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 259 injuries reported from 2005 to 2022 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. Another excellent study was published in 2016 by The American Academy of Pediatrics entitled “Cheerleading Injuries in United States High Schools.” Perhaps the most recent study of note was published in 2021 by The Orthopedic Journal of Sports Medicine entitled “Progress In Cheerleading Safety: Update on the Epidemiology of Cheerleading Injuries Presenting to US Emergency Departments, 2010-2019.”
The ongoing AYC study which began in 2005 provides a consistent source of additional information on cheer injury trends. The injury results are shown for the periods 2005-2022 and 2015-2022 to illustrate the impact of any recent 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 less frequent compared to other sports
According to the National High School Sports-Related Injury Surveillance Study, 2009-2014, cheerleading was 18th out of 22 sports in terms of overall injury rate. Between 2005 and 2022, 259 cheer injuries were captured within AYC. Over the same time period, 5,160 football injuries were reported within AYF. Cheer injuries only account for 5.0% of the injuries that occur in the combined AYF/AYC program.
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
| 2005-2022 | 2015-2022 | |
| 3+ weeks | 29% | 28% |
| 1 – 3 weeks | 25% | 20% |
| Not answered/unknown | 21% | 31% |
| 1-7 days | 13% | 9% |
| None | 12% | 12% |
| TOTAL | 100% | 100% |
According to the National High School Sports-Related Injury Surveillance Study 2009-2014, cheerleading had the second highest proportion of injuries resulting in 3+ weeks of absence.
When injury occurred
| 2005-2022 | 2015-2022 | |
| Practice | 76% | 78% |
| Before game/practice | 7% | 5% |
| Competitive cheer event | 5% | 3% |
| After game/practice | 3% | 4% |
| Other | 6% | 7% |
| Halftime | 2% | 2% |
| Sideline | 1% | 1% |
| TOTAL | 100% | 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
| 2005-2022 | 2015 – 2022 | |
| Indoor practice area | 50% | 59% |
| Field | 22% | 21% |
| Other | 7% | 3% |
| Sidelines | 5% | 2% |
| Outdoor practice area | 5% | 6% |
| Indoor competition area | 4% | 3% |
| Warm up area | 4% | 3% |
| Practice field | 3% | 3% |
| TOTAL | 100% | 100% |
Once again, these results confirm that most injuries occur during practice.
Surface type
| 2005-2022 | 2015 – 2022 | |
| Grass | 34% | 30% |
| Flat, non-spring | 29% | 36% |
| Mat | 18% | 15% |
| Spring | 8% | 7% |
| Concrete | 5% | 2% |
| Other | 6% | 10% |
| TOTAL | 100% | 100% |
Body part injured
| 2005-2022 | 2015-2022 | |
| Head/temple | 14% | 19% |
| Ankle | 9% | 7% |
| Wrist | 11% | 12% |
| Forearm | 9% | 13% |
| Knee | 8% | 5% |
| Elbow | 9% | 9% |
| Other | 10% | 9% |
| Shoulder/collarbone | 6% | 3% |
| Mouth/teeth | 6% | 6% |
| Neck | 4% | 1% |
| Nose | 3% | 6% |
| Upper arm | 3% | 3% |
| Back | 3% | 4% |
| Finger/thumb | 2% | 1% |
| Hand | 2% | 2% |
| Foot | 1% | 0% |
| TOTAL | 100% | 100% |
Note the 2015-2022 increase in injury to head/temple. This is consistent with a similar increase in concussion injuries being reported over the same time period.
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. Knee injuries commonly occur due to not landing squarely on feet during tumbling passes or jumping down from a pyramid.
Type of injury
| 2005-2022 | 2015-2022 | |
| Fracture | 40% | 50% |
| Joint sprain/strain | 17% | 9% |
| Concussion | 13% | 18% |
| Not answered/other | 8% | 4% |
| Dislocation | 5% | 3% |
| Bruise/contusion | 6% | 5% |
| Dental | 5% | 5% |
| Cut/scrape | 4% | 4% |
| Pulled muscle | 2% | 2% |
| TOTAL | 100% | 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.
Note the significant increase in concussions reported for the time period 2015-2022. This could be due to either the increasing complexity of stunts coupled with greater athleticism or the greater awareness of concussions and increased utilization of medical services.
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
| 2005-2022 | 2015-2022 | |
| Flyer | 34% | 31% |
| Tumbler | 17% | 21% |
| Other | 12% | 9% |
| Right-side base | 8% | 10% |
| Back spotter | 8% | 8% |
| Not applicable | 6% | 5% |
| Left-side base | 5% | 3% |
| Standing in cheer line | 4% | 5% |
| Coach | 3% | 5% |
| Base, not specified | 2% | 2% |
| Front spotter | 1% | 1% |
| TOTAL | 100% | 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
| 2005-2022 | 2015-2022 | |
| Other | 31% | 33% |
| Prep or extended elevator | 19% | 19% |
| Not answered | 10% | 8% |
| Prep or extended cradle | 8% | 7% |
| Round-off | 3% | 2% |
| Cartwheel | 5% | 6% |
| Full twist | 3% | 3% |
| Basket toss | 3% | 3% |
| Back walkover | 4% | 7% |
| Standing back handspring | 3% | 1% |
| Prep or extended full twist down cradle | 3% | 2% |
| Prep/extended awesome/cupie | 2% | 1% |
| Sideline cheer – no stunt or tumble | 2% | 1% |
| Dancing – not stunt or tumbling | 2% | 4% |
| Shoulder sit/stand | 2% | 3% |
| TOTAL | 100% | 100% |
For the novice, an excellent description of the various stunts and tumbles can be found in Wikipedia.
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. Starting in 2012, the percentages of injuries occurring during cartwheels and prep or extended elevator increased significantly.
Physical cause of injury
| 2005-2022 | 2015-2022 | |
| Contact with ground | 53% | 55% |
| Collision with teammate | 22% | 25% |
| Non-contact | 7% | 6% |
| Catching | 5% | 2% |
| Supporting weight | 6% | 6% |
| Not answered | 3% | 4% |
| Other | 2% | 1% |
| Hit by other object | 2% | 1% |
| TOTAL | 100% | 100% |
Activity while injured
| 2005-2022 | 2015-2022 | |
| Flying | 31% | 26% |
| Tumbling | 17% | 22% |
| Catching | 13% | 14% |
| Other | 13% | 18% |
| Supporting | 6% | 4% |
| Walking | 3% | 0% |
| Running | 3% | 1% |
| Lifting | 3% | 2% |
| Dismounting | 3% | 4% |
| Spotting | 3% | 3% |
| Sitting/standing/walking – not specified | 3% | 4% |
| Coaching | 2% | 2% |
| TOTAL | 100% | 100% |
Starting in 2012, the percentage of tumbling injuries increased significantly.
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:
- Limit stunts and other cheer elements/techniques to the applicable rule book, currently the Youth Cheer & Dance Alliance (YCADA) to the extent not inconsistent with the AYC Rulebook.
- Review and adopt best practices from resources such as the AYC Rulebook, YCADA cheer rules, and other manuals, courses, and industry recognized publications.
- Adopt a written risk management program such as our Sample AYF/AYC Risk Management Plan.
- Adopt a written concussion/brain injury risk management program such as our Sample Football/Cheer Brain Injury/Concussion Awareness Risk Management Program.
- Adopt a written abuse / molestation risk management program such as our Safe Sport Child Abuse and Other Misconduct Risk Management Plan.
- Insist that all cheer coaches are trained by an accredited coach training organization such as Coaching Youth Cheerleading: The AYC Way.
