"I'd say there's definitely been a big evolution - there's no more 'Johnny, Johnny, he's our man,'" she said. "Cheerleading is more sophisticated ... they practice a whole lot more to be more synchronized."
It's also getting more dangerous.
Research indicates cheerleading injuries more than doubled from 1990 through 2002, while participation grew just 18 percent over the same period.
A study published last week in the journal Pediatrics estimates 208,800 young people ages 5 to 18 were treated at U.S. hospitals for cheerleading-
"The main injuries for us are going to be the strains and pulls," Williams said. For instance, one girl sprained her wrist earlier this season from doing too many flips in a close basketball game.
Injuries are nothing new at New Madrid County Central, either. During Janey Kennett's five years as coach, she has seen injuries including concussions, sprained and twisted ankles and bad wrists. One cheerleader even lost a tooth.
"We do a lot of stretching and strength building exercises (to avoid injuries)," Kennett said. There are specific exercises for people according to their roles - flyers would focus on their ankles, bases would focus on wrists.
The American Association of Cheerleading Coaches and Advisors executive director Jim Lord said several factors, including the popularity of televised cheerleading competitions, have encouraged more cheerleaders and coaches to mimic difficult tumbling moves before they have the right training.
"Because of more tumbling, I do think you have more injuries," Kennett said. "There are more advanced stunts and a lot of these teams are in competitions to keep current."
Williams said her cheerleaders will often want to try new, more difficult stunts and builds after seeing them at camp or other competitions. "Of course all the kids want to go to the big boys right away," she said.
But both coaches ensure their cheerleaders don't do anything they aren't ready for. "There's a hierarchy - it's a base of things," Kennett said. For instance, when doing builds, cheerleaders first learn to hold the flyer at their shoulders, then above their heads holding both of the flyer's - the girl who is held or tossed in the air - feet, and finally above their heads holding just one of the flyer's feet.
Bases will sometimes practice just holding an empty shoe, so they learn how to properly hold the flyer. Plus, counts keep everyone together, Kennett pointed out.
One advantage at NMCC is that their squad is co-ed. "The girls feel really assured when they have a male base," Kennett said.
Senior Betsy Brittain, who has been a flyer the past four years, agreed. "It just depends on how strong your group is," she said.
Brittain has only had one major injury - she was dropped her freshman year and had a concussion. Weak ankles are a recurring problem, and she often does strengthening exercises for them.
The study found that cheerleaders often practice in hallways and on hard surfaces instead of mats, which can increase the chance for injuries if they fall and land on hard surfaces.
At NMCC, cheerleaders always use mats when they are learning new stunts. And Kennett agreed that practice places aren't always ideal - they often practice in the hallways, where the ceilings aren't high enough to do builds, or on the upper level of the gym, where the floors are slick.
East Prairie cheerleaders also use mats in the summer and when they are learning new stunts. Mats are difficult to use when they are practicing in a location like the hall, though.
"Practices are probably one of the biggest handicaps we have," Williams said. But the school has been helpful in ensuring cheerleaders get some space, too, especially in the fall when junior high and high school teams are practicing and "everyone's wanting the gym," she said.
Unlike some other states, cheerleading is sanctioned in Missouri under the Missouri State High School Activities Association. As a result, there are some guidelines and restrictions. An information packet is sent in August outlining these rules and practice suggestions.
"MSHSAA is very big on wanting cheerleading to be safe," said Williams, who serves on the state cheerleading advisory committee. "That's a big emphasis for them."
She said MSHSAA sponsors a one-day clinic during the summer, where cheerleaders learn new skills and at least one coach from each school is required to attend training, learning basics like "ankle wrapping and how to avoid injuries," as well as stressing that cheerleaders should do stretches to be warmed up.
The Associated Press contributed to this report