As a pediatric mucsuloskeletal speciatist, Dr. Weber examines all the joints of the body (except the inner ear…).
What are common problems that she treats in the office?
Depending on the age and the problem presenting, it is important to address the feet. Infants may have had the feet squeezed in an abnormal position which causes pain and does not allow them to bear weight normally. Toddlers may not bear weight evenly on the feet, or have issues of asymmetrical rotation in the lower legs causing gait difficulties. Young children may develop issues with the growth zones of the feet due to hormones overweight or over training. These are evaluated non-weight bearing and weight bearing to evaluate their function. Treatment can improve the mobility of all the small joints many problems causing discomfort can be addressed. In some situations taping is used to stabilze the foot or lower extremity. Some causes of pain or discomfort actually originate in the low back, so we are always considering this as a possibility of why a patient has foot pain. Some of the different types of problems are heel spur (hälsporre), Achilles tendonitis, Morton’s neuroma, hallux rigidus, hallux valgus, plantar fasciitis among others. In some cases we tape the foot for a period of time to address instability. Our role is to improve function by taping, mobilizing or manipulating different parts of the foot. Once function is improved, exercises to stabilize the foot and appropriate foot wear are recommended. There are cases where ice is recommended.
The knee is a hinge joint. When function is impaired this leads to instability and strains primarily the surrounding joints. In some patients knee pain reflects a primary problem in the hip and must be differentiated. We have these important skills in differential diagnosis. Understanding the origin of the problem is the first step in the assessment of the patient. Only then can adequate treatment be performed and proper rehabilitation recommended. The goal with treatment is to restore normal function in the joint and to recommend exercises to stabilize the joint. In some cases a brace to stabilize the knee is needed.
The hip joint is a ball and socket joint that is part of the pelvis, it is a very stable. Reduced mobility in this joint directly strains the joints of the pelvis and lumbar spine. This responds well to mobilization and stabilizing exercises.
A common problem area for older children is the pelvis, low back and hip complex. Having skills in differential diagnosis is critical to differentiate a hip problem from a pelvis or low back problem. Clinically, it is very common that a patient has been told they have a hip problem when a thorough examination reveals a problem stemming from the low back. The lumbar spine sits on top of the pelvis, in particular the sacrum. The spine is like a chain with many small parts that should be mobile. In the lumbar spine the joints are formed to move sideways and forward and backward. This area is injured most often when bending forward, twisting and lifting. For the young athlete, over-training during a growth spurt is a common reason for injury to the growth plate and more serious low back pain.
As we move up the spine to the thoracic spine, (or bröstryggen), the vertebrae are formed differently and move most easily sideways, forward and backward and in rotation. The ribs attach to the vertebrae (costovertebral joints) making up the chest and they attach in the front of the body to the sternum with the costosternal joints. The rib cage is susceptible to injury during heavy lifts and certain twisting movements that occur in different sports. When the costovertebral joint is sprained, it can be difficult to take a deep breath or twist the upper body. This area is most commonly injured while lifting heavy things with outstretched arms. When the ribs are involved, the pain can travel around the rib and/or through the ribcage. Some people think they are having a heart or lung problem. Examination of this injury or dysfunction requires specialty education in biomechanics. We commonly treat this and show exercises which are necessary to stabilize the injured area.
The cervical spine (halsryggen) sits on top of the shoulders and bears the weight of the cranium. The cervical spine glides sideways, forward and backwards with the majority of rotation at the junction of the uppermost vertebrae and the cranium. In children, the size of the head is disproportionally large compared to the body. This becomes more proportional as children approach their teens. What this means is that in young children the weight of the head is an enormous weight on the neck when it is tipped forward (screen time). Ergonomics have become very important in preventing neck pain in children.
When parts of the “chain” or vertebrae are not moving as they should, there is a strain on the adjacent areas. The goal with treatment is to restore normal functioning and recommend exercises to make the area stable.
The shoulder complex is made up of the clavicle, the shoulder blade and the head of the humerus (top of the arm). The glenohumeral joint or the moveable part of the shoulder is rather unstable compared to the hip. It is more easily injured and requires very specific training to avoid long term problems with the shoulder. The clavicle and shoulder blade are less often injured, but may not function optimally with a shoulder injury. The exception here is snowboard injuries. These are addressed in treatment and rehabilitation.
The elbow and wrist are areas of complaint with injuries falling on the outstretched arm (skateboard, snowboard). The elbow is a unique joint which bends and can rotate. Depending on the type of injury or overuse syndrome which presents treatment addresses joint function and muscles that support the joint. The wrist has many small bones and the joints here must function perfectly to avoid pain and discomfort. In recent years complaints have increased with the monotone use of the hadns, wrists and arms on screens and at the computer (for children gaming for long periods of time can be problematic). Good ergonomics are critical for avoiding overuse and appropriate information is an important aspect of rehabilitation.
Pain in the shoulder, arm, elbow, wrist or hand can reflect a problem in the neck.
Dr. Webers skills in differential diagnosis can determine where the problem comes from, whether it is a problem amenable to chiropractic care, or whether another specialist should examine the patient.