By Brittany Bowyer, Cronkite News

After Lisa Caiazzo’s daughter, Alexa, suffered a third concussion, the Gilbert resident was terrified.

“She was talking funny. She didn’t make sense. She just wanted to sleep,” she said of Alexa. “Oh God. Her eyes were like… It was like she couldn’t even see you.”

It was then Lisa decided to pull her daughters out of cheer.

They tumble, they fly, and they do it all with smiles on their faces. But behind the big bows and the sparkly pom-poms of the sport, another truth emerges: Cheerleading is dangerous, too.

The sport was responsible for 65 percent of direct catastrophic injuries to female high school athletes during a 27-year period, according to a 2012 study by the American Academy of Pediatrics. This supported a 2009 report from the National Center for Catastrophic Sports Injury Research at the University of North Carolina that concluded cheerleading accounted for 65.2 percent of all catastrophic injuries in youth sports.

The risk connected to cheerleading continues to rise as the difficulty of skills performed increases.

During his 31 years of practice, Phoenix orthopedic surgeon Douglas Hartzler has treated numerous cheerleaders for injuries.

“I would agree that cheerleading on a percentage basis… probably has a higher frequency than most sporting activities,” Hartzler said.

Alexa Caiazzo, a former cheerleader at USA Starz in Gilbert, suffered three concussions in approximately six weeks. She began cheering when she was 9 and was hooked immediately.

“I was there four to six days a week for almost eight years. I loved it with everything,” Alexa said.

After suffering her three concussions, Alexa missed two weeks of school because of her symptoms. She had extreme light and sound sensitivity and slept almost day and night. When she returned to school, the lights in the classroom and the sounds were overwhelming for her.

The concussions caused her to have issues with schoolwork. Not only did it put her behind, but it also made it difficult to remember things like math formulas. She also struggled with writing, forgetting how to spell simple words, and would confuse letters like “b” and “d.”

The look that Lisa described on the day she picked Alexa up after the third concussion was a look that haunted her for months

“That blank stare. That not understanding,” Lisa said. “You know somebody with Alzheimer’s? That’s what I felt like she was like. She just had no clue.”

Today, although she is about 75 percent healed, Alexa still has problems with comprehension.

Part of the reason so many cheerleaders suffer serious injuries is because of what is required, Hartzler said. They do gymnastics skills on hard surfaces and rely on other people for safety, which can sometimes be unreliable.

“The most common [injuries] are the shoulder, elbow, ankle, and foot, and occasionally the knee, as well,” he said. “Most of it involves tumbling. Tumbling involves the upper extremities… the shoulder, the elbow, and also the foot and ankle takes a pounding.”

Hartzler is no stranger to the dangers that come with cheerleading.

“I can speak from my own experience that my daughter sustained a fracture dislocation of her ankle in doing a tumbling maneuver,” he said.

Guidelines have been in place for high school cheer to try to combat injuries, yet none of these safety measures can completely eliminate the risk.

One common measure nationally calls for cheerleaders doing stunts to have a padded mat below them if they are on a hard surface besides grass. In Arizona, coaches also have to pass certification courses.

Following Alexa’s injuries, Lisa pulled her younger daughter Bri out of cheer as well. Bri’s only injury in cheer was a hairline fracture.

Lisa said that if Alexa had suffered broken bones, she would still let her and Bri cheer.

“With the brain, it’s a totally different way of thinking about it,” Lisa said. “The brain is the brain. A break, you can fix. It can heal. You can have surgery. That’s not catastrophic. That’s not toying with your mind, or your memory, or your speech, comprehension, or how you live day to day.”