Behind the pom-poms and smiles of every cheerleader is the underlying threat of serious and even fatal injuries.

Thrilling but high-risk stunts involving flips and twists make cheerleading the most dangerous activity for high school girls, as backed by studies by the American Academy of Pediatrics. To prevent injuries doctors recommended changes to cheer, including designating the activity a sport in all states.

“Although the overall injury rate remains relatively low, cheerleading has accounted for approximately 66 percent of all catastrophic injuries in high school female athletes over the past 25 years,” according to the study.

As reported by the study published in this fall’s journal Pediatrics, the most commonly seen injuries are simple sprains, followed by concussions and other head injuries.

It is not the sideline cheering that causes injuries. Rather, it is the flips, tosses and stunts where women are raised above one another’s heads that pose danger.

But cheerleaders say the high flying routines are worth the risk.

“We stunt because it adds something to a performance and is sort of the defining difference between cheerleading and dance,” said junior cheerleader Chloe Kuske. “Even with the possibility of injuries, it’s worth it to continue stunting because unlike other schools who don’t have safe and legal stunts, ours are safe and our coach has us work them over and over again.”

The risks involved with stunting cannot completely be eliminated, although they can be minimized.

In the past few years, Rio cheerleaders have suffered injuries ranging from a broken nose to mild concussions. One of the worst injuries occurred during a practice earlier this season.

JV cheerleader Shasta Bowen suffered a compound fracture to her arm while warming up to perform a roundoff backhandspring during practice.

“Getting injured was really scary and kind of embarrassing,” Bowen said.

However scared she was, she did not shed a tear when breaking her arm. She was forced to endure reconstructive bone surgery the following day.

At other local high schools, like Mira Loma, cheerleaders are not exempt from injuries either.

“There have been a few serious injuries this year alone,” said Nadia Bijaksana, a Mira Loma senior cheerleader. “When we were doing a stunt my flyers chin came down and hit me in the head and cracked her chin open.

Another girl fractured her ankle falling from a liberty.”

Year after year, cheerleaders receive injuries. This, however, does not stop them from wholeheartedly participating in the activity.

“I don’t think that fear of getting an injury should stop anyone from participating in a sport,” said senior cheerleader Laura Eiselman. “There are enough rules and guidelines we follow to make sure we are all safe and taken care of.”

According to the American Academy of Pediatrics Policy Statement there are particular risk factors that increase a cheerleader’s chance of becoming injured. Such risk factors include, “higher body mass index, previous injury, cheering on harder surfaces, performing stunts, and supervision by a coach with low level of training and experience.”

Cheerleading coach of 25 years Demeris Athey said she is well aware of the risk factors and works hard to ensure that cheerleaders at the freshman, JV and varsity levels are all equally safe.

“Most of the injuries at the high school level are a result of teams trying to perform stunts that they are not physically capable of performing,” said Athey. “Poorly trained coaches are also a factor. When a coach does not know how to instruct properly, the girls are more prone to getting hurt.”

Rio squads condition all summer using stunting progressions, spotting techniques and mats when stunting. All of the coaches renew their safety certification annually.

“I keep coaching because I enjoy coaching,” said Athey. “I stay abreast of current safety regulations for high school cheerleading and I make sure the Rio Cheerleaders follow those regulations.”

With properly trained coaches and safety measures, cheerleaders can perform free of fear of injury. Even after breaking her arm, Bowen remains positive.

“I am still looking forward to cheer and tumble again. Even though cheerleading is dangerous it is well worth the risk.”