Approximately 400 000 students participate in US high school cheerleading annually, including 123 386 involved in competitive spirit squads. The degree of athleticism and the difficulty of cheerleading skills have increased in recent decades, renewing safety concerns. This study describes the epidemiology of high school cheerleading injuries and compares cheerleading injury rates and patterns relative to other sports.


Data collected by the longitudinal, National High School Sports-Related Injury Surveillance Study from 2009/2010 through 2013/2014 were analyzed.


Injury rates in cheerleading ranked 18th of 22 sports, with an overall injury rate of 0.71 per 1000 athlete-exposures (AEs). Competition (0.85) and practice (0.76) injury rates were similar, whereas performance rates were lower (0.49). Although 96.8% of injured cheerleaders were girls, the overall injury rate was higher in boys (1.33 vs 0.69, rate ratio [RR]: 1.93, 95% confidence interval [CI]: 1.30–2.88). Although concussions were the most common cheerleading injury (31.1% of injuries), concussion rates were significantly lower in cheerleading (2.21 per 10 000 athlete-exposures) than all other sports combined (3.78; RR: 0.58, 95% CI: 0.51–0.66) and all other girls’ sports (2.70; RR: 0.82, 95% CI: 0.72–0.93). Over half of all injuries occurred during stunts (53.2%).


Although safety remains a concern among cheerleaders, overall injury rates are lower than most other high school sports. Although overall injury rates are relatively low, cheerleading injuries may be more severe when they do occur. A detailed knowledge of cheerleading injury patterns relative to other sports is needed to drive targeted, evidence-based prevention efforts.

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