The popularity of gymnastics classes and competition for young girls is undeniable and rapidly growing in numbers.  Unfortunately, that could also result in an increase in scoliosis case related to some gymnastic activities.   It should be noted that it is not recommended to yank your child out of all gymnastic activities just, because they have been diagnosed with scoliosis, but there are some precautions that should be taken.

The two main concerns in scoliosis and gymnastics are compression on the spine curve and hyper-extension of the mid-back as seen in many of the back bends/bridging found in gymnastics.

Compression on the spine curve in a patient with scoliosis and participating in gymnastics is a fairly obvious argument to make.  Envision a scenario in which you’re trying to hammer a cooked nail into an oak board.  The nail is going to bend at the apexes of the bends and slow collapse on top of itself until it simply buckles over.  While this example may be a bit simplistic and dramatic, I think you get the point.  Hard landings and falls (even on gymnastic mats) are going to add a tremendous amount of compression to the spine curve and could cause further progression.

The link between scoliosis and gymnastics in regards to the back bends is a bit less obvious.  The normal side view of the spine shows a forward curve in both the neck and lower back, coupled with a reverse curve in the mid back (thoracic spine), which again is normal.  However, circumstantial evidence showing a much higher incidence of progressive spine curves in ballet dancers, competitive swimmers, and gymnasts has everyone looking for the common link between the three activities.  It appears the only consistent thread between each is a hyper-extension of the mid back repeatedly during the activity. (try to imagine the mid back curve being bent forward while swimming for many hours in a pool)  The thought is the repeated mid back bends cause a flattening of the normal backwards curve, which causes a de-stabilization in the side view dimension, making it easier for the spine curve to buckle into the pathological curvature of the spine known as scoliosis.

So, is scoliosis and gymnastics good or bad?  Ultimately, it does pose a risk to the scoliosis patient who is genetically pre-disposed to developing a progressive spine curve, but the risks can be managed somewhat effectively if you know what activities you need to avoid.

Don't let a lifetime be defined by idiopathic scoliosis

Now that genetic pre-disposition testing for scoliosis progression risk is available; An Early Stage Intervention Program has also been developed to provide scoliosis patients a non-bracing, non-surgical treatment option that allows them to take immediate action in the prevention of the next stage of the standard treatment process (scoliosis bracing or scoliosis fusion surgery).

While it is not the intention of CLEAR Institute to condemn the efforts of sincere and caring medical professionals who have dedicated their lives to helping individuals with scoliosis. We would, however, like to add to the current list of options; to educate those who are personally involved with scoliosis about what the research says; and, to empower these individuals to make their own decision regarding their own spine, and their own life.

The three medically-sanctioned methods of scoliosis treatment - observation, bracing, and surgery - have been around for decades. A great deal of research has been done on the risks & benefits of each option. However, the general conclusion of this research suggests that a new paradigm is desperately needed as there are many conflicts and inadequacies present in the current model.

Observation Only or the “watch & wait” stage

Once an individual has been diagnosed with scoliosis, no treatment is initially prescribed, and no action is immediately taken, until the Cobb angle has progressed to 25 degrees (which is an arbitrary figure. There is no clinical significance to this number). At this point, bracing is typically prescribed. This period, which is termed "watch & wait," consists only of regular visits to an orthopedic surgeon, where full-spine x-rays are taken consistently to gauge the progress of the patient's condition.

Scoliosis brace treatment (Generally recommended for curvatures 25 degrees and larger)
If there ever was a time when a patient could benefit most greatly from chiropractic, therapeutic exercise, or non-surgical intervention, it would undoubtedly be during the mild stages of the disease - before the muscles & tissues of the body have been deformed by months or even years of compensating for the abnormal twisting & bending of the spine.

Scoliosis bracing dates back to approximately 650 AD, when Paul of Aegina suggested bandaging scoliosis patients with wooden strips. The first metal brace was developed by Ambroise Pare in the 16th century. Today, there is a bewildering assortment of braces in use, ranging from the venerable and bulky Milwaukee brace, to the traditional TLSO (thoraco-lumbar-sacral orthosis) braces such as the Boston and the Wilmington brace. There are "part-time" braces, designed to be worn at night: the Providence brace, and the Charleston brace. There are also "dynamic corrective braces" which may use soft, elastic materials and claim to be able to do more than simply stabilize the progression of scoliosis. An example of a dynamic corrective brace would be the SpineCor brace, developed at the Sainte-Justine Hospital in 1992, or the Copes brace, developed by Arthur Copes to be used in conjunction with his STARS (Scoliosis Treatment Advanced Recovery System) rehabilitation protocol.

This dizzying variety is further complicated by the fact that not every doctor prescribes the braces to be used in the same manner, and not every patient may follow their doctor's recommendations to the same extent. As a result, research is often conflicting (to say the least) in regard to the true effectiveness of bracing in scoliosis treatment. Some studies have shown very little difference between patients who wore the brace for the prescribed time, and those who wore it barely, if at all. Others have demonstrated patients who have been successfully stabilized for years by wearing a bracing constantly; yet, there are also studies on patients who wore the brace for 23 hours out of every day, seven days a week, and continued to worsen. In every case, all corrective benefit is lost very quickly once the patient stops wearing the brace, and the general consensus is that bracing may prove helpful for some, but not for others.

Scoliosis surgery (Generally recommended of curvatures 40 degrees and larger)
Those patients for whom bracing fails to prevent the progression of their scoliosis are left with only one option: surgery. Those who are confronted with this choice may be told that having a metal rod fused to their spine will not impair their daily activities, and will reduce the rib arch & improve their cosmetic appearance. However, research has consistently shown that surgery - which primarily focuses upon the sideways bending, and does little to address the rotation of the spine (and hence the rib protrusion) - will actually cause the rib arch to worsen (Chen 2002, Goldberg 2003, Hill 2002, Pratt 2001, Weatherly 1980, Wood 1991, Wood 1997).

Scoliosis surgery, like most highly-invasive procedures, carries with it the ever-present risk of death. Although mortality rates of less than one percent are claimed, no surgeon can completely eliminate this possibility. There is also the danger of neurological damage, resulting in the loss of sensation or motor function to the arms & legs (paraplegia or quadraplegia). This has become a greater concern in recent years, as surgeons strive for greater corrections in their patients, and place more stress upon the nerves running through the spinal column.

The rate of hardware failure is virtually 100% over the course of a normal lifetime. It may occur immediately after the surgery or several years later, but one or more components of the hardware placed inside the body is highly likely to fail or break. The author of one study stated, "One would expect that if the patient lives long enough, rod breakage will be a virtual certainty". Another study found that amongst seventy-four patients who underwent the surgery, pseudoarthrosis (failed fusion) occurred in 27% of patients within a few years after the procedure.

The truth of the matter is that scoliosis is an abnormality of the spine which involves much more than merely a sideways curve. Yet the "effectiveness" of surgery is measured only by the degree to which it can reduce the lateral deviation through the application of brute force, and a fused spine is every bit as abnormal and dysfunctional as a scoliotic spine.

We can alter the natural course of this disease by identifying which patients are at the highest risk for severe progression via genetic testing (Scoliscore) and by implementing an aggressive, non-invasive Early Stage Scoliosis Intervention program that re-trains the brains involuntary postural controls centers before the spinal curvature reaches the 30 degree "buckling" point