15-year-old Mikaela has always been an athlete, but it wasn’t until she was eight that she discovered her favorite sport: cheer.
“I danced, played soccer, and became a 1st degree black belt in Taekwondo,” Mikaela says. “But then my mom put my little sister in what’s called All Star Cheer, and I remember going to one of her competitions and thinking, ‘Wow, I really want to do this.’”
Almost immediately, she started in the sport herself.
Since then, Mikaela hasn’t looked back. Now part of her high school’s varsity cheer team, Mikaela’s classes are usually followed by long cheer practices where she learns challenging routines and stunts. But in October 2025, a concussion forced her to step away from both cheer and school.
When Mikaela was referred to the Sports Medicine Program within the Jackie and Gene Autry Orthopedic Center at Children’s Hospital Los Angeles, she was worried she’d never return to her old self. But with the expert help of sports medicine pediatrician Jonathan Santana, DO, and a multidisciplinary team of specialists, Mikaela is back doing what she loves.
Pediatric concussions: A common sports-related injury
A concussion is a type of mild traumatic brain injury (mTBI) caused by a hit to the head, face, neck, or body. The sudden force from the hit causes the brain to move rapidly inside the skull, affecting brain function.
A person with a concussion might experience those changes in brain function as headaches, vision changes, and slowed thinking. The biggest challenge with concussions is that they cannot be detected through blood tests or medical imaging.
For youth athletes like Mikaela, sports-related concussions can be a common experience. CHLA’s Sports Concussion Clinic, part of the Jackie and Gene Autry Orthopedic Center, helps ensure those athletes recover and return to their sport safely after injury. Treatment can include several types of specialty care, including physical therapy and clinical psychology.
Not like previous concussions
Competitive cheer is a high-intensity sport that involves learning complex choreography, executing acrobatic movements, launching teammates into the air, and catching them when they return to Earth.
During her first several years of cheer, Mikaela sustained two concussions. Both weren’t that serious,” she says, “After a rest period, I bounced back each time.”
But Mikaela’s third concussion, which occurred in 2025, was far more serious. She and her teammates were trying a new skill in which Mikaela was a base, meaning she helps to catch her teammate’s foot after they have been launched into the air. “My teammate was coming down after spinning in the air, but halfway down, her hands went out to the side and her palm hit me right in the nose,” Mikaela explains. “I heard a crunch and a crack—I thought I broke my nose—and I was immediately in tears from the shock.”
Mikaela’s school athletic trainer advised her to go to the doctor immediately to determine whether her nose was broken. Her trainer also mentioned that since Mikaela had a history of concussions, this new injury could have caused another.
Urgent care doctors confirmed Mikaela’s nose, though swollen and bruised, was not broken. “Later that night, I was trying to do homework and I felt a headache come on,’” Mikaela says. Not wanting to interrupt her daily life for something that felt minor, Mikaela pushed through.
Decision point
Sports concussions for youth athletes are widely underreported for a number of reasons, including the fear of losing playing time in the sport and difficulty identifying symptoms.
Mikaela was highly reluctant to step away from daily activities, especially since she was in several honors and advanced placement (AP) classes, and cheer competition season was rapidly approaching. She’d even cheered at a football game over the weekend. And she knew that if she sat out from cheer for too long, her coach would need to fill her varsity spot with a different athlete. But when she got to school the Monday following her injury, she noticed new symptoms like light and noise sensitivity. She could barely sit through her classes.
Mikaela realized she was facing a decision point. She chose to tell her trainer what she was experiencing.
A quick concussion test confirmed Mikaela’s fear. Fortunately, her trainer was familiar with Dr. Santana at CHLA’s Sports Concussion Clinic. Dr. Santana has specialized expertise in sports-related concussions and has even headed concussion oversight committees for multiple school districts.
Individualized treatment for long term health
“We take an individualized treatment approach for all concussion patients, because everybody has different symptoms as well as different times to full recovery,” Dr. Santana says.
While an MRI confirmed that nothing was broken in Mikaela’s neck and head area, Dr. Santana determined that she had experienced whiplash during her injury in addition to the concussion.
He prescribed physical therapy twice a week for Mikaela’s head and neck pain, as well as eye and neck movements she could practice at home.
One of Mikaela’s biggest worries with this concussion was not being able to concentrate and falling behind in school, as the brain stimulation from reading would exacerbate her symptoms. Dr. Santana advised Mikaela to attend school for limited periods over a couple of weeks.
Mikaela’s mom, Melanie, who is a pediatric nurse at CHLA, was concerned. “I’ve seen many injuries, but as we were going into week two of Mikaela’s symptoms, and then week three, I got really worried because she was still having neck pain and she couldn’t read for more than 5 minutes at a time.” Dr. Santana started seeing Mikaela and Melanie once a week and worked with them to prioritize and address their concerns one at a time.
Mikaela’s other main worry was missing out on cheer. In the third week after her injury, Dr. Santana recommended that Mikaela start resuming light impact aerobic activity, like jogging, with her athletic trainer. Dr. Santana explains that this would allow her to maintain her fitness while letting her brain heal.
When physical symptoms affect mental health
Still, Mikaela’s head and neck pain continued. The expected recovery from a concussion is four weeks, but Mikaela wasn’t feeling any better at that point. “It was indescribable pain, and when someone touched my neck, I would feel it twitch,” Mikaela says. She started to worry that returning to cheer may never be possible.
“I told myself, ’This is something she absolutely loves and is passionate about, but is it over?’” Melanie recalls. “If I have to tell her to stop, she will be so devastated.”
Full school days were still difficult to sit through. Mikaela couldn’t read or put essays together the way she used to—and with no visible signs of injury, her teachers and classmates didn’t always understand why she required frequent breaks. She and her care team decided that she should complete what classwork she could at home until she felt well enough to attend school in person again.
Mikaela’s coach allowed her to observe cheer practices from the bench to at least keep up with what her teammates were learning, but only for 20 minutes to prioritize recovery. “It was hard seeing someone else in my spot during routines and feeling like there was nothing I could do,” Mikaela says. As major competitions grew nearer, she felt anxious to return. “I remember crying to my friend who was also on my team because it was a lot of pressure.”
“It can be really helpful to learn different techniques to manage the mental health symptoms that often accompany concussions, and work through moments that might feel overwhelming,” Dr. Santana explains. He referred Mikaela to clinical psychologist Taylor Cosanella, PsyD, from CHLA’s Behavioral Health Institute.
“She now had a whole care team at CHLA, which was so worth it,” Melanie says.
Flipping a switch
Finally, about five weeks after her injury, things started to shift. “During Thanksgiving break, a switch flipped in my body,” Mikaela recalls. “Out of nowhere, my headache just stopped. My physical therapists said they saw tremendous progress, they were able to release the tension in my neck, and my eyes were able to move easily.”
Per her school’s policy, Mikaela would need to return to classes in person two weeks before the end of the semester to complete her final exams. “I don’t know how she did it, but she finished three of her five classes with finals and everything,” Melanie says.
Once she returned fully to school, Mikaela started practicing cheer routines on her own to ease back into the sport while remaining resilient to any future injuries. “We wanted her to try moving her body, spinning, and turning her head as she would in cheer, and if that went well, she could start tumbling and doing cartwheels and flips to see how that went,” Dr. Santana says.
Finally, in early December, six weeks after the injury, Mikaela was cleared to fully return to cheer by Dr. Santana and her school’s athletic trainer. She came back just in time to keep her spot on the team.
“When I first returned, it was hard—really hard,” Mikaela says. “I was scared to get hit again, and I was in my head.”
“Therapy with Dr. Cosanella played a very big role, helping Mikaela to be patient with herself,” Melanie says. It took another month before Mikaela felt fully back to normal during cheer practices. She also started working with a math tutor to get back into the swing of the new school semester.
Mikaela has participated in three competitions since returning to cheer and even joined a Concussion Alliance group at her school. The group addresses the stigma and fears that can accompany the decision to report a concussion. Mikaela helps encourage young athletes to be honest about how they are feeling and take the time to fully recover. “I want people to know that it’s okay to ask for help and put yourself first, because you only have one brain and you can’t replace it,” she says.
Today, Mikaela is proud of how much she has grown through this experience. “Honestly, I feel stronger than I was before.”
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