"Hip pain in kids: Legg-Calve Perthes Disease"-Issue 14

Legg-Calve Perthes disease is a condition in children in which the ball shaped head of the thigh bone loses its blood supply.  Without blood, the bone tissue dies and the bone collapses.  As the bone collapses, the head of the thigh bone becomes less rounded, changing the movement and stability of the hip.  This causes stiffness, inflammation and pain to occur.

         Often, the first noticeable sign of the condition is a child that begins to limp.  This limp can occur with or without pain and often has no incident of a fall or trauma to tie to it. Pain will typically be located in the hip, knee or groin.  This pain will typically increase with activity and calm with rest. 

Although any child can develop Legg-Calve Perthes, it typically occurs in active children between the ages of 4 to 8 years old. Research documents that boys are four times more likely to get the diagnosis than girls.   

As the condition runs its course, the body begins to absorb, or “clean up” the dead bone cells and replace them with new, healthier bone cells.  It is during this time that treatment by a physician and/or physical therapist becomes vital.

Early diagnosis and treatment allow as much time as possible for the bone to remodel itself back into a round shape.

Without proper or timely treatment, the condition becomes more serious and the bone is more likely to heal in an improper position or shape.  Studies indicate that if the ball does not reshape well, or fit well into its socket the child is at a high risk of developing degenerative arthritis at a very early age.

In contrast, with proper and timely treatment arthritis is typically not a concern later in life.

Treatment goals should include: controlling pain, maintaining hip range of motion, increasing hip strength and preventing any additional hip deformity as the bone reshapes.  This can typically be achieved through physical therapy treatment, limited activity and limited weight bearing.

Occasionally, surgery or bracing will also need to be implemented to resolve the condition. Children who are older than six or who have more severe cases of Perthes disease are more likely to benefit from surgery in addition to physical therapy. The goal of surgery is to prevent the dislocation or collapse of the hip.

The majority of children treated for Legg Calve Perthes have corrections that enable them to walk, grow and live active lives. Diagnosing and treating early in its development greatly increases the likelihood of a successful outcome.

Hip pain in children is always a cause for concern and should be immediately assessed by a physician to rule out potentially serious conditions such as this one. Any child who has been treated for a hip disorder should be followed periodically by his or her orthopedist until skeletal maturity is achieved.

QUICK TIPS:

Signs and Symptoms:

• Walking with a limp
• Complaints of pain in the hip, knee or groin
• Pain that aggravates with activity
• Pain that calms with rest

Who is most likely to get it? 

•  Boys are 4 to 5 times more likely to be affected
• More common in children exposed to second hand smoke
• Affected children are typically:

o   Between ages 4 -8

o   Very physically active

o   Smaller for their age

 References:
1.www.childrenshospital.org
2. Kim H. Legg Calve Perthes and Slipped Capital Femoral Epiphysis: Major Developmental Causes of Femoroacetabular Impingement. J Am Acad Orthop Surg. 2013. 21: 559-563.
3. Perry et al. Abnormalities of Vascular Structure and function in Children with Perthes Disease. Pediatrics. 2012. 130:126-131.

"Kids Strength Training: Weight or Wait?"-Issue 13

Strength training is a common component for youth athletic and physical fitness programs.  In addition to the obvious goal of getting stronger, strength training programs often attempt to improve sport performance, prevent injury, rehabilitate injuries, and/or enhance long-term health.  Strength training programs may include the use of free weights, machine weights, elastic tubing, or body weight exercises.

         Historically, strength training was not recommended for children and adolescents due to the perceived threat of injury, specifically regarding their open growth plates. Further investigation into these injuries suggests that they largely result from a lack of appropriate adult supervision, instruction, or technique and can be prevented. 

Recent studies have shown that supervised strength training programs do not appear to have any adverse effects in children and adolescents and in fact credit these programs to improving overall cardiovascular fitness, mental health, body composition, cholesterol levels and bone density.  These studies also demonstrate compelling evidence that appropriately supervised resistance training can produce substantial increases in muscle strength.

           To design and administer a program appropriate for young children, it is important to understand the unique physical and psychological nature of the child. The child must be mentally and emotionally mature enough to participate.  These programs are only safe and effective if the child is mature enough to understand the process, goals and limitations of the program.  Excessive pressure and unhealthy competition without this maturity can lead to injury both physically and psychologically.

A medical evaluation before beginning a strength-training program can help to identify possible risk factors for injury and provide an opportunity to discuss previous injuries, medical conditions, training goals, and expectations of both the child and the parent. Medical clearance should be obtained when a child has a history of hypertension, receiving chemotherapy, cardiomyopathy, Marfan syndrome, and seizure disorder.

For those beginning a program, proper form and technique should be emphasized. Adequate supervision by a trained adult is mandatory to reduce the risk of injury.  This type of supervision is defined as a trained individual watching no more than ten athletes at one time. The trainer should focus on safety, technique and individual improvement, rather than competition and maximal lifting.  Power lifting and body building should be avoided until physical and skeletal maturity is reached.

Children should begin exercises with no load/weight until proper technique is learned. Once the child can safely perform 8 to 15 repetitions with correct form, it is reasonable to add weight in small increments. Exercises should include all muscle groups and be performed through full range of motion at each joint. The program should be tailored to the individual athlete on the basis of size, age sport and level of experience.  Any sign of injury or illness from strength training should be evaluated before continuing the program.

         To learn more about this topic and others, contact your local physician or physical therapist.

  

 Quick Tips:

• Balance and postural control skills mature at age 7 to 8 years old, strength training should not begin before achievement of these skills
• Most gym equipment is designed for adult sizes and have weight increments too large for young children
• Free weights are small, portable, and require better balance, control and technique to enhance sports performance for the young athlete
•  Strict supervision and adherence to proper technique are mandatory for injury prevention
• Proper supervision is defined as a certified strength training instructor with an instructor-to-student ratio no more than 10 students to 1 instructor
• Power lifting, body building, and maximal lifts should be avoided until reaching physical and skeletal maturity

References:

1.  Faigenbaum et al. The effects of Different Resistance Training Protocols on Muscular Strength and Endurance Development in Children. Pediatrics. 1999; 104(5):1-7. 
2. Council of Sports Medicine and Fitness. Strength Training in Children and Adolescents. Pediatrics. 2008; 121:835-839.
3. Behringer et al. Effects of Resistance Training in Children and Adolescents: A Meta-anaylysis. Pediatrics. 2010; 126:1199-1210.
4. Committee on Sports Medicine and Fitness. Strength Training by Children and Adolescents. Pediatrics. 2001; 107:1470-1472
5. Alleyne et al. Safe exercise prescription for children and adolescents. Pediatr Child Health. 1998; 3(5):337-342.
6. Lubans et al. The effects of free weights and elastic tubing resistance training on physical self-perception in adolescents. Psychology of Sport and Exercise. 2010; 497-504.