Cheerleading Injuries: Stunting Falls, Concussion, Wrists, Ankles and Backs

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Third quarter, Friday night, the home team just scored. On the track, two bases and a back spot push a flyer into a liberty while the student section counts down the extra point. It looks effortless. It isn’t: modern cheer, from Pop Warner and middle school to high school sidelines, all-star gyms, college teams and the Cheerleading Worlds, means tumbling, throwing and catching people. This page covers the cheerleading injuries the research keeps finding, the rare but serious head and neck injuries from stunting falls, concussion, wrists, ankles and backs, overuse, and the safety rules, spotting and warning signs that keep athletes in the air.

This page is general information, not medical advice. If you’re hurt, see a sports medicine doctor, physical therapist (PT) or certified athletic trainer (AT). For the bigger picture of the sport, start at our cheerleading hub.

How often cheerleaders get hurt

The American Academy of Pediatrics (AAP) says more than 3.5 million young people now cheer in the U.S., most of them girls aged 6 to 17, and its 2024 policy statement sums up the injury picture this way: the overall injury rate is fairly low, but the time away from the sport after an injury is long, which suggests that injuries can be severe. A national high school surveillance study (2009 to 2014) found cheerleading ranked 18th of 22 sports for injury rate, at about 0.71 injuries per 1,000 athlete-exposures (one practice, game or competition), with practices and competitions at similar rates. More than half of the injuries happened during stunts. In college, a 2026 review found reported rates of about 2.4 to 2.8 injuries per 1,000 athlete-exposures, again mostly in practice and stunting.

Across U.S. studies, sprains and strains are the most common injuries and the ankle is the most common site, followed by the head and neck. In a survey of 440 Division I college cheerleaders, the ankle (about 45% of injuries) and the wrist and hand (about 19%) were hurt most. Bases and spotters take a large share: in a national surveillance study of 412 teams, about a third of stunt injuries happened to the athlete basing or spotting, and the ankle, lower back and wrist were the sites most often re-injured.

Stunting falls and catastrophic head and neck injuries

This is the part parents worry about, so here are the numbers straight. The National Center for Catastrophic Sport Injury Research (NCCSIR) tracks injuries that cause death, permanent disability or serious harm such as a skull or spine fracture. In its 2012 policy statement, the AAP noted that cheerleading had accounted for about 66% of all catastrophic injuries in high school girl athletes over the previous 25 years. A study of NCCSIR cases from 1982 to 2002 found that most happened during pyramids or basket tosses, and included severe head injuries with skull fractures, two deaths, and fractures and other serious injuries of the neck.

The rules changed, and the numbers moved. A follow-up NCCSIR study counted 54 catastrophic injuries in high school and college cheerleading from 2002 to 2017, about 3.6 a year, or 2.12 per million cheerleaders. Most happened in practice, about half involved the head and about a third the cervical spine (neck), and basket tosses were the single biggest cause. After basket tosses were banned on hard surfaces in 2006–2007, the rate of catastrophic basket-toss injuries fell from 1.55 to 0.40 per million cheerleaders, nearly a fourfold drop.

Falls are the key mechanism. In a surveillance study of fall-related injuries, a stunt or pyramid was involved in 89% of falls, and the most serious injuries (concussions, fractures, dislocations and ACL tears) mostly came from falls of 4 feet or more onto artificial turf, grass, a foam floor without springs or a wood floor. The risk rises as the fall gets higher and as the surface gets harder.

Concussion: recognize it and remove the athlete

In the high school study, concussion was the single most common cheerleading injury, at 31% of all injuries (the concussion rate itself was lower than the average of other sports). A study of U.S. emergency visits from 2010 to 2019 found the total number of cheer injuries fell, but concussions and hospital admissions rose. Concussions come mostly from stunting: a flyer’s head meeting a base’s head on a cradle, an elbow in the face, or a fall. A 2026 study found head injuries in young cheerleaders improved after USA Cheer banned the “double down” dismount (a double twist into the cradle) for high school and younger teams in 2012–2013.

The CDC’s HEADS UP program is clear: if you think an athlete may have a concussion, remove them from activity. “When in doubt, sit them out.” They stay out for the rest of that day and until a health care provider clears them. Signs include looking dazed, confusion, clumsiness, mood changes and vomiting; athletes may report headache, dizziness, nausea, blurry vision, light or noise sensitivity, or feeling foggy.

Call 911 or go to the emergency department for the CDC danger signs: one pupil larger than the other, a headache that gets worse and won’t go away, slurred speech, weakness or numbness, repeated vomiting, seizures, growing confusion or agitation, or loss of consciousness. After any fall with neck pain, numbness, tingling or weakness, don’t move the athlete: keep them still and call for help. Return follows gradual steps (the 2022 Amsterdam consensus suggests relative rest for the first 24–48 hours, then stepwise activity, usually at least 24 hours per step), and there is no same-day return after a diagnosed concussion. A sensible plan brings back running and conditioning before tumbling, flying or basing.

Wrist, ankle and back injuries

Wrist sprains and fractures

Wrists take it from both sides: tumblers land on their hands in round-offs and handsprings, and bases catch and press a teammate’s full weight overhead. Falling onto an outstretched hand can sprain or break the wrist. Wrist pain that swells after a fall, or that keeps coming back every time you tumble, should be checked; in growing athletes, the AAP lists growth plate injuries among cheer’s overuse problems.

Ankle sprains

Short tumbling landings, flyers dropping out of stunts, and bases getting stepped on all roll ankles. A sprain that isn’t rehabbed tends to happen again, so a PT or athletic trainer should guide balance and strength work before full tumbling. Can’t put weight on it, or the bone itself is tender? Get an X-ray.

Back injuries from tumbling

Back handsprings, walkovers, arched jumps and heavy basing bend and load the lower spine over and over. The American Academy of Orthopaedic Surgeons (AAOS) describes spondylolysis, a stress fracture in a small part of a lower vertebra, in sports with repeated stress on the lower back: the pain can feel like a muscle strain, may spread to the buttocks and thighs, and gets worse with activity. Most cases are treated without surgery, but it takes a doctor’s diagnosis. Low back pain that gets worse when you arch, or that lasts more than a couple of weeks, is a reason to stop tumbling and see someone.

Overuse injuries

Cheer is often year-round: school season, all-star season, summer camps and private tumbling. The AAP lists stress fractures, tendinitis and growth plate injuries among cheerleading’s overuse injuries. The AAP’s general advice for young athletes is at least 1–2 days off a week from the main sport and about 3 months off a year, in blocks of at least a month. Pain that comes on gradually, hurts at rest or at night, or makes you change how you land deserves a visit.

Prevention: rules, spotting and surfaces

• Trained, certified coaches. The AAP recommends coaches certified in safety and spotting techniques. Training with a coach who has little experience is one of the risk factors studies keep finding.
• Spotters, every time. The AAP says pyramids should be no higher than two people, with spotters present. Under NFHS high school rules, extended stunts need a spotter with only narrow exceptions, and USASF all-star rules require that spotters be trained in proper spotting techniques. A spotter’s job is the flyer’s head, neck and shoulders, not the trick.
• The right surface. USASF rules ban stunts, pyramids, tosses and tumbling on concrete, asphalt, wet or uneven surfaces or surfaces with obstructions. The AAP adds no stunts on dirt or vinyl floors, and no basket tosses on hard surfaces like basketball courts. Wet track? The stunts wait.
• Progressions and proficiency. USASF rules say coaches must require proficiency before progressing a skill. Don’t skip steps to make a level.
• Strength and conditioning. The AAP recommends proper strength and conditioning for all cheerleaders; see cheerleading training.
• A physical and a plan. The AAP recommends a yearly pre-participation physical and a written emergency action plan in every school and gym, practiced with the whole team.
• Fuel and rest. Tired, under-fueled athletes recover slowly. See cheerleading recovery and nutrition.

Braces, shoes and gear many cheerleaders use

After an ankle sprain, many athletes wear a lace-up brace like the ASO EVO Ankle Stabilizer while they return. USASF rules allow braces and supports in their original manufacturer form without extra padding (altered ones must be padded if you stunt), and an athlete in a hard cast or walking boot can’t stunt, tumble or toss. Shoes matter too: USASF requires soft-soled shoes with a solid sole in competition, and a light cheer shoe like the Nfinity Vengeance is built for tumbling and stunting. For sore calves and hips after practice, a foam roller like the TriggerPoint GRID is a gym-bag staple. None prevents injury on its own; ask your PT or athletic trainer.

More on braces in our best ankle braces for athletes guide and on rolling in best foam rollers.

When to see a sports medicine doctor, PT or athletic trainer

• Right away (call 911): any concussion danger sign, a fall with neck pain, numbness, tingling or weakness, loss of consciousness, a joint that looks out of place or an obvious broken bone.
• Within a day or two: a suspected concussion, an ankle you can’t walk on, or a wrist that swelled after a fall.
• Soon: low back pain that gets worse with arching or lasts more than a couple of weeks, wrist pain every time you tumble, pain at night or at rest, a sprain that keeps rolling, or a child who limps.

A sports medicine physician diagnoses and decides on imaging; a physical therapist guides rehab and the step-by-step return to tumbling, basing and flying; a certified athletic trainer is often the first to see the injury at high schools and colleges. Comparing sports? See our soccer injuries guide.

Cheerleading injuries: FAQs

Is cheerleading dangerous?

Overall injury rates are lower than in most high school sports, but cheer injuries can be serious when they happen, and cheerleading has historically accounted for a large share of catastrophic injuries in girls’ sports. Rules on surfaces, spotting and stunt difficulty have cut catastrophic basket-toss injuries sharply. Trained coaches, spotters and proper mats make the biggest difference.

What is the most common cheerleading injury?

Sprains and strains, mostly of the ankle, are the most common type across studies. In one national high school study, concussion was the single most common diagnosis, at 31% of injuries.

Who gets hurt more, flyers or bases?

Both. Flyers face falls and the most serious head injuries, but in one large study about a third of stunt injuries happened to the person basing or spotting, often sprains and strains, and the ankle, lower back and wrist were the most re-injured areas.

Can a cheerleader keep cheering after hitting her head if she feels fine?

Not if a concussion is suspected. The CDC says remove the athlete for the rest of the day until a health care provider clears them; symptoms can show up hours later. Return then follows gradual steps.

Can you cheer with a brace or a cast?

Under USASF all-star rules, braces and supports in their original form are allowed; altered ones need padding if you stunt, and a hard cast or walking boot rules out stunts, pyramids, tumbling and tosses. School rules can differ, so ask your coach, and always follow the clearance from the person treating you.