Paediatric Musculoskeletal Development
Original Editor - Robin Tacchetti based on the course by Krista Eskay
Top Contributors - Robin Tacchetti, Jess Bell and Naomi O'Reilly
Top Contributors - Robin Tacchetti, Jess Bell and Naomi O'Reilly
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, pelvis rotation on short side,[1]
- Significant increase in pelvic obliquity: seating imbalance, pain from pelvic impingement on the ribs and ischial decubitus ulcers [2]
Knee[edit | edit source]
- newborn: genu varum[3]
- toddler: genu valgus
- 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
- 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: high arch[1][6]
- 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:
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 Eskay, K. Paediatric Musculoskeletal Development. Plus. 2023
- ↑ Karkenny AJ, Magee LC, Landrum MR, Anari JB, Spiegel D, Baldwin K. The Variability of Pelvic Obliquity Measurements in Patients with Neuromuscular Scoliosis. JBJS Open Access. 2021 Jan;6(1).
- ↑ A El-Hak AH, Shehata EM, Zanfaly AI, Soudy ES. Genu Varum in Children; Various Treatment Modalities for Bowleg's Correction. The Egyptian Journal of Hospital Medicine. 2022 Apr 1;87(1):1858-63.
- ↑ Ganeb SS, Egaila SE, Younis AA, El-Aziz AM, Hashaad NI. Prevalence of lower limb deformities among primary school students. Egyptian Rheumatology and Rehabilitation. 2021 Dec;48:1-7.
- ↑ Çankaya T, Dursun Ö, Davazlı B, Toprak H, Çankaya H, Alkan B. Assessment of quadriceps angle in children aged between 2 and 8 years. Turkish Archives of Pediatrics/Türk Pediatri Arşivi. 2020;55(2):124.
- ↑ Sanpera I, Villafranca-Solano S, Muñoz-Lopez C, Sanpera-Iglesias J. How to manage pes cavus in children and adolescents?. EFORT Open Reviews. 2021 Jun;6(6):510.
