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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

 

 

 

 

 

Preventing injuries during the active fall school season.

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Pre-habilitation and injury prevention

At this time of year, your kids most likely just started their sporting season. During these busy times of practices, we often see athletes coming in with all kinds of injuries. Injuries can happen for many reasons, however there are ways to prevent them! This blog post will introduce you to pre-habilitation, and how attending physiotherapy can be beneficial!

Preventing injuries in the fall when activities are back in full force.

  1. When kids grow, their bones lengthen first and then their muscles need to lengthen as well. If muscle length is not addressed it could lead to muscle strains, especially with lots of activity and training.
  2. Addressing muscle imbalances ensures that your child will be moving optimally and prevent injuries that result from poor mechanics, alignment and muscle strains due to lack of strength.
  3. Physiotherapy can treat minor issues so they do not progress into more serious problems. Catching little aches and pains at the beginning of the season gives your child an opportunity to rehab earlier in the season and limit the time missed during the regular season.

Physiotherapy can help your child become more body aware and learn their body’s limits.

  1. When kids grow their body awareness often lags behind, as they need to re-learn their “body dimensions.” Improving body awareness will help your child excel in all their activities.
  2. Becoming more body aware and learning how their body moves can improve coordination and their movement efficiency.
  3. Everyone’s body is different and moves in different ways. It is important for kids to become familiar with how their body functions to prevent injuries, master certain skills and boost their confidence!

A great example!

I have been treating a young dancer who dances 12-15 hours per week. Her mother wanted her to learn more about how her body moves and its’ limitations. She noticed how hard her daughter was pushed at dance and wanted her to learn proper techniques to prevent pain and injuries. My patient was also complaining of slight heel pain during the initial assessment. I determined that the heel pain was most likely an early start of Sever’s Disease. I had found that one of her calf muscles was over-working for her hip muscles. After one week of treatment and home exercises, the heel pain had resolved. If the heel pain had been left unattended it would have worsened and she most likely would have had to take several weeks off to recover. We also have been working on proper form for various stretches – core strength and leg strength – that are commonly performed in the dance class. This parent was proactive and helped fixed an early issue before it became a problem! Her daughter is also learning how to stretch and strengthen her body safely, to help her excel in dance for the remainder of the season.

The body of this article originally appeared in just dance! Magazine