Heel Pain/Sever’s Disease – What is it?

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Severs- what it is, what is happening, how physio can help

What is Sever’s Disease? 

Sever’s Disease occurs when the C shaped growth plate at the back of your heel gets inflamed from stress from the achilles tendon. Growth plates are areas of cartilage located near the ends of the bones, and this is where bone growth occurs. Since it is the last part of a child’s bone to harden, growth plates are particularly vulnerable to injury. Adults don’t have open growth plates anymore, so this condition is found only in kids. Sever’s Disease is also 2-3 times more likely to occur in boys than girls, and it is associated with big growth spurts!

What my child may complain of?

  • No pain in the morning, but usually is worse with increased load during the day
  • Pain worsens with repetitive activities (example: running or jumping)
  • Tenderness on both the inside and outside of the heel
  • No swelling, redness or skin changes noted with this condition
  • Calf tightness

Things that may make Sever’s worse:

  • Worn out shoes
  • Hard surfaces
  • High amounts of physical activity
  • Big growth spurts
  • Back to activity after a long break

How can physio help?!

At Playworks Physio we specialize only in kiddos! We see kids with this type of heel pain VERY often, especially with the start of sports seasons. Your Physio will take a good look at what is happening and what might be causing it, and give lots of tools to help. Some things include stretching and strengthening activities, suggestions for activity modifications, shoe recommendations, and of course, this will all be FUN for your kiddo.

Our main goal is to help reduce your kiddos pain, solve the source of the issue to prevent it from returning, and improve their ability to participate in their activities again, pain free!

– Darrien Cantelo, Physiotherapist

 

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A to Z what about Pee?!

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A to Z but what about Pee !?

Summer holidays – one of the most awaited times of the year! Perhaps it involves a camping trip, or a summer slumber party. Whatever it is; it’s time for kids, and parents to relax, reset, and be stress free from the school year! 

That is the case, unless you’re a kiddo (or a parent of a kiddo) with urinary incontinence. Summer holidays and fun, social plans can be absolutely terrifying. 

How can I go on a camping trip if I pee my pants sometimes?

How will my child go to the birthday sleepover if they wet the bed some nights? 

The most important thing to know is that wetting the bed, or clothing is not your fault, nor your kiddo’s fault. There are many things out there (including Paediatric Physio!) that can help kids decrease these occurrences, so keep smiling … we can help! 

A second crucial thing to know, is that this is more common than you might imagine. The number of children and teens who struggle with continence is astounding, so it’s not just you and your kiddo. And want to know something else? It’s especially common in athletes! So you’re not alone! Helping your child realize that several kids in their class or on their sports teams also live with this can help them appreciate this more. Urinary leakage typically comes with a bunch of shame, guilt and fear. So try to let it go, and again…it’s not your fault!

There are a few definitions I’m going to go over so you can start to understand what may be going on with your situation:

Continuous incontinence – this is for kiddos who constantly leak in non-discrete amounts. This is something that you should see a doctor about, and is usually more of a “hardware” issue, than a “software” issue.

Intermittent Incontinence – this applies to kiddos who have specific, urinary leakage incidents. This can be daytime only, nighttime, only, or both. It can be for kiddos who are over the age of 5 who never achieved continence (primary), but also for kiddos who have previously attained bladder control (secondary). More specific categories include:

    • Urge Incontinence: when a kiddo has a sudden or unexpected need to pee and can’t make it to the toilet in time.  
    • Stress Incontinence: when a kiddo has leakage with a specific activity such as coughing, sneezing, or laughing BUT ALSO during sports when you kick, run, or hop!
    • Nighttime Incontinence: when a kiddo wets the bed at night 

Who are the culprits ?!

Now you’re likely not going to believe this (as did I when I first heard it), but one of the main suspects of urinary incontinence is constipation! Let me explain…

When your rectum is full (even more so in little bodies), it pushes on the bladder and doesn’t allow it to fully fill. Furthermore, all that build up in the abdomen puts extra pressure on the “sensors” making it difficult to tell when it’s really time to go. Even pooping daily can mean constipation, so, everyone is assumed to be constipated until proven innocent! 

Next on the suspect list are those sneaky pelvic floor muscles. These muscles sit in your pelvis and control the flow of pee and poop out of your body. Sometimes they can be weak, however they can also be tight and gripping, trying to hold everything in. When these muscles can’t contract properly, it causes constipation, poo stains in undies, itchy bums, pee dribbles and even those bigger leaks. 

Other culprits can include things such as family history, life events (new sibling, divorce, illness/injury, etc), frequent urinary tract infections, early toilet training and sensory involvement. 

Ta-Da! The solution:

  1. Say it, repeat it, believe it: It is not your fault. You are not alone 🙂 
  2. Get yourself to a qualified physio who has extra training to treat the pelvic floor, but also who has experience working with kids. They will be able to assess the muscles (in a non-invasive way!!) as well as determine other culprits at play. Based on what they find, your paediatric physio can help you come up with a fun plan to becoming continent! CLICK HERE to book an appointment.
  3. It’s important to have a proactive health care team that is up to date with what’s going on. Knowledge is power and having a supportive team will help make the journey even easier! 

For more information check out this cool video made by SickKids in Toronto for a great summary!

https://www.youtube.com/watch?v=E8Khck8lWak

If you want to schedule an appointment with our paediatric physio and pelvic floor trained physio CLICK HERE.

Written by: Karly Dagys, Physiotherapist

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Are Flat Feet Normal in Kids?

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Did you know that almost everyone is born with flat and flexible feet? In their first year, babies’ feet grow extremely fast – about 2.5cm! As children get older and start walking, their feet are still flat because the bones, muscles and ligaments are not yet fully developed.

 

Foot development

The main arch of the foot, the medial longitudinal arch, begins to form at 3-4 years of age. This arch continues to develop throughout the first 10 years of life and many studies state that the mature foot posture is not obtained until 7-10 years of age (Uden et al., 2017). This means that we should expect our children’s feet to be flat during their first 3-4 years and to then start developing an arch over the next 7 or so years.

 

Factors that can affect foot development

  • Poor fitting shoes: too small, too big, too rigid
  • Not enough barefoot time at home

 

What about those Flat Feet?

Flat feet aren’t always problematic. As you can see from above, younger kids tend to have naturally flatter feet and therefore treatment is not always necessary. If your child goes up on their tiptoes you should be able to see their arch form. This is considered “flexible flat feet”. These should not be painful. Ultimately painful flat feet in kids are a problem and non-painful, flat feet in children (or adults!) are not a problem and do not need to be treated unless they are accompanied by any of the points listed below.

 

Here are some reasons why we see kids at PlayWorks Physio for flat feet:

  • Their walking pattern is different. For example, if they do not push off from their big toe, instead they use the inside of the foot
  • Complaints of foot, ankle or knee pain
  • Bunion development on the inside of the foot
  • Frequent rolling of their ankles
  • Complaints of their feet getting tired or sore after activity
  • Excessive pronation (collapsing inwards) of feet

 

Things you can do to encourage proper foot development in your kids

  • Find properly fitting shoes. Look for shoes with a supportive heel cup and flexible sole. CLICK HERE  to learn how to pick the best shoes for your child.
  • Have your child barefoot when safe/appropriate. This helps develop the muscles, ligaments and tendons of their feet and will contribute to arch development.
  • Play around with walking on different types of surfaces. For example: grass, hills, trails, gravel, sand etc.

 

If you have any questions about your child’s foot development, email us at [email protected]

 

Written by: The PlayWorks Team

 

References: Uden et al. Journal of Foot and Ankle Research (2017) 10:37

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Help! My baby has a flat head!

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My baby has a flat head…

Is this a common issue?

YES, this is a very common issue with babies. Flattening can be caused by the following:

  • Your baby has a preference of looking in one direction, resulting from tight neck muscles
  • Your baby prefers looking in a certain direction but there are no neck restrictions
  • Your baby is a good sleeper and doesn’t move much when sleeping

 3 Types of Flattening

Plagiocephaly is flattening on one side of the head from your baby preferring to look left or right. It is often associated with tight neck muscles (torticollis). Things you may notice:

  • Flattening on the back when washing your baby’s hair
  • One cheek appears larger
  • One side of your baby’s forehead is more prominent than the other
  • One eye is slightly larger than the other

Brachycephaly is flattening directly on the back of your baby’s head and is often seen with babies who sleep for long stretches without turning their head to either side. It causes baby’s head to be wider than average.

Scaphycephaly is the rarest type of head shape issues we see and is when the head is more narrow than average. It is most commonly seen in babies who spent long periods of time in the NICU because their heads are being turned from one side to the other.

How will a flat head impact my child?

  • Depending on the severity of flattening, your child may have difficulty fitting helmets, because these are made for the average shaped head.
  • Plagiocephaly can result in a forward shift of the facial bones, which can be purely aesthetic or in severe cases can lead to jaw issues.

What can we do?

  • A paediatric physiotherapist can measure your baby’s head to determine if there are any concerns and provide you with education to best manage your baby’s head shape.
  • When recommended, we can refer you and your baby to an orthoptist for helmeting. This is dependent on your baby’s age and the severity of flattening.

When is it best to seek help?

  • The earlier the better! This provides more time to track your baby’s head growth and improvements in flattening. The earlier you come in the more likely we can address the flattening conservatively (with positioning, education and stretches if needed).
  • If a helmet referral is required, seeking help earlier is better to optimize the amount of change obtained with the helmet.

 If you have any questions about your baby’s head shape, feel free to contact us!

 

Written by: Maegan Mak

 

 

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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

 

 

 

 

 

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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

 

 

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Concussion Baseline Testing for Kids and Teens: What You Need to Know

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