Avin Patel

Perthes’ Disease

Perthes’ Disease is a rare childhood disease affecting the shape of the hip joint. It eventually burns itself out, but can be a cause of arthritis later in life. It also goes by the name “Legg-Calve-Perthes Disease”.

Perthes' Disease

What Is Perthes’ Disease?

This is a condition in which the blood supply to part of the thigh bone is disrupted. Specifically, it is the head of the femur (the ball of the ball and socket) that is affected. Bone is living tissue, and in children affected by Perthes’, it is still growing. Reduction of the blood supply causes part of the bone to die (necrosis), and become misshapen. Long term effects depend on the details of the repair stage described below.

Frustratingly, we don’t know exactly what causes the disease to develop. Some cases are associated with rapid growth spurts that somehow disrupts the blood supply. Other cases are associated with trauma or infection, or even congenital hip dislocation. In about 1/10 cases the other hip develops the same condition after the first.

Symptoms of Perthes’ Disease

Perthes’ begins between the ages of 4 and 10, and many more boys are affected than girls. Early signs often include a limp, which is likely to be worse after exercise. This may be completely painless or persistently painful. Where there is pain, it may spread to the groin or as far as the knee (illustrated above).

The Repair Stage

Once blood flow returns, the body begins to heal the damaged tissue. Some cases heal perfectly, and even an X-ray would not clearly show that there was ever a problem. Other cases can lead to a deformed femoral head, which may have a flat portion or a rough texture compared to a healthy one. This is likely to impact range of movement and may cause a limp. Sometimes a brace will be recommended by the orthopaedics team, in order to hold the femoral head in the roundest part of the socket. This aims to encourage the bone to grow into the correct shape.

Your Osteopath’s Role

We cannot resolve the blood supply, but we may be able to help with the compensatory patterns that develop in response to the pain. A child with suspected Perthes’ Disease requires referral to their GP and on to the orthopaedics team. We can support with symptom management and ensuring the hip maintains as much normal movement as possible.

Longer term complications of the condition can include a limp or early onset arthritis. We may be able to help manage the arthritis, especially if addressed at the earliest symptoms. A limp caused by asymmetry of the thigh bones is not an inherent problem- a well managed limp can be pain free. This depends on the body’s ability to adapt to the demands of the limp. As long as the legs and back can compensate for these changes indefinitely, it should be comfortable. This might require intermittent treatment over years, or it may be perfectly manageable with prescribed exercises.

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Plagiocephaly

Young babies’ heads are relatively soft and can become misshapen. Plagiocephaly is the term for a flat spot on the head.

Plagiocephaly and brachycephaly

To be more precise, a flat spot on the back of the head is called brachycephaly.

Causes of Plagiocephaly

At birth, babies heads are often misshapen, and this often corrects itself. The soft joints in the skull mean that a baby’s head can manoeuvre through the narrow birth canal without injury. Head shape may be more dramatically affected by an instrumental delivery (forceps or ventouse). It is also possible that the head shape was affected by the positioning in the uterus.

Plagiocephaly is closely related to torticollis, which is a neck muscle spasm causing reduced neck movement. Before babies can sit by themselves, they spend a lot of time laying down or reclined. If the neck is uncomfortable when turned one way, they will favour the other side. Combined with gentle but prolonged pressure on the head, this can lead to a flat spot.

Weakness in the neck, which is more common in premature babies, can cause plagiocephaly by a similar means. With premature babies, the effects may be especially pronounced, as their skulls are softer at birth than full term babies.

Red Flags

Osteopaths with paediatric training will screen for red flags in babies with plagiocephaly. Craniosynostosis is an example of a red flag. This is a condition in which the joints in the skull fuse early, which requires medical intervention. The condition is rare, but you should speak to your GP if you suspect that this may be the cause of your baby’s unusual head shape.

Management of Plagiocephaly

There are a number of interventions for plagiocephaly that may or may not be effective. The NHS does not routinely advise for the use of helmets, as they are expensive, may be uncomfortable, and are not well supported by research.

It is important that you do not adopt unsafe sleep habits in an attempt to address your baby’s plagiocephaly. Current guidance is to lay your baby down on a firm mattress, flat on their back. If they are able to roll by themselves, you do not need to roll them back.

Tummy time and supported sitting (before your baby is able to sit unassisted) is recommended to encourage strengthening. Your health visitor can give you guidance on what is appropriate for your baby, and tips that might make these exercises more enjoyable for both of you. Alongside the benefits of strengthening, these exercises require no pressure on the head, so may help with the correction of a flat spot.

Cranial osteopathy uses gentle techniques. Some parents say that this helps to provide comfort for their babies. This kind of treatment does not involve the stronger manipulation (or “clicking”) that you might expect from an adult osteopathy appointment. Among other structures, osteopaths work on tight muscles, so if a baby has plagiocephaly due to tightness in the neck, gentle osteopathic techniques may form part of an appropriate treatment plan.

Make an appointment in Rutland or Leicestershire here.

Infant Torticollis

Torticollis, in adults and babies, is a condition involving neck tightness and reduced movement. This article will focus on torticollis among infants, but some of the information provided will also apply to adults.

Infant torticollis

Signs of Torticollis in Infants

Typically, torticollis is caused by spasm of the SCM muscle. This is the muscle that sticks out on the front of the neck when you rotate your head. In addition to rotation in one direction, it is responsible for bending the neck in the other. Therefore, when in spams, it causes rotation one way and side-bending in the other.

While a baby is very young and lacks neck control, signs can be hard to spot. Sometimes it helps to look at pictures you’ve taken of your child to see if they favour rotation in one direction. It may also be more obvious if:

  • baby prefers to feed laying on one side vs the other, if the feeding position is not in a neutral position for the neck
  • they interact more with toys on one side of their baby gym or seat
  • their cot is next to a plain wall, and they get irritable when placed in such a way that they have to face it

Causes of Torticollis

True congenital torticollis is present from birth (or before). There are controversies about whether the details of the birth have an effect on this. Muscles respond to the demands put on them, so if a baby has their neck in an asymmetric position in the womb, some muscles will tighten up.

Your paediatric osteopath will screen for sternomastoid “tumour” of infancy. Despite the worrying name, it is not a cancer. “Tumour” literally just means mass, and in this case it is a fibrous mass within the SCM muscle. It appears in the first few weeks of life, and in about 50% of cases, it will resolve on its own. Some children who have this condition will have torticollis at the same time, or after it resolves. Your osteopath can help to manage the tight muscle.

Secondary Effects

Young babies have especially soft skulls. While they lack the mobility to spend much time sitting or crawling, they will likely sit in positions where there is pressure on the back or side of their head. If their neck mobility is reduced, they will have more pressure on one spot, as turning the head is uncomfortable. As a result, they may develop a flat spot on the head. This is called plagiocephaly.

Managing Torticollis

Where tight muscles are involved, your paediatric osteopath may be able to help. You can expect gentle techniques to massage and stretch the muscle during your appointments. Where necessary, they will also work gently through the affected joints. Exercises or advice may also be appropriate. Where safe to do so, your osteopath may advise that you help your baby to spend some time every day in a supported sitting position. Plenty of tummy time is usually advisable too, as both positions allow the neck muscles to begin to strengthen.

Make an appointment in Leicestershire or Rutland here.

Cranial Osteopathy

You may have heard news from celebrities getting cranial osteopathy for their newborns. Joe Wicks recently made headlines, as has Pippa Middleton. But what is cranial osteopathy, and why would you want it?

Cranial osteopathy for newborns

What is Cranial Osteopathy?

Cranial osteopathy is actually a treatment for both babies and adults. For babies, this gentle approach can give quick results for problems that may have developed at birth or in the first few weeks of life. One common problem is muscular asymmetry in the neck, which may be diagnosed as torticollis if it becomes more significant.

In October 2019, Pippa Middleton wrote an article in the Waitrose Weekender about her baby’s cranial osteopathy,  reporting that “the osteopath noticed one side of his neck was tighter than the other, which explained why he favoured one side sleeping.” 

As with other forms of osteopathy, the osteopath will take a case history, and assess the feel and movement of tissues in the affected area. When they have an understanding of the problem, they can deduce whether cranial treatment is appropriate.

What Does Cranial Treatment Entail?

The osteopath holds the patient’s head, typically while they are lying on their back. They feel for small movements or imbalances, and use gentle movements to encourage the body to correct itself. This may look like nothing is happening at all- it’s not a spectator sport!

Due to the gentle nature of treatment, any adverse effects are likely to be transient.

Treatment for Newborns

Babies are very responsive to treatment, which means cranial can be particularly effective for them. However, it also means they might react to imbalances in day to day movements. Difficult birth, particularly where the baby was in an awkward position or needed intervention, might cause strains or discomfort through the body.

Very young babies can have a lot of abdominal discomfort too. When they are very young, the bowel does not push waste through (peristalsis) as well as it does in adults. This means they might have to actively push more, or they might experience tummy aches. The only symptom may be crying or general fussiness, which can be hard to pin down to one specific cause. An osteopath may be able to help through cranial treatment, or more direct treatment to the abdomen.

While babies’ skulls are still underdeveloped, the bones are not fused. This means that excessive pressure on one side can change the shape of the head, for example if they like to turn their head one way over the other. As mentioned above, cranial osteopathy can help with the root cause of this if it is due to tightness in one side of the neck. Direct cranial treatment to the skull may also help.

Treatment for Adults

Cranial osteopathy complements generic osteopathy well. For adults, cranial may help with tinnitus or problems with the jaw.

Many people find this kind of treatment particularly relaxing, and may opt in to it for stress related conditions, including some problems with the diaphragm, bowel, or shoulders. Stress related headaches may also benefit.

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