Generalized joint hypermobility, scoliosis, patellofemoral pain, and physical abilities in young dancers

Present but Ignored: Physical Condition and Health-Related Quality of Life in College-Aged Females with Generalized Joint Hypermobility

BACKGROUND

Generalized joint hypermobility (GJH) is prevalent among young adults, necessitating effective monitoring of musculoskeletal health, particularly among college-aged females. This study aimed to identify physical fitness and health-related quality of life (HR-QoL) characteristics associated with GJH.

METHODS

A total of 67 participants were assessed: 26 with GJH (mean age 20.06, SD 1.2 years), and 41 without (mean age 20.15, SD 2.2 years). Assessments included hypermobility, anthropometric data, foot posture, balance, flexibility, strength, and HR-QoL. We used the Mann-Whitney test for two independent samples, categorical variables were analyzed with Cramer's V test. The results indicated that participants with GJH exhibited inferior balance and back muscle static strength endurance but greater flexibility compared to those without GJH. Significant differences were observed in foot posture. However, handgrip strength, explosive strength, and abdominal muscle static strength endurance did not differ significantly between groups. No significant differences were observed in HR-QoL components between the two groups. In conclusion, there appears to be a link between GJH and increased flexibility, impaired balance, reduced back muscle static strength endurance, and altered posture of both feet.

Association of scoliosis with lower extremity alignments, muscle strengths, and foot characteristics and their alterations in adolescent idiopathic scoliosis

BACKGROUND

The association between changes occurring in the spine and lower body parts is not well understood in adolescent idiopathic scoliosis (AIS).

OBJECTIVES

The first aim of the study was to investigate the association of scoliosis with lower extremity (LE) alignments, foot characteristics, and muscle strengths in adolescents. Secondly, comparisons of the data among AIS with single and double curves and control groups were determined.

METHODS

Thirty-one participants were recruited and classified into 3 groups; AIS with a single curve (n= 7), AIS with double curves (n= 14), and controls (n= 10). Association of the presence of scoliosis with LE alignments (Q and TC angles), LE muscle strengths (hip, knee, and ankle), and foot characteristics (arch indexes) were examined using the point biserial correlation, and the data among three groups were compared using the ANOVA.

RESULTS

Scoliosis was associated with Q angle, arch indexes, and all LE muscle strengths except for hip extensors and ankle plantar flexors strengths. Comparisons among the three groups showed significant increases in LE alignments and foot characteristics in AIS. Almost all LE muscle strengths decreased in AIS, especially for the single curve group.

CONCLUSIONS

Apart from spinal deformity, the AIS has changed in LE alignments, muscle strengths, and foot characteristics. Therapists should consider these associations and alterations for designing proper management.

Correlation between physical activity and adolescent idiopathic scoliosis: a systematic review

BACKGROUND

The multifactorial aetiology of scoliosis is well known. Physical activity is considered both a treatment and causative factor for idiopathic scoliosis; however, evidence for a causal relationship between physical activity levels and idiopathic scoliosis in adolescents is conflicting. Therefore, we aimed to summarise the current evidence regarding the association between adolescent idiopathic scoliosis and physical activity and further to assess whether the relationship is dose dependent.

METHODS

PubMed, Cochrane, Scopus, and Web of Science databases were searched from 1991 to July 2022 using the following main keywords: adolescent idiopathic scoliosis, physical activity, and risk factors, supplemented with manual searches, secondary citations, and reference searches. The quality of the included literature was evaluated using the Scale for Reporting Observational Studies in Enhanced Epidemiology guidelines.

RESULTS

Eight studies were included in this review, of which six reported an association between adolescent idiopathic scoliosis and physical activity levels and two reported no association. One British study reported reduced physical function early in life as a new risk factor for scoliosis onset.

CONCLUSIONS

Physical activity is strongly associated with adolescent idiopathic scoliosis. Physical activity should be encouraged as it plays an important role in the prevention of adolescent idiopathic scoliosis. Further research is needed to determine the dose-dependent relationship between physical activity and prevention of adolescent idiopathic scoliosis.

Lumbopelvic Muscle Mobility and Resistance and their Association with Musculoskeletal Pain in Ballet Dancers

Objective  The present study analyzes ankle mobility and lumbopelvic muscle mobility and resistance. In addition, it identifies factors associated with musculoskeletal pain in young ballet dancers. Methods  This is a quantitative, descriptive, cross-sectional study evaluating 14 ballet dancers aged 12 to 16 years old. We used the following instruments: a) Nordic Musculoskeletal Symptom Questionnaire (NSQ) for musculoskeletal pain assessment; b) leg lateral reach test, lumbar lock, and rotation test (for trunk mobility analysis) and lunge test (for ankle mobility evaluation); c) front bridge, lumbar extensor, and lumbar flexor muscles tests to assess lumbopelvic complex resistance. Results  The main complaints reported by ballet dancers were pain in the low back area and in the lower extremities, especially in the knee (57.1%). Those with low back pain had significantly lower lumbar mobility ( p  = 0.05) and lower ankle mobility on both sides ( p ≤ 0.05). Dancers with knee pain presented significantly lower muscular trunk extensor muscle resistance ( p  = 0.05). Conclusions  Our study revealed significant associations between the lumbopelvic complex function and musculoskeletal symptoms, supporting the implementation of preventive strategies.

The Impact of Physical Activity on Adolescent Idiopathic Scoliosis

The prevalence of adolescent idiopathic scoliosis (AIS) is increasing, partly due to a lack of physical activity. In a cross-sectional study with 18,216 pupils (5th, 6th, and 8th grades) from four Croatian counties using the forward bend test (FBT; presumed AIS), the prevalence of AIS and its correlation with physical activity were evaluated. Pupils with presumed AIS were less physically active than their peers without scoliosis (p < 0.001). Abnormal FBT was more prevalent among girls than boys (8.3% vs. 3.2%). Boys were more physically active than girls (p < 0.001). Pupils with presumed AIS were less physically active than their peers without scoliosis (p < 0.001). A higher prevalence of presumed AIS was found among inactive or just recreationally active schoolchildren than among those engaged in organized sports (p = 0.001), girls especially. Pupils with presumed AIS were less active and had fewer weekly sports sessions than their peers without scoliosis (p < 0.001). Notably low prevalence of AIS was detected among pupils engaged in soccer (2.8%, p < 0.001), handball (3.4%, p = 0.002), and martial arts (3.9%, p = 0.006), while it was higher than expected in swimming (8.6%, p = 0.012), dancing (7.7%, p = 0.024), and volleyball (8.2%, p = 0.001) participants. No difference was detected for other sports. A positive correlation was found between time spent using handheld electronic devices and the prevalence of scoliosis (r_s = 0.06, p < 0.01). This study confirms the increasing prevalence of AIS, particularly among less athletic girls. Further, prospective studies in this field are required to explain whether the higher prevalence of AIS in these sports is due to referral or other aspects.

Examination of foot sensations in children with generalized joint hypermobility

BACKGROUND

Generalized joint hypermobility (GJH) is a condition that can be observed in children and children with GJH may have problems such as clumsiness, proprioceptive sensory loss, balance and coordination disorders.

AIMS

To evaluate foot and ankle senses in children with GJH and compare them with their healthy peers.

STUDY DESIGN

A cross-sectional study.

SUBJECTS

Children aged 5-14 years with and without GJH were included in the study.

OUTCOME MEASURES

After assessing the joint hypermobility of the children with the Beighton Score, tactile, vibration, two-point discrimination, and proprioception senses were evaluated.

RESULTS

A total of 40 children (15 females, 25 males, mean age 9.43 years, SD ± 2.98 years, 20 with GJH and 20 without GJH) were included in the study. In children with GJH, foot sole tactile sense and ankle dorsiflexion and plantar flexion joint position sense were deficient in comparison with healthy controls (p < 0.05).

CONCLUSIONS

There were deficiencies in foot and ankle tactile and proprioceptive senses in children with GJH. Neurosensorimotor examination of balance and coordination should be performed and appropriate intervention programs should be planned accordingly in children with GJH.

Associations Between Physical Activity and Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the associations between adolescent idiopathic scoliosis (AIS) and physical activity (PA).

DATA SOURCES

MEDLINE, EMBASE, AMED, SPORTDiscus, Cochrane Library, and CINAHL electronic databases were searched from inception to August 2022/plus citation tracking.

STUDY SELECTION

Observational studies of participants with radiographically confirmed AIS with ≥10° lateral spinal curvature (Cobb method) and comparator groups without AIS that measured PA were selected by 2 reviewers.

DATA EXTRACTION

Data were extracted independently and cross-checked by 2 reviewers. Risk of bias was evaluated using Newcastle Ottawa Scales and overall confidence in the evidence using the GRADE approach.

DATA SYNTHESIS

Sixteen studies with 9627 participants (9162, 95% women) were included. A history of vigorous PA significantly reduced the odds of being newly diagnosed with AIS by 24% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.65-0.89) (high certainty). Moderate PA reduced odds by 13% (moderate certainty) and light PA increased odds by 9% (low certainty), but neither analysis was statistically significant. Ballet or gymnastics (OR 1.47, 95% CI 3.08 (1.90, 5.00) were the only individual sports significantly associated with AIS diagnosis (moderate certainty). Case-control studies of people with and without AIS provided greater evidence that having AIS reduces vigorous PA and sports participation, and less evidence light PA and walking are affected.

CONCLUSION

Adolescents who participate in more vigorous PA are less likely to be diagnosed with AIS. Ballet and gymnastics are associated with AIS diagnosis, but the direction of this association is uncertain. People with AIS are likely to do less vigorous physical and sporting activity compared with those without AIS, which could negatively affect health and quality of life. Further research is warranted into the inter-relations between PA and AIS, studies need to be of sufficient size, include men, and evaluate vigorous including higher-impact PA compared with moderate or light PA.

Prevalence of idiopathic scoliosis in athletes: a systematic review and meta-analysis

Objective

This study aimed to determine the prevalence of idiopathic scoliosis (IS) in child, adolescent and adult athletes of all sports activity levels.

Design

Systematic review with meta-analysis.

Data sources

Electronic databases (PubMed, Scopus, ProQuest, Sage journals, ScienceDirect, Google Scholar and Springer) were systematically searched up from inception to 28 September 2021.

Eligibility criteria for selecting studies

Observational investigations were included to evaluate the prevalence of IS in athletes (engaged in any type of individual and team sports). Congenital scoliosis, neuromuscular scoliosis, Scheuermann’s kyphosis and de novo scoliosis were not included. The risk of bias was assessed using the tool developed by Hoy et al.

Results

Twenty-two studies were included (N=57 470, range 15–46544, participants), thirteen studies were of high-quality. The estimated prevalence of IS in athletes was 27% (95% CI 20% to 35%, I²=98%), with a 95% prediction interval (1% to 69%). The prevalence of IS was significantly higher in female athletes (35%, 95% CI 27% to 34%, I²=98%). Ballet dancers showed a high IS prevalence (35%, 95% CI 24% to 47%, I²=98%). Recreational athletes showed a higher IS prevalence (33%, 95% CI 24% to 43%, I²=98%) than at competitive-level athletes (0.05%, 95% CI 0.03% to 0.08%, I²=98%), followed by elite (20%, 95% CI 13% to 27%, I²=98%).

Conclusions

The prevalence of IS in athletes was similar or higher to that as seen in other studies of the general population. IS prevalence may have a U-shaped relationship relative to level of competition. Further studies are required to determine which sports have the highest IS prevalence.

Systematic review of the association between isolated musculoskeletal hypermobility and adolescent idiopathic scoliosis

INTRODUCTION

Adolescent idiopathic scoliosis (AIS) affects 1-3% of the population, but its pathogenesis remains unclear. The coexistence of musculoskeletal hypermobility and scoliosis in many inherited syndromes raises the possibility that isolated musculoskeletal hypermobility may contribute to AIS development or progression.

METHODS

We performed a systematic review of the evidence for a relationship between isolated musculoskeletal hypermobility and AIS. A meta-analysis was planned, but if not possible, a narrative evidence synthesis was planned.

RESULTS

Nineteen studies met eligibility criteria for inclusion. One study was excluded due to insufficient quality. Substantial heterogeneity in study design and methodology negated meta-analysis, so a narrative review was performed. Of the 18 studies included, seven suggested a positive association and eight found no association. Three reported the prevalence of musculoskeletal hypermobility in individuals with AIS. Overall, there was no convincing population-based evidence for an association between musculoskeletal hypermobility and AIS, with only two case-control studies by the same authors presenting compelling evidence for an association. Although populations at extremes of hypermobility had a high prevalence of spinal curvature, these studies were at high risk of confounding. Wide variation in methods of measuring musculoskeletal hypermobility and the challenge of assessing AIS in population-based studies hinder study comparison.

CONCLUSIONS

There is a paucity of high-quality evidence examining the association between isolated musculoskeletal hypermobility and AIS. Large-scale prospective studies with adequate adjustment for potential confounding factors could clarify the relationship between musculoskeletal hypermobility and AIS to elucidate its role in the pathogenesis of AIS.

Generalized Joint Hypermobility and Anxiety Are Serious Risk Factors for Dysfunctioning in Dance Students: A One-Year Follow-Up Study

Young professional dancers find themselves in a demanding environment. GJH within dancers is often seen as aesthetically beneficial and a sign of talent but was found to be potentially disabling. Moreover, high-performing adolescents and young adults (HPAA), in this specific lifespan, might be even more vulnerable to anxiety-related disability. Therefore, we examined the development of the association between the presence of Generalized Joint Hypermobility (GJH) and anxiety within HPAA with a one-year follow-up. In 52.3% of the HPAA, anxiety did not change significantly over time, whereas GJH was present in 28.7%. Fatigue increased significantly in all HPAA at one year follow-up (respectively, females MD (SD) 18(19), p < 0.001 and males MD (SD) 9(19), p < 0.05). A significantly lower odds ratio (ß (95% CI) 0.4 (0.2−0.9); p-value 0.039) for participating in the second assessment was present in HPAA with GJH and anxiety with a 55% dropout rate after one year. This confirms the segregation between GJH combined with anxiety and GJH alone. The fatigue levels of all HPAA increased significantly over time to a serious risk for sick leave and work disability. This study confirms the association between GJH and anxiety but especially emphasizes the disabling role of anxiety. Screening for anxiety is relevant in HPAA with GJH and might influence tailored interventions.