Are trampolines safe?

trampoline injuries faye knight childrens physio

 

According to my children, "EVERYONE" has a trampoline (except for poor old us!) It does seem that they are prolific these days and I'm seeing a definite increase in the number of trampoline injuries in clinic now that the good weather has arrived; another broken leg this week. I don't want to be all bah humbug about them as I'm the first person to encourage children to be outside exercising and having fun; all play carries some element of risk.

My two children have loved bouncing on trampolines from a young age. Often, might I add under very little supervision and with multiple children (of all sizes) bouncing. So I am totally aware of how difficult it is to instill rules and control to trampolining at home.  However, I do think we should be aware of some common injuries and how we can reduce the chance of them happening.

A study of hospital admissions shows that half of all activity related accidents in the home involving children under 14 are caused by trampolining, a really high figure. Injuries range from bruises, cuts, sprains and strains to fractures and thankfully more rare but serious, head or spinal injuries. All parts of the body can be affected and the type of injury tends to depend upon the age of the child.

According to The Royal Society for the Prevention of Accidents (RoSPA), injuries still occur even with adult supervision, a net surround and padding. Children under 6 are most at risk of injury and are advised not to bounce on a full size trampoline. 75% of injuries are most likely to occur when there is more than one person on the trampoline especially when the weight of the bouncers are mismatched. I particularly want to make you aware of these unique 'trampoline fractures', as many parents I spoke to hadn't heard of them.

The injury occurs when a second, heavier individual (often an adult) causes the jumping surface to recoil upward as the smaller person is descending. This effect on the smaller person has been compared to falling out of a first floor window! The combined excessive load can produce the characteristic fracture through the upper tibia (shin bone) which is most often seen in children aged 2-6 years. This will result in a definite time in plaster and often some rehab afterwards.

I'm not going to go through all of the guidelines which I'm sure most of you are aware of. You can find them on the RoSpa website.The most simple advise is; adult supervision, avoid somersaults and flips, be especially cautious about children under 6 and only one person bouncing at a time. In particular, no double bouncing with mismatched body weights. As parents we already worry and feel guilty about enough things and I really do know how difficult it is to make children wait for their turn, but a few trampoline rules might prevent a miserable summer ahead...

 

 

http://www.rospa.com/leisure-safety/advice/trampoline/

 

 

How to help your child ride a bike

 

 

My latest blog, with some ideas of how to help your child master riding a bike...

Spring is here and a long hot summer is just around the corner (we live in hope..) It’s a great time for families to get out on their bikes. Children can generally learn to ride between 3-6 years; younger for a child on a balance bike. As with all skills, children’s ability to ride bikes are very varied, some pick it up within a few hours and some take much longer. Additionally, some children have extra needs that may further complicate the issue. I see children in clinic with hypermobility, motor planning problems or learning difficulties to name a few that makes learning to ride more difficult.

Also a note on helmets; please use one and put it on correctly. It should sit 1-2 fingers above the eyebrows, the child should be able to see it when they look up. The side straps should form a Y just below their ear and the strap should be tight enough to only allow a finger underneath.

The best way to learn to ride is mastering each skill separately:

1.       It’s all about the balance

90% of learning to ride is about balance so work on this first. Your child needs to learn to scoot and coast along.

·         Don’t buy a bike too big that they will ‘grow into’.

·         Lower the seat so that your child can place their feet flat on the floor.

·         Remove stabilisers, they won’t help to teach balance. You can also remove the pedals if they are in the way. Or you can use a balance bike.

·         Choose the terrain; a grassy area cut short will provide a softer landing but not create drag; a gentle downhill slope that flattens out is perfect.

·         Encourage them to sit with their bottom on the seat and scoot along with their feet. Move onto lifting up both feet from the ground for increasingly longer times; try playing counting games to encourage this.

·         Once they have mastered scooting and coasting along in a straight line try work on turning; steering through cones that are placed nearer to each other.

 

2.       Move to pedalling!

·      When they are confident with balancing – and don’t be tempted to rush this, you can pop the pedals back on.

·         Keep the seat low initially so they can still stop still.

·         Place the pedal at 2 o’clock in relation to the handlebars and encourage them to press down on the pedal to move forward. Place the ball of the foot on the spindle.

·         You can hold onto their shoulders when they first start off but don’t keep a hold; it won’t help their balance or your back! Remember to tell them you are going to let go and when.

 

3. Stopping

·         While the seat is in its lowered position try practising braking – remembering to squeeze both brakes at the same time – you can play stopping games like ‘green lights, red lights’. When they can achieve this, pop the seat up. To get the correct height, with their bottom on the seat there should be a slight bend in the knee at the bottom of the pedal stroke.

 

4.       Consolidation

·         Now the basic skills are mastered and your child can ride in a straight line, try playing games practising turning and stopping; make the turning circles progressively tighter. You could use a figure of 8, weave between cones and around an obstacle course. Remember to encourage your child to keep their eyes looking forward.

A little aside with regards to stabilisers, there is sometimes a place for them, for example in children who have known balance or motor problems. It enables children to pedal a bike they might otherwise not be able to do and it helps to work on pedal power. Another option for some children is a trike,recumbent or tandem.

Most importantly try to have fun, keep positive with encouragements rather than screaming instructions in half panic ( I speak from experience!) and teach your child how to be safe on their bike.

If your child is really struggling to ride a bike and also has difficulties in other areas of physical development a children’s physiotherapist will be able to offer a full assessment and advice.

 

Growing Pains??

growing pains


I wanted to write about growing pains as there is often much confusion amongst parents. It is a popular and often wrongly used term by parents, teachers and even health professionals as a ‘one size fits all' diagnosis in the growing child. This blog will look at the typical signs of 'growing pains' as opposed to what may be a specific joint or muscle condition that needs prompt assessment and treatment.

True ‘growing pains’ are actually a misnomer but an easier one to remember than their other name 'benign nocturnal limb pains of childhood'! As this name suggests the cause is unknown and it does not appear to be directly related to growth but is more often found in a physically active child and children with hypermobility of their joints. It is really important to ascertain what may be growing pains, as listed below rather than other pains that could be a sign of something more serious, such as arthritis, vitamin D deficiency and even leukemia.

Signs of growing pains:

Usually affects children ages 3-12. It doesn't affect teenagers

Pain in both legs which develops in the evening, but is never there on waking. Pain usually in shins, calves and ankles

There is no change in daytime physical activities

Pain can be very distressing for all the family and is often described as crampy and intense muscle pains

They can come and go but they may be there for months. They do eventually settle with time

Pain is often worse after a very active day

There is no swelling or bruising

The child is healthy and well

There is no limping

 

When should I seek further advice from the doctor ?

Any joint swelling

Pain in a single leg rather than both

Waking every night with pain

Fever, weight loss, lack of appetite

Limping or reluctance to walk

Unable to continue to play sports or join activities because of pain

Pains affecting other parts of the body rather than just legs

 

What can I do to help?

Growing pains can cause much distress to the child, disturb sleep and generally be a miserable time for all the family.

You can try firm massage and/ or give painkillers such as paracetemol or ibuprofen before bed. Sometimes heat help.

Reassure your child that the pain is not serious but that you do understand it exist.

Keeping a diary may help to ascertain when the pain comes on e.g. After a physically active day.

Check your child’s footwear is supportive and fits well.

Don’t stop your child continuing with their usual activities.

 

Pain that does not fit the very specific criteria above should never be dismissed as ‘just a growing pain’, although it may be a problem due to the maturing skeleton. Most children who come to see me with growing pains do not fit this criteria and actually have a specific musculoskeletal condition that can be treated successfully.

Children and parents are often told they 'will grow out of it' , but in fact recent research has found that children diagnosed with ‘growing pains’ in their knees as teenagers are significantly more at risk of osteoarthritis as adults.

Correct assessment and treatment by a children’s physiotherapist will help children who are in pain and get them back into their chosen activities.

 

 

 

 

 

 

Ban the babywalker!

 

Children’s physiotherapists and many other health professions do not recommend the use of baby walkers. By this I mean the walkers on wheels where a baby sits in the middle and can scoot around, usually before they have begun to walk or even sit and crawl. Children will enjoy sitting in them as it gives them the mobility they often crave and it gives parents another option of keeping baby busy.

 

The reason we urge parents not to use walkers are twofold.

Firstly they are dangerous, a baby walker can move up to 7mph; over 4000 injuries from baby walkers are reported each year, this includes, burns and scalds , head injuries, falling down steps and stairs and getting limbs trapped.

 

Secondly they do not help a baby walk and research shows they can hinder normal development.  Children need to move through the normal stages of development before they walk; rolling, creeping and crawling, kneeling to stand and cruising. This will give them the strength and coordination they require. Research has also revealed that the trays restrict a baby’s view of their moving legs and this deprives them of visual feedback that would help them learn how their bodies move through space. Additionally,  they can also cause a child to start walking on their tip toes which they may then continue to do when independently walking.

 

It is far more beneficial for a child’s development to give them time to play on the floor in a safe environment. Children need to spend time on their tummies, pushing up on their arms to play with toys, playing with their feet, learning to roll and being given the opportunity to move. When they are starting to stand and want to take steps, a push-along walker is more beneficial. This needs to be sturdy so it won’t tip over or speed away and played with under supervision.

 

In the busy world we live in babies spend less time on the floor and more time in ‘equipment’ , but you can help your child’s  visual, sensory, gross and fine motor and cognitive skills by allowing and helping them to explore their surroundings by themselves.

 

 

Flat feet, knock knees and other anomalies- what is "normal"?

I am regularly asked by parents, be it in clinic or the school run to check their child’s feet or legs, worrying whether their limb position is ‘normal’.  Parents have anxiety over knock knees, bow legs, flat feet, and toes turning in during walking. Most of the time these are not issues at all but a normal part of development.

I’ll explain over the next few blogs a little more about what to expect, what is normal and when to be more concerned and get limbs and feet checked out…

 

·        Flat feet (known as pes planus, over pronation, pes valgus, fallen arches.)

 

 

 

 

Most ‘normal’ feet have an arch along the inside of the foot. You can see this more easily if your child stands on their tip toes. A ‘flat foot’ is described when the arch disappears or reduces in standing.

All children under the age of 3 have flat feet.

The bones in the feet are held together by ligaments and children also have baby fat pads between the bones. Most flat feet in children are associated with loose ligaments and sometimes tight muscles.

Even in an older child most flat feet do not need any treatment. However, if there are complaints of pain in the feet, ankles, knees or back, poor stamina in walking or poor balance they would benefit from an assessment.

 

What can we do?

No exercises will improve flat feet, or make them worse, however, children can have tight muscles particularly their calves that need stretching.  A children’s physio can assess this and show you stretches and exercises that will help. Your child may also need an orthotic which can be put in their shoe, again this will not cure the problem but correct the foot positioning, allowing a better position. We very rarely put an orthotic in a child under 5 and even when we do it is usually very flexible.

As I will keep coming back to, a good quality, well-fitting shoe is essential.

 

 

·        In toeing gait (‘pigeon toes’)

Children walking with their toes turned in is very common, it can result in tripping when running and can be exacerbated by tiredness and in children with hypermobility.

 

There are 3 main causes, depending on a child’s age.

 

1.       Metatarsus adductus- When the forefoot curves in. This is evident from birth often due to positioning in utero. It usually resolves spontaneously but in some cases may need extra  stretching.

 

 

2.       Tibial torsion . This is more common in children up to 4-5 years and presents with the shin bones turning inwards with the knee caps still facing forwards. After this age the bones tend to straighten with a more mature gait pattern.

 

 

3.       Femoral anteversion – the whole thigh bone rotates inwards and knees and feet will turn inwards. Seen in children around 2-4 years and usually spontaneously resolves by 10 years. It is more common in girls and is often hereditary.

fem ant.jpg

 

What can we do?

Most of the time there is little indication for treatment. It won’t affect a child running or walking in the long term. Splints and special shoes are not shown to make any difference. However a good pair of well-fitting shoes is recommended. Children can present with tight muscles particularly their calf and  hamstrings and also weakness in specific muscles that can make the problem worse. A full assessment can reveal these weaknesses and an exercise program can help maintain strength as the child grows. Doctors and physios often keep an eye on intoeing gait that isn’t resolving. A very tiny percentage may need an operation when they are older. 

How can parent's help in preventing sports injuries?

In clinic, we are seeing an increase in sports injuries following the holidays as children return to their sports, often after a 6 week break and usually with an additional growth spurt! So why are children getting injured, what injuries do we tend to see and as parents, can we do anything to minimise any risk involved? This is a huge topic and the following is a brief overview..

Causes

Children get injured for all sorts of reasons, both due to their physical make up and other external factors, including;

  •  Immature tissues that are often put under a lot of strain
  •  Growth spurts, causing muscle imbalance and decreased flexibility
  • Morphology; we tend to group children by chronological age, but children vary greatly in  size and strength resulting in a mismatch in contact sports
  • Poor and inadequate equipment or training conditions and surfaces
  • Poor technique and lack of basic screening
  • Intense, repetitive training and high expectations (and sometimes pushy coaches or parents)
  • Inadequate warm ups and cool downs
  • Pressure between Club and School sports


These factors may cause injuries that we can categorise into 2 types;

1. Acute injury
Due to a single traumatic event such as dislocation, muscle strain or ligament sprain or tear; there are more reported ACL tears than ever before, particularly in football. 

Fractures of bones or the growth plate; growth plates are the areas at the ends of long bones where bone growth occurs and are much weaker than the ligament and tendons surrounding it; trauma resulting in badly sprained ligaments in adults are more likely to result in growth plate fractures in children under 14 years.

2.  Overuse injury
These are caused by repeated micro trauma to a growth area and are often harder to detect but result in pain and swelling particularly after activity, but relieved with rest.  The most common injuries we see are, Severs disease ( 9-12 years) presenting with pain and inflammation in the heel at the insertion of the Achilles tendon and Osgood Schlatters (11-14 year olds) which is similar but involves pain just below the kneecap where the patella tendon attaches. (I plan to talk about these common injuries in a future blog).Stress fractures can occur following repetitive trauma to normal bone that is not conditioned to the stress, more commonly in the lower limbs and particularly in sports involving running and jumping.

Injury Prevention/Reduction: 
By understanding the potential risks, observant parents can take steps to help reduce the risk of an injury;

  • Regularly check any protective equipment your child uses isn't damaged and still fits them and is always used! Ensure boots and trainers fit well and are suitable for each specific sport.
  •  Warm ups and cool downs are crucial (but much under used) and it is important to get children into a lifelong habit.
  • Allow them to play at their own intensity and pace
  • Expose children to a wider variety of sports rather than encouraging early specialisation in one specific sport
  •  Ensure they are properly conditioned for a sport before they start playing; many injuries occur at the start of a new season
  • Allow adequate rest between training sessions, remember to add PE at school into the equation along with their out of school sports. 
  • Check there is adequate, qualified adult supervision
  • Ensure your child knows the rules of a sport and sticks to them
  • Recognise injury, STOP and respond to it

Children are not mini adults and many of their injuries are related to their growth processes.  Fortunately, most injuries are mild and children tend to recover quickly. However, should they suffer an injury it is important to get a quick diagnosis and treatment to prevent them from developing a larger chronic problem, which could lead to a child being unable to participate in their chosen sport.

Why are our children suffering with posture and movement difficulties?

I am increasingly concerned about the number of children coming into clinic with back pain, headaches and poor posture, and at a younger age. A staggering 60% of school age children are reported to suffer with back pain at some point and these children are more likely to struggle with chronic pain as an adult. Some surgeons have even coined the term, “Gameboy back”!

We hear a lot of media coverage about children’s increasingly sedentary lifestyles leading to poor posture and pain; a rise in the use of computers and smart phones along with a decrease in physical activity. Of course there are other risk factors including high BMI, genetics and stress along with my own personal bug bear; the general poor quality of standardised ‘one size fits all’ furniture in schools and carrying heavy school bags.   

So, as parents how can we help?


Start from the beginning
Developing good posture and strong muscles begin as a baby. We need to reduce the number of hours babies spend in car seats ( when not travelling) and other types of  supportive seating and most importantly  give babies lots of play time on the floor and supervised tummy time during the day to build up the strength in their back and postural muscles.


Check their seating posture
The state of most of the chairs and desks at schools would not be tolerated in the adult workplace where we haves strict regulations.

In the ideal world, chairs should be height adjustable with a slightly forward sloping seat which allows you to maintain the curve in your lower back and keep feet flat on the floor. The desk should be at a sufficient height so forearms can rest comfortably on the table. A sloping desk would be preferable (like the Victorian desks) to improve line of vision and reduce hunching over work. There should be a gap between the end of the seat and the back of the child’s knees.

Question your school if you feel your child’s posture is suffering and at least try to make changes at home. Check out your child’s seating and posture, ensure they are getting regular short breaks from sitting and maybe think about sitting on a therapy ball to watch TV rather than slumped on the sofa?

I often advise posture packs to parents – they consist of a writing slope and wedge cushion and can significantly aid posture therefore improve handwriting and concentration along with reducing pain. http://www.backinaction.co.uk/posturepack


Reduce their load
Children should not be carrying more than 10% of their body weight – so for an average 34 kg 11 year old that only equates to 3 medium sized books and a lunch box. Encourage your child to only carry the books they need- heaviest at the back and use a locker if they are able. A backpack with wide adjustable straps are best (with a waist band even better but I’m normally pushing my luck with this one!) With the pack on, check your child can stand straight without being pulled backward or tipped forward. As ‘uncool’ as it is, please use both straps!


Exercise 
We all know exercise helps enormously but is your child actually achieving the recommended 60 minutes of moderate to vigorous exercise a day?

I hope my first blog doesn't sound too much like a rant but I am passionate about ensuring our children get the best start in life and we can encourage this by making some simple changes. Back pain can have such a profound effect on health, well-being, behaviour, motivation and academic success.