What is Torticollis?

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What is Torticollis ? 

Torticollis is the term used to describe the tightening of a muscle in baby’s neck. It is the shortening of one of the neck muscles, the sternocleidomastoid (SCM), which results in the baby’s head tilting slightly to the side and rotating in the opposite direction. 

What are some causes of torticollis?

  • Position of baby in utero (higher risk with twins or pregnancies with growth restrictions)
  • A long/difficult labour and delivery which can cause muscle spasms in baby’s neck
  • A preference of looking one direction over the other, eventually leading to the muscle shortening
  • Having a flat spot on the head may cause the baby to always rest in this position and over time, tightens the muscle

These are some conditions that appear like torticollis and are important to rule out: 

  • Vision difficulties
  • Hearing difficulties 
  • Reflux or GERD 
  • Viral infections 
  • Improper alignment of the spine 

How will torticollis impact my child?

Imagine your baby trying to develop their gross-motor milestones while their head is always tilted and looking one way. They will have difficulty with the following:

  • Learning to roll both directions
  • Learning how to sit independently
  • Discovering where the center of their body is (discovering midline)

Furthermore, torticollis can often lead to plagiocephaly – a flat spot on baby’s head, because of a preference to always rest in one position. See our plagiocephaly post here: Help! My baby has a flat head!

The neat thing about torticollis and plagiocephaly is it can be corrected quite easily, especially from a young age. EARLY INTERVENTION is key, and easiest to treat. 

What to expect during an assessment with your paediatric physiotherapist:

  • We will see how your baby’s neck moves to determine if there are any restrictions
  • Rule out the more complicated causes of torticollis
  • Provide tips to help to correct this and if warranted, give you stretches and strengthening exercises appropriate for the stage of your baby’s development
  • Depending on baby’s age and severity of the torticollis, we may also track your baby’s head shape to ensure they’re not developing a flat spot

Remember, the EARLIER the BETTER. It’s much easier to work on positioning and stretching exercises with younger babies, and that can allow us to introduce strength exercises at the optimal time. 

If you have any questions, please contact us at hello@playworksphysio.com! We’re able to provide assessments over video call until we get over the COVID-19 hurdle. You do not need a referral for physiotherapy.

Written by: Karly Dagys, Physiotherapist

In-toeing and what to do about it

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Something we hear a lot as a paediatric physiotherapist is “My kid walks with their toes turned in – is this normal?”

What is in-toeing?

In-toeing is the appearance of one, or both, feet turning in when standing or walking.  This can be a little bit or a lot.  In-toeing typically comes from the position of either the foot, the shin bone or the thigh bone. Each part influences the final position of the foot when walking. Young children naturally have some internal rotation of the leg and this makes the leg appear turned in. This internal rotation is at its greatest at 2 years of age which also happens to coincide with when children are becoming more mobile with running, jumping and climbing. Parents tend to also start noticing those little legs more and the concern about in-toeing comes up. The good news is that after age 2, the leg naturally starts to ‘de-rotate’, meaning that over a number of years, the leg and foot slowly turn toward straight and then even turn out slightly.  This occurs naturally for most children without any complications.

What does a physiotherapist look at?

Foot position– we assess the curve of the foot and whether or not this is contributing to the in-toeing.  A curved foot generally comes from in-utero positioning and resolves with time.

Tibial torsion– this is the turning in of the lower leg bone (tibia) observed when the kneecaps face forward but the foot turns in.  This is a normal presentation in young children and this typically resolves naturally with time up walking.

Femoral torsion– this is the angle of the thighbone (femur) and how it fits into the hip joint at the pelvis.  It is normal at birth for this angle to result in the leg turning in.  This usually resolves naturally over the first 10 years of life.  Femoral torsion can result in kneecaps pointing toward each other, an awkward run, or your child preferring to W sit.

What can be done about it?

In most cases, children that in-toe when walking will naturally grow out of it over years.  This is not a change that you will see in a few weeks! Thanks to the natural development of our bodies, the legs go from turning in as young children to a slight turning out in adolescence.

When you should bring your child in for an assessment:

See a paediatric physiotherapist for an assessment if:

  • the in-toeing appears to be only on one leg
  • the foot is not flexible or iscurved in significantly
  • your child complains of pain in the legs
  • you notice excessive tripping or poor balance
  • your child has trouble keeping up with peers
  • you are concerned that your child’s in-toeing is greater than normal

The physiotherapist will help determine if their in-toeing falls within typical ranges and give you some strategies to help make sure your child develops strong hip and core muscles.

Written by: Lindsay Eriksson, PT

Learn to Skate: 6 Tips to Get You and Your Kids On The Ice

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Do you want your kids to learn to skate, but are too afraid of the ice yourself to teach them? Here are 6 key steps for you and your kids to conquer skating.

  1. Figure Skate Vs. Hockey Skate

There are two main types of skates: figure skates and hockey skates. Knowing which to choose can be difficult so here are the main differences: A figure skate has a flat blade and usually a pick at the front of the blade. This means you won’t rock like you do in hockey skates, but watch out for the toe pick! It may cause you to trip if you forget about it. A hockey skate is generally black or grey and has a curved blade. If you don’t plan on becoming a figure skater or hockey player, it doesn’t matter which skate you choose. It comes down to which one you are most comfortable in.

  1. The Right Size Skate

The wrong size runner can cause you to trip over your own feet. The same rule applies to skates. If the skate is too big, your weight will primarily be on the back of the blade, making it easier to fall backwards. Skates are sized differently so when you try on a pair, line up your foot next to the skate. If there is more than an inch of extra room, it is too big. Your toes should be snug, but not squished.

  1. Protect Your Head and Knees

Helmets are a must! Whether you’re someone who has skated their entire life or just starting out, helmets are your best friend. Everyone can and will fall and it is super important to protect yourself. I suggest beginners should wear knee pads and gloves as well. The ice is cold and hard, but when you have the right gear, it is much less likely you will get hurt when you fall.

  1. Get to Know the Ice – Stand, Fall, Walk

Everyone’s first instinct when they get on the ice is to go fast. The first step to skating is simple – Walk. Skates can wobble, so you have to take it slow at first. Arms out for balance, bend your knees and keep your head up. If you can remember these 3 rules, you are well on your way. Practice falling down with hands out in front (to prevent going backwards) and stand up using your knee to push yourself up.

  1. Penguin Pushes

Once walking has become a piece of cake, the next step is to turn your toes out and try to push back. This is called a push-glide, or otherwise known as the penguins pushes. You can make your push-glide stronger by pushing someone or something on the ice.

  1. Learn to Stop

Snow plows are the first step to learning to stop without using the boards or another person. Put your feet together and glide first, then push both your feet out at the same time. Keep your arms up for balance at all times. Progress to one foot stops when this gets easier.

Once these essential skills are mastered, everything else will come easily. Next steps include backwards skating, one foot glides, crossovers, turns and many more fun skills!

Written by: Kylie Shorter, BKin

 

Why do some kids walk on their tip-toes?

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One of the most recurring comments a paediatric physiotherapist gets when a family brings their child in for assessment of toe-walking is, “everyone told us it will go away and it hasn’t”. The fact of the matter is if doesn’t go away right away, it likely won’t resolve on it’s own and will continue to get worse. Idiopathic toe-walking occurs when children walk on their toes without a neuromuscular, or sensory cause.

So why do some kids learn to walk on their tip-toes?

The calf muscle is a primary postural control muscle, meaning it helps us to control our balance when standing upright. When children are first learning to walk they haven’t mastered their balance and as a result, kids can compensate by activating their calf muscles, resulting in them walking on their tip toes. In typical development, a child should have enough core and glut strength that they are able to maintain an upright position without having to compensate with their calves.  When kids learn to walk before they’ve developed sufficient core strength, toe-walking results.

In some instances, a child will be able to learn how to turn off their calf muscles and begin activating their core appropriately. However, if a child doesn’t learn how to stop their compensation; their core muscles will become weaker, and their calf muscles will continue to get stronger. Over time this compensation becomes much more resilient, is much harder to break, and the toe-walking gets worse.

So how do we ensure kids develop a strong core before they learn to walk?

Milestones are such a crucial part of development because the previous milestone sets the foundation for the next milestone. For example; a baby rolls first, then builds enough strength to push up and move around on their tummy. Then they have enough strength to get themselves into and out of sitting, and they start crawling. Next, a child will have enough strength they can pull themselves into standing, and cruise along furniture. Eventually, they take their first independent steps without holding onto support. A developing baby is ready for the next milestone when they can do it themselves! Babies won’t crawl if they don’t have enough strength in the same way that adults can’t run a marathon if they haven’t trained for it! If a baby is encouraged to walk before they’ve developed adequate strength, they will turn on their calf muscles to help compensate, and voilà! They toe walk.

It is normal for a child to toe-walk when they are learning to walk, so long as they come down onto flat feet after 2-3 steps. If they remain on their toes for more than the first few steps, that is not normal, and they are compensating. The sooner you can correct this compensation, the easier it is to reteach the brain the proper motor pattern!

 Crawling, cruising and more crawling!

Crawling is such a crucial milestone to develop core strength, glut strength, coordination and shoulder stability (to name a few). It is a stage that should not be rushed, nor skipped! Many athletes and children with recurring knee/ankle/hip pain that never had a specific injury tend to be early walkers when we ask parents! Parents are often so excited their child walked early, however these kiddos tend to have weaker core control, and are more likely to compensate when they are active and participating in sports- even if they never walked on their toes!

So how do we know when they’re ready to walk?

When they can do it on their own! Create an environment that’s easy for babies to pull themselves into standing and cruise on their own. For example, chairs, coffee tables, flipped over laundry baskets, boxes and toys, which provide lowsupport. Surfaces that are too high will encourage them to reach up and go on their toes. Similarly, if your baby is walking holding onto your hands, keep your hands low(at their waist level) so they are not encouraged to reach high and activate their calves!

When in doubt – ask a Physiotherapist!

If you’re unsure about your child’s development it’s always great to ask! It’s never too early – the sooner you can get on top of the suspected compensation, the easier it is to re-teach that sneaky brain! Most of the time, a Physiotherapist can give you guidance, tips and tricks to try at home without having to come into physiotherapy sessions regularly!

Written by: Karly Dagys