# Exercise as it relates to Disease/The associated effects of swimming with spinal deformities

This is a critique of the research article: Swimming and Spinal Deformities: A Cross-Sectional Study by Fabio Zaina, Sabrina Donzelli, Monia Lusini, Salvatore Minnella, Stefano Negrini,
Volume 166, Issue 1,2015,Pages 163-167
The critique was written as an assignment for the unit: Health Disease and Exercise in 2022

## What is the background to this research?

Spinal curvature deformities are significant medical problems within the skeletally system caused by a variety of genetic or lifestyle reasons.
Scoliosis, kyphosis, and lordosis are the three main forms of deformities associated with spinal curvature.
* Scoliosis, which is characterised by a side-to-side curvature of the spine the curve is often S-shaped or C-shaped and are frequently adolescents. Adults can also develop scoliosis.
* Kyphosis, which causes the spine to curve forwards creating an abnormally rounded upper back (more than 50 degrees of curvature). most frequently affects elderly persons.
* Lordosis denotes an inward curve of the spine at the lower back. Although lordosis is less frequent than other disorders linked to curvature, it is nonetheless a dangerous condition in and of itself.
* It progresses slowly and affects both the appearance and function of the body, for example, worsening the degree of pain on spine, radicular pain. Once asymmetric load and degeneration of spine starts, it probably results a chronic degeneration and deformity. In extreme cases, it may affect the shape of the rib cage, hence, respiratory system.
* Finding and diagnosing the cause of the spine curvature is the first step in treating a suspected spinal deformity. Surgery is widely regarded as the only intervention that can stop curve progression. However, most research indicates that scoliosis-specific exercise combined with therapy treatment can prevent or delay curve progression of spinal curvature deformities.

## Where is the research from?

Swimming and Spinal Deformities: A Cross-Sectional Study by Fabio Zaina, MD1, Sabrina Donzelli, MD1, Monia Lusini, MD1, Salvatore Minnella, MD1, and Stefano Negrini, Prof, MD2
The study was carried out at Italian Spine Institute (ISICO) , which was formed in 2003 in Italy. ISICO promotes and develops an innovative approach to the rehabilitation of non-surgical spine illnesses in people of all ages, from children to the elderly. Physical and Rehabilitation Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy were also involved.
Portions of the study were presented at the International Society for the Study of the Lumbar Spine meeting, May
13-17, 2013, Scottsdale, AZ

## What kind of research was this?

Cross-sectional study with questionnaire used to gather data on LBP, and a Bunnell scoliometer was used these were to measure the angle of trunk rotation and screen for scoliosis. Kyphosis and lordosis plumbline distances were also measured.

## What did the research involve?

This cross-sectional study used competitive swimming organisations from both public and private schools. They utilised a convenience sample in northern Italy's densely populated area between Milan and Varese, which is thought to be representative of an urban population. Controls were attracted from nearby schools, the ACS group was attracted from a number of swimming societies. To compare competitive swimmers with the general population in the latter group, there were no restrictions on participating in sports activities.
The 329 participants who accepted the invitation were split into the control and ACS groups. ACS participants exercised at least four (up to six) times per week for an approx of 2-2.5 hours per session.
* A clinical evaluation of both groups to look for spinal deformities based on the angle of trunk rotation (ATR), which was measured with a Bunnell scoliometer at the thoracic, thoracolumbar, and lumbar levels, as well as the distances between the plumblines at C7 and L3 to look for kyphosis and lordosis.15,16 The resulting data were then analysed for mean values and the use of clinical cutoff.
* Established cutoffs at 5 and 7 for Bunnell degrees. five is a significant cutoff for subjects who might benefit from a particular exercise programme, and seven is a significant cutoff for patients who need a brace.17-20 For the plumbline distances, various clinical cutoffs, including 50 mm for C7 and 60 mm for C8.
* To determine the amount of LBP, we administered a specific questionnaire that asked about current and previous LBP and sciatica, use of drugs, need for medical visits, and potential diagnostic exams that had previously been validated.

## What were the basic results?

Male average ATR did not differ between the 2 groups however, female average ATR was significantly different. The highest risk of trunk asymmetries was found to be among swimmers(OR, 1.86; 95% CI, 1.08-3.20). Swimming also increased the risk of hyperkyphosis and hyperlordosis (OR, 2.26; 95% CI, 1.35-3.77) and increased LBP in females by 2.1-fold (95% CI, 1.08-4.06).

## What conclusions can we take from this research?

The results of the current study support the literature showing that competitive swimming, is linked to spinal injuries and back pain, losing the protective benefits that the same activity can offer when practised in a less-intense way. key points include;
* The growing spine may be significantly negatively affected by swimming.
* Kyphosis, which is easily detectable clinically, as well as trunk asymmetries that are important for scoliosis detection.
* Females a higher risk of LBP. There was a gender difference in this regard, with swimming appearing to have a greater effect on adolescent girls. Remember that scoliosis and back pain are more common in women overall and even for young children.
* spinal deformities cannot be treated solely through swimming; the conservative treatments for these pathologies continue to be targeted exercises and braces.
* swimming has long been regarded as a risk-free and beneficial sport for the spine, and some medical professionals have even suggested it as a spinal decompression therapy.

## Practical advice

When working with individuals who have a spinal deformation condition, it is critical to slow the development of the deformity, restore the patient's quality of life, and enhance their overall health outlook.
* The study is informing physicians and families about the risks associated with high performance swimming and the link between how much swimming is practised and spinal deformities.
* Swimming is going to cause asymmetries and can impact performance through a number of techniques, muscular function, and postural alignment are some of the mechanisms. though with care and consideration it can be managed with a specialised exercise strength and conditioning program to help balance out the negative affects.

## Further information/resources

Scoliosis information
Asymmetries in Swimming

## References

* 1 2 3 4 5 6 7 8 Swimming and Spinal Deformities: A Cross-Sectional Study, The Journal of Pediatrics, Fabio Zaina, Sabrina Donzelli, Monia Lusini, Salvatore Minnella, Stefano Negrini, Volume 166, Issue 1,2015,Pages 163-167,ISSN 0022-3476, https://doi.org/10.1016/j.jpeds.2014.09.024. (https://www.sciencedirect.com/science/article/pii/S0022347614008750)
* 1 2 3 4 Chiropractic BioPhysics. 2022. Spine Curvature Deformities: Conditions Progressing in Severity. [online] Available at: <https://idealspine.com/spine-curvature-deformities-conditions-progressing-in-severity/>
* ↑ Marks, H., 2021. Spine Curvature Disorders: Lordosis, Kyphosis, Scoliosis, and More. [online] WebMD. Available at: <https://www.webmd.com/back-pain/guide/types-of-spine-curvature-disorders#:~:text=There%20are%20three%20main%20types%20of%20spine%20curvature,back%20%28more%20than%2050%20degrees%20of%20curvature%29.%20Scoliosis.>
* 1 2 Aebi, Max. "The adult scoliosis." European spine journal 14.10 (2005): 925-948. Accessed from: https://link.springer.com/article/10.1007/s00586-005-1053-9
* ↑ Kafer, Enid R. "Respiratory and cardiovascular functions in scoliosis and the principles of anesthetic management." Anesthesiology: The Journal of the American Society of Anesthesiologists 52.4 (1980): 339-351. Accessed from: https://pubs.asahq.org/anesthesiology/article/52/4/339/26890/Respiratory-and-Cardiovascular-Functions-in
* ↑ Brooks, William J., Elizabeth A. Krupinski, and Martha C. Hawes. "Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review." Scoliosis 4.1 (2009): 27. Accessed from: https://link.springer.com/article/10.1186/1748-7161-4-27
* ↑ H. Sanders, R., Thow, J., & M.Fairweather, M. (2011). Asymmetries)in)Swimming:)Where)Do)They)Come)from?). Retrieved 13 September 2022, from https://www.researchgate.net/profile/Ross-Sanders-2/publication/282148341_Asymmetries_in_Swimming_Where_Do_They_Come_from/links/5604eb1908ae8e08c08ac7a0/Asymmetries-in-Swimming-Where-Do-They-Come-from.pdf
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