One of my clearest recollections of childhood was crying to sleep with leg pains. I can't remember exactly at what age they bothered me and I can't remember what my parents tried to do, I just remember they ached. My childhood physical activity was confined mostly to trombone playing and tennis. Maybe I was a better slicer in tennis than some, but I don't remember any particular advantage in trombone that looseness might have provided me. I took up golf in high school and also don't remember any loose advantages there.
Shortly after I began practicing pediatrics, I began running around the block with some other dads on my street. Then we moved to Lake Forest and I left my running buddies behind and I began running by myself and increased my mileage. Without realizing why, I began to have knee pain. I tried changing shoes several times but with no real improvement. Finally I went to a sports podiatrist who told me that I had pronation problems and made orthotics for me which much improved my knee pains. However, after a certain amount of miles, I would start to have pains a gain and realized that even just a little wear on shoes could stress my knee joints. In my running days there were numerous times when I stepped in a hole or off a curb and thought I had severely sprained my ankle, only to walk a little ways and then continue running. I did actually sprain my ankle pretty severely in the dark of early morning near Lake Mission Viejo when we jumped over a barricade and I landed on a quarter-size rock on the other side. Even then, I went to physical therapy for a couple of days and was back to running. But I must truly say that there were only rare days in my running years when something didn't hurt.
Looking way back in the beginning of my life, I was born with a club foot on the left and had a cast on my lower leg for several weeks to correct it.
(Interesting, but not surprising, is the fact that my son, Dr. Mike the pediatric dentist, also had a cast on the same foot for the same reason.)
My parents also told me the story later of the very kind orthopedic doctor in Corpus Christi who treated my foot without out charging my parents because my Dad was in the Navy.
So in my personal life I had these three different circumstances which caused me to start paying attention to babies and children that are "loose", and what follows is what I have figured out by observation and researched a little on the Internet regarding "loose" children. Photo left shows a "loose woman".
It appears to me that most babies that are born with legs and feet which are folded around their bottoms inside the uterus come from mothers who are also "very flexible". Recently I asked a mother of a third baby who was very loose, "Where did you deliver?" She responded, "In the car!" I wasn't very surprised in that the pelvic ligaments loosen with pregnancy and if that happens in a loose mother, babies can almost fall out. It would seem that the size of the baby might also have an influence on the amount of torsion on the legs as they fold up in the uterus. And with that in mind it was
probably no surprise for our 11 lb. 1 oz. son to have a club foot. With my feet, even after having the cast on my clubfoot, I continued to have metatarsus varus which is a turning to the middle of the front of the foot and it still is somewhat visible today and I do better in straight last shoes.
As we watch loose babies grow, we see them start to put their toes in their mouths and often I can put a foot on each ear. When they get on their tummies, they tend to be "flatter on the mat" suggesting that they might someday be great at wrestling. It appears that the looseness of the ligaments prevents being able to lock their elbows and shoulders to push up. Thus we refer to them as combat crawling once they begin moving.
So they are "late to crawl" and when this is combined with the fact that many of them do not walk until a ways past one year, they also appear to be developmentally delayed. Standing means putting their weight on top of a loose ankles, loose knees and loose hips. This is a lot like standing on stilts, and I say that smarter loose babies walk later because they know that walking early will mean banging their head more. These loose babies also tend to sit with their legs in a "W" and my second grandson even walked first on his knees with his feet trailing behind. Loose toddler do fall significantly more because of their instability and the fact that loose hips allow their "tips to cross" and take them down. There appears to be some connection between loose ligaments and certain developmental disorders of children. Some of the loose babies who appeared delayed may actually have a more complicated situation. (See http://skillsforaction.com/?q=node/16#dcdhypermobile for a very nice discussion of developmental coordination disorder or dyspraxia and see reference summary from a study at the end of this blog). There are more stitches involved with being loose, but usually very few broken bones as they grow older because they sort of fall in segments instead of slamming into whatever they fall against.
As the years go by we see loose five and six year-olds at Disneyland saying "Carry me, my legs are tired" and "I don't want to walk anymore." Some of them don't like soccer or other sports because the running makes their legs tired. And often they complain of pains in the knees or shins after particularly physical days. These pains were often thought to be "growing pains" in past times, but it is becoming clear that they most often occur in children with hypermobile joints (loose kids). A simple way of looking at the situation is that the muscles are working so hard to hold the joints steady that they get tired and ache. I have found that often taking a regular strength Tums (calcium carbonate) at suppertime will alleviate the symptoms and perhaps the muscles are calcium depleted from overwork. There certainly are teens who grow a tremendous amount in a short time and probably do have some pain actually related to the rapid growth and stretching, but this is no doubt exaggerated in the loose teen who grows rapidly. There are more stitches involved with being loose, but usually very few broken bones as children grow older because they sort of fall in segments instead of slamming into whatever they fall against. Although sprains, subluxations, and dislocations are more common in hypermobile children, the amount of tissue damage occurring with these acute injuries may actually be decreased due to the increased laxity of joint structures.
What I have termed "loose" is in medical terminology called Benign Joint Hypermobility Syndrome and it ranges from 2% to 30 % of children. The highest freqiemcu os seem om families that have one or more affected individuals; in females; and among people of Asian, African or Middle Eastern descent. Although joint hypermobility is maximal at birth (and perhaps in utero) children between 3 and 10 years of age have the highest occurrence, perhaps because of changes in body shape and size during a period marked by the increased demands of physical activity.
Most commonly, hypermobility has been linked with developmental hip disorders, delayed motor development, anterior knee pain syndrome, joint dislocation/subluxation, back pain, TMJ disease and flat feet. Once of the most controversial debates is whether BJHS predisposes to early osteoarthritis and degenerative joint disease. (There is also debate about whether Benign should be in the name of the process.) Studies have demonstrated a significant association among fibromyalgia, chronic fatigue syndrome and joint hypermobility in school-age children.
Excessive joint movement is associated with the development of symptoms in patients with hypermobile joints. Vigorous and repetitive activities have be listed as aggravating factors. Over training, poor pacing, too many performances or competitions, and focusing on joint flexibility rather than stability may all increase joint pain and risk of injury. Exercise therapy to improve muscular stability and proprioception at specific joints are essential to symptom management.
Back pain tends mainly to affect adolescents and is often associated with poor posture, although the incidence of lumbar disc prolapse, pars interarticularis defects and spondylolisthesis are all more common in hypermobile teens. Sitting posture is particularly important as children can spend a lot of time in front of a computer, at a desk in school or playing electronic games in slouched or unsupported positions, which increases the pain and strain on ligaments. Carrying large heavy book bags slung over the shoulder can also add to the problem.
So in summary, most loose babies will eat their toes more, look a little slow developmentally but recover, fall a little more often and perhaps have a few more bruises and stitches, have more aches and pains in childhood and youth activities, and may or may not have more joint issues as adults than babies who aren't loose.
Addendum: An excellent review article is found at
http://www.thefreelibrary.com/_/print/PrintArticle.aspx?id=54963603
Infants with hypermobility have higher incidences of motor delay, even in the absence of an identified neurological deficit. Among infants between 8 and 14 months of age, 30.2% of those with HMS had motor delay versus 10.9% of infants without HMS. Six months later, 75.9% of the infants with HMS no longer had hypermobility; 83.3% of these infants caught up in motor development, whereas only 54.5% of the infants who remained hypermobile caught up.[43] At 5 years of age, children who had hypermobility and motor delay at age 18 months were 3 times as likely as other children to have motor delay.
No comments:
Post a Comment