Knowing what to treat, and how

Like adults, children can suffer from a wide variety of problems. As specialists in paediatric physiotherapy we have excellent knowledge and experience, treating a broad range of conditions, specific to children.


(Conditions affecting muscle and/or bone.)


Slipped Upper Femoral Epiphysis is a condition seen in adolescence, most commonly occurring during periods of growth. It affects one of the growth plates of the hip joint and in many cases, requires surgery.

Physiotherapy post operatively, is aimed to address range of movement and muscle strength at the hip joint and ensure safe progression of mobility and graded return to appropriate functional levels.


This is a condition affecting the hip joints of children, from as young as 3 years of age. This condition is thought to be more commonly seen in males and can sometimes be evident for long periods of time. In some instances surgery is required, once the disease process is complete.

Physiotherapy is an important part of the treatment of Perthes, with aims to maintain range of hip movement and provide advice regarding pain, mobility and general function.

Growth Spurts and ‘growing pains’

Through out childhood, the body is subject to a number of growth spurts. These are common in adolescence, but can occur at any time. We know that bone and soft tissue/muscle grow at different rates. It is this resultant ‘muscle imbalance’ that appears to be the cause of pain.

Symptoms of such growing pains are most commonly experienced in the legs and are apparent from as young as 4 years through to adolescence. They are often associated with a sudden or prolonged ‘spurt’ in growth.

Physiotherapy as a means of stretching and strengthening exercises should be encouraged to address any developing muscle imbalance.

Back to top

Anterior Knee pain

This is a common diagnosis in adolescence, classically described as pain at the front of the knee joint which is worse with activity and better with rest. Pain often wakes the child at night and is evident during periods of prolonged sitting or going up and down stairs. Sometimes the child complains of a knee that ‘locks’ or ‘gives way’.
It may be as a result of hypermobility , poor biomechanics , growth or a change to sporting activity. Ultimately, the presentation is that of muscle imbalance affecting muscle groups of the lower limb.

At physio4children we have specialist knowledge to assess this presentation, teach graded exercise programmes to reduce muscle imbalance, or discuss benefits of foot orthotics.

Back to top

Varients in Skeletal Growth.

During growth, the body assumes different postures as muscles, ligaments and bones develop at different rates. These postures include flat feet, knock knees, bow legs, walking intoed and toe walking. In many cases these postures are normal, however in some instances they are abnormal. At Physio4Children we have received specific training to assess whether presentations such as these, require further treatment or investigations.

Back to top


Growth plates are located within every bone that has not reached full maturity. Whilst it is an area of rapid growth, it is also an area of weakness.

Osteochondroses is a name given to a group of conditions affecting the growth plates. The following are all types of Osteochondroses:

Osgood Schlatters Disease and Severes Disease

In children and adolescents large/powerful muscle groups attaching to growth plates can place enormous stress onto these boney attachments. This stress is exaggerated at times of rapid growth or during periods of repetitive/impact sport. The traction or repeative ‘pull’ results in swelling, inflammation and pain. Areas where this is commonly seen include the shin ( Osgood schlaters disease) the heel ( Severe’s disease) and the knee cap ( Sindig Larsen Johansen disease)

Physiotherapy exercises can address resultant muscle imbalance and advice can be given regarding swelling, inflammation, sport, foot orthotics and footwear.

Back to top

Kohlers Disease and Friebergs Disease

Conditions such as Kohler’s and Friebergs disease, affecting the bones in the foot, can be diagnosed in adolescence. Although physiotherapy cannot alter the disease process it can be a beneficial adjunct to medication as a means of reducing pain and ultimately increasing function.

Back to top

Osteochondritis Dessicans

Osteochondritis dessicans (OCD) can be seen in adolescents in the elbow or more commonly in the knee joint and is thought to occur as a result of increased impact or rotational forces. This disease process has many levels of severity, some requiring surgery. Pre or post operatively it is important to address the level of activity, address any muscle imbalance, and assess biomechanics as a means of ultimate reduction in pain.

Back to top

Paediatric Trauma

Until an adolescent reaches their final standing height, their bones are different to that of an adult. Babies and toddlers bones have a soft inner core and a thick outer layer. Although they are therefore less prone to ‘fracture’ or ‘break’, it can still happen. Following a fracture, some toddlers and younger children require the specialist advice and encouragement from a children’s physiotherapist. This is necessary either to regain the confidence to move injured areas or to avoid development of abnormal movement patterns. In many cases reluctance to move in the young, is related purely to fear. At physio4children we have both knowledge and experience of children’s developmental needs. We understand that the approach to treatment, can significantly affect the outcome.

Older children and adolescents are more prone to avulsion fractures, as a result of powerful forces sustained during activities such as high impact sports. The strong muscle groups attaching to the weaker area of bone (the growth plate) pull the muscle away from its attachment. This is generally more commonly seen in the legs or in the lower abdomen.

Physiotherapy to address muscle length and strength and grade the recovery to full function, is vital as a means of avoiding future re injury.

Back to top

Neurological disorders:

(conditions affecting the brain, spinal chord and nervous system.)

Conditions which have been shown to benefit from regular physiotherapy input include: Cerebral Palsy, Spina Bifida, Meningitis and Encephalitis, traumatic spinal chord and brain injuries.

The purpose of any physiotherapy input is to normalise tone, prevent soft tissue shortening and joint contractures, encourage normal movement patterns and ultimately improve function and independence.

Babies, children and adolescents who present with these conditions should receive regular physiotherapy by Specialist Paediatric Physiotherapists.
At Physio4Children we understand both the pathology of the conditions and the complications that can occur during periods of growth.

Back to top

Developmental delay

Delay in development may result from prematurity or problems at birth. Additionally some babies display delay in their milestones for no apparent reason. When delay in reaching motor milestones has been recognised, early Physiotherapy intervention should be started in order to encourage normal movement patterns and prevent further problems occurring.

Chronic Fatigue Syndrome

This condition has been shown to benefit from physiotherapy in the form of graded exercise regimes and functional goal setting. With consent, Physio4Children can liase with schools and other health professionals to maximise the success of such a program.

Co ordination disorders

The once ‘clumsy child’ has now been more appropriately recognised as a child with a development co ordination disorder or dyspraxia.

If you have concerns about your child’s movement, co ordination or sensory awareness, Physio4Children may be able to construct an exercise and activity programme to address and help to improve their gross motor skills.

Back to top