Epidemiology and associated risk factors for injuries in collegiate cheerleading: a systematic review

Collegiate cheerleading is a physically demanding sport with high rates of injuries. However, existing injury surveillance is limited, outdated, and inconsistent, underscoring the need to synthesize available evidence to guide prevention strategies.

To investigate the epidemiology and risk factors for injuries in collegiate cheerleading by synthesizing evidence on injury rates, mechanisms, and types.

Eight electronic databases (PubMed, Embase, Web of Science CORE, Web of Science COMPLETE, Science Direct, OMNI, SPORTDiscus, MEDLINE, and CINAHL) were searched from inception to 19 October 2024.

Eligible studies were peer-reviewed, published in English from 2004 onward, and reported injury rates or risk factors in collegiate cheerleaders aged ≥ 18 years. Review articles and studies with ≤2 participants were excluded.

Systematic review.

Level 3.

Risk of bias and level of evidence were assessed using the Scottish Intercollegiate Guidelines Network validity scoring system and Oxford Centre for Evidence-Based Medicine criteria. Findings were narratively synthesized.

Six studies met inclusion criteria: one retrospective study (n = 184 female collegiate cheerleaders), four studies from a shared cohort of 9,022 athletes (96% female), and one case series of 54 catastrophic injuries. Injury rates ranged from 2.4 to 2.8 per 1,000 athlete-exposures. Sprains/strains, concussions, and fractures were the most common injury types. Stunting activities and practice sessions were the most frequent contexts for injury, with catastrophic injuries predominantly involving the head and neck. Inconsistent injury definitions and underreporting limited comparability.

The evidence base is limited by outdated data, descriptive observational designs, self-reported injuries, and inconsistent definitions, restricting generalizability. Collegiate cheerleading presents substantial musculoskeletal injury risk, particularly during stunting and practice. Standardized injury surveillance, targeted prevention strategies, and high-quality, prospective research are needed to identify risk factors and evaluate interventions.