The National Cheer Safety Foundation has put together a library of educational safety guides that specifically target issues that cheerleaders, cheer parents and cheer coaches face each cheerleading season. Below are their tips from Guidelines To Return to Play After a Concussion in Cheer. If you would like to download this PDF, or any of the other safety guides available from NCSF, visit their website and click the Safety Library option.

NCSF Panel of Expert's Guidelines To Return to Play After Concussion in Cheer
Any cheerleader, 18 and under, who is suspected of or may have sustained a concussion during a cheerleading practice or performance should not be allowed to return to activity the same day.

Historically, athletes with mild concussions were allowed to return to practice as long as they reported that their symptoms (headache, dizziness, nausea, confusion) had dissipated. These NCSF guidelines were developed to protect the cheerleader from possible further injury to his/her brain.

Once a concussion is diagnosed, the focus needs to be on "physical and cognitive rest until symptoms resolve". Physical rest has always been the treatment for concussion; but an added focus for treatment to also include cognitive rest is included new criteria.

In other words, cheerleaders who are recovering from a concussion need to quiet their bodies and their minds for efficient healing to take place. The quieter the cheerleader's body and mind, the quicker the recovery. This may mean that cheerleaders in school be required to miss classes as well as practice as part of their recovery plan.

Activities that require concentration and attention (i.e., school work, video games, text messaging) may exacerbate the symptoms and possibly delay recovery.

Graduated Return to Play Progression
Most cheerleaders recover within several days. To ensure a gradual and safe progression for cheerleaders to return to play, the panel recommended a specific progression of activities. The progression levels begin with complete rest and progress through to return to play.

Each level should take 24 hours with the cheerleader asymptomatic (symptom free) before moving to the next level in the progression. If any symptoms occur during the progression, the cheerleader should drop back to the previous level and try to complete that level after a 24 hour rest period. The progression levels are listed below:
  • No activity with complete physical rest and cognitive rest

  • Light aerobic exercise (less than 70% of maximum heart rate)

  • Cheer specific strength and conditioning

  • Non-contact training (No tosses, no tumbling, no above shoulder-drills)

  • Full contact practice

  • Return to play


Ideally, the progression should take about one week from asymptomatic rest to full competition. A cheerleader should not return to play or practice without the written consent of a qualified health professional.

The NCSF Panel of Experts includes experienced doctors and physicians, biomedical researchers, lawyers, athletes and sports professionals, catastrophic cheer injury survivors and more. To learn about the individuals that work with NCSF to promote athletic safety, visit the NCFS website.