Most children incur many bruises, scrapes, cuts, and muscle tears before they are fully grown, and sometimes these can have long-term consequences for the body.
Severe pain can cause muscle guarding, even when an injury heals properly.17 Myofascial trigger points can be activated by soft-tissue injuries. For example, neck traction during birth can strain the suboccipital muscles, leading to trigger points in the myofascia of the skull. Psychiatrist and pediatrician David Cheek, using age regression hypnosis, found a connection between a 50-year-old man’s lifelong migraine headaches and his birth. When forceps were applied to the man’s head, one blade had pressed hard just above one of his eyes, and the other blade compressed his occiput.18 Trigger points in the temporalis, occipitalis, and posterior cervicals, all of which may be caused by birth trauma, are known to induce migraines, while falling on the head or striking it by diving into shallow water can activate trigger points in the posterior cervical muscles.19 Scar tissue can have long-term effects as well. In addition to harboring trigger points capable of referring burning, prickling, or lightning-like jabs of pain to adjacent tissues, scar tissue has an astonishing ability to adhere to adjacent structures with a variety of effects. In one case, scar tissue actually pulled the incisors of one child outward, when a thick scar at the corner of his mouth from biting an electrical cord tightened against his gums.20
My client, Ze’eb, illustrates this point. Ze’eb is an 82-year-old retired scientist. During his birth in Germany in 1928, he was in a shoulder-first position, and traction to his right shoulder and arm during delivery caused trauma to the C5 and C6 nerve roots, with subsequent weakness of his rotator cuff, deltoid, biceps, and supinator muscles. This condition is known as Erb palsy. Until he was 11 years old, Ze’eb had weekly physical therapy, consisting of massage and stretching. His arm was completely straight and he could use it normally. Then, however, his family had to flee Germany and he never received therapy again. Contractures gradually developed in the tissues around his elbow joint. By the time he was 40 years old, the elbow was fixed rigidly against his chest in flexion and adduction, and was completely unusable.
Joint sprains generally occur when a normal joint is wrenched or twisted past its normal range of motion, but they can also occur when a child has congenitally loose joints or when contractures or postural imbalances have created a limited range of motion in an adjacent joint.21 Sprains can have long-term consequences: ligamentous laxity from a poorly healed sprain can cause permanent instability (for example, repetitive unprotected ankle sprains in a young gymnast can progress to complete ligamentous rupture), chronic tension can appear in the muscles around the joint as a stabilizing strategy, (for example, iliosacral ligaments damaged by a fall on the coccyx can lead to chronic iliopsoas muscle tension), and there is an increased risk of developing osteoarthritis.22 Myofascial trigger points can appear immediately after a sprain due to pain and overstretching of muscles.23
Most children break at least one bone during childhood. Any force sufficient to break a bone is also capable of traumatizing the surrounding soft tissues, and severe pain may initiate a pattern of muscle guarding. Nasal fractures can result in septal deviation, fibrosis, intranasal scarring, and activation of trigger points.24 Fracture of the proximal humerus can activate trigger points in the subscapularis, while an ankle fracture can activate trigger points in the gastrocnemius muscle. Immobilizing a fractured humerus in a cast can activate trigger points in the pectoralis major.25 When a cast is finally removed from a healed bone, the muscles around it are usually quite weak. As children begin to actively move the body part through its normal range of motion again, muscle strength and blood flow will begin to improve. However, damage to other tissues can remain, and a change in the way the child holds the area can cause postural imbalances as well. For example, if a fractured femur or tibia results in the femur being shorter than normal, the individual will forever have a short leg on that side. A tilted pelvis, compensatory scoliosis, chronic back pain, and activation of trigger points in the hip, torso, and neck muscles can result.26
As with adults, the way in which children live their lives can create different types of musculoskeletal problems. A complete list would be very long, so only a few examples are given here.
Standing Too Soon
The tension in an infant’s postural muscles can be aggravated by devices such as baby walkers and bouncers, which encourage babies to stand before their bone strength and neuromuscular coordination are sufficiently developed. Their young muscles, especially the iliopsoas, may become rigid to compensate for this skeletal instability. The presence of a tense or shortened iliopsoas can affect a chain of secondary muscle tightness in the adductor longus, tensor fasciae latae, rectus femoris, and quadratus lumborum, and contribute to later foot, knee, and gait problems.27
Improper Sitting Postures
How a child sits can affect the body in a variety of ways. For example, the position of the tibiae in relation to the femur can be permanently influenced by different ways of sitting as a child (that is, habitually sitting cross-legged versus sitting with the feet tucked under the buttocks). If excess inward torsion of the tibiae becomes chronic, the child will have excessive medial ligamentous tightness and uneven alignment of the knee joint, a risk factor for knee osteoarthritis.28 Prolonged sitting in poorly designed chairs that put the pelvis into flexion encourages poor posture with a chronically constricted abdomen, increased thoracic kyphosis, and chronically shortened iliopsoas.29 Between car seats, school desks, and working on the computer, children often sit poorly in chairs for many hours each day.
Early Sports Regimens
Repetitive strain injuries, including tendonitis and torn ligaments, are common in sports such as soccer or gymnastics, especially when children play before their muscles and bones are sufficiently matured. For example, stress fractures of the tibia and fibula are common with endurance running in adolescents, and can activate trigger points in the extensor digitorum longus, extensor hallucius longus, and superficial and deep intrinsic foot muscles.30
Habitual Muscle Contractions
Bone growth can be influenced by habitual muscle contractions. For example, girls who train in ballet from an early age develop grossly enlarged second metatarsals as a response to heavy, continuous stress placed on them, and the tibiae of a child with cerebral palsy can become permanently twisted by leg muscles that are constantly in spasm.31
Episodes of severe pain can lead to sustained contraction of a muscle and activation of trigger points. One 7-year-old girl, with an upper respiratory infection, developed two trigger points in the sternal division of her sternocleidomastoid muscle near an enlarged and very painful tonsillar lymph node. A 10-year-old boy with pneumonia developed a trigger point in one external oblique muscle as he attempted to splint his rib cage to avoid breathing deeply. After both children were well, they each suffered severe referred pain from the trigger points.32 Trigger points in the erector spinae muscles can also be activated by pediatric kidney stone pain.33
Being informed about the childhood origins of adult musculoskeletal conditions can help you understand not only how a single event can have a body-wide impact, but give you a deeper understanding of how the body operates as a whole. This can make you more effective at identifying and “unwinding” old patterns. In addition, this can help you explain these patterns to your clients, and convince them (like Mark) to let you explore farther afield rather than at one limited area. To incorporate this understanding into your practice, begin by asking more questions about childhood problems during your intake process. Ask about anything unusual during birth or infancy, any chronic discomfort (such as growing pains), where stress was expressed in his or her body as a child, and any episodes of severe pain. Did the client have any postural issues as a child, such as turned-out feet or a high hip? You may obtain important clues as to deep, long-standing problems, and in addition, may be able to explain to clients why these long-standing problems might need long-term massage.
By Marybetts Sinclair, LMT, a massage therapist in Oregon for 35 years, and is the author of Pediatric Massage Therapy (Lippincott Williams & Wilkins, 2004). She has taught massage for both infants and children in many different settings, including special programs for children with disabilities in the United States, Ecuador, and Mexico. For more information, visit www.marybettssinclair.com.
Originally published in Massage & Bodywork magazine, September/October 2010. Copyright 2010. Associated Bodywork and Massage Professionals. All rights reserved.
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