The perception of cheerleading as being separated from real sports in some segments of public opinion is at odds with the modern nature of the intense, highly athletic activity that has approximately one million participants in the United States alone. Cheerleading, through its primary association with high schools, colleges, and universities, tends to be a young person's sport. As an adjunct to the generation of school spirit and the support of an institution's athletic program, cheerleading is not regarded as a dangerous or injury-plagued activity.
Cheerleading actually presents a number of specific injury risks for the participants. Data compiled by the National Collegiate Athletic Association (NCAA), the leading governing body of intercollegiate sport in the United States (which has formally recognized cheerleading as a varsity sport), suggests that while the injury rate among cheerleaders is relatively low in comparison to other sports, the severity of injury sustained per occurrence is relatively high.
There are a number of common factors to the cause of a cheerleading injury. Among younger cheerleaders, a lack of basic physical fitness among participants, especially in preparation for the coming cheerleading season is a prominent factor. At some high school and elementary schools, where proper training facilities may not always be available, the athletes practice on hard surfaces not conducive to the absorption of the forces generated in the repetitive exercise required by cheerleading.
Improper coaching techniques, the failure to make available an adult spotter during movements of greater risk, and a general lack of coaching knowledge with respect to injury prevention and risk reduction in cheerleading are also contributors to the injury rate. Coaches, particularly at the younger age levels, do not always appreciate that the sport requires attention to preseason training, particularly in the areas of participant strength, endurance, and flexibility. Cheerleading has also become a year-round activity in many areas of the United States, where the cheerleading team will perform at school or institutional events throughout the entire school year in each of the traditional sports seasons of fall, winter, and spring; the cheerleaders then participate in additional competitive club cheer team events. These long seasons tend to create considerable wear and tear on the musculoskeletal joints, particularly those of the feet, ankles, knees, and wrists, as the athlete is given limited or no opportunity to truly recuperate from these physical stresses.
Cheerleading, both as a practice activity and as a competitive event, is a long sequence of repetitive movements, most of which involve the leg muscles and joints. Studies indicate that over 35% of cheerleading injuries occur to the ankle or the knee. The run up and landing to the multitude of tumbling routines performed by cheerleaders are common causes of leg muscle strain and ligament sprain. It is a significant feature of cheerleading injuries that of the injuries that invariably compel the athlete to miss time from the sport, fractures and dislocations were the second most common, next to strains and sprains of soft tissue.
Most cheerleading injuries are caused during a partner or multi-person team gymnastics maneuver. The most visually dramatic and the most physically catastrophic of these injuries occur when a person near or at the top of a human pyramid falls, or where the person thrown by two or three teammates in a "basket toss" is not caught or otherwise lands incorrectly. In such instances, the risk of a serious fracture, concussion or other head injury, or joint dislocation is significant. Less dramatic but physically debilitating injuries can occur in the pyramid structures themselves if the cheerleaders do not possess the appropriate level of upper body strength to maintain their support position in the structure. The most common injuries sustained in these circumstances are shoulder and wrist damage.
In the component of some cheerleading teams that performs only dance routines without the gymnastic elements, the injuries sustained are similar to those occurring with ballet dancers: plantar fasciitis (foot tissue inflammation), hip injuries, and other overuse injuries the most common.
One specific injury cause identified in recent years among cheerleaders unrelated to the sport itself has been that of inadequate nutrition. The general public sense of cheerleading as something apart from a real sport has perhaps contributed to the failure of the sport itself to emphasize strong nutritional practices as essential to both health and competitive success. A cheerleader, participating in strenuous practices and competition, must be as aware of proper dietary and nutritional practices as any other athlete. In a related sense, the fact that most cheerleaders are female, and that the sport places emphasis on physical appearance, makes cheerleading a sport where coaches must be especially aware of any unusual attitudes toward eating. Bulimia and anorexia nervosa are risks in such circumstances, conditions that both psychologically and physically harm an athlete.