Genu Varum In Kids | A Physiotherapy Approach For Better Health.

Genu varum, also known as "bow legs," is a condition in which the legs curve outward at the knees while the feet and ankles touch. While many infants are born with bow legs, the condition typically resolves on its own by age two or three. However, in some cases, the condition may persist and require medical attention, as it can cause knee pain, loss of balance, and loss of flexibility. In this blog, we will explore how parents can know if their child has genu varum and also explore how Pediatric Physiotherapy can help treat genu varum by strengthening the weak muscles and stretching the stiff muscles.

Observing the Appearance of the Legs:

One of the easiest ways to determine if your child has genu varum is to observe the appearance of their legs. Bow legs can be identified by the following physical characteristics:

1. Curved legs: If your child's legs curve outward at the knees while their feet and ankles touch, they may have bow legs.
2. Separation of the knees: When your child stands with their feet together and their knees apart, there may be a noticeable gap between the knees.
3. Tilting of the ankles: When your child stands with their feet together, their ankles may tilt inward.
4. Uneven gait: Bow legs can also affect your child's gait or the way they walk. Your child may walk with an uneven gait or have difficulty running and climbing stairs.
5. Measuring the distance between the Knees: To measure the distance between the knees, the child is asked to stand with his feet together and knees touching. A ruler or measuring tape is then placed between the knees, with the zero point at the center of the kneecaps. The distance is measured from the center of one knee to the center of the other knee. However, it's important to note that other factors, such as hip alignment and foot position, can also affect the distance between the knees.

How Physiotherapy can help treat Genu Varum in Children?

In individuals with genu varum, the tibia (shinbone) may be angled outward from the knee, while the femur (thighbone) remains straight. This can cause the muscles on the inside of the thigh (adductor muscles) to be tight, while the muscles on the outside of the thigh (abductor muscles) may be weak.
Physiotherapy can be a highly effective treatment option for individuals with genu varum. A physiotherapist will work with the patient to develop a personalized treatment plan that focuses on strengthening weak muscles, stretching stiff muscles, and improving overall alignment and stability. Here are some of the key ways that physiotherapy can help treat genu varum:

Weak muscles that need to be Strengthened:

Genu varum, the muscles that are typically weak are the abductor muscles on the outside of the thigh, and stretching alone may not be sufficient to address the muscle weakness. Stretching exercises can be beneficial for improving overall flexibility and range of motion, and may also help to reduce compensatory muscle tightness that can occur due to muscle weakness.
Muscles that are weak in children with genu varum include:
1. Gluteus medius
2. Tensor fasciae latae
These muscles are responsible for pulling the leg outward and maintaining proper alignment of the knees. Strengthening exercises, rather than stretching exercises, are typically recommended to address muscle weakness in children with genu varum.

Stiff muscles that need to be Stretched:

In addition to strengthening weak muscles, it's also important to stretch stiff muscles that may be contributing to the development of genu varum. The muscles that are tight in genu varum child and need stretching are the adductor muscles on the inside of the thigh. These include:
1. Adductor longus
2. Adductor Magnus
3. Adductor brevis
These muscles pull the leg inward and contribute to the bow-legged appearance in children with genu varum. Stretching these muscles can help to improve flexibility, reduce muscle tension, and improve the alignment of the knees.

If you suspect that your child has genu varum, it's important to consult with a physiotherapist. They can perform a physical examination and recommend an appropriate course of treatment. With the right treatment plan, most cases of genu varum can be effectively managed and corrected, allowing your child to enjoy improved stability, mobility, and overall quality of life.

 

Managing Genu Valgus In Children | Strengthening And Stretching Of Stiff Muscles For Improved Growth

Genu valgus deformity, commonly known as knock knees, is a condition where the knees come together while the feet are apart. This deformity is quite common in children and can cause various issues such as knee pain, joint pain, and difficulty in walking. Physiotherapy can be an effective treatment for genu valgus deformity in children. In this blog post, we will explore how physiotherapy can treat children with genu valgus deformity, the muscles that are weak and tight, and the exercises that can help improve the condition.

Genu valgus occurs due to a variety of reasons, including genetics, obesity, and developmental factors. During early childhood, it is normal for children to have some degree of genu valgus due to the development of the skeletal system. However, as they grow, their legs usually straighten out naturally. If genu valgus persists beyond age 7 or 8, it may indicate a problem.
Genu valgus can affect a child's growth in several ways. It can put extra stress on the knee joint and lead to pain, discomfort, and difficulty with physical activities. It can also affect their gait and balance, leading to clumsiness and an increased risk of falls. In severe cases, genu valgus can cause deformities in the legs, including bowing of the femur (thigh bone) or tibia (shin bone). This can lead to further problems with mobility and even impact the child's overall posture.
If you are concerned about your child's genu valgus, it is important to consult with a medical professional who can assess the severity of the condition and recommend appropriate treatment options. Treatment may include pediatric physiotherapy, braces, or in more severe cases, surgery.

How Does Physiotherapy Treat Genu Valgus Deformity in Children?
Physiotherapy is a non-invasive treatment option that can help improve the condition of genu valgus deformity in children. The goal of physiotherapy is to strengthen the muscles around the knee joint, improve joint stability, and correct any alignment issues. This can help improve the child's walking pattern and reduce the risk of any future knee-related problems.
The first step in physiotherapy treatment is to assess the child's condition. A physiotherapist will examine the child's gait, posture, and muscle strength. They may also take X-rays or other imaging tests to get a better understanding of the severity of the condition. Based on the assessment, the physiotherapist will develop an individualized treatment plan that may include a combination of exercises, stretches, and manual therapy techniques.

Weak Muscles in Children with Genu Valgus Deformity

Children with genu valgus deformity often have weak muscles around the hip, thigh, and knee. The following are some of the muscles that are weak in children with this condition:

• Gluteus Medius: The gluteus medius muscle is located in the hip and is responsible for stabilizing the pelvis during walking. Weakness in this muscle can cause the pelvis to drop on the side of the affected leg, leading to an abnormal gait.
• Vastus Medialis: The vastus medialis muscle is located on the inner side of the thigh and is responsible for extending the knee. Weakness in this muscle can cause the knee to buckle inward, exacerbating the genu valgus deformity.
• Tibialis Anterior: The tibialis anterior muscle is located in the front of the shin and is responsible for the dorsiflexion of the foot. Weakness in this muscle can cause the foot to drop, leading to further misalignment of the knee joint.

Tight Muscles in Children with Genu Valgus Deformity

Children with genu valgus deformity often have tight muscles around the hip, thigh, and knee. The following are some of the muscles that are tight in children with this condition:

• Adductors: The adductors are located on the inner side of the thigh and are responsible for bringing the leg toward the midline of the body. Tightness in these muscles can exacerbate the genu valgus deformity.
• Hamstrings: The hamstrings are located on the back of the thigh and are responsible for bending the knee. Tightness in these muscles can cause the pelvis to tilt backward, leading to an abnormal gait.
• Gastrocnemius: The gastrocnemius muscle is located in the calf and is responsible for plantarflexion of the foot. Tightness in this muscle can cause the foot to remain in a pointed position, exacerbating the genu valgus deformity.

Physiotherapy exercises can help improve the strength and flexibility of the muscles around the knee joint, leading to an improvement in the child's walking pattern.  Overall, the physiotherapist will assess the child's specific condition and prescribe a customized exercise program to address their individual needs. The goal of these exercises is to strengthen weak muscles, stretch tight muscles, and improve the overall alignment and stability of the lower extremities.

 

Top 10 Exercises for Pediatric Patients after Cardiac Surgery

Physiotherapy plays an important part in the recovery process of pediatric patients after cardiac surgery. After cardiac surgery, the child needs to start the exercises as soon as possible. Before cardiac surgery, pediatric patients are given some exercises by the physiotherapist to prepare them for the surgery. These exercises are required to be done after surgery to help them recover and to keep their lungs clear, well-expanded, and free of mucus. Physiotherapy treatment focuses on general mobility and chest care. It is essential to consult a physiotherapist before cardiac surgery. As he guides and teaches exercises that should be practiced before and after the surgery. This blog is designed to mention a few exercises that will help pediatric patients to recover after cardiac surgery.

 

Exercise strategy

A physiotherapist is a health professional who is trained to prevent, identify, and correct movement problems. Pediatric patients should start doing the exercises as soon as possible while in the hospital. The posture is frequently checked during the day to make sure the child sits or stands straight and does not lean forward or to the side.

• Sit in a chair with feet on the floor.
• Sit or stand up straight, with the shoulders pulled back and down.
• Shoulders should be stacked above the hips and should not be arching the back.

The breastbone takes approximately three months to heal. Therefore, to prevent stress on the breastbone the child should avoid pushing through his/her arms. He/she is advised to put his/her hands on the knees and shuffle the bottom when getting out of bed or a chair for the next three months.

 

Chest care

Chest physiotherapy begins on the first day after the surgery. Discomfort or pain from the chest wound can stop the child from taking a deep breath in and coughing. For the first few days, the child may not be as mobile as he/she would normally be and so he/she can't breathe deeply. If the child is taught deep breathing exercises before the surgery, then it is easier to remember these exercises afterward.

 

Breathing exercise:

The physiotherapist will teach the child how to practice deep breathing.

• The child is made to sit upright with hands placed over the sides of the chest.
• Then, asked to slowly take a deep breath through the nose.
• Hold this breath in for one to two seconds and then breathe the air out slowly through the mouth.
• Repeat 5 times.
• Then huff 5 times.

To do a huff take a breath (medium-sized) then force the air out quickly through an open mouth.

Coughing:

• Take a deep breath in and have a good strong cough, supporting the chest wound with a small pillow.
• Take normal relaxed breaths after coughing.
• Young children can practice deep breathing by blowing bubbles.
• Older children can practice deep breathing using a device called an incentive spirometer.

After surgery, once the child is awake and breathing on their own, it is important to start doing the exercises.

 

Chin tucks:

Prevent forward chin posture, to encourage good posture, as forward chin posture can cause neck discomfort.

• Sit in a good posture.
• Sit up tall, drawing the shoulder blades towards the center of the spine.
• While holding this posture, focus on bringing the chin back so the neck is long.
• Hold this position for 5-10 seconds to feel the stretch and repeat 5-10 times.

Initially, some gentle arm and leg exercises should be done to prevent stiffness, help circulation, and then progress to walking

 

Shoulder shrugs:

From the first day after the surgery, exercising should be encouraged.

• The patient is sitting in a chair or standing.
• Gently bring both shoulders up and down.
• Repeat five to ten times.

 

Shoulder rolls:

Improve shoulder movement while maintaining neck posture.

• Sit in a good posture.
• Slowly and gently roll the shoulders in circles forward and backward.
• Relax and repeat 5-10 times.

 

Arm raise:

The exercise goes like this:

• Sit in a good posture.
• Sit up tall, and draw the shoulder blades towards the center of the spine.
• Lift one arm so that the elbow is beside the ear and then lower the arm.
• Repeat 5-10 times. Repeat with the other arm.
• Raise both arms straight forward over the head.
• Then bring both arms back and down.
• Repeat five to ten times.

 

Trunk side flexion:

Reduce stiffness that can happen with a side incision.

• Sit in a good posture.
• Lift the arm straight up on the incision.
• Bend away from the incision so that it feels a stretch.
• Breathe, in, then breathe out.
• Return to the starting position and repeat 5-10 times.

 

Gentle heel slides:

These exercises are taught to help keep the muscles strong and promote circulation.

• The patient lies on the bed with the legs well supported.
• Bend both knees and straighten the legs alternatively.
• Repeat 10 times.

 

Ankle movements:

The exercise goes like this:

• The patient lies on the bed or sits in a chair.
• Draw a circle shape with the feet from ankles, in one direction.
• Repeat in the other direction.
• Repeat 10 times in each direction.
• Bring the ankles up towards the body.
• Then bring them down toward the floor.
• Repeat 10 times with each ankle.

Quadriceps sets:

The exercise goes like this:

• The patient lies on the bed with legs straight.
• Tighten the thigh muscles on the front of the legs.
• Press the back of the knee into the bed and pull the toes towards the body. 

Quadriceps arc:

The exercise goes like this:

• The patient lies on the bed with legs straight.
• Tighten the thigh muscles.
• Lift the leg from the bed to a small height.
• Hold for 2 seconds, then slowly bring it down
• Repeat ten times with each leg. 

From day two onwards following the surgery, begin to progress the mobility under the guidance of an experienced physiotherapist. After heart surgery, the child may have been unable to exercise for some time, so the increase in an activity needs to be done gradually, to build up his/her fitness slowly. Your physiotherapist may also recommend an exercise bike or pedals, to improve the patient's fitness by increasing the length of time on the bike rather than the resistance. At three months after the surgery, the child should be able to do everything that he/she did before the surgery.

 

Pre and Post Physiotherapy for Pediatric undergoing Cardiac Surgery

Cardiac Surgery is successfully performed on numerous Pediatric patients suffering from many different congenital heart defects. The frequency of heart surgery in children with congenital heart disease is very high, and the occurrence of pulmonary complications in post-operative heart surgery is equally common. Children also have postoperative pulmonary risks similar to adults. Since the complications like atelectasis and pneumonia are highlighted among them, it is important to make use of effective means to prevent, reduce or treat such complications. These complications are minimized by drugs, and by Physiotherapy. Positive results have been found after providing physiotherapy services in preoperative and postoperative pediatric cardiac surgery patients. This blog summarizes the efficacy of Pediatric Physiotherapy treatment through different techniques emphasizing the importance of early mobilization and ambulation and also promotes the application of physiotherapy pre and post-operative pediatric cardiac surgery.

 

PHYSIOTHERAPY

Physiotherapy in the pre-and postoperative period in pediatric cardiac surgery is used to reduce the risk of pulmonary complications like atelectasis, retention of secretions, and pneumonia. Physiotherapy interventions contribute to the appropriate ventilation and successful extubation.

 

Pre-operative Physiotherapy:

Physiotherapy techniques used are clearance, re-expansion, abdominal support, and guidance on the importance and objectives of physiotherapy intervention for parents.

 

Post-operative Physiotherapy:

Postoperative physiotherapy includes vibration in the chest wall, percussion, compression, manual hyperinflation, re-expansion maneuver, positioning, postural drainage, cough stimulation, aspiration, breathing exercises, mobilization, and acceleration of expiratory flow.

• After heart surgery, the child must be repositioned (approximately every two hours) throughout the day to ensure that the lungs stay well-expanded and free of mucous. This will also help the child to recover the movement. Whether the child is still on the breathing machine or is breathing by himself, the physiotherapist will check whether the lungs are clear of secretions. The physiotherapist will use techniques to help increase the air going to the lungs and to clear the secretions from the lungs. These techniques may include positioning, deep breathing exercise, chest percussion, and coughing.
• The child should start moving soon after the operation and the physiotherapist will help the child with sitting out of bed if the child is old enough, start walking in the first couple of days after surgery.
• Good positions post-operation includes turning the child onto the side, onto the back, holding him in the arms, and placing them into an infant seat. This will help the child recover sooner so that he can go home.
• Aspiration with the techniques of respiratory physiotherapy such as manual vibration, positioning, percussion, compression, manual hyperinflation, and postural drainage are found to be beneficial. Physiotherapy tends to produce improvement in pulmonary compliance, expiratory tidal volume, and pulmonary resistance.
• The treatment for atelectasis consists of physiotherapy, deep breathing, incentive spirometry, etc. However, sometimes, atelectasis is difficult to reverse and it is necessary to associate it with another method, respiratory physiotherapy, and inhalation of hypertonic saline solution with NaCl at 6% is recommended.
• Chest radiographs and four physiotherapy sessions lasting 20 minutes were performed daily, using maneuvers of bronchial hygiene, pulmonary re-expansion, postural drainage, and tracheal aspiration shows significant results. Immediately before and after physiotherapy inhalation of hypertonic saline solution with NaCl at 6% can be given.
• Breathing exercises are recommended in cases of atelectasis due to thoracic or upper abdominal surgery, because they improve respiratory efficiency, increase the diameter of the airways, which helps to dislodge secretions, prevent alveolar collapse, and facilitate the expansion of the lung and peripheral airways clearance.
• Significant increase in oxygen saturation and reduction in cardiac and respiratory rate after intervention with the increased expiratory flow in children with pneumonia has been proven and the physiotherapeutic technique for bronchial hygiene is found to be effective in improving lung function.
• When the presence of pulmonary complications is associated with other complications regarding the time of hospital stays, such as sepsis, pneumothorax, pleural effusion, and others, if the patient is treated by physiotherapy before and after surgery it shows a lower risk of developing such complications.

Post Surgery:

• Avoid activities that disturb the wound.
• Avoid lying on the tummy.
• Take care of the chest muscles and bones during any movement.
• Avoid lifting the toddlers under the arms. Lift the baby under the head/neck and bottom.
  
  

Physiotherapy is included in the multidisciplinary team that contributes significantly to the better prognosis of Pediatric patients undergoing heart surgery, as it prevents and treats pulmonary complications using various techniques. The effectiveness of physiotherapy in reducing the risk and/or treating pulmonary complications caused by surgical procedures in children with congenital heart disease has been proven.

 

Infant Head Shape | How physiotherapy can help attain a round head?

In a few babies at the time of birth, the head doesn’t look like the charming cue ball which you would have imagined. Instead, it may appear cone-shaped, asymmetrical, or have a flat spot on one side. This can occur because of the vaginal delivery, in which a female has to push for a longer time. While there are various medical interventions that can change the shape of the newborn baby's head, Pediatric Physiotherapy is one of them. In this blog, we have mentioned a few exercises on how your baby's head shape may change during the initial months.

 

At the time of birth of your newborn. The Fontanelles or the soft or membrane-covered gaps between several bony plates making up the skull (head) are helped to shift and mold so it can fit through the birth canal.  But while the female has to push the baby out through the birth canal, the head may appear cone-shaped or pointed. If your newborn’s head is misshapen down the birth canal, then it requires immediate treatment. Physiotherapy is one of the best-known interventions. The physiotherapist does a comprehensive physical examination, to check cone-shaped or flat spot changes and head unevenness. The physiotherapists guide and plan out a program for the treatment. Below mentioned are a few guidelines by our Physiotherapist:

 

Tummy Time:

Baby should get plenty of tummy time when he’s awake. 15 minutes of tummy time per day helps to strengthen the newborn baby's neck muscles, as well as develop motor skills that can help your baby to crawl. Slowly increasing tummy time to 30 minutes, 3 times a day is recommended.

 

Switching up baby's sleep position:

Baby's head can return to a more rounded shape by altering his position while he's feeding, asleep, and playing.  Changing a baby's position is called counter-positioning or repositioning. It encourages the flattened areas of the newborn’s head to reshape naturally. For the baby's safety, always put him on his back to sleep. When the baby is put down on his back, the rounded side of his head should be in contact with the mattress, which helps keep one side of his head from flattening. In Moses' basket or crib, turn the head around regularly so that the newborn is not always looking in the same direction. If he's in a cot alternate the direction in which the baby is placed down to sleep.

 

Encouraging Side-lying:

Encourage the baby to lie on his side when possible. It is safe to do so when if he is wide awake or is sleeping during the day under supervision. Always keep an eye on the newborn when he is lying on his side, be sure that nothing happens to prevent him from breathing properly or obstructing his nose.

 

Holding the new-born:

When the newborn is awake, he should be kept out of the bouncer, stroller, car seat, or any other carrier as much as possible, instead carried in the arms, to relieve pressure on his head. The baby should be kept upright when awake to help relieve pressure on my baby's head from swings, carriers, and infant seats. The newborn must also be held with alternate arms at each feeding.

 

Helmets or bands:

In certain babies, cone-shaped or flat spot head doesn't resolve on its own, so it is recommended that the baby wears a special band or a medical helmet that applies gentle pressure to redirect the skull's growth. The baby wears the band or helmet all day and night -Along, taking it off only for bathing. For most babies with flat spots, physiotherapy should be started at around 5 or 6 months of age and usually lasts for about 3 months.

 

Stretching Exercises and Physical Therapy:

The newborn might have an asymmetrical head shape due to congenital torticollis, in such cases, your physiotherapist does some stretching and strengthening exercises to help lengthen and loosen the baby's neck muscles.

 

Horseshoe-shaped Pillows:

Horseshoe-shaped pillows may help make their baby's head round, though pillows are not recommended for babies under the age of one. Pillow, soft objects, and loose bedding can obstruct the infant's airway and cause a suffocation risk like sudden infant death syndrome (SID) also known as cot death.

 

A flat area does not affect the baby's developing brain. The head shape can be improved, and the earlier intervention is started the better it is. The younger the baby is, the easier it is to remold the head. Too much pressure can make him uncomfortable, or even hurt him.