Whether or not cheerleading is considered a sport, it is a popular activity among female athletes. In 2002 there were over 3.5 million cheerleaders six years of age and older in the United States. While the injury rate might be low compared to contact and collision sports, such as football, injuries in cheerleading do occur.

Data from the National Electronic Injury Surveillance System revealed that from 1990 to 2002, the number of injuries that occurred in cheerleading treated in U.S. emergency departments rose 110% from 10,900 in 1990 to 22,900 in 2002.4 A report from the National Center for Catastrophic Sports Injury Research showed that more than 50% of all catastrophic injuries among female athletes occurred in cheerleading.

Steps to prevent or decrease injuries in cheerleading

Fortunately, there are some recommendations that can help to keep cheerleading safe for females of all ages.

How can we decrease injuries in cheerleading?

Learn and follow rules for pyramids and basket tosses.

Pyramids are a common mechanism for injury in cheerleading. Height restrictions have been implemented which must be followed to minimize the chance of an injury. In high school, pyramids can be no more than two levels, and in college, they may only be 2.5 body lengths. The base cheerleaders must remain in contact with the floor and with the cheerleaders they are supporting. The cheerleader suspended must not allow her head to fall below horizontal and not rotate on her dismount.

Likewise, basket toss rules must be followed as well. No more than four throwers should be involved in the toss, and one of the throwers must be behind the flyer. The flyer must not have her head fall below horizontal during the toss. Although not required, the use of floor mats when performing stunts could be helpful as well.

Also read:
Catastrophic injuries in cheerleading

Utilize mats whenever possible.

Current rules do not mandate the use of landing mats, but they are encouraged, especially when practicing new stunts. Although it can be difficult to set up landing mats to perform acrobatic stunts during performances, their use should still be encouraged. If possible, routines that involve advanced gymnastic maneuvers, basket tosses, and pyramids should utilize mats, so these performances should be scheduled to allow enough time to set them up, such as at halftime of games.

Avoid wet floor and surface conditions.

Wet surfaces, such as the ground at rainy football games, have been implicated in several serious injuries. If such conditions exist, no pyramids, basket tosses, or other advanced gymnastics maneuvers should be attempted.

Prevent injuries in cheerleading

Progress stunts as skill levels improve.

Most experts feel that the increase in injuries in the last few decades is related mainly to the introduction of high-level gymnastics maneuvers into the sport. Cheerleading coaches should ensure that the participants understand and can perform basic skills before introducing more advanced maneuvers. When the individual cheerleaders and the teams master each level of skill, only then should they progress to more complex and dangerous stunts.

Also read:
Should cheerleading be considered a sport?

Always have sufficient spotters present.

The governing bodies of cheerleading mandate the use of spotters for pyramids and basket tosses, and they should be used in both practice and competition. A spotter has to be present for each cheerleader above shoulder level on pyramids.

Spend time training the spotters.

It is not enough to simply have spotters, but they must be adequately trained. They must understand proper technique to protect the cheerleaders for the different stunts, and only well-trained spotters should be used for complex routines.

Obtain proper safety certification for coaches.

The American Association of Cheerleading Coaches and Advisors has a cheerleading safety certification to help educate cheerleading coaches about injuries in cheerleading at all levels. It is designed to help the coaches promote cheerleading safety and implement safety measures for the complex stunts and maneuvers involved in the sport. The organization believes that only 30% of all the college and high school cheerleading coaches are certified, so encouraging coaches to obtain their safety certification is essential.

Note: This column appears in tomorrow’s edition of The Post and Courier. It is the first in a series of biweekly sports medicine columns I am writing for the newspaper.


1. American Sports Data, Inc. The Superstudy of Sports Participation: Volume II-Recreational Sports 2003. Hartsdale, NY: American Sports Data, Inc; 2004.

2. Boden BP, Tacchetti R, and Mueller FO: Catastrophic cheerleading injuries. Am J Sports Med 31(6): 881-8, 2003.

3. Mueller FO, Cantu RC: NCCSIR Eighteenth Annual Report. National Center for Catastrophic Sports Injury Research: Fall 1982-Spring 2000. Chapel Hill, NC, National Center for Sports Injury Research, 2000.

4. Shields BJ and Smith GA: Cheerleading-related injuries to children 5 to 18 years of age: United States, 1990-2002. Pediatrics 117(1): 122-129, 2006.