Musculoskeletal Conditions in Children

Children are referred to physiotherapy when they complain of pain or discomfort which is affecting their function and/or causing deformity. Persistent night pain in children should be carefully investigated.

Musculoskeletal Conditions may include:

Persistent Anterior Knee Pain:

If pain on activity persists for more than 3 weeks - physiotherapy assessment and advice, muscle strengthening and management would be appropriate.

Hip Pain on Activity:

Persisting for more than 3 weeks - Refer to Paediatric Physiotherapy. If there is an asymmetrical range of movement or a trendelenburg gait present, a hip x ray may be required to exclude any underlying pathology.

Ankle Pain/Instability:

After an acute ankle injury; general PRICE Guideline Advice (protection, rest, ice, compression, elevation) should be followed - Do not Refer to Paediatric Physiotherapy

If there are repeated injuries or full function has not been gained by 4 weeks post injury or if there is chronic ankle pain - Refer to Paediatric Physiotherapy for muscle strengthening and proprioceptive work

Back/Neck Pain:

If the pain has been present for more than 3 weeks or if it is felt the child's poor posture is causing pain and discomfort - Refer to Paediatric Physiotherapy

Posture Advice

Torticollis from Birth:

If a child presents with a preferred head turn Refer to Paediatric Physiotherapy

Wrist/ Hand:

Refer to Paediatric Occupational Therapy

Shoulder Pain/ Instability:

After acute injury PRICE Guideline Advice (protection, rest, ice, compression, elevation) should be followed - Do not Refer to Paediatric Physiotherapy

If pain persists for more that 3 weeks or there are recurrent painful subluxations - Refer to Paediatric Physiotherapy

Scoliosis:

If there is a structural scoliosis noted a referral to an orthopaedic team for assessment and possible management is indicated - Do not Refer to Paediatric Physiotherapy

Soft Tissue Injuries affecting Function:

After an acute soft tissue injury PRICE guidelines should be followed - Do not Refer to Paediatric Physiotherapy.

If pain on activity is present for more than 3 weeks or there is a functional abnormality - Refer to Paediatric Physiotherapy

Post Fracture:

When full function has not returned within an expected time. Once told they can return to full function by their consultant, many children will gain muscle strength and mobility quickly - Do not Refer to Paediatric Physiotherapy.

If the child is anxious and does need a programme of advice and exercise in order to regain pre injury function - Refer to Paediatric Physiotherapy

Elbow Fractures:

Once a child is out of plaster, they should be encouraged to straighten their elbow actively. See Elbow Fracture Sheet. They usually regain full movement after a few weeks without the need for physiotherapy intervention - Do not Refer to Paediatric Physiotherapy.

Intoeing/Outtoeing/Knock Knees:

Parents are often anxious if their child looks different to another child of the same age. There is a vast range of 'normal' and physiotherapy is not required for the majority of children presenting with these cosmetic diagnoses.  Intoeing Gait Abnormalities 

Flat Feet:

Many young children have flexible flat feet. If there is full range of movement available around the ankle and foot, neither insoles nor physiotherapy are required in the majority of children - Do not Refer to Paediatric Physiotherapy.
Gait Abnormalities. Baby Feet Poster. 

Persistent Toe Walkers:

In a child under 5 this is not normally of concern, if certain criteria have been excluded. Over 5 years, persistent toe walking - Refer to Paediatric Physiotherapy

Hypermobility:

Physiotherapists will only see children for a course of strengthening exercises if they complain of pain because of their hypermobility. In many children, flexibility around their joints does not cause any problems and general advice regarding exercise should be given - Do not Refer to Paediatric Physiotherapy. Hypermobility



Last updated: 02/05/2012

Update due: 02/05/2013