The term atlanto-axial refers to the first two cervical vertebrae, also called C1 and C2, which are located at the base of the skull. The Special Olympics Committee recommends that participants with atlanto-axial instability be restricted from activities such as diving, gymnastics, high jump, the pentathlon, butterfly stroke, alpine skiing, soccer, and power lifting.
Of course, contact sports like football, wrestling, and rugby should also be avoided. This recommendation is not without some controversy, however, because people with this instability don't always demonstrate it initially, and even the reverse is true; some actually demonstrate the instability and later appear to grow out of it.
All children's cervical spines are relatively hypermobile (able to move beyond normal range of motion) because of ligamentous laxity (loose ligaments) and underdevelopment of the osseous structures. They also have relatively large heads and weaker neck muscles than adults compared to the rest of their bodies, which also predisposes them to neck injuries. But if your child has Down syndrome, rheumatoid arthritis or any upper cervical spine anomaly known to be associated with instability, they should be evaluated before participating in athletics.
How Your Chiropractor Can Help
To screen for atlanto-axial instability, X-rays of the cervical spine in flexion and extension are performed. They show the motion of the vertebrae and the anatomy as it relates to each adjacent level during motion. These images are very helpful in determining increased risk of ligamentous laxity.
The neurological manifestations of atlanto-axial instability include neck pain, problems with walking, decreased neck motion, muscle spasm and rigidity in the neck muscles, changes in coordination, hyper-reflexive reflexes to name the most common. If any of these symptoms are present, neurological injury is suspected and the child should be carefully evaluated. The work-up should also include an MRI of the cervical spine to rule out any damage to the spinal cord. This evaluation must be done prior to participation in any sports.
If you are uncertain whether or not your child has anomalies in their cervical spine, but they are experiencing any of the above symptoms or have been diagnosed with Down syndrome, rheumatoid arthritis, etc., it is best to have them evaluated - certainly before they participate in any type of athletics. The same is true if your child appears to be healthy, but is beginning to participate in organized sports, particularly sports that involve contact and/or require specific repetitive training (perhaps involving weight-lifting, etc.). Many chiropractors have X-ray facilities in their clinics and will be able to perform the necessary examination to determine spinal instability. They are a great resource for evaluating the spine and musculoskeletal disorders, as it is their specialty.
Stay-Safe Strategies: Reducing Youth Injury Risk
It's important to encourage your children to be active, but of course, with increased activity comes increased opportunity for injury. In addition to the observations and suggestions by Dr. Pate, here are some things to keep in mind if your child is interested in participating in athletics, courtesy of the National Institute of Arthritis and Musculoskeletal and Skin Diseases:
Enroll your child in organized sports through schools, community clubs, and recreation areas that are properly maintained. Any organized team activity should demonstrate a commitment to injury prevention. Coaches should be trained in first aid and CPR, and should have a plan for responding to emergencies. Coaches should be well-versed in the proper use of equipment, and should enforce rules on equipment use.
Organized sports programs may have adults on staff who are certified athletic trainers. These individuals are trained to prevent, recognize, and provide immediate care for athletic injuries.
Make sure your child has and consistently uses proper gear for a particular sport. This may reduce the chances of being injured.
Make warm-ups and cooldowns part of your child's routine before and after sports participation. Warm-up exercises, such as gentle stretching and light jogging, can help minimize the chance of muscle strain or other soft-tissue injury during sports. Warm-up exercises make the body's tissues warmer and more flexible. Cooldown exercises loosen muscles that have tightened during exercise.
Learn and follow safety rules and suggestions for your child's particular sport.
Deborah Pate, DC, DACBR, is a San Diego chiropractor specializing in radiological assessment of the spine and musculoskeletal system. In fact, she was the first chiropractor accepted into a fellowship in osteoradiology at the University of California at San Diego. Contact her with questions and comments regarding this article at
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