Cheerleading injury prevention for girls.
The leading source of catastrophic injury in girls' sport — and the one with the least medical coverage.
Stunting
The mechanism behind the majority of cheerleading injuries in national surveillance.
Ankle
Among the most commonly injured body sites in competitive cheer.
Surface
Practising stunts on hard or unmatted surfaces is the most-cited modifiable risk factor.
National surveillance of cheerleading injuries found the majority occur during stunting, with the ankle among the most commonly injured sites and concussion a substantial share of severe injuries. Cheerleading has also historically accounted for a disproportionate share of catastrophic injuries among female high school and collegiate athletes — driven by falls from height during pyramids and basket tosses.
The distinguishing feature is structural: cheer is frequently classified as an activity rather than a sport, which in many programs means less athletic-training coverage, fewer mandated surfaces, and weaker return-to-play enforcement. The most effective interventions here are administrative — surface, supervision, skill progression — as much as physical.
What actually injures cheerleading players
Fall from height during stunting
The severe-injury mechanismMechanism: Flyer dropped or dismounted uncontrolled from a pyramid or basket toss, often onto an inadequate surface.
Female-specific: Cheer's catastrophic injury burden is concentrated here; height limits, mandated spotters, and appropriate matting are the direct controls.1
Concussion
A significant share of severe injuriesMechanism: Flyer-to-base head contact, head-to-floor impact on a fall, or collisions during pyramid transitions.
Female-specific: Under-recognized where no athletic trainer is present; a written removal-from-play protocol is essential in cheer specifically.1,4,3
Low back and wrist overuse
Common in bases and tumblersMechanism: Repeated overhead loading and catching for bases; repeated wrist weight bearing for tumblers.
Female-specific: Same physeal considerations as gymnastics apply to skeletally immature tumblers.5
Why the risk is different for girls
These factors change what prevention has to address — they are not reasons to train girls less.
Bases and flyers need different programs
Bases perform repeated overhead loading and catching and need shoulder, trunk, and posterior-chain strength above everything else. Flyers need single-leg balance, ankle control, and body-position strength. Programming everyone identically leaves both groups under-prepared for their actual job.1,6
The administrative controls matter more than the exercises
Injury surveillance points repeatedly to the same modifiable factors: stunt height, mandated spotters, appropriate matting or spring surfaces, skill progression rules, and access to an athletic trainer. No warm-up compensates for a basket toss over a hard floor.1
Energy availability comes before every other adaptation
When an athlete does not eat enough to cover the energy her training burns, the body downregulates the systems it treats as optional first — menstrual function, bone remodeling, immune response, and tissue repair. The IOC calls this Relative Energy Deficiency in Sport (REDs), and it raises bone stress injury and soft-tissue injury risk independent of how good her mechanics are. Amenorrhea (no period for three or more months) in an athlete is a clinical finding, not a convenience.8,9
Puberty changes the machine mid-season
The adolescent growth spurt lengthens the levers (femur, tibia) faster than the neuromuscular system recalibrates, and in girls the strength gain that accompanies growth is smaller than in boys. The result is a two- to three-year window of reduced dynamic knee control, wider dynamic valgus on landing, and higher relative injury risk. Programming should get more — not less — landing and single-leg work through this window.7
Menstrual-cycle phase is a variable, not a taboo
Hormonal fluctuation across the cycle affects laxity, neuromuscular control, thermoregulation, and perceived exertion, and prospective data in international footballers found injury incidence differed by cycle phase. The practical action is not to restrict training but to track: a simple cycle log next to load data lets athletes and staff see patterns and adjust intensity, hydration, and fueling.10
The protocol, block by block
Run before every practice. Split the last block by role — flyers to balance, bases to overhead strength.
- 2 min
General warm-up
Jog, skips, arm circles, hip openers, thoracic rotations.
- Whole body first
- Progressive range
- Get warm before you stunt
- 2 min
Ankle and foot
Calf raises through full range, single-leg balance, hop-and-stick, short-foot work.
- Quiet landings
- Full range
- Control the wobble
- 2 min
Posterior chain and hip
Single-leg RDLs, glute bridges, lateral band walks, Nordic lowers twice a week.
- Hips level
- Slow lowering
- Knees out
- 2 min
Trunk and overhead control
Dead bugs, side planks, Pallof press, overhead holds with a neutral rib position.
- Ribs down
- Brace and breathe
- No back arch under load
- 2 min
Role-specific finish
Flyers: single-leg body positions and balance holds. Bases: catch-position eccentrics and controlled overhead lowering. Tumblers: progressive wrist weight bearing.
- Rehearse the catch, not just the throw
- Land, then reset
- New skills spotted, always
What to check, and when to escalate
Single-leg balance
30-second eyes-closed single-leg stance, both sides — especially for flyers.
Red flag: Prior ankle sprain without completed balance rehab.
Overhead strength and control (bases)
Overhead press and catch-position hold assessment; watch trunk position.
Red flag: Ribs flaring or low-back extension under overhead load.
Surface and supervision audit
Document what surface each stunt group practices on and whether a trained spotter is present for every skill.
Red flag: Any stunting on hard or thinly matted surfaces, or unspotted new skills.
Load rules that prevent overuse
- New skills are introduced with a trained spotter and on an appropriate surface, in a documented progression — never first attempted in a full routine.
- Cap full-out routine repetitions per session; fatigue is when stunting falls happen.
- Build genuine recovery days into a year-round competition calendar.
- Log tumbling and basing volume separately — they load completely different tissue.
Gear & equipment
- Spring floors or appropriately rated matting for all stunting and tumbling — the highest-value control in this sport.
- Shoes with adequate lateral support and intact midsoles; cheer shoes are frequently worn far past their life.
- Ankle bracing for athletes with a prior sprain, particularly flyers.
Stages, not dates
Progression is criteria-based and clinician-led. A calendar date is not a clearance.
- 1
1. Symptom-free daily function
For concussion: symptom-free at rest and through return-to-learn before any physical steps.
- 2
2. Strength and balance restored
Single-leg balance and strength symmetric; overhead strength restored for bases.
- 3
3. Conditioning and jumps
Full conditioning, jumps, and non-stunting choreography symptom-free.
- 4
4. Graded stunting
Return to basing or flying with spotters and reduced height first; tumbling reintroduced progressively.
- 5
5. Full routine
Full-out routines tolerated; concussion clearance from the treating clinician, no same-day return ever.
Questions coaches and parents ask
Is cheerleading dangerous?
Overall injury rates in cheer are comparable to other girls' sports, but the severity profile is different: cheer has historically accounted for a disproportionate share of catastrophic injuries in female athletes, almost entirely from stunting falls. Surface, spotting, height limits, and skill progression are what reduce that risk.
Why does cheer have fewer athletic trainers?
Because many states and institutions classify it as an activity rather than a sport, which affects medical coverage, surface requirements, and safety-rule enforcement. Advocating for sport classification is a genuine injury-prevention action in cheer.
How often does this program need to be run to work?
Meta-analyses of neuromuscular training find the protective effect tracks with dose: roughly two or more sessions per week, sustained across the full season, is the threshold where injury reductions become reliable. Programs run only in preseason lose most of their benefit by mid-season.
Should girls train differently from boys?
The exercises are largely the same; the emphasis and the dose differ. Female athletes get disproportionate benefit from posterior-chain strength, single-leg landing control, and trunk stability work, and they need explicit attention to energy availability, bone health, and menstrual function — areas boys' programs typically ignore entirely.
Is strength training safe for adolescent girls?
Yes. Supervised, technique-first resistance training is safe from pre-adolescence and is one of the most consistently protective interventions in sports medicine. The risk in youth sport is under-training strength, not over-training it.
Every claim, sourced
13 peer-reviewed sources. Each links to a PubMed search so you can read the original.
- 1
Shields BJ, Smith GA. Cheerleading-related injuries in the United States: a prospective surveillance study. J Athl Train. 2009;44(6):567-577.
PubMed - 2
McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34(7):1103-1111.
PubMed - 3
Covassin T, Moran R, Elbin RJ. Sex differences in reported concussion injury rates and time loss from participation: an update of the National Collegiate Athletic Association Injury Surveillance Program from 2004-2005 through 2008-2009. J Athl Train. 2016;51(3):189-194.
PubMed - 4
Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711.
PubMed - 5
Kox LS, Kuijer PPFM, Kerkhoffs GMMJ, Maas M, Frings-Dresen MHW. Prevalence, incidence and risk factors for overuse injuries of the wrist in young athletes: a systematic review. Br J Sports Med. 2015;49(18):1189-1196.
PubMed - 6
Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871-877.
PubMed - 7
Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492-501.
PubMed - 8
Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097.
PubMed - 9
De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad. Br J Sports Med. 2014;48(4):289.
PubMed - 10
Martin D, Timmins K, Cowie C, et al. Injury incidence across the menstrual cycle in international footballers. Front Sports Act Living. 2021;3:616999.
PubMed - 11
Sugimoto D, Myer GD, Foss KDB, Hewett TE. Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses. Sports Med. 2014;44(4):551-562.
PubMed - 12
Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.
PubMed - 13
Jayanthi N, Pinkham C, Dugas L, Patrick B, LaBella C. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013;5(3):251-257.
PubMed