Increasing levels of sport, leisure and lifestyle activity means that children often present with a range of injuries that are becoming more common. Physioworks Health Group are continually developing specific approaches in general and sports physiotherapy tailored for the management and treatment of paediatric injuries.
Numerous paediatric injuries occur around the hip; including Slipped Upper Femoral Epiphysis (SUFE); Perthes’ Disease, Avulsion Fractures and Muscle strains.
Slipped Upper Femoral Epiphysis (SUFE):
The femur is the long bone in the thigh. The main function of the femur is to transmit forces from the tibia (leg) to the hip joint. It acts as the place of origin and attachment of many muscles and ligaments
The proximal (upper) area of the femur forms the hip joint with the pelvis. It consists of a head and neck. SUFE occurs when the growth plate in the proximal femur is weak and the femoral head slips down and back.
Symptoms of SUFE include groin, hip, thigh or knee pain (some children may only have knee pain);Limp, Limited movement of the hip joint and there may be slight shortening of the affected leg.
Treatment depends on how severe the slip is which can be seen on an X-ray.Unstable slips need urgent medical attention.Most children, regardless if the slip is stable or unstable will, require surgery to stabilise the femoral head. Following surgery the child will be unable to put weight on the affected leg ( eg crutches or wheelchair) for 6 weeks the progress as pain tolerates with a tailored managed physiotherapy program to restore range of movement, strength and normal movement patterns.
Perthes’ is a disease of the hip joint that affects children, usually aged 6-10 years. Poor blood supply means the femoral head deteriorates. It is more common in boys than girls (4:1). Symptoms include sudden onset of limping and thigh pain, pain with lifting the hip up and rotating it in and there could be some muscle wasting in their thigh.
Initial conservative treatment includes hydrotherapy, swimming,rest if required to stabilise the pain and maybe some traction of the affected leg to relive muscle spasm. Corrective surgery is also a treatment option if conservative management fails.
An avulsion fracture is an injury to the bone where a tendon or ligament attaches to the bone. The tendon or ligament pulls off a piece of the bone when an Avulsion Fracture occurs where as in adults the tendon or ligament is more likely to tear.
Avulsion fractures are more common in children than adults. In adults, the ligaments and tendons tend to be injured first, whereas in children the bone may fail before the ligament or tendon is injured, because in children the cartilaginous plates where tendons attach are relatively weak attachments.
Treatment includes ice and rest initially to control pain, and gentle exercises to promote bone healing. However, if the bone fragment is too far apart for the bones to fuse naturally surgery may be required.
About the Author: Chelsea Low – Bachelor of Physiotherapy. Chelsea has a long term interest in the health, well-being and fitness of children. She is furthering her education in paediatrics with specific Monash University accredited courses. Chelsea consults at Physioworks Health Group Cranbourne and Pakenham; for an appointment with Chelsea please call the clinic on 5995 1111.