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

Abstract

ObjectiveThis study aimed to determine the prevalence of idiopathic scoliosis (IS) in child, adolescent and adult athletes of all sports activity levels.DesignSystematic review with meta-analysis.Data sourcesElectronic 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 studiesObservational 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.ResultsTwenty-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%).ConclusionsThe 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.

The Impact of Physical Activity on Adolescent Idiopathic Scoliosis

“…However, some degree of asymmetry is present in all sports, even those considered mostly symmetrical, and each person typically has a dominant side [ 24 ]. Our results support the published findings of elevated scoliosis frequency in swimming [ 9 , 11 ], volleyball [ 11 ], and dancing [ 6 ]. Indeed, volleyball could be considered an asymmetrical sports activity, and even dancing has unilateral loading and high-intensity unilateral movements [ 24 ].…”

“…We believe it is mostly due to selection bias, i.e., referral by public opinion or professional advice. We had 321 examinees engaged in gymnastics, and, contrary to the literature [ 6 , 9 , 11 , 25 ], we found no significant association with AIS, despite the putatively long-lasting, asymmetrical loading of the spine [ 25 , 26 ]. Similar to our results, Meyer et al found that scoliosis in gymnasts is associated with higher joint laxity and is not generated by exercise [ 27 ].…”

“…Tennis is one of the sports charged with asymmetry as it preferentially stimulates the dominant side muscles [ 9 , 11 , 24 ]. Thus far, in our study, it has not been associated with scoliosis.…”

“…Negrini et al suggested that regular sports activity can reduce scoliosis even in patients with braces [ 10 ]. However, certain types of sports are seemingly associated with a higher prevalence of AIS: ballet [ 9 , 11 ], rhythmic gymnastics [ 6 , 9 , 11 ], dance [ 6 ], volleyball [ 11 ], tennis [ 11 ], badminton [ 11 ], and swimming [ 9 , 11 ]. This link may be due to the referral of children with abnormal postures to some of these sports (e.g., swimming) or AIS potentiation, favoring one side of the body (e.g., tennis).…”

Richard III’s Scoliosis Revisited

“…diopathic scoliosis (IS) is in the spotlight of sports medicine research due to its high prevalence in athletes, and although it is still unknown what sport causes its highest prevalence, a cause-and-effect relationship between this spinal change and sports activity has been cautiously postulated. 1 IS has a long historical record: King Richard III (1452-1485) can be counted among its most famous ancient "patients," as he has been described as being affected by adolescent-onset IS, a condition that likely emerged after he turned 10 without causing him to limp or preventing him from engaging in physical activities. Notably, Richard III was killed at the Battle of Bosworth (August 22, 1485).…”