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Puppies and children

Puppies and children - they're really the same!

Puppies are wonderful, aren't they? They seem to have boundless energy, graphicamazing enthusiasm for life and unlimited affection for those around them. Two members of McNaughton Physiogrange staff have each just welcomed a puppy into their life (Labrador and Pointer) and it's fair to say that family life will never be the same again.

Along with the joy of having a dog around comes the responsibility of looking after it properly. We have been well warned by both Breeders and Vets that puppies can have too much exercise.
In fact, the puppies are only allowed 5 minutes off the lead per day for every month old they are until they are fully grown. Too much exercise can be bad for the developing skeleton of a dog, particularly their hips.
Children can have problems too.
Although the focus of media attention is on how little exercise the youth of today take, as Physios we get to meet fantastic kids who are passionate about their sport and want to do well. They can be very keen and very determined to excel which can cause their parents some concern.

Parents ask us if there are any injuries which active kids are susceptible to. Younger athletes suffer many of the same injuries as adults, such as blisters and sprains, but they can develop specific overuse injuries at the foot, knee and pelvis due to the diifferences in the structure of growing bone compared with adult bone. Where an adult would develop a painful tendon with overuse, a child or teenager will develop pain at the junction between the tendon and growing bone.

These junctions are called "apophyses" and when inflamed, are referred to as "apophysitis". Two of these conditions, Sever's Disease (SD) and Osgood-Schlatter Disease (OSD), have pretty scary sounding names, which can make parents worry unnecessarily.
Sever's Disease (SD)
Sever's Disease (SD) is the common name for calcaneal apophysitis which is characterised by pain at the junction between the heel bone (Calcaneum) and the Achilles tendon. It often occurs in active children between the ages of 7 and 10 years and develops during a growth spurt when the muscle / tendon unit becomes tight as bone grows longer.
The child will first complain of pain with activity which eases with rest. It can occur in one or both heels. Pain can increase when he or she stands on tiptoe and so to avoid this, the child may walk with a limp. The heel bone can be sore to touch.
Osgood-Schlatter Disease (OSD)
Osgood-Schlatter Disease (OSD) is apophysitis of the tibial tubercle, the spot just below the knee cap where the quadriceps tendon inserts into the bone at the top of the tibia or shin bone.
This condition usually develops in active adolescents during the 2 year period in which they grow most rapidly. This can be between the ages of 8 - 13 for girls and 10 - 15 for boys.
Pain can occur in both knees but most often occurs in only one. Symptoms of OSD include pain at the knee which is worse with exercise and easier with rest. Swelling or tenderness is found just below the knee over the shin bone. Very often, the hip flexor muscles, the hamstrings, quadriceps and calf muscles are found to be tight.

What is the best way to treat these conditions?
As these conditions are associated with growth, and will get better with time, medical advice used to be very simple and was "rest until the pain gets better". Thankfully, as these conditions have become better understood, a lot can now be done to help.

Initially, treatment is geared towards reducing the symptoms with the general principles which apply to all injuries.
  • Rest from the aggravating factors but remember that rest is relative. Activities that do not cause pain such as swimming or cycling can be continued.
  • Ice can be used to help the local pain and inflammation. An ice pack wrapped in a damp towel can be placed on the heel or knee for 10 - 15 minutes. Ice can be repeated every 2 - 4 hours to help pain.

Treatment should also involve a regular stretching programme for tight muscles. We have met many dedicated young athletes who put adults to shame by following stretching programmes regularly to improve their symptoms quickly.
If foot posture or inappropriate footwear is thought to be a contributing factor then a review by a sports podiatrist should be sought for advice on appropriate footwear or for the provision of specific in-soles to help improve lower limb biomechanics. This can make a significant improvement to current symptoms and also help prevent future problems.

Once symptoms are brought under control a phased return to sports can begin, always remembering the importance of warm-up before activity, cool down after activity and a regular stretching programme to help prevent recurrence.

Young athletes have a huge amount of enthusiasm and talent for sport. As they grow they may develop some painful conditions unique to the young athlete but simple, sensible measures such as stretching regularly, ensuring good footwear, and participating in a variety of activities to prevent repeated strain on one area of the body, will help prevent problems.

Now, how could we persuade our healthy active kids to take the dog out on a run with them, when the dog is old enough, of course!

This article was written by the McNaughton Physiogrange Team and first appeared in the October 2009 edition of 702 Gazette

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