Should children with Down syndrome and atlantoaxial instability participate in contact sports?

• A. Yes
• B. Only non-contact activities
• C. No
• D. Only with supervision

Answer: (C)

Safety risk from atlantoaxial instability in Down syndrome during activities that load or move the neck is the concept being tested. Atlantoaxial instability means the C1–C2 joint can move abnormally because of ligamentous laxity and possible odontoid anomalies, which is more common in children with Down syndrome. In contact sports, there is repeated or sudden neck flexion, extension, rotation, and direct impacts that can force dangerous movement at C1–C2. If instability is present or even unrecognized, these movements can compress or injure the spinal cord, leading to catastrophic outcomes. Because of this risk, participation in contact sports is contraindicated to protect the cervical spine. Safer options include non-contact activities or sports with no risk of neck injury, and any participation should be guided by a clinician after appropriate imaging to assess stability. Some scenarios may allow activities with medical clearance if stability is proven, but the general rule for someone with atlantoaxial instability is to avoid contact sports.