Pediatric Bone and Joint Health
by Maureen Suhr
Being both a pediatric physical therapist and a mom has its pros and cons. My kids don’t always love it – do you remember your mom telling you to sit up straight? Imagine how many more times she would have said it if she were a physical therapist. On the other hand, my friends think it’s great. I’m constantly being asked questions on everything from sprains to strains to normal development. Occasionally I have to remind them that I don’t have an expert answer for everything. But, in honor of World Pediatric Bone and Joint Day and my inquiring friends, here are some pearls of wisdom I’ve gleaned as a physical therapist and a mom.
- Don’t ignore a limp: Limping in a child or adolescent is a sign of pain or pathology. If a limp persists more than 24-48 hours it is worth seeing your pediatrician or pediatric orthopedist, regardless of whether or not a child complains of pain.
- Bones grow faster than muscles: Because bones grow faster than muscles, children and adolescents tend to get asymmetrical forces about their joints during growth spurts. When an active child goes through a growth spurt, his muscles suddenly become much tighter and less flexible. Additionally, in a growing child, the tendons tend to be stronger than the growing bone. This puts him/her at risk for an avulsion fracture. A sports injury that would likely result in a muscle strain in an adult, may result in an avulsion fracture (injury where a tendon pulls off a small piece of bone from its attachment) in an adolescent. Treatment typically involves pain management, possibly with crutches, and rest with gradual restoration of flexibility and strength.
- Be aware of the potential for stress fractures: It is common today for children and adolescents to specialize in one sport early on. This increases their potential for overuse injuries like tendonitis or stress fractures, which are small breaks in the bone that are typically not displaced. They are particularly common in high-impact sports such as long distance running or gymnastics and tend to be common in females. Female athletes who train at a high level may present with the “female triad” of poor nutrition, absent menstrual cycles, and weak bones, which predisposes them to stress fracture. As parents and coaches we need to remember the importance of balanced nutrition and balanced training (cross training).
- Knee pain doesn’t always mean a knee injury: Sometimes, as is the case of knee pain in a child or adolescent, it’s not always what it seems. Pain in the knee may be referred from the nerves in the hip. In a child between the ages of 4-9 years of age, it may be due to Legg-Calve-Perthes disease which is degeneration of the top of the thigh bone where it inserts in the hip socket. This is a serious condition which may lead to significant loss of motion and potential deformity if left unchecked. Another serious hip condition that presents in adolescents typically between the ages of 10-15 years of age is Slipped Capital Femoral Epiphysis (SCFE). This also presents with a limp, with the child’s foot turned out, and referred pain to the knee. Symptoms may come on gradually over a few months or it may occur suddenly with severe pain limiting the child’s ability to walk altogether. With SCFE, the growth plate on the top of the thigh bone separates from the shaft of the bone. Again, if left untreated, serious and debilitating consequences may occur including pain and arthritis.
- Red Joints = Red flags: If a child’s joint becomes inflamed, red, and hot to the touch, it may be infected. Check for signs of fever and consult a physician. Bone and joint infections need to be treated with antibiotics. If infection is permitted to spread, the health and integrity of the bone or joint is at risk.
- Children get arthritis: Juvenile arthritis affects 1 in every 1000 children with severe arthritis affecting 1 in 10,000 children. Symptoms include muscle pain, joint stiffness, “growing pains,” fatigue, and depression. Proper care of juvenile arthritis requires oversight from a pediatric rheumatologist.
Maureen Suhr is a doctor of physical therapy and board certified pediatric specialist, and is the assistant section manager at CA Technologies Rehabilitation Center at the Lerner Children’s Pavilion, Hospital for Special Surgery. She has volunteered with the Foundation for Orthopedics and Complex Spine and traveled to Ghana in November 2008 to assist in the rehabilitation of children and adults following joint replacement and spine surgery.