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A referee signals a timeout in a middle school basketball game, and 8 young girls run onto the floor to perform their choreographed cheer.

Meanwhile, one girl remains in her chair. She looks sad as she watches her friends perform. She tore her anterior cruciate ligament (ACL) when she landed awkwardly after a jump, and she needed major reconstructive surgery for her injury. She’s wearing a big brace on the knee, and she’s still months away from being able to do the jumps and splits that she did before her injury.Despite her spectator status, the girl with the knee brace is more fortunate than some cheerleaders. She’s one of thousands who suffer serious personal injuries that send them to emergency rooms every year. She didn’t fall from a great height and land on her head and suffer a traumatic brain injury, suffer a permanent spinal cord injury or rupture her spleen and bleed to death.

The girl in the knee brace is a fighter. She’s determined to rehabilitate her knee and return to the cheering action. She may always have some pain in her knee, but if she’s very careful, and if she doesn’t become a flyer, she may only have to deal with sprained wrists and ankles the rest of her cheering career.

When young girls try cheerleading for the first time, they and their parents probably aren’t aware that by some statistical measurements, cheerleading is now more dangerous than football. Parents probably think that cheerleading is a fun and social activity that will keep girls active and in good shape. They’re correct in that belief, but it’s not the entire story of modern cheerleading.

These frightening stories and statistics are clear evidence that cheerleading isn’t what it used to be. It’s no longer just pretty girls with pom-poms and megaphones cheering for their school. Today, cheerleading is a dangerous and largely unregulated activity that frequently involves stunts that send girls 20 feet into the air. Cheerleading exists in a nebulous world where safety standards are often minimal or nonexistent, and at many levels, coaches don’t even need certification.

Originally, cheerleading was exactly what the name says. The first cheerleaders encouraged fans to root for their team in the hope that the enthusiasm would give the players an extra adrenaline rush and lead to a victory.

Then, in the 1970s, things started to change. Someone started throwing cheerleaders into the air, and soon the injuries started piling up. So did the dollars. Today, cheerleading is a $2.5 billion dollar business, and the activity has national championships that encourage risky routines.

A recent court ruling addressed the legal status of the dangers associated with cheerleading. A court in Wisconsin decided that cheerleading is a contact sport, and that one member of a squad cannot hold another member, or the school district, liable for an injury sustained during a stunt. The ruling said, essentially, that cheerleading is dangerous, and participants accept the risk of injury. So, for one member of a cheerleading squad to sue a teammate would be the same as a quarterback suing one of his linemen if the quarterback gets sacked and suffers an injury.

Cheerleading is definitely dangerous, but it’s not going away. There is a crying need for strict safety standards. Keeping cheerleaders safe is the obligation of every club and school, and they should have a plan in place to prevent severe injuries and deal with injuries if they do occur. If the people in charge of cheerleading don’t take steps to make it safer, the courts will.

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Richard Alexander