Let Them Play Sports! Addressing the Topic of Sports and Scoliosis
The discovery of scoliosis or other spine structural changes often leads to a myriad of follow-up questions. Among them, discussion around the role of sports participation. Bottom line – let them continue to play sports! Let’s dig in a bit deeper.
Today’s blog post will address the role of sports and physical activity participation for the well-being of the child/adolescent VERSUS as a treatment for scoliosis and spine structural changes as well as answer common questions we encounter when speaking with families about this topic.
Let’s differentiate between these two concepts of sport for wellness vs sport as a specific treatment.
Sport for Well Being vs Specific Treatment for Scoliosis
Sport and Overall Wellness
Sport and physical activity participation carry numerous benefits, among them:
✓ development of the nervous system and musculoskeletal system
✓ bone and connective tissue health
✓ muscle strength
✓ coordination
✓ power
✓ psychological and emotional well-being
✓overall wellness
Specific Treatment for Scoliosis
Exercises that treat scoliosis and spine structural changes during growth have more specific aims, as described by the 2016 SOSORT Guidelines1:
✓ stop, slow, and possibly reduce scoliosis curve progression
✓ prevent or address respiratory issues
✓ prevent or address spinal pain
✓ improve aesthetics
Historically, certain sports were viewed as a potential treatment for scoliosis. However, current clinical guidelines advise NOT to use sport as a specific management strategy for scoliosis.1
Sports and physical activity ARE ENCOURAGED for children and adolescents with scoliosis for the various benefits listed above. Additionally, there is emerging research to suggest that sport participation may be protective against the progression of scoliosis in growing children and adolescents with idiopathic scoliosis.2
Common Questions about Sports and Scoliosis
Should I enroll my child in swimming to help with their scoliosis?
Swimming has historically been touted as not only beneficial for scoliosis, but as a treatment for scoliosis.1 Interestingly, this recommendation, which has often come from pediatricians and surgeons alike, has never been based in evidence. There is no research to support the effectiveness of swimming as a treatment for scoliosis. That said, if your child/teen is involved in swimming and likes to swim, continue doing it!
My child plays a sport that involves rotation (ie. golf, tennis). Is it okay for them to continue?
Parents are often concerned about the relationship between scoliosis, which involves a certain degree of rotation in the spine, and playing a rotational sport such as volleyball or tennis. A 2008 study by Modi and colleagues looked at 116 volleyball players vs a control group of 46,428 adolescents.3 The volleyball players in the study did demonstrate a higher incidence of scoliosis as well as trunk asymmetry. However, all curves that were detected in the group that played volleyball were mild (between 10 and 15 degrees via Cobb angle measurement on x ray), and there was no correlation between the size of the curve and the number of years played.3 It was hypothesized that the one side dominance that is inherent in volleyball leads to muscle imbalances between the right and left side of the body and this explained the trunk asymmetries.3
My child enjoys gymnastics or ballet. Is it okay to continue?
The research does suggest a correlation between sports such as ballet or gymnastics and scoliosis. Watanabe and colleagues published a 2017 cross-sectional study that found an increased incidence of adolescent idiopathic scoliosis in females who engaged in classical ballet training. The incidence increased with longer years in training, as well as higher frequency/duration of training.4
However, this finding can be explained. Individuals who succeed in sports such as ballet and gymnastics often inherently have more joint mobility/flexibility. Scoliosis is known to be correlated with joint hypermobility.5 Therefore, it is thought that individuals with increased joint mobility gravitate towards sports such as ballet and gymnastics, where they may find more success, and these individuals carry a higher risk for scoliosis. The common denominator lies in the increased joint mobility, not in the relationship between the sport itself and scoliosis.
Current recommendations suggest continuing ballet and gymnastics if it’s something your child/teen loves to do. Expert opinion does recommend collaboration with the physician, orthotist, and physiotherapist in situations where the child/teen is involved in heavy training of at least 25 hours/week in gymnastics or ballet, as they are more frequently and for a longer duration of time placing their spines in end ranges of motion.
My child is not physically active. What is the best sport to enroll them in?
For children/teens who are not currently physically active and were recently diagnosed with scoliosis, there is no one sport that is recommended for them to participate in. Explore a variety of activities/exercises/sports to find one or a few that sparks the interest of your child.
Take Home Messages
- Sports/physical activity should not be used as a treatment for scoliosis
- Physical activity is beneficial for humans of all ages, including children and teens. Let them play!
- There is not a causative link between rotational sports and scoliosis. Let your child/teen continue!
- Take note if your child/teen is heavily involved in ballet/gymnastics at a training volume of 25 hours/week or higher. Collaborate with your healthcare team to come up with an individualized plan.
Author Note: This article was inspired and influenced by the work of Alessandra Negrini, physiotherapist and researcher working at ISICO in Italy.
About the Author
Kelly Grimes is a physiotherapist living and working in California. She has been in practice for 14 years, six of them happily immersed in helping individuals with scoliosis and other spinal structural variations live powerful lives. Kelly is trained at the C2 level of the BSPTS Concept by Rigo method (a Schroth-based method) and Level 2 of the SEAS approach. She is also a Co-Chair of the Communications Committee of the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT).
References
- Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3. Published 2018 Jan 10. doi:10.1186/s13013-017-0145-8
- Negrini A, Donzelli S, Vanossi M, et al. Sport activity reduces the risk of progression and bracing- an observational study of 511 JIS and AIS patients (Risser 0-2 Adolescents). Oral Presentation at the 15th Annual International SOSORT Meeting. 2018; Dubrovnik, Croatia.
- Modi H, Srinivasalu S, Smehta S, Yang JH, Song HR, Suh SW. Muscle imbalance in volleyball players initiates scoliosis in immature spines: a screening analysis. Asian Spine J. 2008;2(1):38-43. doi:10.4184/asj.2008.2.1.38
- Watanabe K, Michikawa T, Yonezawa I, et al. Physical Activities and Lifestyle Factors Related to Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am. 2017;99(4):284-294. doi:10.2106/JBJS.16.00459
- Czaprowski D. Generalised joint hypermobility in caucasian girls with idiopathic scoliosis: relation with age, curve size, and curve pattern. ScientificWorldJournal. 2014;2014:370134. Published 2014 Jan 16. doi:10.1155/2014/370134
- Watanabe K, Michikawa T, Yonezawa I, et al. Physical Activities and Lifestyle Factors Related to Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am. 2017;99(4):284-294. doi:10.2106/JBJS.16.00459
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