Cheerleading can be dangerous for teens and young adults. Here’s how the sport is getting safer.

Since Katie Greb started cheerleading at 6 years old, her goal has been to win the cheerleading world championship.

But one injury after another threatened to end her dream — and put her at risk of serious harm. At 9, she broke her arm. At 14, she dislocated an elbow. Two years ago, she landed hard doing a tumbling routine involving three back handsprings to a double twist.

“I landed on the side of my leg and heard a pop,” said Greb, 18, who lives in Alburtis, Pa.

She had torn her ACL which required surgery and physical therapy and kept her out of the gym for about eight months. But her love for the sport brought her back.

“At first I was a little nervous when I came back because I didn’t want it to re-tear or anything else to happen,” said Greb, who will attend Lehigh Carbon Community College in the fall. “But it made me feel more powerful to know that I overcame those injuries.”

Greb’s dream came true in April 2022 when her team, the New Jersey Spirit Explosion Fab 5 from Cinnaminson, won an international competition, the Cheerleading Worlds in Orlando.

USA Cheer, the national governing body for cheerleading, estimates there are about four million cheerleading participants in the United States. Many, like Greb, solely compete against other squads while others also cheer for school or professional sports teams.

In the early 2000s, the sport was plagued by injuries, with about 65% of catastrophic injuries for female high school and collegiate athletes coming from cheer, said John Salvo, a sports medicine surgeon at Rothman Orthopaedic Institute and a team physician for the Philadelphia Eagles. Those include traumatic brain injuries, cervical spine injuries, and any other injury that leads to significant disability or deformity.

Cheer athletes still face non-catastrophic injuries, including ankle and elbow sprains, finger and ankle fractures, knee injuries such as ACL and meniscus tears, and shoulder and elbow dislocations, Salvo said.

Cheerleading has seen a major reduction in injuries since 2010, according to the National Center for Catastrophic Sport Injury Research, which tracks injuries and illnesses among college, high school and youth athletes. In the 2019-2020 season, which included the beginning of the pandemic, there were zero reported catastrophic injuries. That was down from nine in the 2005-2006 season and just three were reported in the last five years.

“These injuries are related to the way cheerleading has progressed over the years with their aerial stunts and large pyramids,” Salvo said.

The decline can be attributed mostly to additional rules and restrictions that came about after a cheerleader from Southern Illinois University was seriously injured during a basketball game in 2006. After losing her balance, she fell backward 15 feet off a human pyramid, rather than rolling forward into the arms of teammates.

That led the American Association of Cheerleading Coaches and Administrators to recommend that college conferences bar cheerleaders from high pyramids and basket tosses — throwing a cheerleader into the air — without a mat.

At the same time, the NCAA and many states began requiring additional safety training and risk management for instructors.

“Rules are a part of safety but you also have to make sure coaches are properly educated and trained so that they understand the skills and they follow the proper safety progressions to minimize injuries,” said Jim Lord, director of education and programs for USA Cheer.

Ashley Martin, one of Greb’s coaches, said these changes were much needed. Martin began cheerleading at 7 years old and suffered injuries throughout her career whose treatment included three ACL surgeries. Her experience with injuries has made her a better coach, she said. Martin’s gym follows U.S. All Star Federation rules and guidelines, and coaches must pass certain tests, including concussion, stunting, and tumbling safety.

“I coach differently now,” Martin said. “My eyes are glued differently, watching the kids’ tumbling, how they are bending and their landings.”

New students are encouraged to take a skills camp to be sure they are learning skills properly and are placed in an appropriate level. The equipment is also safer. Thin foam dead mats have been replaced with new spring mats that offer a safer landing. Athletes wear soft helmets when learning certain tricks to prevent head injuries.

“Back in the day, we competed on wrestling mats,” she said. “We would never do that now.”

Nyla Lassiter, Martin’s daughter, has endured hip and ankle sprains over the seven years she’s been cheerleading. Two years ago, she injured her hip while tumbling during a competition.

“After I was hurt, I was hesitant to do skills,” recalled Lassiter, 14, who lives in Cinnaminson.

“I would get a tumbling block, which is basically when you stop tumbling because you’re too scared to do the skill that got you hurt.”

She also suffers from Osgood-Schlatter disease, a common cause of knee pain and swelling among children experiencing growth spurts. She has learned to handle the physical pain, but the disease, which is more common among athletic children, has added mental stress.

“Sometimes I would have a lot of pain, and it was too hard to push through,” Lassiter said. But she realized that her love for the sport outweighed the pain. “It’s a release for me where I can see my friends and my coaches who I really enjoy being around. It’s a part of me and if I give it up, it’s like giving up a part of myself.”

For Temple University cheerleaders, a progressive training regimen that allows athletes to work up to elite skills is the key to keeping the team safe, said Jenna Komosinski, head cheerleading coach. The staff stays on top of training and communicates clearly with athletes to set them up for success, she said.

“With any sport there is a risk of injury, but we’ve been taking the steps necessary to prevent the majority of injuries,” Komosinski said. “In cheerleading, you rely on each other to build pyramids and catch and spot other athletes, so we have to be sure everyone is on the same page.”

Meanwhile, Greb is still reveling in her team’s success, looking forward to new challenges in the sport she loves.

“I’ve learned lessons like responsibility, making sure I’m prepared for practice, I manage my time and know how to be a leader,” Greb said.