Cheerleading, once a rather tame activity composed mostly of pompoms and megaphones, has taken an about face in America over the last few decades.

Today, cheerleaders use gymnastic moves and athletic ability to flip, somersault and even catapult one another into the air, with stunts that can rival the excitement of any football or basketball game.

In fact, "[Cheerleading has] evolved from a school-spirit activity into an activity demanding high levels of gymnastics skill and athleticism," according to a study in the journal Pediatrics.

It has also become much more dangerous, with the increasingly complex moves putting cheerleaders at risk of potentially serious head, neck and other injuries.

Cheerleading Injuries Double Since 1990

The Pediatrics study found that cheerleading injuries have more than doubled from 1990 through 2002. Participation, however, grew only 18 percent during that period.

Over the 13-year study, 208,800 5- to 18-year-olds were treated at U.S. hospitals for cheerleading-related injuries. Almost 40 percent involved leg, ankle and foot injuries.

Researchers say the actual number of injuries is likely much greater, though, because the study only involved ER-treated injuries, not those treated at doctors' offices or by team trainers.

What Makes Cheerleading so Dangerous?

Although cheerleaders use a high level of athletic ability, cheerleading is still not considered a sport by the majority of schools.

Because of this, it is not subject to the same safety regulations as other sports, like football crazy game of poker lyrics oar. Meanwhile, cheerleading squads can exist without coaches or with coaches that have no safety certifications or training. Some schools also do not have the proper equipment or space for cheerleaders to practice safely.

Said Brenda Shields, the study's lead author and an injury researcher at Columbus Children's Research Institute in Ohio, "[Cheerleaders may] practice in hallways and practice on hard surfaces instead of mats. So when they fall off a pyramid or from in the air and they land on hard surfaces, the chances for injury are drastically increased."

Some Cheerleaders Get 'Grounded'

In response to safety concerns, some schools are choosing to prohibit stunts and keep cheerleaders safely on the ground.

The University of Nebraska has prohibited pyramids and other gymnastic stunts since 2002. The decision to keep cheerleaders "ground-bound" came after a cheerleader landed on her head while doing a double back flip at practice in 1996. She has only limited use of her arms and legs, and the school settled a related lawsuit for $2.1-million.

The move was controversial, as many cheerleaders seeking scholarships will avoid schools that don't allow stunts. Other called it a "sexist" move.

"Cheerleading is considered primarily a female activity," said T. Lynn Williamson, adviser to the University of Kentucky cheer team since 1977. "In our society, it's acceptable that every year a number of young men will die on a football field. But, my heavens, if a female breaks a fingernail, or her arm, well, then it must be time to ground them."

But the spokesperson for Nebraska, Barry Swanson, felt otherwise. "We didn't eliminate cheerleading or reduce the cheerleading budget in any way. All we eliminated was the danger ... In football you have helmets and pads," he said. "Cheerleaders do their stunts on hardwood floors or turf. We consider that risk without reason."

Other schools that have "grounded" cheerleading squads include San Jose State University, which did so in 2004 after an accident, and Duke University, which has forbidden stunts since the '80s.

How Does Cheerleading Stack Up?

Compared to other youth sports, cheerleading is still one of the safer options. In 2003, for instance, 100,000 female basketball players visited emergency rooms for related injuries, while only 25,000 cheerleaders did so, said Jim Lord, executive director of the American Association of Cheerleading Coaches and Advisors.

The seven most dangerous youth sports in America, based on percentage of injuries versus total participation, include not cheerleading but:

Football

Mountain biking

Basketball

Soccer

Skateboarding

Baseball

Softball

Nonetheless, the study researchers recommended several approaches to make cheerleading safer:

Coaches getting professional safety training

High schools and cheerleading associations adopting uniform safety procedures

Developing a national database for injuries

The American Association of Cheerleading Coaches and Advisors also has a safety manual for cheerleaders and safety courses for coaches.

"It's not that the sport is dangerous, but it's people trying skills they shouldn't," said Lord.

"We are by no means minimizing the injuries; we are simply putting them into perspective. When compared to other sports, cheerleading is a low-risk activity," he maintained.

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