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

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

Children aged 1-4 years old should be physically active for at least 180 minutes (3 hours) a day. 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

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) a day across the week
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

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 we 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 don't aggravate your pain). Therefore referral to physiotherapy is often appropriate.

For more information 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]

For more information have a look at this leaflet from the APCP

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 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 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 glute 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