Musculoskeletal Conditions

The musculoskeletal system is made up of all of the bones, muscles, joints, cartilage, tendons and ligaments in a person’s body. The bones provide the body with a framework, giving it shape and support. Muscles make deliberate movement of a body part possible. Joints, cartilage, tendons and ligaments connect the bones and muscles in the body together.

Children, from babies, through childhood, into adolescence can experience a variety of musculoskeletal problems. These may be related to injury, growth, biomechanics, posture, inflammation or as a result of an underlying condition.

It is important to remember that …

Children are not simply ‘small adults’, their musculoskeletal system continues to grow and develop in most up to 18 years of age, for some it is even longer! There are growth plates that are active in all bones during the growing years. The growth plates in bones are active at different times of children’s development, making them susceptible to different growth-related conditions and sports related injuries at various stages of childhood.

It is essential that your child is assessed and treated by a Specialist Paediatric Physiotherapist who understands this and the implications for treatment and management of the child’s condition.

These are some of the musculoskeletal conditions that we commonly treat at Chiltern Children’s Physiotherapy. We would be happy to discuss the concerns that you have for your child and how we can help.

Conditions Affecting the Lower Limbs

Knee Pain

Knee pain in children can occur for a variety of reasons. This section contains some information about some of the more common reasons for knee pain, these include:

  • Injury, from soft tissue injuries to bony injuries such as fractures
  • Altered biomechanics, possibly as a result of growth
  • Growth related conditions

Anterior Knee Pain

Anterior knee pain describes pain which is felt around and under the patella (knee cap)

  • Very common, particularly in adolescent girls
  • Usually worse following prolonged periods of sitting and on stairs
  • In more severe cases may result in subluxation or dislocation of the patella (knee cap)

Osgood Schlatters Disease or Syndrome

An irritation of the patellar ligament at the tibial tuberosity, caused by traction on the patella tendon.

  • Characterized by painful lumps just below the knee
  • The condition tends to occur during the adolescent growth spurt before the tibial tuberosity has finished ossification
  • More common in children who participate in sports involving running and jumping
  • Also known as Apophysitis of the tibial tubercle, where small avulsion fractures occur at the ossification centre
  • More common in boys than girls

Sinding-Larsen and Johansson Syndrome

Caused by persistent traction at the junction of the patella and patella ligament

  • Pain and inflammation at the inferior pole of the patella (knee cap)
  • Is usually related to over activity
  • Usually occurs in pre-teenage boys

Sever’s Disease

Caused by inflammation of the calcaneal apophysis

  • Pain and possible swelling in the heel
  • Stiffness in the feet on awaking
  • Occurs in children and adolescents
  • Thought to be due to repeated ‘microtrauma’ at the site of the attachment of the Achilles tendon to the heel, combined with a growth spurt
  • Often occurs in children who actively participate in sporting activities
  • More common in boys than girls
  • Often worse after sporting activities

Plantar Fasciitis

Inflammation of the plantar fascia, a strong band of tissue (like a ligament) that stretches from the heel to the ball of the foot.

  • Thought to be caused by repeated small injuries to the fascia
  • Can occur as a result of an increase in physical activity or a change in training surface (track running to road running)
  • Poor footwear may contribute

How can Chiltern Children’s Physiotherapy help?

Our Specialist Paediatric Physiotherapists:

  • Understand that children are not just ‘small adults’
  • Know that the growth plates in bones are active at different ages, making them more susceptible to growth-related conditions and sports-related injuries at various stages of childhood
  • Will undertake a thorough examination and an in depth history to identify the problems
  • Provide physiotherapy treatment, exercises; stretches and advice regarding levels of activity and participation in sporting activities

Other Conditions

Back Pain

By the age of 15, 20 to 70 percent of children will report back pain. Most children will a have non-specific back pain that is not a result of a serious condition. Some children do have a specific underlying reason for back pain, which may be serious. Non-specific back pain is usually a result of poor posture or a muscle strain. Postural Kyphosis and Scoliosis can be improved with physiotherapy.

How can Chiltern Children’s Physiotherapy help?

Our Specialist Paediatric Physiotherapists

  • Will undertake a thorough examination and an in depth history to identify the problems
  • Provide physiotherapy treatment and exercises, including core strengthening exercises; stretches and advice regarding levels of activity and participation in sporting activities
  • Postural re-education exercises and activities
  • Provide advice about lifting and carrying objects safely

Congenital Torticollis

Congenital torticollis is due to tightness in sternocleidomastoid muscle. The cause is uncertain, but is possibly due to positioning in the womb or after a difficult childbirth.

  • Baby has a tilted head or difficulty turning his or her neck to one side
  • It can be present at birth or take up to 3 months to develop
  • Torticollis usually resolves with simple position changes or stretching exercises
  • Sometimes it is associated with positional plagiocephaly (flat head), due to the baby lying with its head turned to one side all the time
  • Baby may have a small lump or bump in the affected muscle, which tends to resolve as the torticollis improves

How can Chiltern Children’s Physiotherapy help?

Our Specialist Paediatric Physiotherapists

  • Will undertake a thorough examination and an in-depth history to confirm the diagnosis
  • Provide physiotherapy treatment, exercises and activities that will help the baby to regain movement in the neck
  • Provide advice regarding positioning and carrying the baby

The Association of Paediatric Physiotherapists (APCP) website has a useful parent information leaflet on Head Turning Preference and Plagiocephaly: APCP : http://apcp.csp.org.uk/publications/parent-leaflets

Obstetric Brachial Plexus Injuries

Obstetric Brachial Plexus Palsy (OBPP) is an injury to all or a portion of a child’s brachial plexus which affects the movement and feeling in a child’s arm.

  • Often caused by birth trauma
  • May spontaneously recover
  • May require specialist intervention
  • Ranges from bruising to tearing of the nerves
  • Erb’s palsy is often used to describe injury to the upper brachial plexus
  • Klumpke’s palsy is used to describe injury to the lower brachial plexus

How can Chiltern Children’s Physiotherapy help?

Our Specialist Paediatric Physiotherapists

  • Will undertake a thorough examination and an in depth history to determine the difficulties that the baby is experiencing
  • Provide physiotherapy treatment, exercises and activities that will help encourage the baby to move their arm
  • Provide physiotherapy exercises that prevent the baby’s arm from becoming stiff
  • Provide advice regarding positioning; carrying; and handling the baby

The Erb’s Palsy Group has a useful website with more information, is can be accessed by using the following link: www.erbspalsygroup.co.uk

 

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