Spotlighting a decade of concussion risk in Cirque du Soleil artists
By Maya Chawla. This article was initially published in the 11/20/25 Edition of our Concussion Update newsletter; please consider subscribing.
Overwhelmingly, the conversation around concussion focuses on sports, while performing arts, even at a globally-recognized level, are given little attention. The scarce few existing studies on circus arts only consider musculoskeletal injury or student performers, but in September 2025, a group of performing arts scientists led by Dr. Jeff Russell pulled back the curtain on concussion risk in high-level circus artists for the first time. Russell & colleagues’ 10-year epidemiological investigation into the medical records of Cirque du Soleil performers, published in Sports Health: A Multidisciplinary Approach, identified a concussion incidence rate among Cirque artists numerically comparable to varsity and professional non-contact athletics, unique mechanisms of injury in circus that remain overlooked, and significant time loss before safe return to performance.
Examining the Cirque’s medical records from 2010-2019, the researchers quantified concussion incidence rates by calculating “artist exposures” (AEs); one AE is defined as one artist participating in one rehearsal, training session, or performance. Throughout the records, the researchers identified that for every 10,000 AEs, 1.3 concussions occur on average. The year with the lowest rate was 2010, with 0.86 concussions per 10,000 AEs, while 2019 had the highest rate at 1.93 per 10,000 AEs; the authors believe this increase is more likely due to increased awareness and reporting. According to Van Pelt et al.’s (2019) exposure scale, 1.3 falls within typical ranges for non-contact projectile sports such as women’s softball, baseball, and tennis.
Of the four types of Cirque performers, acrobats sustained 90% of all documented concussions. This is unsurprising for a group that performs physically treacherous stunts with apparatus like trapeze, suspension, or trampoline. However, the study also addresses the rarely considered (but non-zero) risk for non-acrobatic performers. In fact, the mechanisms of injury (MOI) accounting for 90% of Cirque concussions are collision impact from apparatus, other performers, or landing surfaces, which are in no way restricted to acrobats. This type of collision is still possible among dancers, musicians, or character performers, especially when their act accompanies acrobatics. The predominance of impact-based MOI in Cirque is a striking revelation, given that performing arts are often considered much less dangerous due to a lack of expected contact. However, this study also shows that concussions can occur without impact, with whiplash forces accounting for 7% of the concussions in the data.
Time lost due to concussion recovery averaged 35.5 days, with a minimum of 1 day and a maximum of 1,338. Additionally, 70.3% of concussions occurred during performances rather than rehearsals. Just as the social pressure of coaches and spectators can deter sporting athletes from reporting concussions, reporting a concussion in the performing arts is difficult when “the show must go on.” Furthermore, unlike non-artistic athletes, circus artists must execute feats of high athleticism in a way that appears effortless and easy, with the cognitive load of performing a storyline or emotion during their act. The practice of concealing effort may obscure the observers’ perception of the risks these performers take. While injuries from sporting impacts, such as hits and tackles, are approached with concern for athlete safety in non-artistic sports, collisions with apparatus or other artists are more likely viewed as a shortcoming of the artist in skillfully navigating their environment and as a disruption to the performance.
Over the course of the decade, concussion diagnosis and education protocols were still evolving within Cirque du Soleil, as the increase in concussion incidence between 2010 and 2019 appears to reflect not a greater count of concussions, but an increase in concussion reporting and identification. Although improvement in reporting and identification is encouraging, it is important to remember that the broader phenomenon of underrecognition, underreporting, and misdiagnosis can lead to incidence estimates that are substantially lower than the true number of people affected. Cirque du Soleil may be comparable to relatively lower-risk sports, but the fact that this risk has long been unacknowledged is dangerous. Fortunately, the inaugural efforts of Dr. Russell’s group to statistically quantify the risk of concussion in circus arts are a monumental step towards ensuring that the safety of these artists takes center stage.
