The competition, in which participants hurl themselves 640 feet down a hill after an eight-pound piece of cheese, has been celebrated for centuries in Gloucestershire, northwest of London.
The race is thought to originate from a heathen festival to welcome the spring. The first person to follow the cheese across the line at the bottom of the hill wins the cheese and a small cash prize.
Thousands of people attended Monday's event and the local ambulance service reported three people were taken to hospital with suspected fractured limbs, while 18 were treated for bruises and abrasions.
Teenager Chris Anderson, who won one of four cheese rolling races contested Monday, was taken to hospital on a stretcher, clutching his winning slab of cheese to his chest.
"The pain was worth it," Anderson said. "This cheese is going straight in a cupboard when I get home. It's definitely not for eating."
Organizer Richard Jefferies said Monday's event ran smoothly and injuries were down on previous years.
"It's a good part of the local heritage and a tradition we would like to keep going," Jefferies said.
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