In fact, the latest reports show that severe injuries to cheerleaders occur even more often than previously thought. High school cheerleading accounted for 65.1 percent of all catastrophic sports injuries among high school females over the past 25 years. Previously, the figure was believed to be 55 percent.

The findings came from National Center for Catastrophic Sports Injury Research, based at the University of North Carolina in Chapel Hill.

Among college squads, new data show cheerleading accounted for a full two-thirds of all female sports' catastrophic injuries -- injuries resulting in death, permanent disability such as paralysis or brain damage, or serious head or neck injury where the victim does have complete recovery.

The revised numbers are due to a new partnership between the UNC center and the National Cheer Safety Foundation, a California-based not-for-profit body created to promote safety in the sport.

"A major factor in this increase has been the change in cheerleading activity, which now involves gymnastic-type stunts," said the center's director, Frederick O. Mueller, Ph.D., professor of exercise and sports science in UNC's College of Arts and Sciences, who has authored the report since it was first published in 1982.

"I think when you have these basket tosses where an individual's thrown in the air 25 or 30 feet, and then they're dropped when they come down: these can cause serious injuries," Mueller said. "If these cheerleading activities are not taught by a competent coach and keep increasing in difficulty, catastrophic injuries will continue to be a part of cheerleading."

The study shows that, overall, football is still associated with the greatest number of catastrophic injuries for all sports, but the incidence of injury per 100,000 participants is higher in both gymnastics and ice hockey.

A 1990s study by Mark Hutchinson at the University of Chicago reported that cheerleaders lost nearly six times as much time from their activity due to injury as football players did.

"Their season is endless," he said, "with no time for rest or recovery."

Almost 95,200 female students take part in high school cheerleading annually, along with about 2,150 males, the UNC report stated.

"The problem is that it's not considered a sport in most schools -- not part of the athletic department -- so there are really no regulations governing how long they can practice and all of those kinds of things," Mueller explained.

Though college participatory numbers are hard to find because cheerleading is not regarded as an NCAA sport, a full 25 percent of the money spent on student-athlete injuries in 2005 resulted from cheerleading.

Improvements over recent years have been reflected in standardization of the industry and certification of its coaches, administrators and practitioners.

What may drive further improvements in coming decades is the issue of liability.

"That's what happened with football back in the 1970s," Mueller said, "when there were all of those court cases and people were suing for millions of dollars. It brought a lot of attention to the football community. If it ever happens in cheerleading that someone gets sued for a million dollars, it's going to make them more aware of some of the problems."

The American Association of Cheerleading Coaches and Administrators offers a safety certification program, study manuals and a timed exam designed to educate cheerleading and dance coaches about safety and risk management.

More to the point, AACCA certification provides the certified full-time coach with $1 million in secondary liability insurance coverage.

Similarly, the AACCA's College Cheerleading Safety Initiative now promotes collegiate cheerleading safety, and most Division I schools -- including Duke, N.C. State and UNC -- are all on board with the initiative already.

Similarly, local cheerleaders insist their schools are fully safety-conscious.

"Everyone that tumbles already knows how," said Chapel Hill High School ninth-grader Bailey Backus, a newcomer to the Tiger cheerleading squad. "Some (stunts) are illegal to do without mats underneath you, so we wouldn't do them at games."

"Before anyone goes into the air (for a stunt), we practice over and over ... to make sure of where everyone's going to be," Backus added. "We also always have a big circle around the stunters make sure that if there's a fall, there are people to help."

Fresh off a "Best Performance" victory by CHHS cheerleaders at a July United Cheer Association competition in Boone, Tiger cheerleading veteran Ebony Edwards was chosen by the camp director as one of three all-stars from CHHS. Last season, however, she suffered a broken ankle while coming out of a cheerleading stunt.

"People get all kinds of injuries," said Edwards, who also said she'd seen other teams perform risky stunts.

"Some teams just do stunts that are illegal -- like 'level three' stunts," she said. "Our coach has (safety) handbooks, though, because she used to work for the ECA (Eastern Cheer Association).

The ECA also conducts coach certification, while staging summer camps and numerous competitions.

Indeed, more and more programs' coaches list safety and coaching certifications proudly.

Carrboro High School cheerleading coach Monique Brady boasts seven years of coaching at the high school level, and also lists AACCA safety certification, NCA and ECA coach certification, plus certification for first aid and CPR among her credentials. Mueller applauded such standardization of excellence, but said it likely has yet to trickle down into smaller secondary school systems.

"I think some of the cheerleading organizations have certification processes for coaches," he said, "but with many schools across the nation, they still make the last or youngest teacher hired be the cheerleading coach. Whether you know anything about it or not, you're the cheerleading coach."