Physiotherapy For Kids: Advice For Concerned Parents

Physiotherapy for kids is a topic that every parent should be aware of. There is nothing more important than the well-being of our precious little ones. But the fact is, children are prone to getting different injuries than adults due to their musculoskeletal immaturity. Have you ever heard the expression kids are like rubber? The reason being is that their ligaments (structures supporting joints) are very lax, which makes their bones more vulnerable to injuries and breaks. The situation reverses once they have reached maturity and as an adult you are more likely to damage your ligaments before breaking bones.

 When a child starts developing pain they will start compensating for it immediately. Different compensation strategies commonly seen are limping, awkward running patterns or they become apprehensive when participating in school sports. If you notice any of these behaviour's with your children then it is imperative that you seek advice from your regular doctor or physiotherapist. If biomechanical abnormalities are picked up from an early age physiotherapists are able to reduce the likelihood of Orthopaedic issues down the track.

Common conditions that physiotherapists treat in children are:

While physiotherapy for kids is often recommended when a sports-related injury occurs, it can also be used to treat conditions that may already be present. While certainly not a comprehensive list, these are a list of the most common non-sports related injuries and conditions that bring children to our physiotherapy program.

• Scoliosis (back)
• Hip dysplasia
• Sever's disease (heel)
• Osgood Schlatter's (knee)
• Sinding- Larson-Johansson (knee)

The Most Common Sports-Related Injuries Treated by Physiotherapy for Kids

Although sports injuries can range from scrapes and bruises to serious brain and spinal cord injuries, most fall somewhere between the two extremes. When it comes to kids, especially the very young ones, it is always better to err on the side of caution. As most very young children are unable or are afraid to articulate their pain or an incident which could have caused them unseen injuries.

Whenever a child acts out of the ordinary, maybe withdrawn or a little more lackluster than they usually do, it would be best to have a general pediatrician give them a body check up. If needed, a referral to a physiotherapist will be given for further analysis and examination.

Sprains and Strains

A sprain is an injury to a ligament, one of the bands of tough, fibrous tissue that connects two or more bones at a joint and prevents excessive movement of the joint. An ankle sprain is the most common athletic injury.

A strain is an injury to either a muscle or a tendon. A muscle is a tissue composed of bundles of specialized cells that, when stimulated by nerve messages, contract and produce movement. A tendon is a tough, fibrous cord of tissue that connects muscle to bone. Muscles in any part of the body can be injured.

Growth Plate Injuries

In some sports accidents and injuries, the growth plate may be injured. The growth plate is the area of developing tissues at the end of the long bones in growing children and adolescents. When growth is complete, sometime during adolescence, the growth plate is replaced by solid bone. The long bones in the body include:

• the long bones of the hand and fingers (metacarpals and phalanges)
• both bones of the forearm (radius and ulna)
• the bone of the upper leg (femur)
• the lower leg bones (tibia and fibula)
• the foot bones (metatarsals and phalanges).

If any of these areas become injured, it's important to seek professional help from an Orthopaedic surgeon, a doctor who specializes in bone injuries.

Repetitive Motion Injuries

Painful injuries such as stress fractures (a hairline fracture of the bone that has been subjected to repeated stress) and tendinitis (inflammation of a tendon) can occur from overuse of muscles and tendons. Some of these injuries don't always show up on x rays, but they do cause pain and discomfort. The injured area usually responds to rest, ice, compression, and elevation (RICE). Other treatments can include crutches, cast immobilization, and physical therapy.

Heat-Related Illnesses

Heat-related illnesses include:

• dehydration (deficit in body fluids)
• heat exhaustion (nausea, dizziness, weakness, headache, pale and moist skin, heavy perspiration, normal or low body temperature, weak pulse, dilated pupils, disorientation, and fainting spells)
• heat stroke (headache, dizziness, confusion, and hot dry skin, possibly leading to vascular collapse, coma, and death).

Heat injuries are always dangerous and can be fatal. Heat-related injuries are a particular problem for children because children perspire less than adults and require a higher core body temperature to trigger sweating. Playing rigorous sports in the heat requires close monitoring of both body and weather conditions. Fortunately, heat-related illnesses can be prevented.

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Preventing and Treating Injuries with Physiotherapy for Kids.

Injuries can happen to any child who plays sports, but there are some things that can help prevent and treat injuries. And especially with kids, prevention is always better than a cure. No one wants their energetic child to become fearful of playing again because of a childhood injury. As parents with kids in sports, we should always be the first to practice injury prevention, no matter how much our kids may dislike our care and reminders.

Prevention

• Enroll your child in organized sports through schools, community clubs, and recreation areas that are properly maintained. Any organized team activity should demonstrate a commitment to injury prevention. Coaches should be trained in first aid and CPR, and should have a plan for responding to emergencies. Coaches should be well versed in the proper use of equipment, and should enforce rules on equipment use.
• Organized sports programs may have adults on staff who are Certified Athletic Trainers. These individuals are trained to prevent, recognize, and provide immediate care for athletic injuries.
• Make sure your child has—and consistently uses—proper gear for a particular sport. This may reduce the chances of being injured.
• Make warmups and cool downs part of your child's routine before and after sports participation. Warmup exercises, such as stretching and light jogging, can help minimize the chance of muscle strain or other soft tissue injury during sports. Warmup exercises make the body's tissues warmer and more flexible. Cool down exercises loosen muscles that have tightened during exercise.
• Make sure your child has access to water or a sports drink while playing. Encourage him or her to drink frequently and stay properly hydrated. Remember to include sunscreen and a hat (when possible) to reduce the chance of sunburn, which is a type of injury to the skin. Sun protection may also decrease the chances of malignant melanoma—potentially deadly skin cancer— other skin cancers that can occur later in life.
• Learn and follow safety rules and suggestions for your child's particular sport. You'll find some more sport-specific safety suggestions below.

Keep Kids Exercising

Let's take the case of one of our patients, Raoul. Luckily for Raoul, his injury wasn't serious. In a few weeks, he will be fully recovered and able to play again. Even though Raoul got hurt, it's important that he continue some type of regular exercise and sports involvement after the injury heals. Exercise may reduce his chances of obesity, which is becoming more common in children. It may also reduce his risk of diabetes, a disease that can be associated with a lack of exercise and poor eating habits. Exercise also helps him build social skills and provides him with a general sense of well-being. Sports participation is an important part of learning how to build team skills.

As a parent, it is important for you to encourage your children to be physically active. It's also important to match your child to the sport, and not push him or her too hard into an activity that he or she may not like or be capable of doing. Teach your children to follow the rules and to play it safe when they get involved in sports, so they'll spend more time having fun in the game and be less likely to be sidelined with an injury. You should be mindful of the risks associated with different sports and take important measures to reduce the chance of injury. For sport-specific suggestions, see the information below.

Play It Safe in the Heat

• Schedule regular fluid breaks during practice and games. Kids need to drink 8 ounces of fluid—preferably water—every 20 minutes, and more after playing.
• Have your child wear light-colored, "breathable" clothing.
• Make player substitutions more frequently in the heat.
• Use misting sprays on the body to keep cool.
• Know the signs of heat-related problems, including confusion; dilated pupils; dizziness; fainting; headache; heavy perspiration; nausea; pale and moist or hot, dry skin; weak pulse; and weakness. If your child experiences any combination of these symptoms or doesn't seem quite right, seek medical attention immediately.

Adapted with permission from Patient Care magazine, copyrighted by Medical Economics.

Physiotherapy for Kids Treatment

Treatment for sports-related injuries will vary by injury. But if your child suffers a soft tissue injury (such as a sprain or strain) or a bone injury, the best immediate treatment is easy to remember: RICE (rest, ice, compression, elevation) the injury. Get professional treatment if any injury is severe. A severe injury means having an obvious fracture or dislocation of a joint, prolonged swelling, or prolonged or severe pain.

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Treat Injuries with "RICE"

Rest: Reduce or stop using the injured area for at least 48 hours. If you have a leg injury, you may need to stay off of it completely.

Ice: Put an ice pack on the injured area for 20 minutes at a time, four to eight times per day. Use a cold pack, ice bag, or a plastic bag filled with crushed ice that has been wrapped in a towel.

Compression: Ask your child's doctor about elastics wraps, air casts, special boots, or splints that can be used to compress an injured ankle, knee, or wrist to reduce swelling.

Elevation: Keep the injured area elevated above the level of the heart to help decrease swelling. Use a pillow to help elevate an injured limb.

‍Sport-Specific Safety Information

Here are some winning ways to help prevent an injury from occurring, so you are less likely to get that alarming phone call like Raoul's mom did.

Basketball

• Common injuries and locations: sprains; strains; bruises; fractures; scrapes; dislocations; cuts; injuries to teeth, ankles and knees. (Injury rates are higher in girls, especially for the anterior cruciate ligament (ACL), the wide ligament that limits rotation and forward movement of the shin bone.)
• Safest playing with: eye protection, elbow and knee pads, mouth guard, athletic supporters for males, proper shoes, water. If playing outdoors, wear sunscreen and, when possible, a hat.
• Injury prevention: strength training (particularly knees and shoulders), aerobics (exercises that develop the strength and endurance of heart and lungs), warmup exercises, proper coaching, and use of safety equipment.

Track and Field

• Common injuries: strains, sprains, scrapes from falls.
• Safest playing with: proper shoes, athletic supporters for males, sunscreen, water.
• Injury prevention: proper conditioning and coaching.

Football

• Common injuries and locations: bruises; sprains; strains; pulled muscles; tears to soft tissues such as ligaments; broken bones; internal injures (bruised or damaged organs); concussions; back injuries; sunburn. Knees and ankles are the most common injury sites.
• Safest playing with: helmet; mouth guard; shoulder pads; athletic supporters for males; chest/rib pads; forearm, elbow, and thigh pads; shin guards; proper shoes; sunscreen; water.
• Injury prevention: proper use of safety equipment, warmup exercises, proper coaching techniques and conditioning.

Baseball and Softball

• Common injuries: soft tissue strains; impact injuries that include fractures caused by sliding and being hit by a ball; sunburn.
• Safest playing with: batting helmet; shin guards; elbow guards; athletic supporters for males; mouth guard; sunscreen; cleats; hat; detachable, "breakaway bases" rather than traditional, stationary ones.
• Injury prevention: proper conditioning and warmups.

Soccer

• Common injuries: bruises, cuts and scrapes, headaches, sunburn.
• Safest playing with: shin guards, athletic supporters for males, cleats, sunscreen, water.
• Injury prevention: aerobic conditioning and warmups, and proper training in "heading" (that is, using the head to strike or make a play with the ball).

Gymnastics

• Common injuries: sprains and strains of soft tissues.
• Safest playing with: athletic supporters for males, safety harness, joint supports (such as neoprene wraps), water.
• Injury prevention: proper conditioning and warmups.

‍Safety Tips for All Sports

• Be in proper physical condition to play the sport.
• Follow the rules of the sport.
• Wear appropriate protective gear (for example, shin guards for soccer, a hard-shell helmet when facing a baseball or softball pitcher, a helmet and body padding for ice hockey).
• Know how to use athletic equipment.
• Always warm up before playing.
• Avoid playing when very tired or in pain.
• Get a preseason physical examination.
• Make sure adequate water or other liquids are available to maintain proper hydration.

Adapted from Play It Safe, a Guide to Safety for Young Athletes, with permission of the American Academy of Orthopaedic Surgeons.