Nikki Jennings started cheering when she was 4 years old. She became a flyer, a human baton spinning and twisting through the air before being caught by teammates. But sometimes she wasn’t caught: She got her first concussion in the third grade.

Jennings continued cheering in college, at the University of Hawaii. In her junior year, she slammed into a teammate’s shoulder during a basket toss, snapping her head back and giving her yet another concussion—her seventh. Coaches later cut her from the team.

Two years ago, at 21, Jennings retired from competitive cheerleading with a chronic hip injury, occasional slurred speech, and headaches she attributes to traumatic brain injury. Only now has she realized that her injuries—physical and emotional—aren’t unusual in the world of American cheerleading.

“Every day I make more and more pieces click,” she says.

Nationwide, more than 3 million children, mostly girls, participate in cheerleading each year. Despite its reputation as a fun sideline to on-the-field sports such as football, cheer can be dangerous in its own right: It puts its participants at a higher risk of concussion than most other sports, and over the past 40 years it has been responsible for 89 catastrophic injuries and 9 deaths in the U.S.

Nikki Jennings started cheering when she was 4 years old. She became a flyer. She would spin and twist through the air before being caught by teammates. But sometimes she wasn’t caught. She got her first concussion in the third grade.

Jennings continued cheering at the University of Hawaii. In her junior year, she slammed into a teammate’s shoulder duringa basket toss. Her head snapped back, and she got her seventh concussion. Coaches later cuther from the team.

Two years ago, at 21, Jennings retired from competitive cheerleading. She has a chronic hip injury, occasional slurred speech, and headaches that she attributes to traumatic brain injury. She has realized that her injuries aren’t unusual in the world of American cheerleading.

“Every day I make more and more pieces click,” she says.

More than 3 million children, mostly girls, participate in cheerleading each year in the U.S. Once, it was just a sideline to on-the-field sports such as football. But it can be dangerous in its own right.  Participants are at a higher risk of concussion than in most other sports. Over the past 40 years, cheerleading has been responsible for 89 catastrophic injuries and 9 deaths in the U.S.

Most of those injuries occurred in competitive versions of the sport such as All Star and STUNT cheerleading, where teams perform high-flying aerial routines that heighten the risk of collisions or falls to the floor. Its rising athleticism has made competitive cheerleading increasingly popular at the youth, high school, and college levels, with national competitions aired on ESPN.

But medical experts are raising alarms. In October, the American Academy of Pediatrics (A.A.P.) released a statement noting the rapid growth of competitive cheer and calling for cheerleading’s governing bodies, including high school and college sports associations, to formally recognize it as a sport. This would give cheerleaders the same protections as other athletes.

Pediatricians say they’re seeing cheerleading patients all too often.

“As the athleticism and the height on [cheerleading] stunts get higher and higher, that leads to an increased risk of injury—and some degree of serious injury,” Greg Canty, medical director of the Sports Medicine Center at Children’s Mercy Hospital in Kansas City, Missouri, told National Public Radio.

Most of those injuries occurred in competitive versions of the sport such as All Star and STUNT cheerleading. Teams perform high-flying aerial routines that increase the risk of collisions or falls to the floor. Competitive cheerleading has grown increasingly popular at the youth, high school, and college levels. National competitions air on ESPN.

But medical experts are raising alarms. In October, the American Academy of Pediatrics (A.A.P.) released a statement about  the rapid growth of competitive cheer. The group called for cheerleading to be officially recognized as a sport by governing bodies, including high school and college sports associations. That would give cheerleaders the same protections as other athletes.

Pediatricians say they’re seeing cheerleading patients all too often.

“As the athleticism and the height on [cheerleading] stunts get higher and higher, that leads to an increased risk of injury—and some degree of serious injury,” Greg Canty, medical director of the Sports Medicine Center at Children’s Mercy Hospital in Kansas City, Missouri, told National Public Radio.

Cheerleading started more than a century ago as a way of boosting team morale at college football games, and soon it became a staple of American high schools (see timeline, below). But it grew into a cultural phenomenon in the 1980s with the introduction of All Star. In this version of the sport, cheer squads aren’t connected to schools or sporting events. They’re dedicated cheer teams, usually formed at private gyms, that compete year-round with routines showcasing ever more daring stunts choreographed to earsplitting music. Even young children can participate.

“If you could do a cartwheel, we had a team for you,” says Dennis Worley, who helped pioneer All Star as an employee of Varsity Spirit, the company that’s long been the sport’s biggest competition organizer.

But with growing participation came injuries. From 1980 to 2001, emergency room visits for cheerleaders soared by nearly 500 percent, and the number of catastrophic injuries exceeded those suffered by female athletes playing all other high school and college sports combined. For flyers—the girls tossed in the air—injury rates were “semi-suicidal,” says Robert Cantu, medical director of the National Center for Catastrophic Sport Injury Research.

“Why it is still called cheerleading is not quite clear,” wrote Frederick Mueller, then-director of the research center, in 2009. “It is a competitive contact sport that involves all types of gymnastic stunts, pyramids, and partner stunts as well as throwing flyers high in the air and catching them (we hope).”

The problem, he added, was that “cheerleading associations have also not kept up with the safety needs of the sport.”

Cheerleading started more than a hundred years ago. It was seen as a way of boosting team spirit at college football games. Soon it became a part of most American high schools (see timeline, below). In the 1980s, it grew into a cultural phenomenon with the introduction of All Star. In this version of the sport, cheer squads aren’t connected to schools or sporting events. They’re dedicated cheer teams, usually formed at private gyms. They compete year-round with routines showcasing ever more daring stunts choreographed to earsplitting music. Even young children can participate.

“If you could do a cartwheel, we had a team for you,” says Dennis Worley, who helped pioneer All Star as an employee of Varsity Spirit, the company that’s long been the sport’s biggest competition organizer.

But with growing participation came injuries. From 1980 to 2001, emergency room visits for cheerleaders soared by nearly 500 percent. The number of catastrophic injuries exceeded those suffered by all other high school and college female athletes combined. For flyers, injury rates were “semi-suicidal,” says Robert Cantu, medical director of the National Center for Catastrophic Sport Injury Research.

“Why it is still called cheerleading is not quite clear,” wrote Frederick Mueller, then-director of the research center, in 2009. “It is a competitive contact sport that involves all types of gymnastic stunts, pyramids, and partner stunts as well as throwing flyers high in the air and catching them (we hope).”

The problem, he added, was that “cheerleading associations have also not kept up with the safety needs of the sport.”

There were no consistent rules for protecting cheerleaders because school athletics organizations hadn’t officially designated cheerleading a sport. And in many places, they still don’t.

Cheerleading oversight depends on where you are. Thirty-six states and the District of Columbia currently recognize competitive cheer as a sport, according to the National Federation of State High School Associations (NFHS), the rule-making body for most high school sports. That designation means cheerleaders have access to certified coaches, medical care, and limits on practice time. And data collection on injuries is more thorough, as it is in football.

But in 14 states cheer isn’t an official sport, making it an outlier: None of the NFHS’s 17 other member sports—including football, soccer, and lacrosse—have this patchwork state-by-state designation. And at the college level, the N.C.A.A., the governing body for athletics, doesn’t consider cheerleading a sport, though it has labeled STUNT an “emerging sport.”

Varsity Spirit has worked for years to keep it that way, arguing that additional safety requirements and limits on practice hours—which other N.C.A.A. athletes must follow—could hamper the athleticism fueling the popularity of cheer competitions. The company says in official documents that it advised the U.S. Department of Education against listing cheerleading as a sport, as that would have an “adverse effect on Varsity’s business,” which includes training camps and cheerleading apparel. Still, Varsity Spirit maintains that it hasn’t sacrificed safety. On its website, the company says: “The health and safety of athletes is our top priority.”

Since cheerleading wasn’t officially designated a sport by school athletic organizations, there were no consistent rules for protecting cheerleaders. And in many places, cheerleading still isn’t a sport.

Oversight depends on where you are. Thirty-six states and the District of Columbia currently recognize competitive cheer as a sport, according to the National Federation of State High School Associations (NFHS), the rule-making body for most high school sports. That designation means cheerleaders have access to certified coaches, medical care, and limits on practice time. It also means the data collected on injuries is more thorough, as it is in football.

But in 14 states cheer isn’t an official sport. None of the NFHS’s 17 other member sports—including football, soccer, and lacrosse—have this state-by-state designation. And at the college level, the N.C.A.A., the governing body for athletics, doesn’t consider cheerleading a sport. It has labeled STUNT an “emerging sport.”

Varsity Spirit has worked for years to keep it that way. The company argues that additional safety requirements and limits on practice hours could hamper the athleticism fueling the popularity of cheer competitions. In official documents, the company says it advised the U.S. Department of Education against listing cheerleading as a sport, as that would have an “adverse effect on Varsity’s business.” That includes training camps and cheerleading apparel. Still, Varsity Spirit maintains that it hasn’t sacrificed safety. On its website, the company says: “The health and safety of athletes is our top priority.”

A federal court supported cheerleading’s current designation at the college level. In 2010, a judge ruled that cheerleading didn’t meet the definition of a sport, siding with athletes at Quinnipiac University, in Connecticut, who had sued the school for eliminating a volleyball team and replacing it with a competitive cheer team. The school had been trying to comply with Title IX, a law requiring gender equality in scholastic sports participation.

Yet had that designation been in place, it might have protected Jennings at the University of Hawaii.

“It would solidify cheerleaders’ access to trained individuals, to making sure they have athletic trainers that are available, they have strength and conditioning personnel,” Canty told NPR.

Despite the regulatory inconsistencies, there has been progress in cheerleading safety. In 2006, the NFHS and the American Association of Cheerleading Coaches and Administrators began eliminating the basket toss on hard surfaces such as basketball courts, limiting it to softer surfaces like mats and grass. That led to a 74 percent reduction in catastrophic basket toss injuries over the next decade. And a recent study by the Consumer Product Safety Commission found that, in 2023, there were fewer emergency room visits for girls ages 12-18 for cheerleading than for basketball, soccer, volleyball, and softball.

But pediatricians, who continue to push scholastic organizations to designate cheer a sport, still worry about safety. The A.A.P.’s October statement cites concussions as an ongoing concern. Concussions accounted for nearly half of all high school cheerleading injuries in the 2023-24 school year, according to High School Reporting Information Online.

A federal court supported cheerleading’s current designation at the college level. In 2010, a judge ruled that cheerleading didn’t meet the definition of a sport. The ruling sided with athletes at Quinnipiac University in Connecticut, who had sued the school for eliminating a volleyball team and replacing it with a competitive cheer team. The school had been trying to comply with Title IX, a law requiring gender equality in scholastic sports participation.

Yet had that designation been in place, it might have protected Jennings at the University of Hawaii.

“It would solidify cheerleaders’ access to trained individuals, to making sure they have athletic trainers that are available, they have strength and conditioning personnel,” Canty told NPR.

There has been progress in cheerleading safety. In 2006, the NFHS and the American Association of Cheerleading Coaches and Administrators began eliminating the basket toss on hard surfaces such as basketball courts. Teams had to use softer surfaces like mats and grass. In the decade that followed, catastrophic basket toss injuries were reduced by 74 percent. A recent study by the Consumer Product Safety Commission found that, in 2023, there were fewer emergency room visits for girls ages 12-18 for cheerleading than for basketball, soccer, volleyball, and softball.

But pediatricians, who continue to push for cheer to be designated a sport, still worry about safety. The A.A.P.’s October statement cites concussions as an ongoing concern. These accounted for nearly half of all high school cheerleading injuries in the 2023-24 school year, according to High School Reporting Information Online.

Addison Bockover suffered three concussions in a year as a high school cheerleader in Tyler, Texas. The third happened in 2021, when her head struck a teammate’s in practice. She started having seizures and underwent laser surgery to increase blood flow to her brain. When the seizures continued, she dropped out of school for a year, traveling long distances for treatment.

“I was angry that this happened to me,” Addison told her local CBS news station. “Especially as young as I am.”

Despite the dangers, competitive cheerleading is as popular as ever. Families pack venues. Music fills the air. Cheerleaders of different sizes and abilities take the floor—stronger girls as bases, smaller girls flying up in the air, the more-athletic tumbling on the mats. Some land their stunts, and others fall and collapse into tears and group hugs.

For families that have dedicated years to competitive cheerleading, the risk of injury—not to mention the investment of time and money—is worth it for the rewards of seeing their children develop as athletes.

“Cheer is unlike any other sport,” said cheer mom Meredith, who spoke on an episode of the Cheer Mom Podcast and only gave her first name. Her daughter Peyton attends a competitive cheer gym in Denver, Colorado.

“At the end of the day, I would do it 10 times over,” she said. “And I would work 10 times harder to make sure she can stay in the sport that is giving her so much more than just an athletic ability.”

But the pain goes on for the ones who’ve had serious injuries. Jennings, who still lives in Hawaii, takes pills to control her headaches, and stretching keeps her hip injury from flaring up. When she walks into the gym where she works as a personal trainer, the thumping music opens a portal in her memory: She imagines she’s flying through the air again, twisting and falling into her teammates’ waiting arms.

“I let myself think about it,” she says, “but then I kind of just push on past.”

Addison Bockover suffered three concussions in a year as a high school cheerleader in Tyler, Texas. The third happened in 2021, when her head struck a teammate’s in practice. She started having seizures and underwent laser surgery to increase blood flow to her brain. When the seizures continued, she dropped out of school for a year to travel long distances for treatment.

“I was angry that this happened to me,” Addison told her local CBS news station. “Especially as young as I am.”

Despite the dangers, competitive cheerleading is still popular. Families pack venues. Music fills the air. Cheerleaders of different sizes and abilities take the floor. Stronger girls serve as bases, smaller girls fly up in the air, and the more-athletic are tumbling on the mats. Some land their stunts, and others fall. They collapse into tears and group hugs.

For families that have invested years in competitive cheerleading, the risk of injury is worth it for the rewards of seeing their children develop as athletes.

“Cheer is unlike any other sport,” said cheer mom Meredith, who spoke on an episode of the Cheer Mom Podcast and only gave her first name. Her daughter Peyton attends a competitive cheer gym in Denver, Colorado.

“At the end of the day, I would do it 10 times over,” she said. “And I would work 10 times harder to make sure she can stay in the sport that is giving her so much more than just an athletic ability.”

But the pain goes on for the ones who’ve had serious injuries. Jennings, who still lives in Hawaii, takes pills to control her headaches. She stretches to keep her hip injury from flaring up. When she walks into the gym where she works as a personal trainer, the thumping music transports her to the past. She imagines she’s flying through the air again, twisting and falling into her teammates’ waiting arms.

“I let myself think about it,” she says, “but then I kind of just push on past.” 

David Gauvey Herbert is an investigative journalist based in New York City.