A global evaluation of cheerleading injuries and risk factors: a systematic review and meta-analysis

Cheerleading has become growingly popular in recent years due to the nature of athleticism and competitive, which can pose a great risk of injury. The current research aimed to provide a comprehensive overview of cheerleading-related musculoskeletal injuries and its risk factors in amateur or competitive cheerleaders through the presentation as a systematic review and meta-analysis methodology.

A comprehensive search of seven credible databases (the Epistemonikos, Cochrane, Scopus, PubMed, Medline, Embase, and Web of Science) was conducted using two sets of keywords up to March 2025 in accordance with the PRISMA guidelines. The quality assessment of the literature was carried out using JBI method. Random effects meta-analysis on prevalence rates was carried out using STATA software.

Forty articles included in the study, which 175739 athletes were studied. The prevalence range of musculoskeletal injuries in cheerleaders was between 0.2 and 68.0 percent in different parts of body. Head/neck in 17 out of 40 studies (42.5%), ankle injuries in 13 out of 40 studies (32.5%), knee injuries in 12 out of 40 studies (30.0%), wrist injuries in 12 out of 40 studies (30.0%), hand injuries in 9 out of 40 studies (22.0%), and shoulder injuries in 8 out of 40 studies (20.0%), were the highest prevalence in all injuries. Sprains, contusions, strains, fractures, and concussions in various body parts were also observed. BMI, previous injury, surface firmness of participation, and carrying out stunts and/or training in the presence of a trainer with less coaching experience are major risk factors in incidence of musculoskeletal injuries in cheerleaders. The subgroup analysis showed that the polled prevalence of ankle injuries in cheerleaders with BMI 20-25 kg/m² (39.32%; 95% CI 16.23, 94.89) was higher than in cheerleaders with BMI <20 kg/m² (23.60%; 95% CI 19.43, 27.76).

These results signify the need for injury prevention and management schemes, particularly targeting vulnerable body parts such as head/neck and ankle in cheerleaders. Also, paying attention to risk factors, particularly hiring trainers with much coaching experience, is of utmost importance.