When you think of injuries at sporting events, you might think of a football player hurting a knee or a basketball player twisting an ankle. It might surprise you to know that more and more injuries are happening on the sidelines -- not to players, but to cheerleaders.

According to a study in the January issue of the journal Pediatrics, the number of cheerleading injuries more than doubled from 1990 through 2002, and that has some experts calling for changes.

Toshimi Takamura has torn the anterior cruciate ligament in her knee -- not once, but twice in the last year, and she's not alone, reported TheWBALChannel.com in Baltimore.

"We had girls who had hurt wrists, who had to wear wrist guards, we had girls with back injuries, and a couple girls pulled their hamstrings doing you know, kicks or splits or whatever," Takamura said.

Researchers said those injuries are becoming more common because cheerleading for different sports has become a sport itself and the competition is fierce.

Brenda Shields, a researcher at Columbus Children's Hospital, found that almost 209,000 young cheerleaders aged 5 to 18 were treated at hospitals.

In the 13-year study, Shields found most injuries happen in the legs and feet of girls between the ages of 12 and 18. These days, cheerleaders are expected to do complex gymnastic routines and sometimes without the proper training, she said.

"Cheerleading used to be the pom-pom girls who just yelled out the cheers and stuff," Shields said. "Now they're starting to incorporate some very fancy gymnastic maneuvers."

But the training of coaches has not kept pace, the study said. Shields found that coaches are not always trained, and some schools lack the proper facilities and equipment. And some cheerleaders practice in hallways and on other hard surfaces.

Although researchers did find a dramatic increase in the number of injuries, they were relieved to see that they were not serious most of the time. Only about one in five cheerleaders is hospitalized for their injuries, and the rest recover at home.

Even so, Shields recommended that all cheerleading coaches be certified in safety training, and she would like to see the routines change from the ground up. She also urged high schools and cheerleading associations to adopt uniform safety procedures.

"The stunts should be performed on some kind of an impact-absorbing surface such as gymnastic mats, and definitely not on the hard gym floor," Shields said.

By taking those precautions, Shields said people may get to spend more time cheering on the sideline instead of being sidelined by their injuries.

Additional Resources:

• Pediatrics
• American Association of Cheerleading Coaches and Advisors