Sideline Voices: Cheer, Marching Band, and the Fall Sports Vocal Athlete
Friday nights in September, where a stadium contains several people using their voices harder than most professional singers will all week. Without any guidance, support, or training, cheerleading can cause vocal injury that lasts a lifetime.
Why do Cheerleaders get hoarse and lose their voices?
The research community noticed cheerleaders decades ago. Vocal behavior in school cheerleaders was studied and described in 1983, and a survey of dysphonic cheerleaders followed in 1986.¹˒²
Cheering is a distinctive vocal behavior, sustained, high-intensity, often in cold air and over crowd noise. Modern competitive cheer involves more practice hours, longer seasons, and vocal demands layered on top of significant physical exertion. This makes cheerleaders likely to sustain vocal injury. The most common causes of hoarseness in cheerleaders are prenodules and nodules.
Why shouting injures
Phonation is a contact sport at the tissue level. A two-hour game at high intensity is thousands of collisions per second, sustained. The result is swelling, and with enough repetition, prenodular and then nodular lesions. These develop because before and after games, the cheerleader is still using their voice in school and after.
The population most at risk
Most of the people on that sideline are teenagers. In a 2024 study of 502 adolescents aged 13 to 17, researchers found a 24.3 percent lifetime prevalence and a 7.4 percent current prevalence of voice problems, with frequent loud talking identified among the risk factors and voice problems associated with reduced extracurricular participation and school absences.⁶
What to do this season
Treat the voice as equipment. Cheer programs should build vocal rest into practice structure the way they build in stretching, and should refer for care for persistent hoarseness. Warming up and cooling down the voice is as important as practicing routines. Athletes should be encouraged to vocal rest and hydrate after practices and games as well.
For everyone on the sideline: hoarseness that persists more than two to three weeks past the game, pain with speaking, or a voice that no longer recovers by Monday is not toughness. It is a symptom, and it deserves a look at the vocal folds rather than another season of pushing through.
References
M. Andrews and K. H. Shank, "Some Observations Concerning the Cheering Behavior of School-Girl Cheerleaders," Language, Speech, and Hearing Services in Schools 14, no. 3 (1983): 150–156.
A. Reich, M. McHenry, and A. Keaton, "A Survey of Dysphonic Episodes in High-School Cheerleaders," Language, Speech, and Hearing Services in Schools 17, no. 1 (1986): 63–71.
D. Fellman and S. Simberg, "Prevalence and Risk Factors for Voice Problems Among Soccer Coaches," Journal of Voice 31, no. 1 (2017): 121.e9–121.e15.
K. L. Buckley, P. D. O'Halloran, and J. M. Oates, "Occupational Vocal Health of Elite Sports Coaches: An Exploratory Pilot Study of Football Coaches," Journal of Voice 29, no. 4 (2015): 476–483.
V. D. Baker and N. Cohen, "University Vocal Training and Vocal Health of Music Educators and Music Therapists," Update: Applications of Research in Music Education 35, no. 3 (2017): 46–54.
R. B. Fujiki and S. L. Thibeault, "Voice Disorder Prevalence and Vocal Health Characteristics in Adolescents," JAMA Otolaryngology–Head & Neck Surgery 150, no. 9 (2024): 800–810
