Pediatrics

Musculoskeletal Development and Sports Injuries in Pediatric Patients

By Frank M. Painter|June 19, 2011|Diagnosis, Pediatrics, Sports|

Musculoskeletal Development and Sports Injuries in Pediatric Patients

SOURCE: Dynamic Chiropractic

By Deborah Pate, DC, DACBR

Physical activity is extremely important for everyone, but especially for children. A well-designed exercise program enhances the physical and intellectual development of a child. Competitive sports are often a child’s first introduction to programmed exercise.

In the past decade, there has been an increase in the number of children participating in team and solo sports. Younger children are allowed to participate in sports for enjoyment, health and personal development. However, this changes as competitive elements become more dominant and young athletes train harder and longer, and may practice a sport throughout the whole year. Consequently, sports-related injuries in children have significantly increased.

To understand pediatric injuries that can occur during sports performance, it’s important to be aware of the peculiarities of the growing musculoskeletal system. Children’s tendons and ligaments are relatively stronger than the epiphyseal plate; therefore, with severe trauma the epiphyseal plate will give way before the ligament. However, children’s bones and muscles are more elastic and heal faster. At the peak period of adolescent linear growth, the musculoskeletal system is most vulnerable because of imbalances in strength and flexibility and changes in the biomechanical properties of bone.

Physiological loading is beneficial for bones, but excessive strains may produce serious injuries to joints. Low-intensity training can stimulate bone growth, but high-intensity training can inhibit it. Growth plate disturbances resulting from sports injuries can result in limb-length discrepancy, angular deformity or altered joint mechanics, possibly causing permanent disabilities. Sports involving contact and jumping have the highest injury levels.

Pediatric Musculoskeletal Growth

Chiropractors have been uniquely trained to understand the musculoskeletal system, making them excellent resources for the management of sports-injuries. We need only to make certain we are aware of the peculiarities of the pediatric musculoskeletal system when pursuing appropriate evaluation and case management. (more…)

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The Pediatric Elbow: A Review of Fractures

By Frank M. Painter|June 18, 2011|Pediatrics, Radiology|

The Pediatric Elbow: A Review of Fractures

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Deborah Pate, DC, DACBR

The elbow fracture is one of the most common fractures in children. Assessing the elbow for fracture can be difficult because of the changing anatomy of the growing skeleton and the subtlety of some of these fractures.

It’s important to be aware of the radiographic signs of fracture in the elbow, along with knowing the appearance and fusion of the ossification centers in the pediatric patient, to avoid confusing an ossification center with a fracture fragment. Of course, alignment and radiographic positioning are also extremely important in making a diagnostic assessment.

Diagram of a distended joint capsule
with the fat pads displaced.

When reviewing an X-ray study for trauma, it’s best to have a methodical way of viewing the study. Perform (at the very least) two views of the elbow at 90° to each other, AP and lateral. Positioning is very important, particularly in the growing skeleton. Alignment of the joint cannot be assessed unless the positioning is accurate.

The two most common errors in positioning are: 1) elbow is lower than the shoulder, which projects the capitellum onto the ulna; and 2) elbow is higher than the wrist, which will make the capitellum and the head of the radius appear anterior, and the epicondyle appear posterior, making it difficult to assess the alignment. In a true lateral view, the elbow and the shoulder should be in the same plane and the wrist should be higher than the elbow to compensate for the normal valgus position of the elbow. The thumb should be up to keep the radius from rotating. (more…)

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ICPA Launches “Chiropractic Care and Wellness” Research Project

By Frank M. Painter|March 17, 2011|Announcement, Pediatrics, Research|

ICPA Launches “Chiropractic Care and Wellness” Research Project

The Chiro.Org Blog

The ICPA is pleased to announce that its Practice Based Research Network (PBRN) has achieved recognition by and affiliation with the Agency for Health Care Research and Quality, under the US Department of Health and Human Services.

The ICPA/ PBRN is the first chiropractic PBRN to have achieved this status. We would like to thank all of our participants so far for their contributions of data, making this possible.

A Practiced Based Research Network (PBRN) is our best opportunity to determine the parameters of care we provide by submitting data from our practices. The ICPA has formed the largest PBRN in chiropractic and the only one addressing family wellness care. This is your voice in evidenced based chiropractic care. We need your participation now! (more…)

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New Study Ties Processed Foods To ADHD in 78% of Children

By Frank M. Painter|February 10, 2011|ADHD, Attention Deficit, Education, Food Sensitivity, Pediatrics, Processed Foods, Research, Supplementation|

New Study Ties Processed Foods To ADHD in 78% of Children

The Chiro.Org Blog

According to a new study, just published in Lancet Journal, a diet free of processed foods significantly reduces the symptoms of ADHD in 78% of 4-8 year old children. This 5-week study involving 100 subjects found that 63% of them experienced a relapse in ADHD symptoms upon re-introduction of problem foods into the diet.

This randomized crossover study was titled Effects of a Restricted Elimination Diet on the Behaviour of Children With Attention-deficit Hyperactivity Disorder (INCA study). Patients in the Netherlands and Belgium were enrolled via announcements in medical health centres and through media announcements. In the open-label phase (or first phase), children aged 4—8 years, who were diagnosed with ADHD, were randomly assigned to either 5 weeks of a restricted elimination diet (diet group) or to instructions for a healthy diet (control group). [1]

In the second phase, those children who responded positively (with an improvement of at least 40% on the ADHD rating scale) proceeded into the second phase, with a 4-week double-blind crossover food challenge, in which they were exposed to either a high-IgG or low-IgG food diet (classified on the basis of every child’s individual IgG blood test results).
(more…)

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MDs Admit Low Confidence In Diagnosing Musculoskeletal Complaints in Children

By Frank M. Painter|December 20, 2010|Pediatrics|

MDs Admit Low Confidence In Diagnosing Musculoskeletal Complaints in Children

The Chiro.Org Blog

SOURCE: Journal of Pediatrics 2009 (Feb); 154 (2): 267–271

Sharmila Jandial, Andrea Myers, Elspeth Wise, Helen E. Foster

Musculoskeletal Research Group,
Newcastle University, Newcastle Upon Tyne,
United Kingdom. sharmila.
jandial@ncl.ac.uk

A recent study, published in the Journal of Pediatrics, details the results of sending questionnaires to a broad spectrum of British medical providers (practicing in Primary Care, Pediatrics, Emergency Care, and Orthopedics management). These doctors were asked to self-rate their confidence in pediatric musculoskeletal clinical assessment.

The depressing results are that 73% of these doctors graded themselves as having “low” to “no” confidence in their pediatric assessment skills. [1] (more…)

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Trading Backpacks For Rolling Luggage Fails in German Primary School Study

By Frank M. Painter|December 19, 2010|Backpacks, Books, Low Back Pain, News, Pediatrics|

Trading Backpacks For Rolling Luggage Fails in German Primary School Study

The Chiro.Org Blog

It’s well understood that heavy backpacks are taking a heavy toll (excuse the pun!) on adolescent spines. [1] A recent standing magnetic resonance imaging study by the Department of Orthopaedic Surgery, University of California, at San Diego revealed that: “Increasing backpack loads significantly compressed lumbar disc heights measured in the midline sagittal plane” and that: “student subjects reported significant increases in back pain, associated with increasing backpack loads from 4, to 8, and finally to 12 kgs of carried weight”. (more…)

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