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Competitive cheer: the most common injuries

August 29th, 2016 | 5 min. read

By Rob S Williams, MD


With its elements of school spirit, dance, gymnastics, and daring stunts, competitive cheerleading is an extremely popular high school athletic activity. Over 400,000 high school girls participate in cheer each year, and many continue on to compete in college.

When practiced safely and responsibly, cheer is a fun activity with a low rate of injury  safer than most other high school sports. However, it does have some risks.

Competitive cheerleading has a lower rate of injury than most other high school sports. However, according to studies, those relatively infrequent cheerleading injuries tend to be more severe and sometimes debilitating, at least temporarily. 

Consider these little-known facts.

cheerleading injuries: the facts

  • Cheerleading injuries can be more severe than football injuries. Research from the journal Pediatrics recently revealed that competitive cheer injuries tend to be more serious than injuries sustained in other high school sports (like baseball, basketball, football, hockey, and soccer). According to a 2012 report published by the American Academy of Pediatrics, cheerleading accounts for the majority of "catastrophic" athletic injuries to high school girls and female college athletes. (Fortunately, this is still a very small number — only a tiny fraction of participants experience life-threatening injuries.)
  • Cheer injuries can sideline team members for a season or more. When looking at the proportion of injuries that cause players to miss weeks or even a full season, cheerleading comes in second only to gymnastics. Stunts can put participants — both the "flyers" and the "bases" — at risk for concussions and fractures. Splits, aerials, tumbling passes, and other gymnastic and acrobatic work can also put significant strain on the body.

  • Young men get hurt more than women. Although competitive cheerleading injuries rank high on the list of sports injuries sustained by young women (especially in Texas, where cheer is popular), male cheerleaders are injured more frequently than female cheerleaders. This is because they perform so many strenuous catches and lifts. 




most common cheerleading injuries

1. Concussions

Concussions — mild traumatic brain injuries caused by a jolting of the brain inside the skull — account for about one-third of all cheer-related injuries.

Cheerleaders sometimes get concussed by falling during a stunt and hitting their heads on the ground.

However, it's even more common for a teammate at the base of a stunt (for example, at the bottom of a pyramid formation) to sustain a blow to the head — to be elbowed or kicked by someone who is being thrown or caught.

Though concussions happen to both male and female cheerleaders, in general they are statistically more likely to happen to females.

Recent studies show that women sustain concussions at a higher rate than men. Researchers believe hormonal differences may be partly responsible for women's sensitivity to brain injury. Women also have less isometric neck strength and girth, which may make the head more vulnerable to sudden movements.

2. Ligament sprains 

Because so much jumping, landing, and pivoting is involved in cheer, ligament sprains are common — especially in the ankles and knees. Cheerleaders, particularly girls and young women, need to beware of:

  • Ankle sprains. Landing awkwardly from a leap or stunt can lead to a rolled ankle, especially when practicing on an uneven surface like grass. Immediate RICE treatment can help bring the swelling down until the athlete can see a doctor.

  • ACL sprains and tears and PCL tears. Because women land their jumps differently than men, in a more upright position, they are more likely than men to injure their ACLs (ACL injuries are three to six times more common in women). Both tears can make it difficult or impossible to put weight on the injured knee. Surgery may be required to repair the ligament.

  • Another knee injury that may affect cheerleaders, though it is not a ligament sprain, is jumper's knee (patellofemoral syndrome), which can create soreness and stiffness in the front of the knee and around the kneecap. 


3. Muscle strains

Muscle strains are stretches and tears of the muscle due to sudden stress  for example, moving the muscle quickly and forcefully.

Strains can happen when making explosive or sudden moves. They can also happen when an athlete works a muscle that isn't properly warmed up or conditioned for the current level of activity.

The jumps, twists, splits, and acrobatic moves of competitive cheer put stress on just about every muscle in the body. Strains are common in all the major muscle groups. 

  • Lower back strains are the most common muscle strains in cheerleaders.

  • Hip and groin strains, often caused by performing splits, are also common.

Fortunately, most strains can repair themselves with RICE therapy and NSAIDs (over-the-counter anti-inflammatory pain medications like naproxen or ibuprofen).



4. Fractures

Cheerleading can lead to several types of fractures, all of which require a doctor visit and X-rays to diagnose. Some fractures may heal quickly (in a couple of weeks), but others will require splinting, casting (with crutches), or a brace. In some cases, bone growth stimulation therapy may be advisable to speed the healing process.

Frequent fractures seen in cheerleaders include:

  • Ankle or foot fractures. A forceful, wobbly landing from a jump, stunt, or tumbling pass can sometimes lead to a broken bone or hairline fracture.

  • Back fractures. Falling onto the back (especially from a height) can crack or break the vertebrae in a few different ways that vary in severity. Occasionally, fractured vertebrae can cause spine instability that requires surgical fusion of the vertebrae. This surgery greatly reduces flexibility in the back, which would eliminate the possibility of performing acrobatic moves in the future.

  • Stress fractures. Landing, dancing, or stomping repeatedly on a hard surface can lead to stress fractures in the legs.

  • Hand and wrist fractures. Tumbling puts a great deal of stress on the wrists, thumb, and fingers, and can lead to small fractures in these bones.

5. Wrist and elbow injuries

Cheerleaders who performing tumbling moves support the entire weight of their bodies on their wrists and elbows, which can lead to injury. Cheerleaders who form the bases of stunts undergo similar stresses when they're supporting teammates.

  • As a result, wrist fractures, sprains, or ligament tears are common. However, these happen most often when falling onto an outstretched hand. If swelling and pain occur, ice the injury and see a doctor for X-rays.

  • Elbow pain or weakness when performing tumbling or stunts may indicate a ligament sprain along the inside of the elbow. Elbows may also be sore from hyperextension or tendinitis (inflammation of the tendons).

  • Another elbow injury that sometimes affects cheerleaders (and tumblers and gymnasts) is "pitcher's elbow." This condition occurs when bones in the joint knock together. Chips may flake off and float in the joint, creating pain and a clicking sound. Surgery may be required to remove the chips and restore full range of motion.

prevention & care 

Studies show that most competitive cheerleading injuries happen at practice, not at games or competitions.

To prevent injuries at practice, cheer teams or squads can follow some key safety measures:

  • Practice in a dedicated space with limited distractions and plenty of room (horizontal and vertical!) to move safely.

  • Adjust stunts and routines to the environment provided. If you cannot secure a dedicated, large space to practice throwing routines, for example, consider scaling your routines down to fit the space.
  • Use spotters during stunts.

  • Place mats on the floor or ground to reduce the impact from falls.

  • Be alert to tripping hazards or slippery ground that may cause a fall.

  • Use an experienced coach and athletic trainer, and listen to their advice.

  • Carefully select teammates with the same level of experience. Never work beyond your group level.

Individual preparation and self-care is also important:


  • Always warm up before practice.

  • Cool down and stretch after workouts. Regular stretching is critical to avoiding muscle strains.

  • Strengthen your core muscles to protect your back.

  • Wear proper shoes that support the feet and ankles.

  • Wear knee, ankle, hand, or wrist braces during practice or competitive events, especially if you have a known issue.

  • Practice landing properly; women athletes can learn proper techniques to land in stable positions that protect the knee and ankles.

  • Train at a gradual pace. Doing too much too soon frequently leads to injury.

  • Eat enough calories. To avoid stress fractures, consume foods high in bone-building nutrients (calcium, vitamin D, vitamin K, vitamin C, magnesium, and iron).

To learn more about preventing and treating common cheer-related injuries, give Coastal Orthopedics located in Corpus Christi, TX a call. Telephone: 361.994.1166.


Article written by: Rob Williams, MD


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Rob S Williams, MD

Dr. Williams has been practicing orthopedic surgery in Corpus Christi since 1998. After graduating from Texas Tech hereceived his medical degree from the University of Texas at San Antonio. At the prestigious Campbell Clinic located at the University of Tennessee, Dr. Williams completed not only an Orthopedic Surgery Residency, but an additional year of Fellowship Training in Spine Surgery. Dr. Williams is dedicated to creating an excellent patient experience in the office or in the surgery suite.