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Cheerleaders on a football field

Cheerleading: Common Injuries and Prevention

Author: CHKD Sports Medicine
Published Date: Tuesday, April 12, 2016

By: Jessica Eisenberg DPT, MS, ATC

Gone are the days of cheerleaders just waving pom-poms, doing kicks in the air, and only standing on the sideline at games. Cheerleading has evolved into a high energy, cardio driven, advanced tumbling, and people lifting competitive sport. The wide range of skill levels are observed in different divisions in the competitive cheerleading world through all-star teams as well as with many middle school and high school teams competing. From 1990 to 2003, cheerleaders age 6 and older increased from 3 million to 3.6 million.1 With increased and more complex skills, as well as an increased number of participants, there comes an increased risk of injury. One retrospective study reported that cheerleading injuries in children ages 5 to 18 increased 110% from 1990 to 2002.2 The most common injuries in cheerleading include strains/sprains, soft tissue injuries, fractures/dislocations, lacerations/avulsions, and concussions/closed head injuries.

Sprains and Strains

Sprains and strains of the legs are the most common injury occurring in cheerleading.3 The top injury locations for sprains and strains included ankles, neck, lower back, knee, and wrist.4 Back Pain is a common injury that many cheerleaders experience and can be caused by muscle strains. Decreased core stabilization and overuse of back muscles can cause decreased muscle control leading to increased low back pain during stunting, tumbling, and can affect activities of daily living. Not only do cheerleaders often experience muscle pain in their backs, there is an increased risk for stress fractures of the spine.5 Many injuries occur during tumbling and stunting so knowing proper mechanics for cheerleading skills (jumps, tumbling, landing, and stunts) can help to prevent injury. Physical therapy can help alleviate that athlete’s symptoms, address impairments, and work on a progression for safe return to prior level of function. At physical therapy sessions, the physical therapist and physical therapist assistant will address pain, muscle weakness, range of motion deficits, and focus on proper form for functional activities.

Fractures and Dislocations

The second most common types of injury in cheerleading are fractures and dislocations.2 Common fracture sites in cheerleading include lower extremities (ankles, leg), upper extremities (wrists, forearm, elbow), and vertebra fractures (aka spondylolysis) in the low back. Dislocations can occur in ankles, patellas/kneecaps, elbows, and shoulders. Following a fracture or dislocation, the body part is often immobilized in a cast, splint, or brace. It is possible that immobilization will cause the athlete to have decreased range of motion, strength, and functional use of the extremity. Physical therapy will help to regain lost range of motion, improve strength and stability, and transition the athlete back to their prior level of activity for a safe return to sport.


According to a recent study by Shields and Smith, concussions account for 4-6% of injuries in cheerleading.4 A concussion can occur during the many stunts and pyramids or from falls during tumbling skills. A concussion is a type of brain injury that occurs due to a bump or blow to the head or a hit to the body that causes the brain to move back and forth inside the skull.6 Brain cells can become damaged, resulting in chemical changes in the brain. Some lasting effects and symptoms of concussions include sensitivity to light or sound, nausea, vomiting, dizziness, balance difficulties, personality changes, and headaches. All of these symptoms can lead to a decreased endurance and ability to perform sport activities and can have an effect on home and school life. Following a concussion, physical therapy is used to assess impairments associated with ongoing symptoms, assess if there is a vestibular component to any dizziness or balance impairments, and progress the athlete through exertion based activities for a safe return to sport.7


Many injuries can be prevented when an athlete practices the proper form and technique for their skills. Biomechanics Physical therapy can help to strengthen weak muscles and stretch tight muscles. The physical therapist will address functional impairments including faulty biomechanics and jumping and landing form. The CHKD Sports Medicine department offers many classes to help with injury prevention. A detailed list and information the programs that CHKD has to offer can be accessed here: CHKD Injury Prevention Programs and CHKD Fitness and Sports Training.

With the rise in participants for cheerleading of all ages, there has been an increase in injuries related to the sport. Increased skill level and earlier age participation may play a role in the more frequently observed injuries. Physical therapy can help to return an athlete to cheerleading following many different types of injuries as well as play a role in prevention of future injuries.


  • Cheerleading Injuries: Epidemiology and Recommendations for prevention. American Academy of Pediatrics. November 2012; 130:(5):966-971.
  • Shields, B., Smith G. Cheerleading-Related Injuries to Children 5 to 18 Years of Age: United States, 1990-2002. Pediatrics. January 2006; 117(1):122-129.
  • Shields, B., Smith, G. Epidemiology of Cheerleading Fall-Related Injuries in the United States. Journal of Athletic Training. 2009; 44(6):578-585.
  • Shields B., Smith, G. Cheerleading-Related Injuries in the United States: A Prospective Surveillance Study. Journal of Athletic Training. 2009; 44(6)567-577.
  • Ullrich, P. Isthmic Spondylolisthesis During Adolescence. Last updated: 2/22/2011. Accessed: 2/22/16.
  • Centers for Disease Control and Prevention. Heads Up: What is a Concussion? Last updated: 2/16/15. Accessed: 2/22/16.
  • CHKD Sports Concussion Program.  

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About CHKD Sports Medicine

About CHKD Sports Medicine  CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.