Participation in sports and physical activities plays an important role in developing physical, intellectual, and social well-being in adolescents. One of our CLEAR Scoliosis Institute goals as doctors of chiropractic is to support our adolescent patients by encouraging healthy and safe participation in these activities. While this may seem a straightforward goal, it can be complicated somewhat by a diagnosis of adolescent idiopathic scoliosis (AIS). In these cases, it can be difficult to determine which sports or activities could be detrimental to the spine. A review of 18 Scoliosis Organizations revealed no position papers on scoliosis patients and sports activities. The purpose of this article is to present a helpful guide to determining which activities arc most safe for the adolescent with scoliosis. and which activities might pose a potential risk. In 2009. Green et al published a systematic literature review exploring appropriate sports and activities for people living with seoliosis.1 In this paper, the authors mention how a study performed by the American Orthopedic Association led to widespread recommendations across the United States that seoliosis patients avoid sports and exercising, but note that, "a new emphasis is being placed on exercise to combat the epidemic of obesity in the United States: people with seoliosis often desire to remain active, and a rise in female participation in sports has been noted over the past couple of decades." leading them to conclude tliat. "investigation into the appropriateness of physical activity for people with seoliosis is needed." especially considering that "no published recommendations arc found regarding the suitability of physical activity for those with seoliosis." There are some concerns that certain sports and activities, due to the unique physiology and biology of seoliosis. may be associated with an increased incidence of seoliosis.2 This is especially true in activities that heavily favor one side of the body (such as golf or tennis). Adolescents with seoliosis tend to have a higher degree of ligament laxity and joint hypcnnobility."' which often predisposes them to become involved with activities such as dance, gymnastics, and chccrlcading.4 Amcnorrhca can arise in young women who arc engaged in high levels of athletic activity, which can have negative effects upon bone hcalth.5 This is of particular concern for individuals with seoliosis. who tend to demonstrate lowcr-than-avcragc levels of bone density.'' Participation in sports and physical activities should be limited or restricted only when these activities might negatively influence the patient's health status or limit the potential health benefits that they could receive as a result of care. As an adolescent, the social and emotional significance of group activities and team sports is quite powerful, and the doctor must be careful in making recommendations, lest the patient come to resent the restrictions. When possible, participation in most activities should be reduced or modified rather than restricted completely: the one exception is if the patient experiences pain during the course of exercising. Any activities that cause pain should be eliminated completely. If there arc activities or sports that the doctor feels should be discontinued, every effort should be made to consider possible replacements for these activities, to help the patient maintain good physical habits and condition. Every adolescent with seoliosis should be evaluated on a case-by-case basis: certain sports or activities that may be allowable for one individual may not be appropriate for another. It's also important that the doctor and patient (as well as their guardians) maintain open communication. The doctor needs to understand exactlv what is involved in each sport or activity so they can make the best possible recommendations. Through CLEAR Scoliosis Doctors clinical experience, reviews of the scientific literature, and Digital Motion X-ray (DMX) studies on scoliosis patients conducted during the performance of various activities, the exercises that might be considered high-risk' in cases of AIS include: Collision sports: football, hockey, rugby, full-contact martial arts, chccrlcading. gymnastics, pole vaulting, lacrosse • One-sided or rotational sports and activities: golf, tennis, bowling, shot put or javelin, string or wind instruments such as flute or violin Repetitive, comprcssivc sports or activities: longdistance running, horseback riding, off-road cycling, triple jump or long jump, weight lifting, drum line or marching band • Sports and activities which may cause spinal trauma: butterfly swimming, martial arts, downhill skiing, trampoline, roller coasters and other amusement rides Exercises which compromise the health of the spine: sit-ups. push-ups, and pull-ups. Meanwhile, young people with scoliosis are encouraged to participate in the following: • Swimming (non-competitive): avoid the butterfly stroke (freestyle, backstroke, or breaststroke arc preferred): scuba diving and diving are also permissible Cycling (not off-road cycling) Walking, hiking, and sprinting (avoid long-distance running and jogging) Aerobics, such as dance, color guard, yoga, and flexibility training Table sports: table tennis/ping pong, foosball Croquet, badminton, and shuffle board • Gliding-type activities such as cross-country skiing, as well as ellipticals. Nordic track. Gazelle edge, and similar exercise machines that do not involve repetitive shocks Also, short-term, high-intensity exercise (burst training) is preferable to endurance training In essence, sports that do not involve repetitive or excessive rotational or comprcssivc forces (such as swimming, cycling, aerobics, sprinting, and dance) arc more advisable for patients to participate in than sports that do involve such activities (including golf, tennis, triple jump or long jump, butterfly swimming, weight lifting, off-road cycling, horseback riding, long-distance running, and martial arts). The level of competition must also be taken into account: an elite athlete who trains and competes regularly will be at greater risk of sports-related injury or trauma to their spine. Patients with a larger amount of potential growth remaining (typically 12 or younger for females, and 15 or younger for males) should be counseled against high-risk sports and activities more strongly than patients who arc skclctally mature, due to the risk that, as the growth forces tend to cause scoliosis to worsen during periods of rapid grow th. the spine may be more vulnerable to trauma in these individuals. This also includes pushups, pull-ups and situps. In most cases. CLEAR Scoliosis Institute recommends that adolescents with scoliosis should feel free to engage in most sports and activities at an amateur level. Extra attention should be given when there is active pain, a severe curve at high risk for progression, or the adolescent is competing at a very high level. In females, the occurrence of amenorrhea is a sign that the exercise regimen needs to be scaled back, as this could have long-term effects on bone health. With their unique understanding of biomcchanics and the musculoskclctal system, doctors of chiropractic arc well equipped to guide AIS patients in making informed and responsible decisions regarding sports and activities. For further information, go to www.CLEAR-Institutc.org. Dr. Dennis Woggon is the founder of the CLEAR Scoliosis Institute and the St. Cloud Chiropractic Clinic. lie graduated from Palmer C 'allege of Chiropractic in 1974. He is an international instructor for CIJiAR Scoliosis Institute. He can be contacted at [email protected]. Dr. A. Joshua H'oggon. a 2010 Graduate of Parker College, serves as the Director of Research for the CLK-IR Scoliosis Institute, a Non-Profit Organization dedicated to advancing chiropractic scoliosis correction lMMM.clear-institute.org). lie can be contacted al pvoggon'iijclear-institute.org. Research & References: J. Green el al: Is physical activity conlraindicaled for individuals with scoliosis? A systematic literature review. J Chiro Med 2009.\far;8(l):25-37. 2. Kenanidis et al: Adolescent idiopathic scoliosis in athletes: is there a connection? Phys Sporlsmed. 2010 Jun:38(2): 165-70. 3. Czaprowski et al: Joint hypermobilily in children with idiopathic scoliosis: SOSORTaward2011 winner. Scoliosis2011,6:22. 4. Longworlh el al: Prevalence and predictors of adolescent idiopathic scoliosis in adolescent ballet dancers. Arch Phys MedRehahil. 2014 Mar 21. 5. Xichols el al: Bone mineral density in female high school athletes: interactions of menstrual function and type ofniechanical loading. Bone. 2007Sep:41(3):371-7. Epub 2007May 13. 6. Li et al: Low bone mineral status in adolescent idiopathic scoliosis. EurSpineJ. 2008Nov: 17(11): 1431-40.
