But there's no coming back from some of the injuries cheerleaders now risk. An injury is deemed catastrophic if it causes permanent spinal injury and paralysis. There were 73 of these injuries in cheerleading, including two deaths, between 1982 and 2008. In the same time period, there were only nine catastrophic injuries in gymnastics, four in basketball and two in soccer.
In 2008, 20-year-old Lauren Chang died during a cheer competition in Massachusetts when an accidental kick to the chest caused her lungs to collapse.
"Lauren died doing what she loved, cheering and being with her friends," said Nancy Chang, her mother, soon after the accident. "We hope her death will shed light on the inherent risks of cheerleading and we hope that additional safeguards are taken."
"It's a national epidemic," said Kimberly Archie, who started the National Cheer Safety Foundation to campaign for more safety practices in cheerleading. "I think we should be extremely concerned as a nation. ... [It's] a self-regulated industry that hasn't done a good job. If I was going to give them a report card, they'd get an F in safety."
Cheerleading is big business. Uniform sales alone are a multi-million-dollar industry. And there are thousands of cheer events all year across the nation, with competitors from ages 3 to 23. There are cheerleading all-star teams that do not cheer for any school but compete against one another.
"We don't want the kids to be hurt. We want the kids to be safe," said Tammy Van Vleet, who runs the Golden State Spirit Association, which trains cheerleading coaches and runs competitions in California. "It's our priority to make sure we provide that environment. ... Since about 1999, the degree of difficulty in cheerleading has just exploded. And we're seeing elite-level gymnasts on these cheerleading squads. And not just one athlete on the floor but 35 at a time, and [the] acrobatics and stunts that they are doing, you know, have not been matched."
That's why Van Vleet keeps two EMTs on site at major cheerleading exhibitions. But there are no uniform regulations that require such safety measures.
Jim Lord is executive director of the American Association of Cheerleading Coaches and Administrators, the largest cheerleading organization in the country. "Nightline" asked him whether cheerleading is safe.
"That's a great question for any sport or athletics, is, 'What is safe?'" Lord said. "There's something that says, 'Well, these are cheerleaders so they shouldn't be hurt, they shouldn't have any risks, they should be on the sidelines and they shouldn't be doing anything' -- when a lot of girls have selected this as their favorite athletic activity. And so I think there's that stigma, I think that goes along with it, for some reason."
Lord says that recognizing cheerleading as a sport would not increase safety and would only complicate managing an activity that is still not primarily competitive for most cheer squads.
"You can minimize the chance of having an injury, and what that comes down to [is] having a coach that's qualified," said Lord. "There's always going to be risk there, our job is to minimize that risk, especially from the catastrophic type of injury."
But Archie charges that the current system of recommended safety and training measures does not protect kids. Many cheer coaches only have to pass an open-book test to gain a safety certification.