Member Case Study: Activity Limitation with Scoliosis or Degenerative Disk

author : AMSSM

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Swimming and cycling are well tolerated sports. Running should be limited based upon an athlete’s pain and functional limitations.

Question from Runnerteach

Does scoliosis or degenerative discs inhibit you from doing various sports activities? If you have these, is there anything you should be doing?

Answer - Writer: Troy Smurawa, M.D. Member AMSSM
 
Scoliosis is a lateral curvature of the spine measuring greater than 10 degrees. Eighty percent of scoliosis is of an unknown etiology and is called idiopathic scoliosis. It is more common in girls and typically develops in the teenage years during skeletal growth. Neurological conditions, bony lesions, and fractures are less common causes of scoliosis. In the mature athlete spinal curvature can result from degenerative disc disease, compression fractures, or neurological conditions.

Most patients with idiopathic scoliosis are asymptomatic. In general, studies indicate that scoliosis itself is not a contraindication to participation in most sports. There is no clear evidence that sports participation is directly associated with worsening of the spinal curve. Adolescent athletes with curves greater than 25 degrees are treated with bracing and careful repeated exams. Bracing is not a contraindication to sports participation; most athletes can participate wearing the brace and, in some cases, the treating physician may allow participation out of the brace.

If surgery is required, sports participation depends upon the type of surgery and the desired sport. In general, collision sports are not recommended. Sports are usually limited for 6 -12 months after surgery. Spinal fusion surgery limits flexibility and can affect performance in sports such as gymnastics, skating and dance that demand high degrees of flexibility.

Sports that involve extensive running and jumping place an increased stress load on the spine and participation is cautioned. Studies have shown that over the long term, athletes with idiopathic scoliosis tend to have more impairment in sports activities than those without. The main reason for this is functional impairment and back pain rather than activity restrictions and physical impairment.

Degenerative causes of scoliosis may result in pain and limited function. Limitations in sports activities are dependent upon the level of pain and functional impairment as a result of the degenerative disease rather than the curvature itself. The incidence of degenerative disc disease is higher in the aging individual. Studies have found that the prevalence of radiographic evidence of disc degeneration is higher in athletes than nonathletes. However, it is unclear whether this correlates with a higher rate of back pain in athletes. Disc degeneration appears to be influenced by the type and intensity of the specific sport.

Sports that increase rotational or compressive forces on the spine such as golf, gymnastics, football and weightlifting have a higher incidence of degenerative changes. The primary treatment is nonoperative rehabilitation.  Rehabilitation includes early mobilization, pain control, spinal stabilization, lumbar strengthening and return to functional sports activities. Restrictions in sports activities are based upon pain and functional limitations. Sports that involve excessive rotational or compressive forces and high impact sports should be avoided or limited, as these could progress the degenerative changes. Swimming and cycling are well tolerated sports. Running should be limited based upon an athlete’s pain and functional limitations.

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date: June 5, 2006