From: "Douglas Smith, D.C." Date: Sun, 29 Dec 1996 11:08:42 -0800 Subject: JrnlArt: Spondylolisthesis no contraindication to sports Citation: The Back Letter, August 1996 v11 n8 p88(1) Title: Spondylolisthesis no contraindication to sports, at least for elite athletes and ballet dancers. Reference #: A18624085 ================================ Spondylolysis and low-grade spondylolisthesis need not keep young patients from pursuing athletic careers or engaging in vigorous sports. A new study from Germany shows that asymptomatic young athletes with spondylolysis or low-grade spondylolisthesis generally do not experience pain or a significant progression of slippage if they resume intensive athletic training. A second new study demonstrates that some elite athletes--in this case professional ballet dancers--have an extremely high prevalence of low-grade isthmic spondylolisthesis, yet have no more back symptoms than dancers without vertebral slippage. Michael Muschik, MD, et al. from Humboldt University in Berlin, Germany, carried out a retrospective study of 86 young athletes with spondylolysis or isthmic spondylolisthesis. The subjects included 62 boys and 24 girls between the ages of six and 20 years. The mean degree of displacement in the young athletes was 10.1% at the beginning of the study. (See Journal of Pediatric Orthopaedics, 1996; 16(3):364-9.) The researchers wanted to observe the impact of intensive athletic training on these young athletes' symptoms and the progression of vertebral slippage. The subjects were all students at a special school for competitive athletes preparing for international competition. All the young athletes engaged in "unusually intensive" training for at least 20 hours per week for several years. Thirty-nine of the athletes played handball, basketball, or volleyball, 24 were gymnasts, and the remainder trained in track and field events. "In spite of intensive daily training, the athletes had no symptoms during the entire period of observation, which lasted an average of 4.8 years," conclude Muschik et al. Increase in displacement over the course of the study was "minor" overall, according to the researchers. There was an increase in displacement-with an average progression of 10.5%-in 33 athletes. In 36 athletes, there was no change in the degree of slippage. Seven athletes actually had a decrease in their vertebral displacement. The researchers were unable to determine the course of displacement in 10 athletes, due to problems with their x- rays. "From our study," conclude Muschik et al., "there is no reason to advise athletes with spondylolysis or limited spondylolisthesis against participation in competitive sports." They do recommend regular medical monitoring of children and adolescents with either condition but would advise no further restrictions if the slippage is limited, if there is normal lordosis in the affected spinal level, and if the athletes are pain-free. Spondylolisthesis has been regarded as a contraindication to participation in several different sports. Seppo Seitsalo, MD, and colleagues from Helsinki, Finland, recently performed a study of elite Finnish ballet dancers to see if there is any justification for spondylolysis or spondylolisthesis being a contraindication for an elite-level dance career. (As yet unpublished.) They examined the spinal x-rays of 60 members of the Finnish National Ballet and had 50 dancers complete questionnaires on history and presence of low back symptoms. Thirty-two percent (19) of the dancers had spondylolysis. Of these 19, 15 had associated spondylolisthesis and four did not. The cases of spondylolisthesis were generally moderate`, with a mean slip of 12 degrees. Almost all of the dancers with spondylolysis and spondylolisthesis had a history of back pain but so did the dancers without these conditions. The occurrence of back pain over the previous year was similar for dancers with and without spondylolysis and spondylolisthesis. The dancers with spondylolysis/spondylolisthesis had slightly greater transient back symptoms associated with dance performance-typically in the hyperextended postures of the arabesque and in lifts-but the two groups had similar levels of sick leave and overall work disability. The researchers conclude that elite ballet dancers have a fivefold increased risk of developing spondylolysis/spondylolisthesis relative to the general Finnish population. Yet this increased prevalence did not lead to any increased disability or work restriction. Low-grade spondylolisthesis would not appear to be a contraindication to a ballet career, at least for these physically talented individuals. During discussion of this study at the annual meeting of the International Society for the Study of the Lumbar Spine, British spine surgeon Robert Mulholland, MD, speculated that intensive exercise and athletics might actually protect patients with spondylolisthesis against symptoms. He asked whether participation in ballet might not be a viable strategy to prevent symptoms in a 14- year-old girl with spondylolisthesis. However, it is not clear to what extent the experience of elite athletes and performers applies to ordinary individuals. No matter how easy elite performers make it look, not everybody can do an arabesque while keeping the spine in a biomechanically sound posture. ============================================= This material is presented for private discussion, research and educational purposes only. 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