Sports Participation with Scoliosis

One of the most common concerns that I hear from my scoliosis patients (or their parents) is related to risks vs benefits of sports participation when it comes to their scoliosis. While sports exercises are not considered therapeutic for the correction of a scoliosis (only scoliosis specific exercise programs like the Schroth Method, SpineCor Rehabilitation or SEAS are helpful for correction) the overall benefits of most recreational sports participation is still applicable.

Health benefits such as increase in cardiovascular health, increased aerobic capacity, increased bone density, improved mental outlook, reduced body fat and increased life expectancy are gained by regular exercise so they are recommended for scoliosis patients in most cases. (1) Yet, there is still some reason for concern when it comes to rigorous exercising, especially for adolescents who are still growing and are skeletally immature.

While there has been a well documented genetic connection for scoliosis the average incidents of scoliosis is only around 1.5 – 2% in the general population. Yet the incidents of scoliosis have been found to be significantly higher in certain sub-populations.

For instance, incidents of scoliosis among gymnasts and especially rhythmic gymnastics is found to be as high as 20% of the total population.

Similarly, ballet dancers have been reported to have an incidents as high as 24%. (2)

With statistics like this many parents are asking the question: “Is the participation of my child in these sports causing or contributing to her scoliosis? If so, should I have her quit?”

This is somewhat of a “chicken-and-the-egg” type of question.

Is it the activity that is contributing to the scoliosis

or

is it the type of girl who is attracted to the sport that accounts for the increased incidents of scoliosis?

While the exact mechanism that causes scoliosis remains somewhat unclear, the onset of the progression of the curve in adolescence is relatively well delineated. In animal studies performed on chickens with scoliosis the initiating event appears to be a delay in the ossification of the growth center at the side of one or more of the vertebra that results in the initial tilt at the vertebral segment. Muscular adaptations that follow cause furthering of this imbalance, which leads to further postural distortion, resulting in additional imbalance that can cause a rapid increase in the scoliosis curve as the spine is going through a major growth spurt.

This is known as the “Vicious Cycle of Scoliosis”.

So what are some of the factors that can initiate the onset of this “vicious cycle” in gymnast and dancers at a much higher rate?

Dangerous Triad for Scoliosis

1. Joint Laxity
   

2. Delayed Maturity

3. Asymmetric Spinal Loading

Each of these factors has the potential of driving the vicious cycle of a scoliosis. Let’s examine each separately.

1. Ligamentous Laxity – Gymnast and dancers must have a good degree of flexibility in order to achieve a high level in their discipline. Whether it’s because girls with lax ligaments are naturally attracted to a sport that flexibility plays an important part or a tremendous emphasis on stretching causes the girl becomes far more flexible, it doesn’t really matter. It is the imbalance between her flexibility and her own muscular stability that can cause a development of her scoliosis curvatures.
2. Delayed Maturity – The rigorous training required to become a world class gymnast or prima ballerina can cause the delay in onset of menses and this can have a profound impact on a scoliosis. It is well known that Estrogen is very important to bone density. While much attention is paid to post-menopausal estrogen levels when it comes to bone density, very little consideration is give to lower levels of estrogen in per-menstral female and the effects it would have on bony development. A delay in maturity can result in imbalances in the ossification centers in the spine resulting in imbalances vertebral growth.
3. Asymmetric Spinal Loading – Repetitive movements, especially those performed unilaterally, can have a negative impact on spinal development. While intermittent loading of a vertebra can stimulate growth, a constant or repetitive loading of a segment can suppress a growth plate. When this is done on one side of the body more than the other an imbalance in growth can occur from side to side that can lead to a scoliosis. An example of a unilateral repetitive movement pattern would be ballet being taught with student on a bar facing the instructor on the same side of the room while they perform dance movements on one side only, over and over again. A horse back rider practicing roping would be prone to asymetrically loaded forces to the spine. Another example would be a golfer, who develops a scoliosis after practicing driving all the time without any attention to performing similar movements in the opposite direction. These type of activity can lead to significant asymmetrical spinal loading that can drive a scoliosis.

Researchers Cann et al found a decrease of 20% to 30% in trabecular bone (aka – spongy bone) mass of the vertebra in pre-menopausal amenorrheic women engaged in vigorous exercise programs and noted that running-related fractures were most frequent in amenorrheic elite runners, so there appears to be a connection between menstrual irregularity and athletic injury. (3)

In the spine spongy bone porosity can vary greatly from 30–90% depending on the adaption to the load on the body. This type of bone is surrounded by blood. Alterations in the strain or load to this type of bone is known to result in the rearrangement of the trabeculae pattern in the bone.

We know that physical activities, especially those that are weight bearing, play a major role in bone remodeling and overall bone mass and that immobilizing bones results in loss of bone density and that increased weight bearing activities result in increase in bone mass. This is why mild to moderate exercise is recommended to post menopausal women. Yet other researchers have shown that vigorous exercise in amenorrheic athletes resulted in attrition in bony density. (4)

In fact, the average bony density of a 25 year old female athlete who is amenorrheic was found to be so low that is was comparable to bone density found in a 51 year old woman! This same logic can apply to a pre-menstral female.

Conclusion:

If your child has scoliosis and is participating in sports activities at a casual level then they should continue with these activities as they are important for your child’s overall health and well being, but if your child has scoliosis and is participating at a high level in competitive sports such as gymastics, dance or horseback riding you should consult your doctor for advise on their participation as it relates to their scoliosis.

 

Author:

Dr. Brett Diaz, D.C.

Scoliosis Treatment Alternatives

http:ScoliosisTreatmentAlternatives.com

1) Eur Spine J. 2011 August; 20(Suppl 3): 415–419. Beneficial effects of aerobic training in adolescent patients with moderate idiopathic scoliosis

2) 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

3) Marcus, M., Cann, C. Maduis, et al, Menstral function and bone masss in elite runners. Annals of Internal Medicine.

4) Menstrual function and its relationship to stress, exercise, and body weight. P. R. Gindoff