American Youth Cheer Releases Study on Injury Trends 2005-15

American Youth Cheer insurance

American Youth Cheer (AYC), the cheer division of American Youth Football (AYF), has released a study of injuries reported under its Accident insurance program through the endorsed insurance provider, Sadler Sports & Recreation Insurance.

The study consists of 183 injuries reported from 2005 to 2015 for cheerleaders ages 5 to 18 with the vast majority in the 5 to 15 age group. AYC includes both sideline cheer and competitive cheer.  The injury descriptions are collected on an injury report form that is completed by the authorized cheer coach prior to submitting an insurance claim. Page 3 of the AYC injury report includes 20 questions about the circumstances of each injury and the answers are entered into a database from which reports are generated.

Importance of the AYC study

Cheerleading has evolved from a primarily sideline activity into highly competitive sport with more complex stunts and gymnastics-like maneuvers. Even sideline cheer has adopted some of the same stunts and maneuvers. This has greatly increased the risk factors involved. As a result, injuries have risen dramatically, as reported by many sources.

Cheer injury studies are scarce due to the fragmented nature of the industry with so many sanctioning bodies and lack of injury data collection. An excellent article published in 2012 by the Journal of the Canadian Chiropractic Association entitled  “Cheerleading Injuries: A Narrative Review of The Literature” compiles the results from 23 unique articles on cheerleader injuries.  The ongoing AYC study which began in 2005 provides a consistent source of additional information on cheer injury trends.

Limitations of the AYC study

Since all injuries are reported from Accident insurance claims, the AYC study overstates the more serious injuries that require outside medical treatment and understates the minor injuries where medical treatment was not sought or where an on-site trainer provided treatment. In addition, the number of total claims in the database is surprisingly low taking into account the number of cheer participants at risk. However, the study does represent a reasonably accurate overview of the types of cheer injury trends that occur within AYC and youth cheer as a whole.

Cheer injuries are much less frequent than football injuries in combined program

Between 2005 and 2015, 183 cheer injuries were captured within AYC.  Over the same time period, 3,855 football injuries were reported within AYF. Cheer injuries only account for approximately 4.5% of the injuries that occur in the combined AYF/AYC program. However, after taking into account that football players outnumber cheerleaders by a wide margin in the combined program, the participant adjusted percentage of injuries attributable to cheer is approximately 14%.

Catastrophic cheer injuries in AYC

According to the National Center For Catastrophic Sports Injury Research report, “Catastrophic Sports Injury Research: 1982-2014,” cheerleading has the highest catastrophic injury rate of all high school sports. Fortunately, the AYC Accident insurance program has never experienced a catastrophic injury claim. However, local cheer program administrators and staff must always be vigilant of the potential for catastrophic injuries in cheer, and as a result should implement the risk management suggestions that appear later in this article.

Absence from play after an injury

3+ weeks 30%
1 – 3 weeks 26%
1-7 days 14%
None 13%
Not answered/unknown 17%
TOTAL 100%

Note that many of the less serious injuries were never reported as Accident insurance claims. As a result, this category tends to overstate the length of absence from play.

When injury occurred

Practice 76%
Before game/practice 7%
Competitive cheer event 5%
After game/practice 4%
Halftime 2%
Sideline 1%
Other 5%
Total 100%

Other studies have confirmed that the majority of cheer injuries occur during practice. Not only are more hours devoted to practice than play, but new tumbles and stunts are learned during practice. It makes sense that learning a new tumble or stunt entails a higher risk of injury.

Location of injury

Indoor practice area 45%
Field 22%
Sidelines 6%
Outdoor practice area 5%
Indoor competition area 4%
Practice field 3%
Other 15%
TOTAL 100%

Once again, these results confirm that most injuries occur during practice.

Surface type

Grass 37%
Flat, non-spring 26%
Mat 17%
Spring 9%
Concrete 6%
Other 5%
TOTAL 100%

Body part injured

Head/temple 12%
Ankle 10%
Knee 10%
Wrist 9%
Elbow 8%
Shoulder/collarbone 8%
Forearm 8%
Mouth/teetch 7%
Neck 5%
Upper arm 3%
Back 3%
Nose 3%
Finger/thumb 3%
Hand 2%
Foot 2%
Other 7%
TOTAL 100%

Other studies that capture data from all injuries (not just Accident insurance claims) indicate that ankles are the most common body part injured during cheer. Cheerleaders are thought to be susceptible to ankle injuries due to landing mechanics in an erect position, the prevalence of hard surfaces with lack of shock absorption, and difficult maneuvers.

Type of injury

Fracture 35%
Joint sprain/strain 21%
Concussion 10%
Dislocation 7%
Bruise/contusion 7%
Dental 5%
Cut/scrape 4%
Pulled muscle 2%
Not answered/other 9%
TOTAL 100%

Because the injuries in the AYC study are taken from Accident insurance claims where medical treatment has been sought, fractures tend to be overstated. Other studies on all cheer injuries (including incidents where medical treatment is not sought) indicate that the most common injury types are sprains/strains.

The American Academy of Pediatrics 2015 study “Cheerleading Injuries in United States High Schools” reported that concussions accounted for 31% of total injuries. Clearly, the percentage of concussions occurring in youth based non-scholastic cheer is much lower.

Position while injured

Flyer 35%
Tumbler 14%
Right-side base 8%
Back spotter 8%
Not applicable 6%
Left-side base 6%
Standing in cheer line 4%
Coach 4%
Base, not specified 2%
Front spotter 1%
Other 12%
TOTAL 100%

It’s not surprising that flyers are injured most frequently from falls as contact with ground and collisions with teammates are the leading physical causes of injury in the AYC study.

Type of tumble or stunt while injured

Prep or extended elevator 21%
Prep or extended cradle 9%
Roundoff 4%
Prep or extended full twist down cradle 4%
Cartwheel 4%
Standing back handspring 3%
Full twist 3%
Basket toss 3%
Sideline cheer – no stunt or tumble 2%
Prep/extended awesome/cupie 2%
Dancing – not stunt or tumbling 2%
Back walkover 2%
Other 31%
Not answered 10%
TOTAL 100%

Note the high number of injury report responses falling under “other” and “not answered.” This is an indication that there is not widespread agreement over the names of the types of stunt or the fact that some stunts have multiple names.             

Physical cause of injury

Contact with ground 53%
Collision with teammate 20%
Catching 7%
Non-contact 6%
Supporting weight 5%
Other 4%
Not answered 3%
Hit by other object 2%
TOTAL 100%

Activity while injured

Flying 32%
Tumbling 13%
Catching 13%
Supporting 7%
Walking 4%
Running 4%
Lifting 4%
Spotting 3%
Sitting/standing/walking – not specified 3%
Dismounting 3%
Coaching 2%
Other 12%
TOTAL 100%

Risk management recommendations

AYC has experienced many fewer injuries than its football counterpart, AYF. There have been no catastrophic injuries recorded in AYC since injury tracking began in 2005 or any prior to that period.

However, it is strongly recommended that all local cheer programs consider the following risk management practices: