Common Musculoskeletal Conditions in Children

“Last time I fought in the same ring was 2 years ago, and I lost by KO, so it’s been a bit of a roller coaster ride and an emotional win!” - Nada Khalid, UFIT Clinic Orchard’s Senior Physiotherapist and competitive Muay Thai fighter on her recent victory on 23 February 2019. Nada competes in amateur and professional bouts in Singapore and Thailand.

Being active in her sport, Nada listens to her body and is aware of any issues that might arise. She would be able to take the necessary actions and precautions as needed. That being said, this will not always be the case when it comes to children who are active in sports.

They are not as self-aware when it comes to injury and may not be able to determine on their own if immediate treatment or a trip to the physiotherapist is required.

This brings to mind the question – is it appropriate to take our children to see a physiotherapist and if there is any difference from the rehabilitation work adults go through?

Physiotherapy can benefit children and adolescents in many instances. It is helpful for growing pains, sporting injuries and any congenital or developmental issues. Most musculoskeletal and sports injuries sustained in adults can occur in children and adolescents. There are, however, certain conditions that present themselves in childhood and adolescence but not in adulthood.

In this article, we address two of the common groups of musculoskeletal conditions and sports injuries that can affect a growing child or adolescent:

Traction Apophysitis

Not quite the common term that you would come across every day, traction apophysitis is commonly referred to as “growing pains” and is often the result of overuse.

For the skeletally-immature (children and adolescents), some amount of stress (through-weight bearing) is required to stimulate bone development on the growth plates, which are the ends of the long bones that grow longitudinally.

This amount of stress may increase significantly during growth spurts and with high-impact sporting activities and cause tendon attachments to exert traction forces on the growth plates, causing inflammation.

Before you get confused with the different terms and names above, below is a table of common locations of pain and conditions in a growing child or adolescent, which may have resulted from traction apophysitis.

Hypermobility-related injuries

Children tend be more mobile in their joints, this extra mobility, together with reduced postural awareness and reduced joint neuromuscular control can increase the risk of ligament sprains and joint injuries. Some common areas of these injuries include:

Ankle sprain

Although ankle sprains can be a traumatising event for a child, not all ankle sprains need to be rushed for an X-Ray at the A&E. A promising sign is the ability to place weight on the ankle. A physiotherapist can assess the severity of the ankle sprain and advise on the appropriate management, such as referring your child to A&E or an orthopaedic specialist if any fractures or more complex injuries are suspected. In most cases of simple ankle sprains, your physiotherapist may recommend a short period of rest, followed by early rehabilitation to regain range of motion, strengthen the ankle musculature and improve neuromuscular control and stability to reduce the risk of recurrent sprains.

Medial patellofemoral ligament (MPFL) sprain

Don’t let the long name scare you, in short, the MPFL is an important stabiliser and acts as a passive restraint to prevent the patella from dislocating towards the outer knee. MPFL injuries tend to occur more in girls due to the wider nature of the pelvis. In high-impact injuries, the MPFL may rupture, causing the patella to dislocate outwards. In cases where the patella does not relocate spontaneously, a visit to the A&E is warranted for relocation by a medical professional. MPFL injuries may require a period of immobilisation to prevent excessive motion of the patella. A physiotherapist can assess for risk factors and guide your child through a rehabilitation program to improve neuromuscular control and reduce the risk for recurrent injury.

Anterior cruciate ligament (ACL) sprain

You might have heard of professional athletes suffering from ACL injuries, children and adolescents can also suffer from the same injury. High-impact sporting activities which include rapid deceleration such as jumping, pivoting and change of direction, coupled with poor neuromuscular control can increase the risk of ACL injury in youth athletes. In many youth ACL injuries, initial conservative management is often encouraged to improve and maximise strength and neuromuscular control before any decision for surgical intervention is made. In the event the child undergoes an ACL surgery, he or she should be informed and prepared for regular rehab sessions with their physiotherapist to ensure they eventually return to sport & activity, with a reduced risk for a re-injury.

As we can see, physiotherapy is not restricted to just adults and can be beneficial to children, whether the conditions are due to growing pains, sporting injuries and any congenital or developmental issues.


ABOUT THE AUTHOR

Upon completing her physiotherapy studies at Trinity College Dublin, Nada started her career back home in Singapore at KK Women’s & Children’s Hospital. She specialises in the areas of musculoskeletal and sports therapy and spent 8 years as a competitive sprinter and hurdler before playing varsity Touch Rugby. These days she remains active in Muay Thai and enjoys surfing in her free time.