. The

original idea was to incorporate some corrective exercises after testing, however time constraints and

contract constraints related to Athletic Training Services were prohibitory. There is an ongoing

discussion between myself and the cheerleading coach on preventative measures that will incorporate

individual and group FMS scores into a cheerleading conditioning program in the near future.

There were multiple limitations in this project that could have resulted in unfavorable or lacking

results. Cheerleading has truly become a year-‐round sport so it would have been beneficial if this project

timeline could have spanned a full calendar year instead of a short snippet of the season. Greater

injuries could have been documented and more corrective actions could have been taken. Another

limitation was the time spent by the Athletic Trainer in the school setting which limited the amount of

time that could be spent on this project.

Other Athletic Trainers could take this project and incorporate it into their own research studies

or their own clinical practice. The time needed to test each athlete was approximately 5 minutes so

while it seems daunting, it is time well spent. The ideal situation would probably to include FMS testing

into the pre-‐participation examination that athletes must undergo prior to athletic participation.

Continued research is necessary in both components of this project. Additional study is

warranted at the high school level utilizing the FMS. I think that as the Functional Movement System

continues to be recognized in the rehabilitation and fitness industries, more and more clinical research

will be undertaken by those clinicians in the field. Cheerleading injuries must also undergo additional

study. Further recognition as a sport by athletic associations and the medical community should also

lead to further development and improvement of rules, competition surfaces, and regulations. This is

important for continued improvement of the sport so that it can succeed safely in the future.

Cheerleading can no longer be neglected and regarded as an afterthought. Medical professionals and

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athletic administrators must include cheerleading in conversations about sports safety just like any

other sport. Cheerleaders should be required to undergo pre-‐participation exams, be involved in

strength and conditioning programs, and have access to qualified medical professionals during

competitions and practices. The safety of the cheerleaders and the liability of the schools depend on it.

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References 1) Mueller FO. Cheerleading injuries and safety. Journal of Athletic Training. 2009;44(6):565-‐566. 2) Shields BJ, Smith GA. Cheerleading-‐related injuries in the United States: A prospective

surveillance study. Journal of Athletic Training. 2009;44(6):567-‐577. 3) Kiesel K, Plisky PJ, Voigh ML. Can serious injury in professional football be predicted by a

preseason functional movement screen? North American Journal of Sports Physical Therapy. 2007; 2(3):147-‐158.

4) Paszkewicz JR, McCarty CW, Van Lunen BL. Comparison of functional and static evaluation tools among adolescent athletes. Journal of Strength and Conditioning Research. 2013;10:2842-‐2850.

5) Schneiders AG, Davidsson A, Horman E, Sullivan SJ. Functional movement screen normative values in a young, active population. The International Journal of Sports Physical Therapy. 2011; 6(2):75-‐82.

6) Cook G, Burton L, Hoogenboom B. Pre-‐participation screening: The use of fundamental movements as an assessment of function-‐Part 1. North American Journal of Sports Physical Therapy. 2006; 1(2):62-‐72.

7) Cook G, Burton L, Hoogenboom B. Pre-‐participation screening: The use of fundamental movements as an assessment of function-‐Part 2. North American Journal of Sports Physical Therapy. 2006; 1(3):132-‐139.

8) Frost DM, Beach TAC, Callaghan JP, McGill SM. FMS scores change with performers’ knowledge of the grading criteria-‐Are general whole-‐body movement screens capturing “dysfunction”? Journal of Strength and Conditioning Research. Ahead of Publication 2013.

9) Shields BJ, Smith GA. Cheerleading-‐related injuries in the United States: A prospective surveillance study. Journal of Athletic Training. 2009;44(6):567-‐577.

10) Shields BJ, Smith GA. Cheerleading-‐related injuries to children 5 to 18 years of age: United States, 1990-‐2002. Pediatrics. 2006;117(1):122-‐129.

11) Shields BJ, Smith GA. Epidemiology of cheerleading stunt-‐related injuries in the United States. Journal of Athletic Training. 2009;44(6):586-‐594.

12) Shields BJ, Smith GA. Epidemiology of cheerleading fall-‐related injuries in the United States. Journal of Athletic Training. 2009;44(6):578-‐585.

13) Cook G, Burton L, Kiesel K, Rose G, Bryant MF. Movement: Functional Movement Systems: Screening, Assessment, Corrective Strategies. 1999.

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Tables/Figures Table 1. Deep Squat Scores

Table 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Average Standard Deviation

Deep Squat 3 2 2 3 3 2 3 3 2 2 2 2 2 2 2 2 2 2 3 1 2.25 0.5501

Table 2. Hurdle Step Raw Scores


Right 2 2 1 2 2 1 3 2 1 2 1 2 2 2 2 1 2 3 1 2 1.8 0.6156

Left 2 2 2 2 2 2 3 2 2 2 1 2 1 2 0 1 1 2 1 1 1.65 0.6708

Table 3. Hurdle Step Final Score


Hurdle Step 2 2 1 2 2 1 3 2 1 2 1 2 1 2 0 1 1 2 1 1 1.5 0.6882

Table 4. Inline Lunge Raw Scores

Table 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Average Standard Deviation Right 2 2 2 2 2 3 3 3 2 2 2 2 3 2 1 1 2 2 2 2 2.1 0.5525 Left 2 1 2 3 2 3 3 2 2 2 2 2 2 1 1 1 1 2 3 2 1.95 0.6863

Table 5. Inline Lunge Final Score


Inline Lunge 2 1 2 2 2 3 3 2 2 2 2 2 2 1 1 1 1 2 2 2 1.85 0.5871

Table 6. Shoulder Mobility Raw Scores


Right 2 2 3 3 3 3 3 2 3 2 3 2 3 0 3 3 3 3 3 3 2.6 0.7539

Left 2 3 3 3 2 3 3 2 2 1 3 2 3 2 3 3 3 3 3 3 2.6 0.5982

Table 7. Shoulder Mobility Final Score


Shoulder Mobility 2 2 3 3 2 3 3 2 2 1 3 2 3 0 3 3 3 3 3 3 2.45 0.8256

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Table 8. Active Straight Leg Raise Raw Scores


Right 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 0.0000

Left 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 0.0000

Table 9. Active Straight Leg Raise Final Score


ASLR 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 0.0000

Table 10. Trunk Stability Push Up Score

Table 10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Average Standard Deviation Trunk Stability PU 3 2 0 3 0 3 3 2 3 3 2 3 3 3 3 2 3 3 3 3 2.5 0.9459

Table 11. Rotary Stability Raw Scores


Right 2 3 2 2 2 3 2 2 1 2 2 2 2 2 2 2 3 2 3 2 2.15 0.4894

Left 1 2 2 2 3 3 2 2 2 2 2 2 2 1 2 2 3 2 3 2 2.1 0.5525

Table 12. Rotary Stability Final Score


Rotary Stability 1 2 2 2 2 3 2 2 1 2 2 2 2 1 2 2 3 2 3 2 2 0.5620

Table 13. FMS Composite Score


Composite Score 16 14 13 18 12 18 20 16 14 15 15 16 16 12 14 14 16 14 18 15 15.3 2.0800

Table 14. Injuries

Cheerleader 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Injuries Ankle,

knee Back,

concussion knee wrist ankle foot hand

Hopper, Spring 2014

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Figure 1 . FMS Test Kit Figure 2 MPTSM Injury Consult Form

Figure 3 . Deep Squat

Figure 4 . Hurdle Step Figure 5. Inline Lunge

Hopper, Spring 2014

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Figure 6 . Shoulder Mobility Figure 7. Active Straight Leg Raise

Figure 8 . Trunk Stability Push Up Figure 9. Rotary Stability

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