atlantoaxial instability

What Is It?

Atlantoaxial instability (AAI) is a condition affecting the joint between the first cervical vertebra (atlas) and the second cervical vertebra (axis). This joint is known as the atlantoaxial joint.

In some folk with Down syndrome, the ligaments and connective tissues supporting this joint can be "lax" or floppy. Instability in this area can potentially place pressure on the spinal cord and, in some cases, cause serious injury.

This is an important consideration when planning exercises in aerial yoga and mat-based movement practices, particularly those that place stress on the cervical spine (neck).

It is best practice to discuss any concerns with an appropriately qualified health professional before introducing higher-risk movements.

Screening practices for atlantoaxial instability can vary. Some schools and sporting organisations may have specific requirements, while routine X-ray screening is not generally recommended for people without symptoms.

As a result, some parents and carers may be unaware of the condition or the signs and symptoms to look out for.

Trampolining can be a particular concern because of the potential for falls, sudden impacts and neck injuries.

Movements to Consider Carefully Before Appropriate Medical Assessment or Clearance

Excessive neck flexion, extension and rotation: Avoid movements involving extreme bending forwards, backwards or twisting of the neck where cervical spine instability is suspected.

Inversions: Movements where the head is positioned below the body, including certain aerial yoga poses and headstands, require careful consideration. Particular caution is needed when these movements place weight or stress on the cervical spine.

Impact or sudden jarring movements: Be mindful of activities involving quick, uncontrolled head movements, jumping or any movement that increases the risk of falls.

Weight-bearing on the head and neck: Avoid placing weight directly on the head or neck, such as during headstands, shoulder stands or activities involving heavy loads supported by the head.

Care should be taken to protect the cervical spine by minimising unnecessary stress in this region, particularly when instability is suspected or an individual is awaiting medical assessment.

Within the aerial space, I personally prefer to keep the hammock low while individual risks are being assessed. I also limit fast or jerky movements and focus on slow, controlled movement.

Slow and low is best!