2 Lower Extremity Injuries in Cheerleading and Gymnastics

Understanding Lower Extremity Injuries in Cheerleaders and Gymnasts

February 24, 2025 7:30 am by Ashley R. Kelley, PT, Cert DN, AIB-VRCLeave a Comment

Cheerleading and gymnastics are incredibly demanding sports requiring strength, flexibility, and precision. Yet, they also carry a significant risk of injury, particularly in the lower extremities.

The prevalence of lower extremity injuries in cheerleading and gymnastics worldwide has increased significantly over the last decade as both sports have evolved^1,2. One study, including 6-to-17-year-old gymnasts, found that the lower extremity was the most affected site of injury (60.5%), with the ankle/foot and knee joints accounting for 49% and 27% of injuries, respectively. This study also found that 10-to-12-year-olds and 13-to-17-year-olds were at greater risk for lower extremity injury due to increased growth rates compared to 6-to-9-year-olds².

The nature of injuries often sustained in cheerleading and gymnastics are related to the athlete’s age and repetitive activities. Collegiate/Elite cheerleaders and gymnasts tend to be older and are likely to sustain a traumatic injury that requires surgery. This is due to the increased force and loading demands by those with elite skills². Overuse injuries can affect many tissues including, ligaments, muscles, tendons, and bones. In children, these structures are still growing, and that growth occurs unevenly. For example, bones grow at a faster rate than muscles. This uneven growth causes the muscle, tendon, and growth plates to be seen as vulnerable areas for overuse injuries to occur³.

Common Types of Overuse Injuries

Osgood-Schlatter Disease

Osgood-Schlatter disease causes inflammation of the bone at the growth plate at the front of the shin below the kneecap (tibial tubercle). The repetitive jumping and running cause a traction force at the insertion of the patellar tendon into the tibia that can lead to a stress reaction or stress fracture if the athlete’s activity level is not decreased³.

Sever’s Disease

Sever’s disease causes inflammation of the calcaneus (heel bone) at the growth plate. Repetitive jumping and running activities result in a traction force at the insertion of the Achilles tendon on the calcaneus, which can lead to further injury to the bone if the athlete’s activity level is not decreased³.

Medial Tibial Stress Syndrome (MTSS)

Medial Tibial Stress Syndrome, or MTSS, is an early stress injury in the continuum of a tibial stress fracture, which often is referred to as “Shin Splints.” Repetitive muscle traction of the tibialis anterior (shin muscles) can result in a fracture of the tibia bone if the repetitive activity is not stopped⁴.

Patellar Tendinopathy

Patellar Tendinopathy, often referred to as “Jumper’s Knee,” is inflammation of the patellar tendon insertion on the kneecap caused by repetitive quadriceps muscle contractions during jumping and running activities³.

Achilles Tendinopathy

Achilles Tendinopathy is caused by inflammation of the Achilles tendon insertion into the calcaneus (heel bone). This inflammation is caused by repetitive gastrocnemius complex contractions resulting from running and jumping activities³.

Osteochondritis Dissecans (OCD)

With Osteochondritis Dissecans, or OCD, small segments of bone in the knee and ankle begin to separate due to high repetitive forces and decreased blood supply to the area. A piece of bone and cartilage can separate from the rest of the bone in a joint, resulting in a loss of range of motion. Rest and activity modification are important to avoid surgery⁵.

Meniscus Tear

Gradual degeneration of the meniscus, the cartilage that cushions between the shinbone (tibia) and thighbone (femur), can progress into tears. A tear in areas of low blood supply, in certain patterns/locations, may require surgery^1,3.

Other Ligament Sprains

Repetitive forces cause ligamentous breakdown in the knee and ankle, resulting in a tear in the tissue that can be acute (1 time) or chronic (repetitive stress) ^1,3,6.

Symptoms of Overuse Injuries

Pain during or after activity
Tenderness
Swelling
Changes in form or technique
Decreased interest in practice

How to Reduce Risk for Athletes

The prevalence of overuse injuries among gymnasts is a significant concern. It is rooted in repetitive training, inadequate recovery, early sports specialization, and biomechanical deficiencies^1,2,8. Addressing these issues through a comprehensive physical therapy approach can substantially reduce the risk of injury. By focusing on individualized treatment plans that enhance strength, flexibility, and technique, physical therapists empower gymnasts and cheerleaders to maintain peak performance while safeguarding their long-term health. Proactive measures in physical therapy promote injury prevention and contribute to more sustainable training practices, allowing gymnasts and cheerleaders to continue participating in the sports they love.

Find a Gymnastics/Cheerleading Specialist Near You

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions

References:
1. Injury epidemiology and risk factors in competitive artistic gymnasts: a systematic review – PubMed (nih.gov)
2. Injury Pathology in Young Gymnasts: A Retrospective Analysis – PubMed (nih.gov)
3. https://orthoinfo.aaos.org/en/diseases–conditions/overuse-injuries-in-children/
4. Medial Tibial Stress Syndrome – StatPearls – NCBI Bookshelf (nih.gov)
5. https://orthoinfo.aaos.org/en/diseases–conditions/osteochondritis-dissecans/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905051/
7. https://blogs.bmj.com/bjsm/2022/09/30/monitoring-training-load-in-artistic-gymnastics/
8. https://usacheer.org/3-common-risk-factors-for-stress-fractures-and-how-to-avoid-them

Ashley R. Kelley, PT, DPT, Cert DN, AIB-VRC is a board-certified physical therapist located in Midlothian, VA. After earning her doctoral degree from Old Dominion University, Ashley started her physical therapy career as a spine specialist at a highly regarded spine and sports private practice. Ashley has continued her education in the management and treatment of spinal conditions by completing advanced spinal manipulation courses. Ashley utilizes many different treatment methods including the McKenzie Method, manual therapy, and dry needling for the treatment of spinal conditions. Ashley has extensive experience working with individuals of all ages with hypermobility disorders, such as, Ehlers-Danlos Syndrome. Ashley provides high quality, evidence-based, and individualized rehabilitation services to all orthopedic and sports populations without the need of a physical therapy prescription. During her doctoral clinic and in-class training, Ashley underwent extensive instruction in differential diagnosis. This well enables her to refer patients to the appropriate medical provider for further evaluation, if warranted. She also specializes in the treatment of concussions and vestibular conditions, including, BPPV and vestibular hypofunction. Ashley has extensive experience helping patients return to sport, school, and work after they have sustained a concussion.