By LISA WHELDON, DPT

If your child gets diagnosed with scoliosis you may be a bit taken aback. It can be unsettling to get a medical diagnosis with little explanation of what it is or how it can be treated. Scoliosis means that there is a change to the “normal” shape of the spine so the spine may have moved to the side or turned. This can alter a person’s overall trunk alignment and posture. The abnormal curvature of the spine can alter other areas of the body. This may include: shoulder height, hip height, pain in area of shoulders pelvis and hip, and painful movement patterns. As physical therapists we can often be an important part of the team to help a child with scoliosis.

Scoliosis is a relatively common condition that can affect “2% to 3% of the general population, and is more common in females than males APTA”. Adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, is diagnosed in children aged 10-18 years. Idiopathic means no identifiable cause is known, but 30% of children with AIS have some family history of the condition. Other types of scoliosis include congenital, neuromuscular, and early onset (infantile and juvenile). Congenital scoliosis is when a deformity to the bones of the spine happens during baby’s development in the womb. Neuromuscular scoliosis is caused by the nervous system and can occur in conditions like cerebral palsy (CP) or muscular dystrophy. Early onset scoliosis is diagnosed from birth to 3 years of age or juvenile scoliosis diagnosed before age 10. Both of these onsets have an unknown cause.

Physical therapists can even be involved in the screening and initial diagnosis of scoliosis (although an x-ray from an orthopedic physician can truly confirm). Upon screening of the patient, the PT can discuss what activities are difficult for the child due to their current condition. They will evaluate the patient’s ROM and then assess strength and flexibility of the surrounding muscles. Upon evaluation the therapist can then create a program to address areas of impairment. If there appear to be movement limitations then some gentle stretching may be appropriate to improve the child’s mobility. Areas of weakness are often an issue so the therapist would provide a proper strengthening program. This program could include exercises to strengthen weak back muscles, core, shoulders and hips.

Manual therapy can also be a part of the treatment plan. We are trained professionals to restore mobility and ROM in a joint. This can include joint mobilizations, manual stretching, and soft tissue mobilizations to gently restore motion. Education is also an important part of treatment. If a child doesn’t pay attention to their posture and they are hunched over looking at tablets or the computer (which is common at this time) they can exacerbate the curvature. Unfortunately, scoliosis isn’t really “preventable” but educating on the condition and body movement is an important piece of the puzzle.

Typically, the goal of therapy is to do things to work on the muscle imbalances from the curvature. If a child has tight hamstrings, then we would stretch that area out in the clinic and provide the patient with proper exercises to improve the muscle length of hamstrings. Providing patients with tools to self-treat and maintain gains made in therapy is critical. Then to address areas of weakness is another important piece. Core strengthening can be important for any spinal condition. Creating a core strengthening program that the patient can perform in the clinic and then continue with following discharge is another component. Physical therapy doesn’t end once the patient is discharged from the clinic. It is important for the parent and child to remember the program created by the therapist be maintained and may even require updating/progression periodically by the therapist. So, if your child is diagnosed with scoliosis physical therapy is a viable option for treatment. Contact Rye Physical Therapy at 603-929-2880 to learn more.

Source: https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-scoliosis

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Most of us remember the years of our youth as being very physically flexible.  Many of us could do splits, do a perfect backbend, and some of us could even look like a human pretzel.  On the other hand, some of us report that we could barely touch our toes, but I am sure you were far closer than you are today!  Kids are generally known to have a lot of flexibility but throughout their youth, that flexibility can sometimes come and go, so it is important to have flexibility on your kid’s to-do list.

Throughout the years of puberty, kids will tend to have extreme growth spurts.  According to Dr. Keith Dominick (Pediatrics Specialist in Hampton & Portsmouth, NH), most girls will start puberty by age 13 and most boys will start puberty by age 14.

Dr. Dominick reports that flexibility should be a topic of concern for children throughout puberty.  As kids grow, some will grow at a nice steady pace making the transition physically seamless while others will be driving with a heavy foot on the gas and then come to a sudden halt on and off throughout their childhood.  This sudden fast growth spurt can cause many problems physically such as coordination issues, weight struggles, and flexibility restrictions leading to injuries.

How is coordination affected?

Coordination, you can imagine will be a bit of a struggle for the kid that has a heavy foot on the growth spurt pedal.  According to the Magic Foundation, most kids grow on average 2inches/yr. from age four until puberty.  During puberty, a growth spurt of 2 ½ -4 ½ inches/yr. for girls and boys average 3-5 inches/yr.  This can be very frustrating for many kids.  Perhaps they have been a great athlete and all of a sudden, they are dropping the ball, tripping over their feet, and every game or practice seems like they are in a constant funk.  It is very important to educate your child on growth spurts and how this can affect their ability to play.  They need to be reassured that they just need time to adjust to their new playing tools.  Practice and time will allow them to get use to their new size.  They must understand that they may have a bad season one year and the next they could be at the top of their game.  This will prevent the child from deciding to give up on a certain sport all together.  The best thing you could do for your child is keep them physically involved in sports, help them get through these ups and downs that are beyond their control.

Flexibility Restrictions and Injuries:

Flexibility restrictions occur because during growth spurts kid’s bones grow so fast that the length of their muscles are unable to keep up.  Suddenly your limber child that you referred to as Gumby suddenly is complaining that they are tight and are complaining of knee pain or heel pain.  Two of the most common conditions that many kids will have secondary to their bones growing too fast for their muscles and often in combination with increased activity are Osgood Schlatters (knee pain caused by tightness in quad muscle) and Sever’s Disease (heel pain due to tightness in Achilles Tendon).  Both these conditions occur because of a traction injury to the cartilage and bony attachment of the tendons.  These are both apophysitis injuries, which is an inflammation or stress injury to the area on or around the growth plates in children.  Other less common apophysitis’s locations:

Little league Elbow (Medial epicondyle apophysitis) is common in kids that throw or bat. Stretching should target the tightness in a child’s wrist flexor muscles since these muscles attach on the medial epicondyle.

Pelvic/Hip Apophysitis -The location on the hip may be in 7 different locations! Common in dancer’s, soccer players. Take a look at this picture as it shows the points of pain.  Muscles to target: Sartorius, rectus femoris, hamstrings, abdominals, abductors, iliopsoas, and adductor longus.

Iselin’s Disease (5^th metatarsal apophysitis) Pain located on the Outside foot- Muscles to target: peroneals/gastroc muscles (outside of ankle and back of calf stretch) most common in soccer, basketball, gymnastics and dance.

What flexibility stretches should all kids do?

In order to be proactive and try to avoid the areas that kids commonly have apophysitis’s, have your child routinely do these stretches at least 3 days/week. If your child is involved in sports, try and make it a habit for them to do the attached exercises after every practice or game once they get home.

The goal for them during a warm up is to do more of a dynamic warm up with their team (dynamic stretching is more movement-based stretching such as walking lunges with a twist) and then when they come home; they should do these exercises – (see and/or print out Flexibility Stretching Exercises pdf)

*Parent Tip for avoiding these conditions: An important factor to discuss is the huge push kids are getting to specialize in single sport participation despite the recommendation against it from the American Academy of Orthopedic Surgeons (AAOS).  Early sport specialization is defined as intensive training or competition in an organized sport by prepubescent children for eight or more months out of the year. The AAOS attributes lack of sport diversification with a significantly higher incidence of repetitive injury. Bones, muscles, ligaments, and joints do not have enough time to heal and can lead to maladaptive mobility and a decline in flexibility. (AAOS, 2019).  I encourage you to do your best and try to not cave with the constant pressure from sports organizations.  The more sports you expose your kids to the less incident of repetitive injury they will have.

At Rye Physical Therapy, we treat these conditions regularly.  All of our therapists hold Doctorate Degrees and have advanced certifications to offer the latest treatments while using Evidence Based Medicine as their guide.  Please feel free to reach out and speak directly with a skilled Therapist regarding your individual concerns. www.HamptonPT.com

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by Jessica Leberman, DPT – Hampton NH Clinic

• Young athletes may have had an increase in complaints of knee pain this past winter after playing on harder indoor courts. Adolescent athletes are among those most frequently plagued by knee injuries. Knee pain and clicking not precipitated by a traumatic injury is a common complaint heard from young athletes. One of the most common diagnoses for adolescents with knee pain is Patellofemoral Pain Syndrome (PFPS)(1).
• 
  The knee joint is comprised of the articulation of 3 bones; the femur, the tibia and the patella (knee cap). The patella rests in a groove commonly referred to as the “patellar groove”. As a person bends and straightens the knee the patella glides within the groove(1).

• What is Patellofemoral Pain Syndrome?

• PFPS is an umbrella term used to describe pain and/or clicking or crunching in and around the knee joint associated abnormal gliding of the patella in the patellar groove. Often the symptoms occur on the front side of the knee and underneath the patella.
• Common signs and symptoms of PFPS include;
  • pain with repetitive activities such as running, jumping, or squatting
  • pain with climbing/descending stairs
  • pain after sitting with your knees bent for a long period of time such as in school at a desk, at the movie theater or on an airplane
  • Popping or crackling sounds (known as crepitus) in your knee when bending the knee or squatting down(1)

What Causes Patellofemoral Pain Syndrome?

Common causes of PFPS include a change in activity level, a change in activity surface, or a change in footwear. Adolescents that participate in activities on more firm surfaces such as basketball, indoor track and dance are more prone to PFPS. PFPS can be due to abnormal alignment of the patella within the patellar groove, muscle imbalances, biomechanical abnormalities of the hip, knee and/or feet, and walking/running/jumping mechanical faults1. Genu valgum (knock knees) is a biomechanical abnormality commonly associated with PFPS. PFPS occurs more commonly in females (55%) than males (45%) as females are more prone to genu valgum(2).

How can Physical Therapy help?

A physical therapist will perform a full assessment to determine the underlying source of your pain and establish a comprehensive individualized plan based on your presentation. Your individualized plan can include any combination of the following;
• Taping treatments to address mal-tracking of the patella(3)
• Guided strengthening activities of the core, pelvic, hip, knee and ankle stabilizing muscles(4)
• Myofascial treatments such as stretching, Instrument Assisted Soft Tissue Mobilization and Dry Needling.(5)
• Assessment for orthotic prescription to address abnormal biomechanics of the feet. Those who over pronate (more commonly referred to as having flat feet) are more prone to PFPS and can benefit from arch support in shoes.(6)
• Assessment of your walking, running, and/or jumping mechanics and training to optimize mechanics and dynamic balance to decrease abnormal stresses through the knee joint.(4,6)

Although adolescent athletes are those that frequently experience PFPS people of any age and activity level can experience symptoms related to PFPS. If you start to notice knee pain or crepitus within your knee Rye Physical Therapy can help you. If you have any questions regarding this condition feel free to call or stop into one of our two locations in either Hampton or Seabrook to speak to one of our physical therapists.

References:
1. Patellofemoral Pain Syndrome-OrthoInfo–AAOS. https://orthoinfo.aaos.org/topic.cfm?topic=A00680
2. Glaviano NR Kew M Hart JM Saliba S. Demographic and epidemiological trends in patellofemoral pain. Int J Sports Phys Ther. 2015;10(3):281-290
3. Kurt EE, Büyükturan Ö, Erdem HR, Tuncay F, Sezgin H. Short-term effects of kinesio tape on joint position sense, isokinetic measurements, and clinical parameters in patellofemoral pain syndrome. J Phys Ther Sci. 2016 Jul;28(7):2034-40
4. Chevidikunnan MF, Al Saif A, Gaowgzeh RA, Mamdouh KA. Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome. J Phys Ther Sci. 2016 May;28(5):1518-23.
5. Telles G, Cristovão DR, Belache FA, Santos MR, Almeida RS, Nogueira LA. The effect of adding myofascial treatments to an exercise programme for patients with anterior knee pain. J Bodyw Mov Ther. 2016 Oct;20(4):844-850
6. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003 Nov;33(11):639-46.

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It’s that time of year again when your child will be returning to school. But before you head out for that infamous back-to-school shopping, it is important to make sure your child’s backpack is making the grade. Although backpacks are still the best way for your child to carry their homework and school supplies, if worn or fit incorrectly, or overloaded in weight, it could be doing more harm than good. A child’s growing muscles and joints are more susceptible to injury when heavy loads are repeatedly placed and not properly supported on their backs.

A recent study, led by American Physical Therapy Association member, Shelley Goodgold PT, associate professor of Physical Therapy at Simmons College in Boston, found that 55 percent of children surveyed carried backpack loads heavier than 15 percent of their bodyweight, the maximum safe weight recommended by most experts. These heavy loads can cause harmful postures (i.e. forward lean, leaning to one side, arching the back) that could result in compression of the vertebral discs, muscle strain/sprains of the back and neck, or strain on the shoulder joints and nerves. The spinal and abdominal muscles are some of the strongest muscles of the body, and if backpacks are worn correctly, these muscle groups can work together to stabilize the spine and protect the body from injury.

So what can you do, as a parent, to help your child avoid injury? Follow these simple steps:

· Supply your child with a proper fitting backpack. The size of the backpack should fit the size of the child, NOT the amount of books/supplies the child needs to carry. The shoulder straps should fit comfortably on the shoulders and under the arms, so that the arms can move freely. The bottom of the pack should rest in the contour of the lower back, NOT sag down toward the buttocks.
· Use a backpack that has a padded back and shoulder straps to reduce pressure on your child’s back/shoulders.
· A waist belt helps distribute some of the load to the pelvis.
· Compression straps on the sides or bottom of the backpack that, when tightened, compress the contents of the backpack and stabilize the articles.
· Wear BOTH straps. Using only one strap, or a backpack with a strap that runs across the body and over only one shoulder, forces one shoulder to support the weight of the bag. Wearing both straps allows the body to support the weight of the backpack in a neutral spinal posture.
· Use caution when using backpacks with wheels. If the handle does not extend far enough, your child will be forced to bend forward or twist when pulling their backpack, both actions that can cause serious back injury. Also, remember that wheeled backpacks may present problems when trying to carry them up/down stairs or onto the bus.
· Try to monitor how much weight your child is carrying in their backpacks. It is recommended that children not carry more than 15 percent of their bodyweight in their bags.

Finally, look out for signs that your child may be negatively affected by an improper fitting/wearing backpack.

· Pain when wearing or shortly after wearing the backpack.
· Red marks on the shoulders.
· Numbness or tingling into the arms or fingers.

If your child is complaining of any of these symptoms, or if you feel your child would benefit from an evaluation of a medical professional, please don’t hesitate to call and speak with one of our Doctors of Physical Therapy at Rye Physical Therapy with clinics in Hampton and Seabrook, NH.

We would be glad to help in any way we can! www.HamptonPT.com 603-929-2880
RESOURCES: Pediatric Physical Therapy: Fall 2002-Volume 14, Issue 3: 122-131. Backpack Use in Children. Goodgold, Shelley ScD, PT; Corcoran, Moira DPT, MSPT; Gamache, Diana MSPT; Gillis, Jennifer MSPT; Guerin, Jennifer MSPT; Coyle, Jennifer Quinn MSPT.

Grimmer KA, Williams MT, Gill TK. The associations between adolescent head-on-neck posture, backpack weight, and anthropometric features. Spine. 1999; 24: 2262–2267.

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