High Risk

Last summer's death of 14-year-old Ashley Burns illustrates why cheerleading, with all of its highflying, acrobatic, crowd-pleasing stunts, is the most dangerous sport of all for young women.

To compete against other squads and win, cheerleaders (like these members of the Billerica Indians) need to perform daring stunts. (Christopher Churchill Photo)

"DOWN IN FRONT! DOWN IN FRONT!" 88-year-old Josephine Miele screams at the fans blocking her view of Cassandra Dugas, her great-granddaughter and the tri-captain of the Mustangs, the all-girl cheerleading squad from Medford High School.

It's getting frantic. It's almost time. "Oh my God, you have no idea. I've been a nervous wreck for a week," says Cassandra's now-hoarse mom, Debby Dugas, before she starts screaming, "Here we go, Medford, here we go!" She is fired up, as are five generations of the Dugas family, here to cheer on 17-year-old Cassandra as she competes in the North Regional Cheerleading Tournament at Burlington High School. Five generations, crammed onto the front-row bench in the gymnasium, surrounded by hundreds of pumped-up fans, families, and even football players who, in a sweet twist, are here supporting their supporters.

As the 22 Medford Mustangs—hair shellacked and held back in sparkly red scrunchies, makeup caked on, Tammy Faye Bakker-style, all practiced to perfection at last night's "curling party"—prance onto the big blue mat, Cassandra's grandmother, Marianne Dugas, leans over and whispers, "Now my heart bursts with pride."

And then it's an explosion. A blur of limbs and uniforms synched to the remixed beats of early-1980s disco numbers blasted on hyper-speed. Girls fl y across the mat, tumbling and tucking and flipping. Girls are chucked high, higher, into the air. Girls shoot up in precarious pyramid formations. They pause to deliver a quaint cheer—almost an afterthought, it seems, since the gymnastic stunts garner the big "oohs" from the crowd. When one girl falls, slipping out of the hands of her teammates, that gets an even bigger reaction.

It was a similarly unsuccessful stunt performed by this same squad last summer that renewed concern across the state, and the country, about the safety of cheerleading. One of the youngest members of the Mustangs, 14-year-old Ashley Burns, died from injuries she sustained during practice in August, before the season even began, and now it's not hard to imagine that the parents of the other cheerleaders are watching with a little more unease as their girls fl y and spin in the air.

"I've always worried about it being dangerous," admits Cassandra's father, Phil Dugas, a former youth hockey player. "I didn't want her cheerleading at the beginning. You've got young girls catching young girls."

The Dugas clan gets restless as the November day wears on and one adrenaline-pounding two-minute routine bleeds into the next. To the untrained eye, they all look the same. But the father of a cheerleader knows better. "Our routine is more difficult," Dugas says. He attributes that to the $200 each Medford team member pays every year for a choreographer—money raised, in part, by shaking a can outside a Dunkin' Donuts. The judges, of course, know exactly what to look for, and their score sheets are reworked every year to reflect the specialized stunts that the most advanced teams are performing.

The moment has finally arrived. The judges have tallied their calculations for the 12 competing teams. The Dugases cling to the edge the bench. The Medford Mustangs, the MC announces, take second place. "They're really disappointed," Debby Dugas says later. They'd expected to come in first—at least before the girl fell.

Falling from several feet in the air did not used to be a cheerleading hazard. Since widely recognized start in 1898, when peppy University of Minnesota student Johnny Campbell picked up a megaphone, recruited several male "yellers," and led the crowd in a cheer, cheerleading was all tame pageantry. Men have long been involved—even President Bush was a cheerleader at Phillips Academy in Andover—but women joined in the 1920s and eventually dominated the activity.

For decades, rah-rahing had nothing to with athletic prowess. If you could lift a megaphone and shake a sparkly pompom, you were in. But now, the stunts grow more difficult and dangerous every year. Injuries for high school and college cheerleaders have more than doubled since the early 1990s, according to the US Consumer Product Safety Commission, with the estimated number of emergency-room visits spiking from fewer than 12,000 in 1991 to about 28,000 in 2004. And no other sport comes within shouting distance of cheerleading in terms of major injuries, such as spinal and head trauma, according to the National Center for Catastrophic Sports Injury Research, which is based at the University of North Carolina Chapel Hill. Of the 101 catastrophic injuries sustained by female high school and college athletes between 1982 and 2004, 55 percent resulted from cheerleading—more than every other sport combined. Dr. Frederick Mueller, director of the center, puts it plainly: "There's no doubt that [cheerleading] is the most dangerous women's sport."

SOME WOULD SAY CHEERLEADING IS THE most dangerous sport, period. Recent statistics from the National Collegiate Athletic Association suggest that it may be even riskier than football, the sport it was created to support. Last year, the NCAA's Catastrophic Injury Insurance Program found that 25 percent of its claims for college student-athletes since 1998 have resulted from cheerleading. "[That is] second only to football, and football was not that far ahead of it," says Juanita Sheely, NCAA travel and insurance manager. When you consider the ratio of college cheerleaders to football players—about 12 to 100, estimates Sheely—that 25 percent figure is shocking.

During the 2003-2004 school year alone, six cheerleaders across the country sustained catastrophic injuries, according to Mueller's research center. Among high schoolers, one hit her head and was put in a medically induced coma to reduce the swelling of her brain. Another was struck in the back by a teammate's shoulder, sustaining a spinal cord contusion, and yet another was injured when her teammates failed to catch her. At the college level, one fell headfirst into the ground and fractured a cervical vertebra and damaged her spinal cord, resulting in permanent disability, while another plummeted to the ground after being tossed in the air and was paralyzed. The one fatality occurred when a high school girl's heart failed during practice.

"It's nothing like when we were kids," Debby Dugas says of her own rah-rah days in the 1960s. "Every kid just made the squad. You didn't even have to try out. Now it's all tryouts and competitions." For the typical Medford Mustangs member today, cheerleading is an enormous commitment for most of the year—they practice nearly every day, compete on weekends, hit the nationals circuit, and, of course, cheer at football and basketball games. (The Medford coaches declined to speak with the Globe for this story.) Dugas says that cheerleading keeps her daughter, an honor-roll student, focused: "It's the best thing that has ever happened to her."

Making the Mustangs squad was a dream come true for Ashley Burns, a tiny girl with curly auburn hair and a spray of freckles on her upturned nose who started cheerleading for Pop Warner football teams when she was in the first grade, says close family friend Angela Murphy. In 2005, the vocational-technical student was one of only a handful of incoming freshman to secure a spot on Medford High School and Medford Vocational-Technical High School's combined varsity cheerleading squad, which had won a national championship the year before. "She was so happy to be on the team at Medford High," says Murphy. "She was always a flier, always loved to be on top. . . . She had just learned how to do her back tuck. She went from the little girl who wouldn't let my son let go of her back when she practiced to so self-confident."

On Tuesday afternoon, August 9—about a month after making the varsity squad—Ashley's grandmother, Ruth Burns, took Ashley to the East Elite Cheer Gym in Tewksbury for a preseason training session with her new teammates.

Ashley, just 4 feet 9 inches and 90 pounds, was working on a sophisticated stunt, an arabesque double-down. Three teammates held her aloft by one foot. They tossed her in the air. Ashley twisted once and then, instead of fully rotating again and landing on her back, landed short, on her stomach. Soon afterward, she complained of abdominal pain. She thought she had the wind knocked out of her. It happens all the time. But as the minutes passed she didn't feel any better; in fact, she was getting worse. Her coach, Julie Brown, called 911 just before 5 p.m. Ashley could still speak when paramedics arrived, but then she had trouble breathing and lost consciousness. An hour later, she was pronounced dead, and an autopsy later revealed a lacerated spleen due to blunt abdominal trauma.

Murphy does not hold the girl's death as an indictment of cheerleading. "They take it seriously," she says. "And this was a fluke, and why it happened nobody will ever know."

Murphy's son, Brian, who helped raise Ashley from a young age, says she was doing flips in the backyard just the Sunday before her accident. Cheerleading "gives you a lot of respect for yourself," he says. "It's gotta be one of the hardest sports I've ever seen done, and I've played football for six years." As difficult as the death has been for Ashley's teammates, he adds, "Every girl out there, they put their hearts and souls into it, and this shouldn't be a deterrent to them. It could've been a bump on the ride home."

It wouldn't be surprising if parents clung to this notion like a life raft or if cheerleaders repeated the word "fluke" over and over, like a soothing mantra. The girls have to, to keep up the confidence needed to fling themselves about as they do. But the parents no doubt worry, just like the parents of any athlete. Even so, Debby Dugas says she would never take her daughter away from the tightknit friendships and the leadership skills Cassandra has developed through cheerleading. As Angela Murphy puts it: "It's a sport where the girls really become a family. I don't care what anybody says; it's as safe as walking across the street."

CHEERLEADING IS SEEING A SURGE IN popularity. According to the Sporting Goods Manufacturers Association, 4.1 million people now participate in amateur cheerleading around the country. Since 1998, it's grown faster than football, faster than any team sport—including soccer and basketball and field hockey—no matter that the 1972 gender equity law Title IX opened up other sports to girls.

"Cheerleading has been increasing in popularity over the last 20 years, and it really is due to the increased level of athleticism," says Lisa Moskow, the regional safety certifier for the American Association of Cheerleading Coaches and Advisors, a nationwide cheerleading safety organization. After many high schools across the country slashed their gymnastics programs in the 1980s for liability reasons, sidelined gymnasts joined the cheerleading squads, forcing the traditional cheerleaders to up their gymnastic skills just to make the team. Many turned to private gyms to learn those skills, and the private gyms then cashed in on the phenomenon in the 1990s and became specialized cheer gyms. In addition to training local squads, these cheer gyms created all-star teams to compete against one another. "With the advent of the all-star programs and having them perform higher-level skills, that kind of pushed the high school programs to want to do some of the same things," says Jim Lord, the cheerleading association's executive director. "The injury rate in cheer-leading went up so much from it being non-athletic, or barely athletic, to being athletic."

While the competition has raised cheerleading's popularity and transformed it from a seasonal pursuit to one requiring year-round, intensive training, it has also inspired some soul-searching. The 2004 report from the National Center for Catastrophic Sports Injury Research poses the question, what is the role of the cheerleader? "Is cheerleading an activity that leads the spectators in cheers or is it a sport? If the answer is to entertain the crowd and to be in competition with other cheerleading squads, then there must be safety guidelines initiated," the report concludes.

But who is going to take that initiative? At the high school level, would it be the individual schools, which are already making do with less because of tightened budgets, or a national body powerful enough to make squads and their schools abide by its safety rules? Right now, neither seems likely to do so. "The state of cheerleading is a state of chaos," says Susan Loomis, spirit coordinator for the National Federation of High School Associations, a nationwide sports rule-writing body.

In Massachusetts, as in many other states, high school cheerleading isn't regulated in any significant way. If it were governed by the Massachusetts Interscholastic Athletic Association, or MIAA, which strictly regulates sports like football, golf, and swimming, cheerleading would have trained coaches, among other things. Instead, in 1997, cheerleading became the purview of the Massachusetts Secondary Schools Administrators Association, the professional organization for high school principals that oversees non-athletic clubs like debate team and student government and which treats cheerleading like a student activity, not a sport. "The MIAA's athletic director didn't want any part of it," says Jerry Silverman, assistant director of the principals' association, who's in charge of cheerleading. Before 1997, he says, cheerleading in the state was completely unregulated.

Since high school cheerleading in this state is not governed by the MIAA, it is not subject to the oversight of the National Federation of High School Associations, which writes all the rules for athletics nationwide and has set some for cheerleading. Though Silverman says that Massachusetts voluntarily follows the federation rules, Loomis, spirit coordinator at the federation, doubts there is enforcement of those rules. "A lot of people say they follow National Federation rules," she says. "[But] I don't think the principals' association enforces them, unless they do it from a coach-to-coach and who-can-rat-on-each-other basis."

On top of that, individual schools are not required to belong to the MSSAA for cheerleading (only about 200 of the state's public high schools do)—and, even then, they can organize the "activity" in any way they want. So, for example, the Brockton High School football cheerleading program is considered a sport, under the athletic department and independent of the principals' association, but at Concord-Carlisle Regional High School, it is a non-athletic co-curricular activity (along with the science olympiad and moot court) that belongs to the principals' association and is not linked to the athletic department.

In the end, this bureaucratic mess puts cheerleaders at more of a risk than a three-person-high pyramid. "Cheerleading isn't dangerous on its own—it's dangerous in an environment that doesn't provide for safety," says Lord, of the coaches association. "If we can make sure all the coaches are qualified, then the injuries that are coming from negligence now will mostly go away, and we'll be left with reality, which is there's risk involved in athletics."

His organization provides safety certification courses for cheer coaches, and the national federation offers education programs. But unless coaches are required to meet standards, the experts say, it's just not going to happen.

"Cheerleading doesn't bring in any money, so there is often not a lot of money in the budget to pay a cheerleading coach, much less pay for them to get safety training," says Moskow, the regional safety certifier for coaches. Loomis, from the National Federation of High School Associations, agrees: "Cheer coaches are at the bottom of the feeding chain." When they take courses or go to conferences, they often have to pay for it themselves, she says, adding, "Football coaches don't have to do that."

CHEERLEADERS AND COACHES ON THE college level train fiercely. At a four-hour practice at Northeastern University last November, the 24-member coed Huskies cheerleaders are working on their routine for the national championships in April. Jaclyn Bent is doubled over on the gymnasium floor, bawling, clutching her neck, rubbing the middle of her back. The third-year student was just thrown impossibly high in the air, and dropped hard. "You get bumped and bruised all the time," the 20-year-old says after the tears have dried.

"People really underestimate cheerleading," says 19-year-old sophomore Kristina Chianese, captain of the squad. "Some of the craziest athletes, football and basketball players, will come and try it once, and they're like, 'I can't believe you do this.' Our team is half guys and half girls, and the guys are in the gym more than any other guy, more than the ones who are considered athletes and getting paid to go to school. We don't have any scholarships, and we work harder than everybody."

And they get none of the respect reserved for the gridiron. Northeastern has the top-ranked Division I cheerleading program in the state, placing in the top five for the past 10 years and, in 2002, winning the grand national championship, the Super Bowl of cheerleading. "For us to beat those Southern schools was amazing," says Lorrie Wright, the head coach for the past 23 years. "Down South, it's huge. They offer scholarships; it's under the athletic department; it's a big thing." At Northeastern, cheerleading was a student activity until two years ago, when it became a club sport. "The only benefit we get out of that is practice time in the gym," Wright says, "but that's after all the varsity teams."

Just as there is no single, national governing body for high school cheerleading, none exists for college cheerleading. "It's not an NCAA sport," says Sheely, the NCAA travel and insurance manager. "We don't initiate any of the rules, and we're not the governing body for it like we are for other sports."

The NCAA's catastrophic injury insurance program for student-athletes does cover cheerleaders, however, and the organization is examining the cost of treating them. After its insurance provider, Mutual of Omaha, found that cheerleading injuries were representing 25 percent of the catastrophic injury claims since 1998, the NCAA decided to take action. With cheerleading, says Sheely, "when it's not supervised properly, that's when we're seeing these severe injuries happen." And so, as of August 2006, in order to be covered by Mutual of Omaha, the NCAA is requiring that all collegiate squads be supervised by a coach with safety certification by the American Association of Cheerleading Coaches and Advisors. The move is an attempt to decrease injuries due to coach negligence, but it won't remove the risk of serious injury, like paralysis, or even death.

Though, as a club sport, Northeastern's squad is part of the athletic department, money is still an issue. "Nobody wanted to claim us because nobody wanted to pay for us," Wright says. She splits her salary with her two assistant coaches—pocketing about $6,000 a year for herself—and has a budget of $17,000. "Football could be a million. It's very frustrating," she says. Wright ends up fund-raising for everything, including the $5,000 mats that keep her cheerleaders from breaking their necks. "We put in at least 30 hours a week, if not more. No benefits, nothing."

While the mats may help cushion falls, many universities take another, more controversial, approach to limiting injuries: They have instituted weight restrictions on female cheerleaders, ostensibly to protect the male and female cheerleaders who lift and throw them. At many schools, the limit is set at about 120 pounds. At Northeastern, there are weight limits only for the advanced "fliers," those women sent airborne, who need to be less than 135 pounds. These weight restrictions, many say, are responsible for eating disorders often found among cheerleaders. "When I notice that a girl isn't eating or she's going to the bathroom, I address it," says Wright.

Male cheerleaders have their own issues to deal with. In 2004, a male cheerleader at the Air Force Academy in Colorado was caught taking steroids. "I've heard a lot of guys talking about taking steroids," says 20-year-old Rob DiVincenzo, an incoming Emerson College student who is trying to land a spot with Pro X, a nationwide professional cheerleading squad that does extreme stunts. "It happens. It's all hush-hush, though."

In spite of the risks, cheerleaders will probably continue to do what they think it takes to practice the sport they love. "Teeth knocked out, concussions, broken collarbones—it's just injury after injury after injury just waiting to happen," says DiVincenzo.

"It's definitely dangerous," agrees Chianese, the Northeastern cheerleading captain. "It can happen to anybody."

Back at Northeastern's gym, the hard-core thumping bass line of Metallica pushes the Huskie cheerleaders. Women crash down from three-person-high pyramids—sometimes pitching face-forward, sometimes flat back. One guy, rubbing his chest furiously after being whacked by a falling teammate, walks in circles muttering profanities. Another violently chucks his shirt to the ground and stomps off—only to return with two bags of ice, which he and a teammate tape to their backs.