Spinal deformity in the adolescent athlete

The impact of anthropometric measures on plantar pressure distribution in male handball players and non-athletes: A cross-sectional study

BACKGROUND

Increasing body anthropometry brings substantial spinal stress, which influences the spinal curvatures; this in turn may affect the foot plantar pressure distribution.

OBJECTIVES

This study investigated the impact of body anthropometry on static plantar pressure distribution and their relationship among handball players and non-athletes subjects.

METHODS

Thirty handball players aged from 21 to 26 years, and thirty age-matched non-athletes subjects aged from 21 to 28 years participated in this study. The spinal lordosis and kyphosis angles, trunk length, pelvic tilting, and pelvic rotation were evaluated using Formetric 4-dimensions and the Pedoscan device was used to assess the plantar pressure distribution.

RESULTS

The handball players were significantly taller, heavier, and have a long trunk length than non-athletes group (p < 0.05), and a significantly increased thoracic kyphosis, forefeet pressure distribution compared to non-athletes group (p < 0.05). The handball players had a significantly increased forefeet pressure distribution compared to the rearfeet pressure distribution (p < 0.05), a high positive correlation between body height, and both trunk length and kyphosis angle (r = 0.932, 0.665 respectively), and the body height showed a high positive correlation with the forefeet pressure distribution (r = 0.665). There was a high positive correlation between the handball players' thoracic kyphosis and forefeet pressure distribution (r = 0.751).

CONCLUSION

Increasing the handball players' body height was related to increased thoracic kyphosis and forefeet pressure distribution compared to non-athletes subjects. Additionally, the kyphotic posture of handball players is associated with increasing the total forefeet pressure distribution compared to the total rearfeet pressure distribution.

Biological principles of adult degenerative scoliosis

The global aging population has led to an increase in geriatric diseases, including adult degenerative scoliosis (ADS). ADS is a spinal deformity affecting adults, particularly females. It is characterized by asymmetric intervertebral disc and facet joint degeneration, leading to spinal imbalance that can result in severe pain and neurological deficits, thus significantly reducing the quality of life. Despite improved management, molecular mechanisms driving ADS remain unclear. Current literature primarily comprises epidemiological and clinical studies. Here, we investigate the molecular mechanisms underlying ADS, with a focus on angiogenesis, inflammation, extracellular matrix remodeling, osteoporosis, sarcopenia, and biomechanical stress. We discuss current limitations and challenges in the field and highlight potential translational applications that may arise with a better understanding of these mechanisms.

Characteristics of Body Posture in the Sagittal Plane in 8–13-Year-Old Male Athletes Practicing Soccer

Background: An important part of a healthy lifestyle for children and adolescents is exercising to satisfy the natural need for physical activity. However, young athletes should take special care when they participate in intense physical training, to ensure their proper physical development. The aim of this study was to evaluate the body posture in the sagittal plane of soccer players in comparison with healthy untrained peers. Methods: A total of 245 young males aged 8–13 who participated in the study were divided into two groups: “Group F—Footballer”, elite youth soccer players comprising 132 male athletes, and “Group C—Control group”, consisting of 113 boys from primary schools. The elite, youth soccer players played and trained in the Gold Standard Certificate Academy for their age group and belonged to the top 1% of all players from their category, respectively (Polish Soccer Association (PZPN)). The control group consisted of healthy boys from primary schools in Wroclaw not practicing any sport. A photogrammetric method based on the projection moiré phenomenon was used to assess the body posture in all subjects. Results: The analysis showed statistically significant differences in body posture parameters in the sagittal plane between the trained (F) and non-trained (C) groups. In all age groups, a significantly higher value of the upper thoracic angle and a lower value of the trunk inclination angle were observed in the football players’ group. Significant differences were also observed for the thoracic spine in each age group. In the groups of 8–9 and 12–13 years, they concerned the angle of thoracic kyphosis, and in the group of 10–11-year-old, the depth of thoracic kyphosis. In the group of children with ages 8–9 and 10–11, significantly higher values of lumbosacral angle and upper thoracic angle were observed in the group of soccer players. Conclusions: The soccer training load can influence the anterior–posterior curvature of the spine. In the group of footballers in all age groups, higher angular values of thoracic kyphosis and greater tilt of the torso forward were found, compared with their untrained peers. There were also significant differences in body posture between children of different ages, both in the group of footballers and in the group of untrained children. In the group of footballers, the differences concerned mainly the size of the lumbosacral angle and the depth of both curves, which decreased with the age of the players. A similar phenomenon was observed in the group of untrained boys but only in children in the older age groups.

Timelines for returning to physical activity following pediatric spinal surgery: recommendations from the literature and preliminary data

Objective

Participation in physical activity and sports is known to have positive implications for physical health, and for social and emotional wellbeing of children. Following corrective spinal surgery for scoliosis, the timeline for the return to activities and sports varies from surgeon to surgeon and from location to location, and return to activities can be limited due to pain, fear, and decreased flexibility. It is critical that patients know best-practice guidelines, and it is equally critical that medical professionals know whether their patients are following those guidelines. This paper includes a summary of recommendations published in the literature, and a pilot study to address a gap in the literature on determining how long, post-surgery, adolescents with idiopathic scoliosis waited before returning to various self-care and physical activities, and what factors influenced return to activities. We used a mixed-method approach that involved two phases: a questionnaire (n = 8), and subsequent interviews of some participants (n = 3). Participants were ages 14–17 (M = 15.4) and had had posterior instrumentation and fusion for scoliosis in the past 2 years.

Results

Some patients were cautious about return to activities, either because of emotional or medical reasons. However, in many instances, participants returned to physical activities earlier than was recommended, primarily for emotional and social reasons.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05571-2.

Etiological Theories of Adolescent Idiopathic Scoliosis: Past and Present

Adolescent idiopathic scoliosis is one of the most common spinal deformities, yet its cause is unknown. Various theories look to biomechanical, neuromuscular, genetic, and environmental origins, yet our understanding of scoliosis etiology is still limited. Determining the cause of a disease is crucial to developing the most effective treatment. Associations made with scoliosis do not necessarily point to causality, and it is difficult to determine whether said associations are primary (playing a role in development) or secondary (develop as a result of scoliosis). Scoliosis is a complex condition with highly variable expression, even among family members, and likely has many causes. These causes could be similar among homogenous groups of AIS patients, or they could be individual. Here, we review the most prevalent theories of scoliosis etiology and recent trends in research.

Pediatric Return to Sports After Spinal Surgery

CONTEXT

Pediatric patients who undergo spinal surgery are frequently involved in sporting activities. Return to play is often an important postoperative concern for the patient and family.

EVIDENCE ACQUISITION

A PubMed search was conducted for articles in the English language on return to play after treatment of pediatric acute disc herniation, degenerative disc disease, spondylolysis, spondylolisthesis, and scoliosis from 1980 to 2015. Reference lists were reviewed for additional pertinent articles. We included articles that focused on return to sports after surgical treatment of these conditions in this review.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

There are no published guidelines, and most of the literature in this area has focused on return to play after spinal injury rather than after spinal surgery. Most children and adolescents have excellent outcomes with minimal pain at 1 year after lumbar discectomy. The majority of surgeons allow return to full activity once pain-free range of motion and strength are regained, typically at 8 to 12 weeks postoperatively. Pediatric patients with spondylolysis have good outcomes after direct pars repair. Satisfactory outcomes have been demonstrated after fusion for low- and high-grade spondylolisthesis. Most surgeons allow return to noncontact sports by 6 months after surgical treatment of spondylolysis and spondylolisthesis. Return to contact and collision sports is controversial. After posterior spinal fusion for scoliosis, most surgeons allow return to noncontact sports by 3 months and return to contact sports between 6 months and 1 year. Return to collision sports is controversial.

CONCLUSION

There is little evidence to guide practitioners on return to sports after pediatric spinal surgery. Ultimately, the decision to allow any young athlete to resume sports participation after spinal injury or surgery must be individualized.

Return to sports after surgery to correct adolescent idiopathic scoliosis: a survey of the Spinal Deformity Study Group

BACKGROUND CONTEXT

There are no guidelines for when surgeons should allow patients to return to sports and athletic activities after spinal fusion for adolescent idiopathic scoliosis (AIS). Current recommendations are based on anecdotal reports and a survey performed more than a decade ago in the era of first/second-generation posterior implants.

PURPOSE

To identify current recommendations for return to sports and athletic activities after surgery for AIS.

STUDY DESIGN/SETTING

Questionnaire-based survey.

PATIENT SAMPLE

Adolescent idiopathic scoliosis after corrective surgery.

OUTCOME MEASURES

Type and time to return to sports.

METHODS

A survey was administered to members of the Spinal Deformity Study Group. The survey consisted of surgeon demographic information, six clinical case scenarios, three different construct types (hooks, pedicle screws, hybrid), and questions regarding the influence of lowest instrumented vertebra (LIV) and postoperative physical therapy.

RESULTS

Twenty-three surgeons completed the survey, and respondents were all experienced expert deformity surgeons. Pedicle screw instrumentation allows earlier return to noncontact and contact sports, with most patients allowed to return to running by 3 months, both noncontact and contact sports by 6 months, and collision sports by 12 months postoperatively. For all construct types, approximately 20% never allow return to collision sports, whereas all surgeons allow eventual return to contact and noncontact sports regardless of construct type. In addition to construct type, we found progressively distal LIV resulted in more surgeons never allowing return to collision sports, with 12% for selective thoracic fusion to T12/L1 versus 33% for posterior spinal fusion to L4. Most respondents also did not recommend formal postoperative physical therapy (78%). Of all surgeons surveyed, there was only one reported instrumentation failure/pullout without neurologic deficit after a patient went snowboarding 2 weeks postoperatively.

CONCLUSIONS

Modern posterior instrumentation allows surgeons to recommend earlier return to sports after fusion for AIS, with the majority allowing running by 3 months, noncontact and contact sports by 6 months, and collision sports by 12 months.

Is physical activity contraindicated for individuals with scoliosis? A systematic literature review

OBJECTIVE

The purpose of this study was to perform a systematic review of the literature and other authoritative sources for recommendations regarding the appropriateness of physical and sporting activity for those with scoliosis.

METHODS

The literature was systematically searched in PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Index to Chiropractic Literature, and the National Guidelines Clearinghouse from the earliest date of each database through July 2008. All languages and research designs were included. Web sites of respected organizations were searched for position/white papers on scoliosis and physical activity. Included articles were rated using the Oxford Centre for Evidence-Based Medicine criteria, and recommendations for physical activity were made using the Oxford Centre's criteria for grades of recommendation.

RESULTS

Of 42 articles retrieved, 11 met the inclusion criteria. The Internet review of 18 organizations yielded no previous guidelines or position papers for physical activity and scoliosis. Recommendations were made from 3 level 3b studies and 8 level 5 studies; they include the following: (1) brace-treated and surgically treated scoliosis patients have demonstrated that they can physically participate in physical activities at the same level as nonsurgical patients (grade C recommendation); (2) nonsurgically treated patients are encouraged to participate in sports and physical activity and (3) scoliosis is not a contraindication to participation in most sports (grade D recommendation); (4) brace-treated scoliosis patients are encouraged to exercise with their brace on; however, exercise may also be done outside of the brace (grade D recommendation); and (5) physical activity may be commenced after surgery for scoliosis; however, no high-quality evidence exists that guides the timing of return to physical activity (grade D recommendation). A potential association between elite-level competition in specific sports at an early age and an increased prevalence of scoliosis has been reported (grade C recommendation).

CONCLUSION

This article offers evidence-based guidance to health care providers and to patients with scoliosis when making decisions to participate in physical and sporting activities.

Medical and orthopedic conditions and sports participation

The presence of certain medical or orthopedic conditions need not preclude adolescents from being physically active and participating in sports. The benefits of continued physical activity far outweigh any concerns for potential complications for most such conditions. This article reviews sport participation guidelines for adolescents with conditions that include juvenile chronic arthritis, eye injures, solitary kidney, skin conditions, scoliosis, and spondylolysis.

Spinal deformity and athletics

Exercise and athletic competition for the young individual has become increasingly more important in society. Scoliosis and Scheurmann kyphosis are spinal deformities prevalent in up to 2% to 3% and 7% of the population respectively, requiring nonoperative and occasionally operative treatment. Curve progression and patient physiologic age dictate treatment regimens. Bracing and physical therapy is the mainstay for nonoperative treatment, whereas soft tissue releases and fusion with instrumentation are used for operative correction. Athletic activity and sports participation is usually allowed for patients undergoing nonoperative treatment. Return to sport after surgical correction is variable, often decided by the treating surgeon, and based on the level of fusion and sporting activity. Although most treating surgeons promote some form of activity regardless of treatment modality chosen, caution should be taken when deciding on participation in collision activities such as football and wrestling.

Juvenile kyphosis in pigs. A spontaneous model of Scheuermann's kyphosis

The development of kyphotic lesions in pigs with different weights from herds with a high frequency of the lesion was analysed pathologically, radiologically, and for alkaline phosphatase, calcium, magnesium, and phosphate in blood samples. The development of kyphosis was caused by the formation of ventral hemivertebrae due to the absence of ventral vertebral epiphyseal centres of ossification. Within the ventral parts of affected vertebral epiphyses, the retained chondroid tissue was dysplastic and the contents of cartilage canals with vessels often clotted with fibrin were reduced. As lesions such as fractures and inflammation that may be a secondary cause of kyphosis in pigs were absent and all blood parameters were within normal range, secondary causes of the condition, including metabolic disturbances, were excluded. It can be seen that the present type of porcine kyphosis does not develop until later in life as the ossification centres within the epiphyses of vertebrae have a retarded appearance. As the present porcine type of kyphosis pathomorphologically is comparable with Scheuermann's kyphosis in man, it constitutes a spontaneous model for this common cause of structural kyphosis of the thoracic or thoracolumbar spine.