Cheerleading concussion statistics show a mixed picture: cheerleading has a relatively low overall injury rate in one high-school comparison, but concussions and closed-head injuries have become a larger share of emergency-department injuries and admissions. Stunts are the central setting for serious head injuries, while practice accounts for most injuries in prospective surveillance.
Contents
- How common are cheerleading injuries?
- What do concussion rates show?
- Why stunts matter
- Where and when injuries happen
- Age, sex, and team-type differences
- Emergency visits and hospital admissions
- Catastrophic injury context
How common are cheerleading injuries?
The American Academy of Pediatrics (AAP) summary of a 2016 Pediatrics study ranked cheerleading 18th out of 22 high-school sports for overall injury rate. The study measured injuries per 1,000 athlete-exposures, where an athlete-exposure represents one athlete taking part in one practice, competition, or other organized activity. Its overall cheerleading injury rate was 0.71 per 1,000 athlete-exposures.
The same study reported different rates by setting. Competition had an injury rate of 0.85 per 1,000 athlete-exposures, practice had a rate of 0.76, and performance had a rate of 0.49. These figures describe overall injuries, not concussions alone.
The study also found that concussions represented 31.1% of all cheerleading injuries in its sample. The cheerleading concussion rate was 2.21 per 10,000 athlete-exposures. For comparison, the rate was 3.78 per 10,000 athlete-exposures across all other sports combined and 2.70 per 10,000 athlete-exposures across all other girls’ sports. These comparisons use the measurement framework of the AAP/Pediatrics 2016 study.
A separate prospective surveillance study by Shields & Smith (2009) tracked 9,022 cheerleaders across 412 U.S. teams and recorded 567 injuries. It found an injury rate of 1.0 per 1,000 athlete-exposures during practice. The rates were 1.4 during competition, 0.6 during pep rallies, and 0.6 during athletic events.
What do concussion rates show?
Several sources report different concussion measures because they cover different populations, periods, and definitions. The AAP summary of school cheerleading concussion reporting from Rank One/PMC (2019) reported a total sport-related concussion rate of 6.02 per 10,000 athlete-exposures from 2012 through 2017. School cheerleading participation in that study ranged from 3.24 million to 4.03 million athletes across those years.
The AAP’s 2024 policy statement gives another comparison: a practice concussion rate of 2.51 per 10,000 athlete-exposures for cheerleading. In that comparison, cheerleading ranked behind boys’ football at 4.78 and boys’ wrestling at 3.02 per 10,000 athlete-exposures. The policy statement also places the cheerleading rate below the listed rates for girls’ soccer, basketball, lacrosse, softball, and field hockey in one comparison table.
| Sport or comparison | Reported concussion rate | Measurement shown by source |
|---|---|---|
| Cheerleading | 2.21 per 10,000 athlete-exposures | AAP/Pediatrics 2016 study |
| Other sports combined | 3.78 per 10,000 athlete-exposures | AAP/Pediatrics 2016 study |
| Other girls’ sports | 2.70 per 10,000 athlete-exposures | AAP/Pediatrics 2016 study |
| School cheerleading | 6.02 per 10,000 athlete-exposures | 2012–2017 Rank One/PMC surveillance |
| Cheerleading practice | 2.51 per 10,000 athlete-exposures | AAP 2024 policy comparison |
The AAP 2024 policy statement also reports a concussion rate of 0.06 per 1,000 exposures in its summary. Because the sources use different surveillance systems and reporting periods, these values should be read as separate reported estimates rather than combined into one trend line.
An AAP/Pediatrics 2012 review reported that cheerleading concussion rates increased by 26% per year from 1998 through 2008. That is a historical trend from the review period, not a forecast of future rates.
Why stunts matter
Stunts are repeatedly identified as the main setting for cheerleading injuries. The AAP/Pediatrics 2016 study found that more than 53% of cheerleading injuries occurred during stunts. The AAP 2024 policy statement says stunting accounts for 42% to 60% of all cheerleading injuries and causes 96% of concussions and closed-head injuries. Pyramid stunts account for 50% to 66% of head and neck injuries in the policy statement.
The prospective Shields & Smith (2009) surveillance study found that 52% of injuries occurred while attempting a stunt. It also reported that 24% occurred while an athlete was basing or spotting one or more cheerleaders. Together, these figures show why a stunt-related injury can involve both the athlete being lifted and the athletes supporting or catching that person.
The AAP 2024 policy statement breaks down all cheerleading injuries by body region. Head and neck injuries make up 16% to 19% of injuries, while the policy’s separate concussion and head-injury category accounts for 3.5% to 4%. Lower-extremity injuries account for 30% to 37%, upper-extremity injuries for 21% to 26%, and trunk injuries for 7% to 17%.
Injury type also matters. Sprains and strains represent 53% of all cheerleading injuries. Abrasions, contusions, and hematomas represent 13% to 18%; fractures and dislocations represent 10% to 16%; and lacerations and punctures represent 4%, according to the AAP 2024 policy statement.
Where and when injuries happen
Practice is a major part of the injury picture because it is where athletes spend substantial time repeating skills. In the Shields & Smith (2009) prospective study, 83% of the 567 recorded injuries occurred during practice. The same study reported 52% during stunt attempts and 24% while basing or spotting.
The setting-specific rates in that study were not identical. Competition had the highest reported rate at 1.4 per 1,000 athlete-exposures, followed by practice at 1.0. Pep rallies and athletic events each had a rate of 0.6 per 1,000 athlete-exposures. The AAP/Pediatrics 2016 study, using a different surveillance design, reported 0.85 for competition, 0.76 for practice, and 0.49 for performance.
These figures should not be treated as contradictory measurements of one unchanged population. They come from separate studies, and the difference illustrates how rates can vary with the definition of exposure, the type of event included, and the period observed.
The Shields & Smith study found that 30% of injuries affected the lower extremity and that 53% were sprains or strains. Those broad injury categories include more than concussions, but they help place head injuries within the wider distribution of cheerleading harm.
Age, sex, and team-type differences
The AAP/Pediatrics 2016 study reported that 96.8% of injured cheerleaders were girls. It also reported an injury rate of 1.33 for boys compared with 0.69 for girls, producing a rate ratio of 1.93. The two findings describe different aspects of the data: the percentage describes the sex distribution of injured athletes, while the rate comparison describes injury occurrence within the reported groups.
Age-related injury patterns in the AAP 2024 policy statement differ between athletes aged 6 to 11 and those aged 12 to 17. Among younger cheerleaders, upper-extremity injuries accounted for 41% of injuries and lower-extremity injuries accounted for 29%. Among older cheerleaders, upper-extremity injuries accounted for 25% and lower-extremity injuries for 38%.
The prospective Shields & Smith (2009) study also identified differences by team type. Collegiate cheerleaders were 2.98 times more likely to sustain a concussion than cheerleaders on other team types. All Star cheerleaders were 1.76 times more likely to sustain a fracture or dislocation than cheerleaders on other team types. These are relative comparisons from that study and do not give the underlying absolute rate for each team category.
Emergency visits and hospital admissions
An emergency-department study by Xu et al. (2021), covering 2010 through 2019, found that estimated annual cheerleading-related injuries declined by 15%. The estimated annual number fell from 35,000 to 30,000, and the injury rate per 100,000 cheerleaders declined by 27%.
At the same time, estimated annual concussions and closed-head injuries increased by 44%, rising from 3,800 to 5,500. Patients requiring hospital admission increased by 118%, from an estimated 330 to 720. Thus, the study reported fewer total injuries but more recorded concussion or closed-head injuries and more admissions over the 2010–2019 period.
The AAP 2024 policy statement summarizes 2012–2019 NEISS data in a different way. Concussion and closed-head injuries represented 16% of all cheer-related emergency-department visits and were the leading cause of cheer-related hospital admissions at 22%. Head and neck injuries represented 43% of cheer-related injuries in that NEISS summary; ankle injuries represented 12%, hand and wrist injuries 9%, and trunk injuries 8%.
Return timing was also reported in the AAP 2024 policy statement. Thirty-four percent of athletes returned to cheer in less than one week after injury, while 41% returned in one to three weeks. These percentages describe reported return timing after injury; they do not establish that a particular return interval is medically appropriate for every concussion.
Catastrophic injury context
The AAP/Pediatrics 2012 review reported 76 direct catastrophic injuries among high-school cheerleaders and 34 among collegiate cheerleaders from 1982 through 2009. The review reported a catastrophic injury rate of 0.4 per 100,000 participants in high-school cheerleading and 2.0 per 100,000 participants in collegiate cheerleading.
For female athletes across the sports included in that historical review, cheerleading accounted for 65.0% of direct catastrophic injuries to high-school girls from 1982 through 2009 and 70.8% of direct catastrophic injuries to college women during the same period. These figures concern direct catastrophic injuries, a narrower and more severe category than all concussions or all cheerleading injuries.
Taken together, the available statistics describe several different layers of risk: overall injury frequency, concussion incidence, stunt-related mechanisms, emergency-department burden, admission counts, and rare catastrophic events. Measurement period and geography matter throughout: the cited surveillance covers U.S. teams, U.S. school participation, or U.S. emergency-department data, while the historical review spans 1982–2009 and the more recent emergency-department analysis spans 2010–2019.