Preventing Catastrophic Injuries in Cheerleading

By Terry Zeigler, EdD, ATC 

With the increase in catastrophic injuries on the rise in the sport of cheerleading, the focus has recently turned to the cause of these injuries and how to prevent them. According to the 25th Annual Catastrophic Injury Report released in 2009, more than half of the total catastrophic injuries sustained in girls and women’s sports were in the sport of cheerleading.

Taking steps to prevent catastrophic injuries begins with analyzing the types and mechanisms of injuries. Once the mechanisms of injuries are understood, steps can then be put into place to reduce future injuries.

A majority of the catastrophic injuries occurred from falls on to hard surfaces from basket tosses (stunts in which “base” athletes toss a “flyer” into the air) and pyramid (formations of stacked athletes) stunts. Skull fractures, brain injuries, and spinal cord injuries are all examples of injuries listed in the catastrophic injury report from these types of falls.

There are a number of factors that have contributed to the significant increase in catastrophic injuries in cheerleaders including:

• Unqualified coaches not trained in gymnastics, stunts, and safe tumbling progressions and without proper coaching certification
• Cheerleaders performing stunts they are not trained or prepared for
• Lack of emergency medical plans in the event of a catastrophic injury
• Stunts performed on hard surfaces including gym floors, grass, asphalt, rubberized track
• Evolution of sideline spirit squads into competitive cheer and stunt teams without appropriate evolution of safety standards and guidelines

The National Cheer and Safety Foundation has recently teamed up with the United States Sports Academy to develop safety courses, training and certification specifically designed for cheer coaches. This comprehensive course is a step in the right direction for protecting young athletes.

Coaches without a background in gymnastics, stunt, and tumbling progressions should not be coaching competitive cheer teams. Gymnastics and tumbling are high risk sports that need to be taught through careful progressions and lead up stunts. Without this knowledge, young athletes are at risk for serious injury.

Parents need to be proactive in asking the type of training, experience, and certification cheer coaches have. Because there are cheer coach certifications that exist that do not require comprehensive training, care must be taken to research the specific type of cheer certification and training that a coach has.

Even if the number of catastrophic injuries can be reduced in the sport of cheerleading, the risk will still be there due to the nature of the high risk stunts performed. Because of this, emergency medical plans need to be developed at each institution.

Emergency medical plans need to be in place in the event of a catastrophic injury so that competent emergency medical care can be quickly provided. The development of an emergency medical plan should include the institution’s medical staff, coaches, and local emergency services personnel.

The foundation of every emergency medical plan is to ensure that every coach is certified in cardiopulmonary resuscitation and first aid through either the American Red Cross or the American Heart Association. Both associations are well respected and offer standardized courses.

Along with identifying staff with emergency medical training, an emergency medical plan should also include:

• Emergency first aid kit and emergency equipment
• Location and easy access to emergency first aid kit and equipment
• Location and access to ice
• Location of telephones
• Access points to facilities for emergency services
• List of local trauma hospitals

Being able to provide adequate and timely emergency first aid can help in the reduction of secondary injury to damaged tissue and other complications. Providing rescue breathing and cardiopulmonary resuscitation can mean the difference between life and death for a catastrophically injured athlete or the amount of brain damage due to lack of oxygen in a brain-injured athlete.

The latest research published by the Journal of Athletic Training (“The Potential for Brain Injury on Selected Surfaces Used by Cheerleaders, November 2009) provided evidence for the first time that grass surfaces, carpet, dry dirt, artificial turf, and rubberized surfaces are not safer than gym hardwood floors to stunt on.

However, the leading rulebooks used in cheerleading (American Association of Cheerleading Coaches and Administrators and the National Federation of State High School Associations Spirit Rules Book) both state that high risk stunts are permitted “on appropriate mats, grass, rubberized and soft-yielding surfaces” (NFHS 2009-2010 Spirit Rule Book).

Knowing certain guidelines are important in preventing injury. Research published by the Journal of Athletic Training specifically studied the critical height (“an approximation of the fall height below which a life-threatening head impact injury would not be expected to occur”) of a number of surfaces commonly used by cheerleaders when stunting.

Critical heights of different cheer surfaces include the following:
• Carpet – 1 ft
• Asphalt – 1 ft
• Rubberized track – 1.5 ft
• Dry dirt – 2 ft
• Dry grass, 2 inches tall – 3.5 ft
• Artificial turf – 4 ft
• Traditional wood gym floor – 4.5 ft
• Dry grass, 4 inches tall – 4.5 ft
• Landing mat on vinyl tile – 6.5 ft
• Landing mat on foam floor – exceeds 10.5 ft
• Spring floor – exceeds 11 ft

This data is significant to preventing catastrophic injuries in cheerleaders. Many of the surfaces currently used by cheerleaders for stunting on the sidelines of games are surfaces with critical heights well below even the heights of the athletes.

When considering that “flyers” are regularly tossed 15 – 20 feet into the air, only two surfaces tested would be considered safe surfaces for basket tosses and pyramid stunts. The only safe surfaces for high risk cheer stunts are landing mats on foam floors and spring-loaded floors.

In an ideal world, athletes should only stunt on these two surfaces. In reality, thousands of athletes are currently performing stunts on surfaces that are likely to cause catastrophic injuries.

Separating “sideline pep squads” from “competitive cheer teams” is another way to reduce catastrophic injuries. Competitive teams would practice and compete on one of the two floors deemed safe by the research. Sideline pep squads would be required to keep their feet on the floor with their focus on low level stunts, routines, and crowd involvement.

Because a majority of catastrophic injuries were sustained through falls on to hard surfaces (wood gym floors), removing high risk stunts from the sidelines of athletic events would decrease these types of injuries.

Some universities have already taken steps to separate “sideline pep squads” from “competitive cheer squads”. One example is the newly formed “National Competitive Stunts and Tumbling Association”. The association was created by the coaches and administrators from eight universities (including the University of Oregon, Baylor University, and the University of Maryland).

One of the universities in the association, Fairmont State University, has separated their “Competitive Cheerleading” team from their “Spirit Squad”. The “Competitive Cheer Team” performs only in local and national competitions and does not perform on the sidelines of athletic events. The sideline cheering is left up to the “Spirit Squad”. The high risk stunts are kept off the sidelines at athletic events and kept on the safety mats.

Splitting cheer into two distinct paths is one way to reduce the risk of catastrophic injuries in the sport of cheerleading. Athletes that enjoy the gymnastics and tumbling can gravitate towards the competition teams while athletes that do not have the gymnastics background can participate on spirit squads.

Schools that do not have the financial resources to purchase safety equipment and hire qualified coaches can opt for a traditional spirit squad. This would ensure that girls who want to participate in cheerleading could continue to do so in a safe manner.


ABC News. (January 5, 2010). The Most Dangerous Sport of all may be Cheerleading. Nightline.

American Association of Cheerleading Coaches and Administrators (2007). High School Safety Rules 2007-2008.

Mueller, F., and Cantu, R. (August 19, 2008). National Center for Catastrophic Injury: 25th Annual Report. University of North Carolina.

National Cheer Safety Foundation (June 29, 2009). Experts Call for Congressional Hearing on Cheer Injuries. Press Release:

National Federation of State High School Associations (2009). Spirit Rules Book 2009-2010. NFHS: Indianapolis, IN.

Shields, B. & Smith, G. (November, 2009). The Potential for Brain Injury on Selected Surfaces Used by Cheerleaders. Journal of Athletic Training 44(6).