“my child is the patient”
Navigating your healthcare system is complex enough when are the patient… When your child is the patient well, things are even more complicated. You have the added stress of not being able to know for sure what your child is experiencing, and concerns about whether or not your child is able to effectively communicate what they are feeling. Sifting through the possible causes of your child’s symptoms is no small task. In making a decision on how to proceed, you are likely to weigh up the opinions of friends, family, doctors, other health professionals, and of course the internet. It’s difficult to know for sure which info is the “right” info. Often as the healthcare “consumer”, there is a risk that you will be provided contradictory information from different health professionals. This is confusing and frustrating.
In general, I think contradictory advice is usually an indication of how little is known for sure about a given condition or set of symptoms. It might be a surprise for you to learn that much of what is accepted as mainstream, “proven” treatment for injuries and/or painful conditions is not supported by particularly strong or definitive evidence. Thus we see the evolution of divergent diagnoses for similar sets of symptoms, and the evolution of divergent treatment regimes for said diagnoses. That is messy for you, and your child.
Children suffer many of the same injuries as their adult counterparts. However, the structure of bone and cartilage of the growing child or adolescent is different than that of an adult. As such, children and adolescents carry a higher risk profile for:
- injuries to growth plates of bones
- avulsion/traction injuries of bone at tendon attachment sites
- greenstick fractures to long bones
- injuries to cartilage (osteochondrosis)
- children also tend to have difficulty coordinating their ever lengthening limbs and body, which can reasonably be thought to increase risk of injury.
This decision is usually derived from an assessment of the mechanism of injury, how much time has passed since the injury occurred, x-ray/MRI reports etc. Essentially we need to work out…
- Which tissues and joint structures your child has injured
- What stage of healing these injured structures in
- Is it safe to start rehabilitative movements and loading of the injury?
Feel free to call us on 9665 9667 to discuss your child’s situation.
The decision to start Physio is usually straight forward, given that we have a good understanding of the healing timelines for tissues that children typically injure. Decisions regarding how to safely progress Physio are more complex, because we need to deal not just with the healing injury, but also the protective stiffness, pain and movement habits that set in following injuries to children and adolescents.
Following an injury our bodies shift into “protection mode”. What this means is that the injured joint or body part stiffens and becomes painful. The stiffness is the result of protective tensioning of muscles around the injured area. The pain and stiffness is our body’s most effective mechanism for forcing us to take it easy on our injured joints or body parts. We humans have evolved a very effective mechanism for protecting ourselves if/when we are subjected to trauma. From a treatment perspective, our goal is to ensure that this protective response lasts only as long as is necessary to facilitate complete healing and rehabilitation.
PHASE 1. CALM THE SYSTEM DOWN
The first phase of your child’s rehabilitation is all about reducing the level of unnecessary guarding in the muscles surrounding the injured joint, and also other muscles that maybe secondarily “protective” following injury.
This occurs naturally, as time passes and the injury heals. However, we can help the process along with manual therapy and gentle movement interventions. The trick is to unload the injured tissues and reduce the extent to which the brain is constantly receiving “danger” messages from the injured body part. Manual therapy techniques that unload the injury and slowly but surely explore the limits of stiffness and pain will help to build up a bank of “non threatening” movement experiences that help to drive a shift out of “protection mode”
PHASE 2. EXPLORE RANGE OF MOTION
Exploring movement follows on from, and usually overlaps with those manual therapy techniques that serve the purpose of calming down the protective responses that arise following injury. The exploring movement phase involves both passive and active components. Passive exploration is where the PT safely maneuvers the injured joint in different directions, with a speed and intensity of movement that results in a decreased stiffness, soreness and pain. Active movement are carried out by your child, under close supervision to ensure for safety and appropriate progressions.
By the end of phase 2, your child will feel will be able to move freely enough to safely commence coordination and strengthening exercises.
PHASE 3. RESTORE COORDINATION & STRENGTH
We usually begin very basic strength or gentle activation exercises early in the rehabilitation process, as part of a confidence building strategy, to help assist with shifting your child’s system out of “protection mode”.
However, we don’t really start getting into restoration of coordination and strength until the injured body part is moving freely and we are confident that your child’s healing tissues/structures can tolerate loading. Once ready, we begin an exercise regime that follows the principles of graded exposure. Graded exposure is all about making sure we get the dosage of exercise parameters to match your stage of recovery.
Phase 3 is about selecting an appropriate intensity, duration and frequency of load to subject the injury to, and progressing the parameters gradually to facilitate a return to your preferred recreational, sporting and occupational activities.
By virtue of their accelerated metabolism, children and adolescents are quick healers following injury. A rapid resolution of protective stiffness and pain best ensures a rapid and durable resolution of symptoms. The rehabilitation process can be broken down into 3 phases:
- Calm the protective responses
- Safely explore movement
- Safely restore strength and coordination