Injury Patterns and Trends in US Cheerleading: A Systematic Review of an Understudied Sport

Objective: To systematically compile and analyze studies on cheerleading-related injuries in the United States, with a focus on injury patterns and trends. Data Sources: PubMed, Embase, and Cochrane Central Register of Controlled Trials. Search terms included (“cheerleader” OR “cheerleading” OR “cheer athlete” OR “spirit leader”) AND (“injuries” OR “trauma” OR “accidents”). Included studies reported cheerleading injury data from 1982 to 2019. Extracted data included study characteristics, participant demographics, injury type, anatomical location, mechanism, maneuver, event, and time lost. Main Results: A systematic review using the above data sources was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 372 studies were identified, and 14 studies met inclusion criteria. Inclusion criteria were original clinical studies (level of evidence 1-4) which examined cheerleaders of various expertise and ages who sustained athletic injuries. 28 998 cheerleaders sustained 239 361 injuries. Participants were 96.5% female with a mean age of 16.0 years. Most injuries occurred among high school athletes, primarily during practice. Sprains and strains were the most common injury types, often caused by contact with another athlete. Ankle injuries were most common, followed by head, brain, and neck injuries. Conclusions: This systematic review is the first to compile all studies on cheerleading-related injuries in the United States and to examine associated risk factors, injury patterns, the most common types, locations, and timing of injuries. However, the absence of standardized injury reporting in cheerleading poses a significant barrier to draw definitive conclusions across studies. Our findings highlight the need for mandatory reporting systems to enhance data reliability.