Musculoskeletal (muscles, bones, joints)
What is musculoskeletal (MSk) physio?
This area of physio involves treating injuries and conditions which affect the muscles, bones, joints, and soft tissues.
It is what most people think of when they hear the term 'Physiotherapy'
Most commonly we see children and young people with knee pain, heel pain, back pain, ankle sprains, broken bones and after surgery.
Prevention tips
To prevent injury and joint pain have a look at these 4 tips:
1. Keep active
This is essential for health and wellbeing and to help prevent joint pain and injuries.
- Babies aged 0-1
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Babies should be encouraged to be active throughout the day, every day, in a variety of ways, including crawling.
If they're not yet crawling, encourage them to be physically active by reaching and grasping, pulling and pushing, moving their head, body and limbs during daily routines, and during supervised floor play.
Try to include at least 30 minutes of tummy time spread throughout the day when they're awake.
Once babies can move around, encourage them to be as active as possible in a safe and supervised play environment.
See these NHS guidelines for more information
- Children aged 1-4 years
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Children aged 1-4 years old should be physically active for at least 180 minutes (3 hours). The more the better. This should be spread throughout the day, including playing outdoors.
They should not be inactive for long periods, except when they're asleep. Watching TV, travelling by car, bus or train, or being strapped into a buggy for long periods are not good for a child's health and development.
Please see these NHS guidelines for more information
- Children and young people aged 5-18 years
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Children and young people aged 5-18 years should:
- aim for an average of at least 60 minutes of moderate intensity activity (Moderate activity is when you can still talk but cant sing)
- take part in a variety of types and intensities of physical activity across the week to develop movement skills, muscles and bones
- reduce the time spent sitting or lying down and break up and break up long periods of not moving with some activity
Please see these NHS guidelines for more information
Here is a document of some local sports and activity clubs across Telford and Shropshire that you could try [link document]
2. Reduce sitting down time
Due to phone and video game technology children and young people often spend a lot of time sitting or lying in the same position.
This can contribute to poor posture, back pain, and reduced fitness and wellbeing.
Advice from NHS states you should reduce the time spent sitting or lying down and break up long periods of not moving with some activity
3. Stop overuse
Too much of one sport or activity has been shown to increase risk of pain and injury.
As a rough guide for adolescents, you could be at increased risk of an overuse injury if you spend more hours a week than your age on one sport. For example, a 14 year old who plays 15 hours of netball per week could be at increased risk.
It has also been suggested that children that play sport for 8 months or more out of the year are more likely to experience an overuse injury to their knee or hip.
4. Follow school bag advice
Excessive load bearing for long periods on immature spines could put children at increased risk of future back problems in adulthood.
How much is too much?
It is generally accepted that school children should not be carrying more than 10% of their body weight. An average eleven year old may weigh around 75lbs (34kg), 10% is 7.5lbs (3.4kg) which equates to as little as three medium sized books and a lunchbox.
Design of school bags
Both rucksacks and cross body bags are acceptable however, in both cases the bag should be worn correctly, not suspended from one shoulder or carried in the hand. The straps should be tight enough to hold the bag close to the body. The school bag should be appropriate to your child’s size.
For more on school bags please see this leaflet from APCP
Knee pain
Knee pain is the most common reason for a child/young person to come and see us
The majority of knee pain that we see is anterior knee pain and Osgood Schlatters which have have written about below.
Prevention
They key to preventing knee pain is to keep the muscles around the knee loose and strong, especially as you grow. The two main muscles around your knee are your Quadriceps (front of your thigh) and your Hamstrings (back of your thigh).
Staying active and ensuring you stretch after exercise is key.
Here are some great exercises to help stretch and strengthen these two muscles to help prevent knee pain:
[exercises inc pics here: SLR, chair squat/wall squat, quad stretch, hamstring stretch]
Anterior knee pain
Most cases of knee pain involve pain around the front of the knee and is termed 'Anterior Knee Pain' or sometimes patellofemoral pain syndrome or chrondromalacia patellae
It is more common in Teenagers but can occur at any age. In most cases it is present in both knees but often one side is worse than the other
Causes
Usually there is no physical abnormality in the knee. It can be difficult to pinpoint a specific cause and it is often a combination of factors. The knee is extremely sensitive to small problems in alignment, activity, training, and overuse. Factors that may contribute to anterior knee pain include:
- Imbalance of thigh muscles (quadriceps and hamstrings) that support the knee joint
- Tight quadriceps and hamstring muscles
- Problems with alignment of the legs between the hips and the ankles
- Poor training techniques
- Too much of one activity (Overuse)
- Changes - e.g. in footwear, playing surface, type of training, amount of training
Symptoms
- Usually begins gradually as a dull achy pain
- Frequently brought on by activity
- Generally aggravated by particular activities such as walking, running (especially downhill), stairs (especially going down stairs), squatting, jumping, getting up after prolonged sitting
Management
- Avoiding the trigger activity if appropriate. This may be all that is needed
- Ice pack after activity
- Simple pain relief mediation such as ibuprofen - please speak to your Pharmacist or GP
- Supportive footwear is important
- Modification of training, quadriceps strengthening, hip muscle strengthening and core strength improvement. Referral to a physiotherapist is therefore often appropriate
Osgood Schlatters
This is a term often used to describe knee pain where the pain is just below the knee on the shin bone. Its most common in active, young people around 10-14 years who are going through a growth spurt.
Cause
Growth spurts can cause tight muscles particularly around the front of your thigh (Quadriceps muscle). The quadriceps muscle attaches to the top of your shin bone. Repeated strain on this tight muscle can pull on the bone and cause inflammation and pain. As this heals a hard bony bump may develop.
Symptoms
- Pain and swelling on the bony part at the top of the shin bone, under the knee
- A bony lump which is sore when touched or when you kneel
- Pain during sport at the front of the knee
Management
- Ice pack after activity
- Simple pain relief mediation such as ibuprofen - please speak to your Pharmacist or GP
- Reducing the amount of activity you do until the pain reduced, particularly any running and jumping activities.
- Stretches to loosen up your quadriceps muscle so that they don’t pull so tightly on your bones (as long as they dont aggravate your pain). Therefore referral to physiotherapy is often appropriate.
For more infomation have a look at this leaflet from the APCP
When to seek further advice
- If it is causing you to limp
- If you have any hip or thigh pain
- If it is affecting your day to day activities or hobbies
- If it is waking you up at night and stops you getting back to sleep
- If you have redness, warmth and/or swelling around the knee
- If the knee is stiff and you struggle to move it in a morning
- If your pain is getting worse
- If you have had an accident or injury and your pain isn't improving
If any of these are true for you then please see our Getting more help page
Heel pain and foot pain
Heel and foot pain is common in children and young people and for the majority the cause is Sever's Disease which we have detailed further below.
Prevention
To try to prevent heel and foot pain, we recommend:
- Keeping physically active to keep your muscles strong
- Stretching your calf muscles after walking or any physical activity, particularly during growth spurts
- Avoiding overuse of one activity - see this link for more information
- Wearing supportive shoes for any walking or physical activity
- You can also try these stretches and strengthening exercises to prevent heel and foot pain:
[Exercises inc. pics here: gastroc stretch, soleus stretch, heel raises]
Flat feet and heel/foot pain
Sometimes if your feet are rolling inwards this can contribute to heel and foot pain.
Please contact Podiatry and ask for a children's gait clinic assessment where they may provide you with insoles to help your foot posture and in turn help your heel and foot pain
Sever's Disease
Sever's Disease, also known as Calcaneal Apophysitis, is the most common cause of heel pain in children aged approximately 8 to 14 years old.
Cause
The calf muscles attach to your heel via the Achilles Tendon. If they are tight, for example after a growth spurt, the tendon can pull on the heel bone where there is a growth plate causing inflammation and pain.
This can be exaggerated if your child is involved in sports that involve running and jumping.
Symptoms
- Pain at the lower back of one or both heels, which can also spread to the sides and bottom of your heel
- Pain that worsens during or after activity
- Swelling, redness, or a lump at the heel
- Difficulty walking / limping / walking on toes
- Discomfort or stiffness in the ankles/feet after sleep
Management
It will go away on its own when you stop growing, but there are some things you can do to help relieve the pain.
- Reduce the time spent on running and jumping activities. You can take up swimming to keep your fitness up, or other activities that don't aggravate your heel pain.
- Ice pack after activity, and elevate your foot if swollen after activity.
- Simple pain relief mediation such as ibuprofen - please speak to your Pharmacist or GP
- Supportive shoes. Try to avoid any activities in bare feet. You can also try a heel cushion/gel pad inside footwear.
- Stretches to loosen to calf muscle and reduce the pulling on the heel. Therefore, referral to Physiotherapy can be beneficial. [attach stretch pics]
When to seek further advice
- If your pain is not improving
- If is affecting your walking or daily activities
- If you have any redness, swelling, warmth around the area
- If you have stiffness in the morning when trying to move your foot/ankle
then please see out Getting more help page
Back pain
Back pain in children and adolescents is considered common. It is estimated that 30-70% of 10-17 year olds report episodes of back pain. Typically this is in the lower back area.
Back pain in children 7 years and under
Please note back pain in children 7 years and under is less common and therefore we recommend further assessment via a Consultant before your child is referred to us
Prevention
The key to preventing low back pain is to:
- take part in regular physical activity - Is your child meeting the NHS activity guidelines?
- reduce any long periods of sitting or lying down time. You may need to negotiate screen time limits
- check your sitting posture and ensure you change position every 20 minutes
- Ensure you do not do too much of one activity as overuse [link!] can also cause back pain.
- Keeping your muscles stretchy particularly through growth spurts, and maintain strong core, back and hip muscles. You can try a beginners online Pilates or core and glut strengthening video, or here are some great exercises to help prevent lower back pain:
[insert exercises with pics: -bridge, -bird-dog, -pelvic tilts/cat-cow, -hamstring stretch]
Non-specific low back pain
The most common cause of low back pain in adolescents is muscular also termed 'mechanical' or 'non-specific' low back pain which we have discussed in more detail here.
Cause
The pain can be aggravated by:
- Low levels of physical activity
- Prolonged sitting, lying or standing time
- Poor posture / Lack of change of position
- Growth spurt
- Very high levels of physical activity of one (Overuse)
- Recent hormonal changes i.e. start of menstrual cycle or puberty
- Heavy school bags especially when worn on one shoulder
- Carrying items that are too heavy repeatedly, or incorrect lifting/carrying technique
- Low mood or reduced social support or interaction
- Increased BMI
Symptoms
- Generalised aching into lower and/or mid back
- Tightness in back with activity
- Pain worsens with increased activity or prolonged activity
- Pain increases with sitting up straight from a slouched posture
- Pain improves with rest however irritated with prolonged sitting in hard chairs i.e. school chairs
- Pain improves with hot water bottle/shower or bath
Management
Similarly to our preventing back pain section, here are some tips on how you can try to self manage your back pain:
- take part in regular physical activity - Is your child meeting the NHS activity guidelines?
- ensure you do not do too much of one activity as overuse [link!] can also cause back pain.
- reduce any long periods of sitting or lying down time. You may need to negotiate screen time limits
- check your sitting posture and ensure you change position every 20 minutes
- keep your muscles stretchy particularly through growth spurts, and maintain strong core, back and hip muscles. You can try a beginners online Pilates or core and glut strengthening video, or see our preventing back pain section for some useful exercises.
If your back pain is not improving please see our Getting more help page
When to seek further advice
- Any changes to bladder or bowel movements including overflow or accidents
- Changes to the sensation around your groin or bottom o not feeling the tissue when your wipe
- Regular or constant night pain
- Regular night sweats
- History of trauma/fall or accident
- Noticeable curvature in spine (sideways or forwards)
- Unplanned weight loss
- Pain not settled with rest or reduction of activity
- Back pain with leg or arm pain
- Early morning stiffness that takes more than 20 minutes to get better
- Your back pain is not improving
Then please see our Getting more help page
Local clubs
Please see the attached document for a list of clubs around Telford and Shropshire:
[Upload document]
Helpful leaflets and documents summary
School rucksack advice from APCP
Osgood Schlatters leaflet from APCP
Physio exercises to prevent knee pain
Physio exercises to prevent heel and ankle pain
Physio exercises to prevent back pain
Getting more help
Please see our Getting more help page which includes how to get referred to physio if needed