Is physical activity contraindicated for individuals with scoliosis? A systematic literature review☆☆☆★
Received 30 October 2008; received in revised form 24 November 2008; accepted 25 November 2008.
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.
Corresponding author. Bart Green, MCAS Miramar Branch Medical Clinic, PO Box 452002, San Diego, CA 92145-2002. Tel.: +1 858 577 9948.
☆ Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
☆☆ Refereeing Editor: Jerrilyn Cambron, DC, PhD (jcambron@nuhs.edu), was the Refereeing Editor for this manuscript. She was solely responsible for managing the peer review process, revision process, and the acceptance of this manuscript. The Editor and Associate Editor declare that they were not involved in the peer review process or acceptance decision for this paper.
★ The American Chiropractic Board of Sports Physicians provided funding for this study, which included a small stipend to the principal and second author of this paper. Each author signed a conflict of interest disclosure form provided and stored by the American Chiropractic Board of Sports Physicians. None of the authors had any conflicts of interest to declare.
ABSTRACT