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Pediatric Cheerleading-Related Head Injuries and the "Double Down" Rule Change.

Audrey Lynn Litvak¹, Lillian Ann Litvak¹, Jeffrey G Stepan²

¹Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.

|June 30, 2026

Summary

The "double down" rule change in cheerleading reduced head injuries in young athletes. This safety improvement highlights the benefit of regulating advanced stunts to prevent concussions.

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Area of Science:

Sports Medicine
Pediatric Injury Prevention
Biomechanics of Cheerleading

Background:

The "double down" rule, implemented in 2012-2013, prohibited advanced stunts in youth cheerleading.
This rule change aimed to decrease concussions caused by teammate collisions during complex aerial maneuvers.
Stunting involves lifting or throwing athletes, with dismounts posing significant head injury risks.

Purpose of the Study:

To evaluate the impact of the "double down" rule change on pediatric head injuries in cheerleading.
To analyze trends in cheerleading-related injuries before and after the 2012 rule implementation.
To identify mechanisms of injury associated with head trauma in young cheerleaders.

Main Methods:

Utilized the National Electronic Injury Surveillance System (NEISS) for data from 2004-2023.
Analyzed demographic data, injury mechanisms (MOI), and national injury estimates for cheerleaders aged 6-18.
Employed interrupted time series analysis to assess injury trends per 100,000 participants.

Main Results:

Over 15,000 injuries were recorded nationally, with 14% being concussions/closed head injuries.
Stunting and teammate collisions were primary mechanisms for head injuries (39% and 37%, respectively).
Post-2012, overall injuries, head injuries, and teammate collision MOI significantly decreased (P<.05), while stunting MOI stabilized.

Conclusions:

The "double down" rule change demonstrably improved pediatric head safety in cheerleading.
Regulating advanced maneuvers based on skill level and environment effectively reduces injury risk.
Opportunities exist to further mitigate injuries during return-to-sport periods.