Paediatric Musculoskeletal Development: Difference between revisions
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|2 years old | |2 years old | ||
|Oblong-Shaped | |Oblong-Shaped | ||
|Depressed due to | |Depressed due to [[Diaphragm Anatomy and Differential Diagnosis|diaphragm]] pull and sitting/standing/walking | ||
|Lateral Expansion | |Lateral Expansion | ||
|- | |- | ||
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== Trunk == | == Trunk == | ||
* infancy begins with kyphotic spine moving into a more neutral spine | * infancy begins with [[Kyphosis|kyphotic]] spine moving into a more neutral spine | ||
* prone push-ups and sitting activates posterior chain musculature | * prone push-ups and sitting activates posterior chain musculature | ||
* crawling creates co-contraction of anterior and posterior muscles<ref name=":0" /> | * crawling creates co-contraction of anterior and posterior muscles<ref name=":0" /> | ||
| Line 48: | Line 48: | ||
* 12 months old: 12 degrees of anterior pelvic tilt | * 12 months old: 12 degrees of anterior pelvic tilt | ||
* 30 months old: 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 Muscles|gluteal]] activity, anterior tilt decreases slightly until age 8 | ||
* adult: 10 degrees of anterior pelvic tilt<ref name=":0" /> | * adult: 10 degrees of anterior pelvic tilt<ref name=":0" /> | ||
| Line 78: | Line 78: | ||
* abdominals and hip extensors long | * abdominals and hip extensors long | ||
* hip flexors and lumbar extensors short | * 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<ref name=":0" /> | * '''results''': unable to have appropriate muscle pull of both abdominals and [[Gluteal Muscles|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|gluteus maximus]] is shortened | ||
* '''results''': hip laxity in the front and hip instability<ref name=":0" /> | * '''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) | * depressed hip side (shorter side) | ||
** increased pronation of the foot on that extremity | ** increased pronation of the foot on that extremity | ||
| Line 128: | Line 128: | ||
** decreased balance | ** decreased balance | ||
* increase Q-angle | * increase Q-angle | ||
** quad less efficient secondary to abnormal muscle pull | ** [[Quadratus Femoris|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<ref name=":0" /> | * protective in-toeing<ref name=":0" /> | ||
| Line 148: | Line 148: | ||
* loading | * loading | ||
* static positioning devices | * static positioning devices | ||
* splinting | * [[splinting]] | ||
* bracing<ref name=":0" /> | * [[Bracing for Clubfoot|bracing]]<ref name=":0" /> | ||
== Resources == | |||
* [[Biomechanics]] | |||
* [[Infant Development]] | |||
* [[Coxa Vara / Coxa Valga]] | |||
== References == | |||
Revision as of 23:18, 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 diaphragm 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:
