Paediatric Musculoskeletal Development: Difference between revisions
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== Introduction == | == Introduction == | ||
As an infant grows, movement patterns develop that affect their bony alignment. As movement patterns are practiced thousands of times a day any abnormal muscle pull can create atypical alignment. Abnormal muscle pulls can be caused by genetic conditions and impairments with abnormal tone. Atypical alignment can directly affect | As an infant grows, movement patterns develop that affect their bony alignment. As movement patterns are practiced thousands of times a day any abnormal muscle pull can create atypical alignment. Abnormal muscle pulls can be caused by genetic conditions and impairments with abnormal tone. Atypical alignment can directly affect functional activities and active participation.<ref name=":0">Eskay, K. Paediatric Musculoskeletal Development. Plus. 2023</ref> | ||
The following sections will highlight typical musculoskeletal development for an infant | The following sections will highlight typical musculoskeletal development for an infant, changes that progress over time. and any abnormal outcomes. | ||
== Rib Cage == | == Rib Cage == | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
<ref name=":0" /> | |||
!Rib Cage | !Rib Cage | ||
!Shape | !Shape | ||
| Line 21: | Line 22: | ||
|Lateral Expansion | |Lateral Expansion | ||
|- | |- | ||
|Abnormal | |**Abnormal | ||
|Persistence of Barrel-Shape | |**Persistence of Barrel-Shape | ||
| | | | ||
| | | | ||
| Line 29: | Line 30: | ||
== Trunk == | == Trunk == | ||
* begins with kyphotic spine moving into a more neutral spine | * infancy begins with kyphotic spine moving into a more neutral spine | ||
* prone push- | * prone push-ups and sitting activates posterior chain musculature | ||
* crawling creates co-contraction of anterior and posterior muscles | * crawling creates co-contraction of anterior and posterior muscles<ref name=":0" /> | ||
=== Increased Curvature of Spine === | === Increased Curvature of Spine === | ||
An abnormal increased curvature of spine | An abnormal increased curvature of spine affects: | ||
* breathing | * breathing | ||
* lung positioning | * lung positioning | ||
* heart location | * heart location | ||
* visceral function | * visceral function<ref name=":0" /> | ||
== Pelvis == | == Pelvis == | ||
* | * infancy begins with rounded pelvis and posterior tilt | ||
* | * sitting and standing activates core muscles and anterior pelvic tilt | ||
* 12 months: 12 degrees of anterior pelvic tilt | * 12 months old: 12 degrees of anterior pelvic tilt | ||
* 30 months: 15 degrees of anterior tilt | * 30 months old: 15 degrees of anterior tilt | ||
* with increased gluteal activity, anterior tilt decreases slightly until age 8 | * with increased gluteal activity, anterior tilt decreases slightly until age 8 | ||
* adult: 10 degrees of anterior pelvic tilt | * adult: 10 degrees of anterior pelvic tilt<ref name=":0" /> | ||
== Lower Extremity == | == Lower Extremity == | ||
Below is the lower extremity normal infant pattern for each joint: | |||
* hip: flexion, abduction and lateral rotation | * hip: flexion, abduction and lateral rotation | ||
* knee: flexion, genu varum, medial rotation of tibia | * knee: flexion, genu varum, medial rotation of tibia | ||
* ankle: dorsiflexion, slight pronation | * ankle: dorsiflexion, slight pronation<ref name=":0" /> | ||
=== Hip === | === Hip === | ||
* | * Infants: | ||
** high external rotation | |||
*** decreases over time | |||
** hip adduction limitation | ** hip adduction limitation | ||
** 34 degrees of hip extension limitation | ** 34 degrees of hip extension limitation | ||
*** | *** more time in prone - anterior capsule stretches | ||
*** 6 weeks old: 19 degrees of hip extension limitation | *** 6 weeks old: 19 degrees of hip extension limitation | ||
*** toddlerhood: 7 degrees of hip extension limitation | *** toddlerhood: 7 degrees of hip extension limitation | ||
| Line 68: | Line 70: | ||
** decreases over time to adult - 126 degrees. | ** decreases over time to adult - 126 degrees. | ||
** more ambulatory, lower femoral neck angle | ** more ambulatory, lower femoral neck angle | ||
* newborn: | * newborn: anteversion of the femur - 40 degrees | ||
** adult- 16 degrees | ** adult- 16 degrees | ||
<nowiki>**</nowiki> Abnormal: femoral neck angle remains high: high femoral anteversion: increase risk of posterior hip dislocation (especially cautious of this with non-walkers at 30 months | <nowiki>**</nowiki> Abnormal: femoral neck angle remains high: high femoral anteversion: increase risk of posterior hip dislocation (especially cautious of this with non-walkers at 30 months<ref name=":0" /> | ||
==== Increased anterior pelvic tilt: ==== | ==== Increased anterior pelvic tilt: ==== | ||
* abdominals and hip extensors | * abdominals and hip extensors long | ||
* hip flexors and lumbar extensors | * hip flexors and lumbar extensors short | ||
* results: unable to have appropriate muscle pull of both abdominals and gluteus muscles when you're performing functional activities | * '''results''': unable to have appropriate muscle pull of both abdominals and gluteus muscles when you're performing functional activities<ref name=":0" /> | ||
==== Decreased anterior pelvic tilt ==== | ==== Decreased anterior pelvic tilt ==== | ||
* iliopsoas and anterior hip capsule is stretched out | * iliopsoas and anterior hip capsule is stretched out | ||
* gluteus maximus is shortened | * gluteus maximus is shortened | ||
* results: hip laxity in the front and hip instability | * '''results''': hip laxity in the front and hip instability<ref name=":0" /> | ||
==== Pelvic obliquity ==== | ==== Pelvic obliquity ==== | ||
* common in patients with hemiplegia and diplegia | * common in patients with hemiplegia and diplegia | ||
* | * depressed hip side (shorter side) | ||
** increased pronation of the foot on that extremity | ** increased pronation of the foot on that extremity | ||
** reduced stance time | ** reduced stance time | ||
** reduced loading | ** reduced loading | ||
** functional ankle plantarflexion | ** functional ankle plantarflexion | ||
* long side | * long side | ||
** foot pronation | ** compensatory foot pronation | ||
** medial rotation of the lower extremity | ** medial rotation of the lower extremity | ||
** knee flexion | ** compensatory knee flexion | ||
* | * '''results''': gait asymmetry and pelvis rotation on short side<ref name=":0" /> | ||
=== Knee === | === Knee === | ||
| Line 102: | Line 102: | ||
* newborn: genu varum | * newborn: genu varum | ||
* toddler: genu valgus | * toddler: genu valgus | ||
** maximum around 2 1/2 years old | ** maximum valgus peaks around 2 1/2 years old | ||
** decreases over time | ** decreases over time | ||
* adult: neutral | * adult: neutral | ||
* newborn: 30 degree knee flexion contracture | * newborn: 30 degree knee flexion contracture | ||
** resolves first few months of life | ** resolves first few months of life | ||
* | * newborn: medial rotation of the tibia | ||
** 12 months: medial rotation resolve | ** 12 months: medial rotation resolve<ref name=":0" /> | ||
==== Increased medial tibial torsion ==== | ==== Increased medial tibial torsion ==== | ||
| Line 114: | Line 114: | ||
* not common | * not common | ||
* toeing in | * toeing in | ||
* most likely medial rotation occurring higher up in the chain | * most likely medial rotation occurring higher up in the chain<ref name=":0" /> | ||
==== Increased lateral tibial torsion ==== | ==== Increased lateral tibial torsion ==== | ||
* crouched posture | * presents with crouched posture<ref name=":0" /> | ||
==== Increased genu valgus ==== | ==== Increased genu valgus ==== | ||
Possible | Possible impairments: | ||
* calf, thigh and knee | * pain in calf, thigh and/or knee | ||
* increased fatigue with activities | * increased fatigue with activities | ||
* less efficient gait | * less efficient gait | ||
| Line 129: | Line 129: | ||
* increase Q-angle | * increase Q-angle | ||
** quad less efficient secondary to abnormal muscle pull | ** quad less efficient secondary to abnormal muscle pull | ||
* lateral subluxation of the patella | * lateral subluxation of the patella | ||
* collapse of medial foot arch | * collapse of medial foot arch | ||
* protective in-toeing | * protective in-toeing<ref name=":0" /> | ||
=== Ankles/Feet === | === Ankles/Feet === | ||
* | * newborn: hindfoot varus | ||
** weight-bearing changes to valgus | |||
* newborn: feet straight forward or slight toeing out | |||
* adulthood: toeing out increases | * adulthood: toeing out increases | ||
* newborn: arch | * newborn: arch | ||
* adult: flat feet | * adult: flat feet<ref name=":0" /> | ||
== Physiotherapy Role == | == Physiotherapy Role == | ||
Physiotherapists can facilitate correct movement patterns to attain proper bio-mechanical alignment. The earlier in life the interventions are applied, the better the functional outcome will be. Some of the interventions that physiotherapist can use are listed below: | |||
* weight shifts | |||
* loading | |||
* static positioning devices | |||
* splinting | |||
* bracing<ref name=":0" /> | |||
Revision as of 23:07, 3 February 2023
Introduction[edit | edit source]
As an infant grows, movement patterns develop that affect their bony alignment. As movement patterns are practiced thousands of times a day any abnormal muscle pull can create atypical alignment. Abnormal muscle pulls can be caused by genetic conditions and impairments with abnormal tone. Atypical alignment can directly affect functional activities and active participation.[1]
The following sections will highlight typical musculoskeletal development for an infant, changes that progress over time. and any abnormal outcomes.
Rib Cage[edit | edit source]
| Rib Cage | Shape | Location of Ribs | Other |
|---|---|---|---|
| Infant | Barrel-Shaped | Elevated; Perpendicular to Spine | Rigid |
| 2 years old | Oblong-Shaped | Depressed due to diagragm pull and sitting/standing/walking | Lateral Expansion |
| **Abnormal | **Persistence of Barrel-Shape |
Trunk[edit | edit source]
- infancy begins with kyphotic spine moving into a more neutral spine
- prone push-ups and sitting activates posterior chain musculature
- crawling creates co-contraction of anterior and posterior muscles[1]
Increased Curvature of Spine[edit | edit source]
An abnormal increased curvature of spine affects:
- breathing
- lung positioning
- heart location
- visceral function[1]
Pelvis[edit | edit source]
- infancy begins with rounded pelvis and posterior tilt
- sitting and standing activates core muscles and anterior pelvic tilt
- 12 months old: 12 degrees of anterior pelvic tilt
- 30 months old: 15 degrees of anterior tilt
- with increased gluteal activity, anterior tilt decreases slightly until age 8
- adult: 10 degrees of anterior pelvic tilt[1]
Lower Extremity[edit | edit source]
Below is the lower extremity normal infant pattern for each joint:
- hip: flexion, abduction and lateral rotation
- knee: flexion, genu varum, medial rotation of tibia
- ankle: dorsiflexion, slight pronation[1]
Hip[edit | edit source]
- Infants:
- high external rotation
- decreases over time
- hip adduction limitation
- 34 degrees of hip extension limitation
- more time in prone - anterior capsule stretches
- 6 weeks old: 19 degrees of hip extension limitation
- toddlerhood: 7 degrees of hip extension limitation
- high external rotation
- newborn: increased coxa valga - 140-160 degrees
- decreases over time to adult - 126 degrees.
- more ambulatory, lower femoral neck angle
- newborn: anteversion of the femur - 40 degrees
- adult- 16 degrees
** Abnormal: femoral neck angle remains high: high femoral anteversion: increase risk of posterior hip dislocation (especially cautious of this with non-walkers at 30 months[1]
Increased anterior pelvic tilt:[edit | edit source]
- abdominals and hip extensors long
- hip flexors and lumbar extensors short
- results: unable to have appropriate muscle pull of both abdominals and gluteus muscles when you're performing functional activities[1]
Decreased anterior pelvic tilt[edit | edit source]
- iliopsoas and anterior hip capsule is stretched out
- gluteus maximus is shortened
- results: hip laxity in the front and hip instability[1]
Pelvic obliquity[edit | edit source]
- common in patients with hemiplegia and diplegia
- depressed hip side (shorter side)
- increased pronation of the foot on that extremity
- reduced stance time
- reduced loading
- functional ankle plantarflexion
- long side
- compensatory foot pronation
- medial rotation of the lower extremity
- compensatory knee flexion
- results: gait asymmetry and pelvis rotation on short side[1]
Knee[edit | edit source]
- newborn: genu varum
- toddler: genu valgus
- maximum valgus peaks around 2 1/2 years old
- decreases over time
- adult: neutral
- newborn: 30 degree knee flexion contracture
- resolves first few months of life
- newborn: medial rotation of the tibia
- 12 months: medial rotation resolve[1]
Increased medial tibial torsion[edit | edit source]
- not common
- toeing in
- most likely medial rotation occurring higher up in the chain[1]
Increased lateral tibial torsion[edit | edit source]
- presents with crouched posture[1]
Increased genu valgus[edit | edit source]
Possible impairments:
- pain in calf, thigh and/or knee
- increased fatigue with activities
- less efficient gait
- decreased gait velocity
- decreased balance
- increase Q-angle
- quad less efficient secondary to abnormal muscle pull
- lateral subluxation of the patella
- collapse of medial foot arch
- protective in-toeing[1]
Ankles/Feet[edit | edit source]
- newborn: hindfoot varus
- weight-bearing changes to valgus
- newborn: feet straight forward or slight toeing out
- adulthood: toeing out increases
- newborn: arch
- adult: flat feet[1]
Physiotherapy Role[edit | edit source]
Physiotherapists can facilitate correct movement patterns to attain proper bio-mechanical alignment. The earlier in life the interventions are applied, the better the functional outcome will be. Some of the interventions that physiotherapist can use are listed below:
- weight shifts
- loading
- static positioning devices
- splinting
- bracing[1]
