Cheerleading combines organized athletic participation with stunts, tumbling, pyramids, and dismounts. The available figures show a large U.S. participation base, generally low injury rates relative to many high school sports, and measurable differences by setting and activity.
Contents
- Participation and organization
- Overall injury rates
- Concussions and mechanisms
- Stunts, body sites, and recovery
- Emergency-department and catastrophic injuries
- Safety rules and international reach
Participation and organization
The National Federation of State High School Associations (NFHS) reported 153,820 total Competitive Spirit participants during the 2022–23 school year. Its breakdown included 149,694 girls and 4,126 boys, with 7,216 schools fielding Competitive Spirit. The same survey reported 127 Unified Cheer participants in 21 schools, including 148 girls and 14 boys in the reported participant counts. These categories are reported by NFHS and should not be treated as a complete count of every cheerleading format in the United States.
The International Cheer Union (ICU) says it was established on April 26, 2004, and has 126 member National Cheer Federations. The ICU says its membership represents 10 million athletes on all continents and that it regularly hosts World Championships welcoming more than 70 nations. It received provisional recognition from the International Olympic Committee on December 6, 2016, and full IOC recognition on July 20, 2021.
The ICU has displayed different federation totals over time: one current site rendering reported 121 member National Cheer Federations, while another supplied ICU figure reported 126. Those figures should be read as time-specific website counts rather than combined totals.
Overall injury rates
The American Academy of Pediatrics (AAP) Safety in Cheerleading policy statement reported a U.S. cheerleading injury rate of 0.71 per 1,000 athlete exposures in high school surveillance data. Cheerleading ranked 18th among 22 high school sports studied. The reported cheerleading rate was lower than the rates for soccer, basketball, gymnastics, field hockey, lacrosse, softball, volleyball, track, and cross country. The AAP also reported that cheerleading injury rates remained relatively constant throughout the high-school surveillance period.
The same AAP data showed different rates by setting:
| Setting | Injury rate per 1,000 athlete exposures |
|---|---|
| Practice | 0.76 |
| Competition | 0.85 |
| Performance | 0.49 |
Competition therefore had the highest of these three reported rates, while performance had the lowest. These are rates per athlete exposure, not percentages of all participants.
A prospective study titled “Cheerleading-related injuries in the United States” followed 9,022 cheerleaders across 412 U.S. teams and recorded 567 injuries over one year. It found that 83% of injuries occurred during practice, 52% while attempting a stunt, and 24% while basing or spotting one or more cheerleaders. Lower-extremity injuries made up 30% of injuries, while sprains and strains made up 53%.
That study reported the following overall rates by activity:
- Practices: 1.0 per 1,000 athlete exposures.
- Pep rallies: 0.6 per 1,000 athlete exposures.
- Athletic events: 0.6 per 1,000 athlete exposures.
- Cheerleading competitions: 1.4 per 1,000 athlete exposures.
The results are not directly interchangeable with the AAP figures because the studies used different samples, definitions, settings, and surveillance methods.
Concussions and mechanisms
Concussions represented 31% of all cheerleading injuries reported by athletic trainers in the AAP’s RIO data. The cheerleading concussion rate was 2.21 per 10,000 athlete exposures. For comparison, the reported rate was 2.70 per 10,000 exposures in all other girls’ sports and 3.78 per 10,000 exposures in boys’ and girls’ sports combined.
Practice accounted for 206 cheerleading concussions in the RIO dataset, compared with 21 during performances and 18 during competitions. The practice concussion rate was 2.51 per 10,000 athlete exposures. That was below the reported practice rate for boys’ football, 4.78 per 10,000 exposures, and boys’ wrestling, 3.02 per 10,000 exposures.
The AAP policy statement reported several mechanisms for cheerleading concussions. Stunting caused 69%, pyramids caused 16%, and tumbling caused 9%. In another mechanism classification, contact with another athlete accounted for 59% and contact with the playing surface accounted for 38%. These categories describe different ways of grouping the reported events, so they should not be added together as one single distribution.
The prospective U.S. study found that collegiate cheerleaders were 2.98 times more likely to sustain a concussion. A separate high-school fall-injury study, “Epidemiology of Cheerleading Fall-Related Injuries in the United States,” reported that collegiate cheerleaders were 15.8 times more likely to sustain a concussion or closed head injury. The two findings address different study designs and injury contexts.
Stunts, body sites, and recovery
Stunting accounted for 53% of cheerleading injuries in the AAP policy statement, while tumbling accounted for 21%. Among stunt injuries, shoulder-level stunts accounted for 15% and above-the-shoulder-level stunts for 37%. For reported risky dismounts, cradle dismounts accounted for 64% and dismounts to the floor for 36%.
The most injured body site was the head and neck, at 43% of cheer injuries. Ankle injuries made up 12%, hand and wrist injuries 9%, and trunk injuries 8%. A different narrative review, “Cheerleading injuries: A narrative review of the literature,” described the ankle as the most commonly injured area, with a 44.9% prevalence. Because the two sources use different study populations and measures, their body-site figures should be kept separate.
Recovery time varied across injured athletes in the AAP data. Thirty-four percent returned to cheer in less than one week, 41% returned after one to three weeks, and 11% were out longer than three weeks. Five percent were medically disqualified for the season. The supplied categories do not account for every percentage point, so they should not be treated as a complete mutually exclusive total.
Among injuries requiring three or more weeks before return, concussion accounted for 35%, fractures for 31%, and ligament sprains for 16%. Among season medical disqualifications, fractures drove 29% and dislocations drove 16%.
The prospective U.S. study found that all-star cheerleaders were 1.76 times more likely to sustain a fracture or dislocation. The fall-injury study reported that collegiate cheerleaders were 7.9 times more likely to sustain a dislocation.
Emergency-department and catastrophic injuries
The AAP policy statement estimated that 350,000 patients ages 5 to 25 were treated for cheerleading injuries in U.S. emergency departments from 2010 through 2019. That estimate corresponds to about 35,000 patients per year when averaged across the decade, but it remains an estimate rather than a count of unique athletes. The vast majority of those emergency-department patients were 12 to 18 years old. The proportion of injured patients ages 12 to 18 decreased significantly in the comparison reported for 2010–19.
The same policy statement reported 89 catastrophic injuries in U.S. high school cheerleading over the 40-year span from fall 1982 through spring 2022. Eighty-seven involved female athletes, 77 were direct or traumatic injuries, and nine were fatalities.
For direct traumatic catastrophic injuries among female high school participants, the reported rates were 0.03 per 100,000 for fatal injuries, 0.82 per 100,000 for nonfatal injuries, and 1.50 per 100,000 for serious injuries. For indirect medical catastrophic injuries, the reported rates were 0.27 per 100,000 for fatal injuries, 0 for nonfatal injuries, and 0.14 per 100,000 for serious injuries.
Collegiate cheer had 33 direct or traumatic catastrophic injuries during the same 1982–2022 period. Those included 28 female athletes and five male athletes, with one fatality, 15 nonfatal injuries, and 16 serious injuries.
The narrative review reported that most cheerleading injuries were treated at the scene, at 32%, while about 22% were taken to a hospital for emergency care. It also cited cheerleading as 70.5% of all female catastrophic sports injuries at the collegiate level and 65.2% at the high-school level. Those are review-cited proportions, not a new injury count for the 2010–19 emergency-department estimate.
Safety rules and international reach
The AAP policy statement reported that a basket toss safety-rule change began in the 2006–07 academic year. Before the change, basket toss injuries were responsible for 21% of catastrophic cheerleading injuries. Over the following decade, the rule was associated with a 74% reduction in catastrophic basket toss injuries.
Age also matters in the AAP discussion: cheerleaders ages 5 to 11 were reported to be more than twice as likely to have moderate to severe injuries as older peers. This age comparison is distinct from the emergency-department finding that most patients in the 2010–19 estimate were ages 12 to 18.
A narrative review said that cheerleading injuries and participation grew at roughly 18% per year in the period discussed in its narrative. The review also described reported injury rates of approximately 1 to 2.8 per 1,000 athletic exposures. It reported that 32% of injuries were treated at the scene and about 22% received emergency hospital care, reinforcing the importance of identifying the study period and definitions before comparing rates.
Together, these statistics describe cheerleading across school, collegiate, all-star, competition, practice, performance, and international settings. The clearest comparisons are those that retain each source’s age range, geography, measurement period, and exposure denominator.