Competitive cheerleading is one of the toughest -- and most dangerous -- sports in the nation. Despite the ingrained image of pretty girls in movies wearing sweaters and short skirts waving pom-poms, the modern cheerleader couldn't be further from this stereotype.

Cheerleading has far evolved from its wholesome, but outdated image. Today's cheerleading squad requires athletic stamina, precision, and flexibility. The truth is, even as it struggles to be recognized as a true sport, cheerleading teams all over the world practice more than most of the boys in football or basketball.

Competitive cheerleading has become a world of its own, and the pressure is on to do bigger stunts, harder tumbling passes, and more dance-packed routines to take home coveted state and national titles. This type of pressure has become dangerous to young men and women who attempt stunts they aren't ready for. And the results can be dire.

According to a 2013 Washington Post article, cheerleading was the cause of more than half of the "catastrophic injuries to female athletes. This includes skull fractures, cervical spine injuries, brain injury or concussions, paralysis, and death.

Cheerleading is also among the top 20 sports with highest rate of head injuries, according to American Association of Neurological Surgeons.

Consider the typical cheerleading stunt. There is a flyer, who is the person being held up in the stunt. Two bases support the flyer, and the back supports the bases and the flyer with stability. It is not easy or natural to lift an entire person in this way. With four (or more) people involved in a single stunt that can top eight death-defying feet, one wrong move can spell disaster. The flyer can be injured if they aren't caught correctly (or at all) by their bases, and the bases can be injured should the flyer fall on top of them. Similarly, tumbling passes can result in painful falls and collisions if not executed as intended.

Competition cheerleaders typically perform a two and a half minute routine, which includes tumbling passes, stunts, a cheer, and dance section. While this may seem like a short time span, it is physically exhausting. This is often where accidents happen, because as team members get tired, their brains are less focused and their movements less precise. When a tumbling pass, stunt, or entire routine is done to perfection it is because of many hours of training and practice, and muscle memory. But if enough hours aren't put in, members aren't properly trained, or if something simply goes wrong, someone can get seriously hurt.

Studies show that cheerleading, as a sport, has a higher risk of concussion (14 per 100,000) during practice, when athletes are learning new skills, versus during competition (12 per 100,000), when skills are already learned and perfected. Head injuries account for more than 36 percent of cheerleading-related injuries.

As a former high school cheerleader myself, I am all too aware of the risks of competitive cheer. I was a flyer, and right away I had a healthy respect for both heights and the people supporting me. I was acutely aware that I had three high school girls holding my life in their hands. While my teammates went out of their way to keep me safe, it still made me nervous at times. I had heard stories from years past of one girl breaking an arm falling out of a stunt, and another girl injuring herself doing a jump mid-competition. I knew full well I could get hurt.

And I certainly had my own close calls and mishaps. As I was learning new stunts I fell on my head and neck multiple times; was dropped on my backside; and even was the victim of a haphazard basket toss, where I was thrown way over my bases' heads and landed flat on my face. I wasn't injured during any of these accidents, but they were terrifying. During my first competition, I fell eight feet during a pyramid only to land flat on my back when my bases couldn't catch me. I heard the audience gasp, and felt mortified that I failed the team, when really I should have been counting my blessings that it hadn't put me in a wheelchair. The ultimate wake-up call came during one of our practice sessions. We ran through our competition routine one more time before calling it a day. We were all exhausted and unfocused. I fell during one particularly risky stunt we called "The Matrix." As I was falling, I thought I was going to hit my head, so I put my arm down to break my fall. Well, that broke my bones instead. In the Emergency Room, I found out I had dislocated my elbow, an injury that kept me off the mat for several months.

When I returned to cheerleading, I had an even healthier fear and respect for what I did. I became better at the sport, and often reminded those lifting me in the air to stay focused. The accidents were fewer and farther between.

Eventually I left the world of cheer to pursue other high school interests, but what I learned from it will stay with me forever. According to Medical News Today, damage done to the brain from concussions can last almost that long. Even once the temporary symptoms disappear, abnormal brain wave activity can last for year. Motor pathways can also disintegrate and limit attention spans. Athletes that have suffered concussions are more likely to develop Parkinson's disease as they get older, and may suffer memory and attention deficits.

If you cheer, no matter what your position, advocate for yourself. Speak up if you aren't comfortable with a stunt or tumbling pass. Never let anyone pressure you into doing something you aren't ready for. Also, don't let anyone compromise your safety by fooling around, not paying attention, or stunting improperly. Cheerleading is inherently a fun, positive sport, whether it is competitive or supportive. However, this positivity can mask or undermine the potential risk it poses. When done correctly, tumbling and stunting can be both impressive and safe. But make no mistake, attempting a stunt you aren't comfortable with isn't worth the life-altering changes and injuries that could result.

If you do take a serious fall while cheerleading and suspect you may have a concussion (or any other injury) insist upon seeking medical attention immediately. Don't keep cheering, and don't allow an adult or teammates to tell you to shake it off. You know your body best, and when in doubt, it is always better to be safe than sorry.

Most people suffering concussion have a headache or feel dazed and confused. A few other, more serious, symptoms of concussion to look for include losing consciousness, amnesia, and seizure.

Once you have been looked at and treated by a medical professional, rest and take time off from cheering. Rest may not only include sleeping, because many doctors admonish reading, computer usage, television, music, etc. immediately following a concussion. [NOTE: The old formula for concussions and brain injury was rest and "watchful waiting." Today, many doctors will recommend more active alternative therapies like hyperbaric oxygen therapy and various foods and supplements containing omega-3 to speed the healing of the injury. See www.treatnow.org for more information.]

Follow your doctor's orders exactly, and do not return to your activities until they allow it. And once you do start cheering again, it is important to only do what you feel up to. Do not pressure yourself to take on too much, too soon. Sustaining multiple concussion in a short period of time can cause more serious and permanent brain damage.

Cheerleading coaches, charged with supervising and teaching the team, are not always knowledgeable about the physical risks of over stretching, over work, and serious falls. Not that they intentionally put their girls in harm's way, but they get caught up in the pursuit of the win. Coaches can get so caught up with perfection that they pressure cheerleaders to attempt stunts they aren't capable of, and may later have to live with those dire consequences. Just because a stunt is done in practice with extra spotters does not mean it is competition worthy.

And while the cheerleaders feel pressure to stunt up, parents feel pressure to shut up. Coaches can be extremely proprietary about their routines and methods, and parents, though present at practice, may not feel able to speak up when they feel something is wrong. High school cheerleading regulations have become increasingly more stringent, with the hope of protecting the young athletes. With this support, and the knowledge of potential catastrophic injuries, young cheerleaders and their families can (and should) continue to advocate for their own safety and wellbeing, because no trophy or title is more important.