Bones, Joints & Muscles

Bones, Joints & Muscles

Conditions affecting bones, joints and the tissues around them are described as ‘musculo-skeletal’ ‘MSK’ or ‘orthopaedic’. Because there are many physiological and anatomical differences between children and adults and many conditions are child-specific, children require a specialised approach to their orthopaedic management.

The differences between children and adults include:

• Children’s bones are very different to adult’s bones. One result of this is that when children’s bones break they resemble a broken green branch from a tree ("greenstick fractures") as opposed to the well-defined break generally seen in adults.
• Children’s bones heal more quickly than adults, often about half the time.
• The bones of children and young adolescents contain "growing zones" called growth plates. Special care needs to be taken if the fracture site is near to the growth plate.
• Babies and toddlers naturally have flat feet. It is important for a physiotherapist to recognise whether a foot posture is normal or abnormal.
• Walking (gait) patterns vary as children grow. It is important for a physiotherapist to have a good knowledge of how walking develops so they can determine if a pattern is abnormal or a normal variant.

Some of the child-specific conditions we see at KidsPhysio include:

• Growing Pains are pains, generally in children’s or adolescent’s legs often attributed to, but not necessarily caused by rapid growth.
• Scoliosis is a condition characterised by an abnormal curvature of the spine which develops during childhood.
• Talipes is also called ‘club foot’. A baby’s foot and ankle ligaments and tendons are tight when they are born. The foot and ankle sit in an abnormal position and can be stiff to move. Physiotherapy stretches can help to restore the movement in the foot. Depending on the severity, other treatments such as splinting or surgery may be necessary.
• Erbs Palsy is also known as Brachial Plexus Paralysis and is caused at birth. The nerves that supply the movement and sensation to the arm are partially or completely paralysed causing weakness and limitation in movement. Physiotherapy helps to maximise the range of movement, strength and function of the affected arm.
• Torticollis or ‘Wry Neck’ is a condition affecting babies, where a tight sterno-mastoid muscle in the neck causes an asymmetrical posture and limited neck movement. Physiotherapy stretches, positioning and massage can help to restore movement and alignment.
• Hypermobility describes when a child has an increased range of movement in joints.
• Juvenile Arthritis is an autoimmune disorder causing inflammation of the joints, also referred to as Juvenile Chronic Arthritis (JCA) Juvenile Idiopathic Arthritis (JIA) Children’s Chronic Arthritis (CCA).
• Osgood-Schlatter disease presents as knee pain. It is inflammation of the bone, cartilage, and/or tendon at the top of the shinbone.
• Sever's disease (Calcaneal apophysitis) is a childhood condition, where the growth plate (the main growing part) of the heel becomes inflamed, causing pain in one or both heels.
• Slipped Upper Epiphysis (SUFE) and Perthes Disease (LCPD) are childhood disorders that affect one or both hips. It is extremely important that these conditions are recognised as early as possible.

When to see your GP

If your child has any of these ‘red flags’ please consult your GP prior to arranging Physiotherapy:

• Unremitting pain (pain that doesn’t go away or ease)
• Night pain preventing sleep
• Back pain in under 6’s
• Significant weight loss
• Morning headaches/nausea
• Changes in sensation e.g. pins and needles and numbness
• Changes in bladder or bowel habit
• Systemically unwell
• Thoracic pain (around the chest / ribs)
• One sided hip pain
• TB, cancer, HIV/AIDS

Physiotherapy aims include:

• Screening for pathology/serious conditions and onward referral as indicated
• Reduction of pain
• Improvements in muscle strength
• Improvement in range of movement
• Improvement in muscle balance/symmetry
• Restoration of function
• Provision of advice on activities – PE and competitive level sports
• Provision of home exercise programme
• Provision of advice on home pain management