A 5-year-old child with Down syndrome complaining of intermittent symptoms of torticollis, weakness of the lower limbs and gait disturbance

(B). The incidence of atlantoaxial sublaxation or instability in Down syndrome is about 10-30%, affected patient should not allowed to participate in high risk sports as include diving starts in swimming, butterfly stroke, diving, pentathlon, high jump, equestrian sports, gymnastics, football, soccer, alpine skinning and warm up exercises placing stress on the head and neck