One of the most common “groups” of children that present into our clinic are children that have low tone.  So what is it, how does it effect the child and what can you do about it?

The first concept to understand is that we all have a couple of significant systems that help to hold us upright against gravity.  The first system is made up of our bones and ligaments.  This system is passive and besides stretching the ligaments to allow more movement there is not a lot we can do to change it.  You may know some people who have joints that allow a lot of movement – we call this “hypermobility”.

The second system is made up of our muscles.  This system is active and is controlled by our neurological centres (our brain and spinal cord).  Each of us have a certain amount of tension in our muscular system at any time (even when we are sleeping) we call this tension “muscle tone”.  Muscle tone is influenced by our genetics but also by what we do and therefore we can influence it.  Across the community comparing different people there is no one amount of tone but rather a spectrum with some people having more than the norm – high tone, some people having less than the norm -low tone and the majority of people being somewhere in the middle.

The next main concept to grasp is that our brain uses feedback from lots of different parts of our body to help control it.  This allows our brain to understand where we are in space at any given time.  This includes the position that we stand and sit in – our posture.  The control centre within our brain receives feedback from our eyes, joints, muscles and tendons and our balance centres and assimilates all this information constantly to do the things that we want to do.  It really is amazing!

For people with lower muscle tone there will be less feedback that comes from their muscles and tendons which means it can be more difficult to control our positions and postures and in general makes coordinating our body a little harder.

So given the information above how does having low tone effect children?

It is important to note that the effect will be different for each individual and that there are a myriad of different effects however typically we see:

• Decreased strength.
• Decreased postural endurance so the child typically fatigues more easily especially with prolonged sedentary positions.
• Poor postures with sitting and standing.
• The child will typically slump onto their ligaments (passive system) so they don’t have to use their muscles as much.
• With poor posture and trunk control can come poor hand control.  This might be evident with poor hand writing dexterity.
• More difficulty coordinating movements.
• Hand eye coordination and ball sports are harder.
• Decreased muscular response time.
• Poor concentration can occur as the child fatigues.

In the clinic we also see that these problems and postures lead directly to stiffness and pain through their upper back, neck and shoulders and occasionally headaches.

So if this is your child or a child you know what can you do about it?

For children that have low tone I believe in addressing both the biomechanical and the environmental factors to assist the child to achieve their full potential…

Biomechanical Factors

We want to increase the stimulation of the neurological and balance centres for this child.

Unfortunately the child that has low tone typically finds ball sports challenging and often they become less interested in sports and activity in general.

Finding exercise and activity that they do enjoy and that stimulates their muscular system within their endurance limits is a key.

Examples of this that I have seen work very well include: Trampolining, swimming, bike riding, circus training and martial arts.

Environmental Factors

Ultimately movement and changing positions and postures is ideal for this child rather than being stuck in one position for a long period of time.

If this child is to be sitting for an extended period of time ensuring that they have a supportive comfortable chair and that they can effectively use the backrest will really help.

When they are sitting at their desk at school or at home an inclined reading/writing board or slope board helps to encourage an upright posture where they lean back into the backrest of the chair.

Setting up alternate workstations such as a standing station also helps.

Correct ergonomics of their desktop, laptop or tablet computers is crucial to encourage good posture especially as they get older and study demands increase.

Limit their sedentary behaviours and encourage active play as much as possible.

Do you know a child that has Low Tone? Are they having any difficulties with school, sport or pain? There are lots of ways that we can help them reach their full potential!

Greg Campbell is a husband, father of three young children (aged 11, 9 and 5), Physiotherapist & Managing Director of Smart Health Training and Services and the founding principal of the Smart Health School Program.

Web: FB: P: (08) 8293 1100
E: reception@smarthealthtraining.com.au
Address: 12-22 Richmond Road, Keswick

Whether your child is the next Olympian or you just want to encourage involvement in some type of physical activity, Pilates can be suited to any fitness level.

Pilates for adults often requires a great deal of concentration and focus but with children Pilates needs to be fun and more about just moving. It’s about developing good body awareness and good mind body control by incorporating Pilates based exercises and principles into play. This can be achieved by using lots of tools such as foam rollers, gym balls and chi balls; as well as making up games like renaming the exercises after animals.

Pilates is similar to karate, ballet and gymnastics in that it does teach children a level of calm, coordination and control. Children who don’t otherwise find a sport or physical activity appealing might like the gentle, slow nature of Pilates exercises. The effects may even translate to children being more coordinated and therefore more likely to participate in sport.

The health and wellbeing of today’s children is compromised by a culture of convenience, advancing technology and increasingly sedentary activity. Encouraging children’s involvement in a wide variety of physical activities can only be a good thing.

As children grow and develop, this is when they formulate the physical attributes that they will take through life. Pilates can teach children the correct way to walk, sit, stand and bend; thus alleviating pain and reducing the potential for injury both now and into the future. When trunk stability is absent, sitting and standing for extended periods in school can be difficult. If children are expending their energy maintaining stability, their stamina for homework and other after school activities may be depleted. A strong trunk conserves their energy and allows them to be more attentive at school.

I’ve compiled some Pilates exercises for you to try at home with your kids;

1. An oldie but a goodie – Practice walking around the house with something balanced on your head like a book. This encourages being tall and lengthening through the spine to stop slouching postures!
2. Balance on something wobbly like a pillow, especially on one leg – This helps to improve balance and reaction times.
3. Sit with a partner with your legs out straight, put your feet together and hold hands; taking it in turns to pull one person toward the other and stretch out the back of your legs and back. Don’t bend your knees!
4. Lie on your back now, with your feet up against your partners and try to sit up and touch hands and then lie back down again.
5. Sit up nice and straight on a gym ball and practice lifting one leg up at a time – this also encourages good postural control, good balance and quicker reaction times.
6. Lie with your feet up on a gym ball and practice lifting your bottom up into the air – this will encourage good strength and assist with running and jumping.

There are many other ways to include Pilates exercises in your children’s play to assist their development and encourage ideal fundamental movement patterns both now and into the future.

Lisa Rogers is a Physiotherapist and Pilates Practitioner at Smart Health Training & Services 

Web: FB: P: (08) 8293 1100
E: reception@smarthealthtraining.com.au
Address: 12-22 Richmond Road, Keswick

Ever had one of your children complain about neck pain, back pain or headaches?  You’re not alone……….

A quick audit of the IT devices and “screens” in our household reveals just how heavily invested and surrounded by this technology we are.  2 iPhones, numerous iPods, 2 iPads, 3 Nintendo DS, a Wii, 2 TV’s, 3 laptops and a desktop computer (we’ve so far managed to resist the Playstation & Xbox) this shows that my family is living this IT device dream as much as any!

Being a Health Professional and running a schools-based program has also allowed me to see the effects that using these devices with poor postures and set ups can have on the musculoskeletal health of our children.  We recently ran some comparisons in our clinic and found that compared to just 4 years ago we now see 5 times the amount of under 18 year old clients.  While there will be a number of reasons as to why this is the case there is little doubt that the explosion of mobile technology use by school aged children both at home and at school is a large contributing factor.  As health professionals we are seeing younger patients and a direct link between screen use and back and neck pain and headaches.

As a telling example a recent study out of Western Australia that looked at the posture of young children using tablets compared to other activities concluded that tablet use by young children is typified by less movement, less muscle activity and poor spinal posture compared with toy play.

Habits around screen use, time spent on these devices and a balanced lifestyle are all extremely important in mitigating the risks of musculoskeletal problems associated with using IT devices.  Today however, I’d like to focus on the ergonomic set up.  Getting the ergonomics right is extremely important for all students on all devices.

It’s important to point out that laptops and tablets by themselves don’t encourage good posture. Often the screen is too low or even worse flat on the desk (or their lap or bed etc) bringing the users eyes down which then encourages a slumped posture through the neck, upper back and shoulders.  We relate this head down posture to increased tension through the upper back and neck muscles which may result in neck pain or headaches.

We’ve included a picture of the ideal set up for both sitting and standing workstations.  Try to get the workstations in your home as close to ideal as possible.  It’s sometimes not easy to fit young children to adult furniture so you may need to use props, cushions or pillows to help. The closer you get to the ideal position to encourage the ideal posture the more comfortable they’ll be.

Here are some tips taken from our Smart Health School Program about improving the ergonomics of your computer and tablet set ups at home…

1. Laptops do not encourage ideal ergonomics.  If using a laptop regularly use an external keyboard and mouse, with an external flatscreen (or laptop riser) to allow for ideal positions and encourage ideal postures.
2. When using a computer or laptop for a sustained period of time ideally the top third of the screen should be level with the user’s eyes.
3. If using a tablet regularly use a tablet stand and external keyboard (if data input is required) to allow ideal position of display and keyboard.
4. Good postures don’t just happen naturally, set reminders either through timers or apps that can be downloaded on to the device. Remember to get up, move and stretch every 20-30 minutes.

At Smart Health we’ve developed numerous resources for parents, students and teachers as part of our Smart Health School Program to help them create environments and habits that support physical health and wellbeing when using IT devices. Our online courses for both primary school aged children and secondary school aged children can be found and accessed at  … .  These courses are designed for parents to do at home with or without their children at the device and workstation that needs to be set up.  They take approximately 30-45 min to complete and go through ideal ergonomic set up for tablets, laptops and desktop computers and the physical activity guidelines that specifically relate to different age groups.

For more information about Greg Campbell, Smart Health and the Smart Health School Program go to .

Greg Campbell is a husband, father of three young children (aged 11, 9 and 5), Physiotherapist & Managing Director of and the founding principal of the Smart Health School Program.

Web: FB: P: (08) 8293 1100
E: reception@smarthealthtraining.com.au
Address: 12-22 Richmond Road, Keswick

Growing Pains

As a Mum and a Physiotherapist, I hear of children, especially young teenagers complain of growing pains. But what are they? Is it really a pain or is it just in their heads?  I often get asked this question so thought I’d give my view on the topic.

As we go through puberty and growth spurts, our body lays down bone cells at a faster rate than muscle cells, So, essentially, the skeleton is growing at a faster rate than the muscles are lengthening. In extreme cases, a degree of tension will occur at the point where that muscle is attached to the bone via it’s tendon. The tension can result in some irritation and inflammation through that tendon causing pain. This does tend to occur around  the long bones and especially at the load bearing sites such as the legs. Common points of pain are at the back of the ankle (Achilles), around the knee (patella) or through the front of the hip (hip flexors).

Generally, children report a general discomfort in the area that tends to come on after exercise. When the child is running around or playing, the body warms up and circulation flows but as they rest, circulation slows and inflammation sets in resulting in the post exercise or at rest soreness. This can be confusing as to the real cause. In severe cases, their sleep may be disturbed causing general tiredness and irritability.

We can actually treat growing pains. We still need to wait for the child’s body to go through the cycle of growth before the condition resolves completely, but we can reduce the discomfort they are experiencing, through soft tissue release and myofascial stretching, localised treatment over the points of tendon inflammation and monitor general bone alignment and biomechanics. This may be more pertinent to those adolescents who are involved in greater activity such as ball sports, athletics or dance. It is about managing the symptoms whilst the growing pains occur. Advice will be provided as to when to rest completely from activity or when to reduce activity. This may vary over those adolescent years, whilst their growth spurts vary in speed. We prefer to manage the condition rather than stop the child from participating in their activities.

A specific home program of foam roller muscle release assists in lengthening the muscles gradually, somewhat like rolling out plasticine and keeping it “soft”, ice treatment around the severe points of pain after activity to reduce the inflammatory process and taping the effected joints during activity. Specific exercises to help stabilise the joints effected can reduce symptoms and protect those joints whilst they mature.

So growing pains are real pains. They are a direct result of inflammation of the soft attachments of muscle to bone, in the situations where those bones are growing incredibly quickly. They cannot be stopped until growth stops and may vary in intensity as the growth spurts occur. Because there is no specific injury event and the pains are vague and more evident after exercise rather than during, they are difficult to identify. But they are not in the child’s head, they are not an excuse to be lazy. Growing pains are real and can be managed by your therapist to prevent any permanent damage and make your child much happier.

Jen Guest is a Physiotherapist and Senior Pilates Practitioner at Smart Health Training & Services who holds a strong belief in working with junior dancers through their developmental years to achieve maximum potential. 

Web: FB: P: (08) 8293 1100
E: reception@smarthealthtraining.com.au
Address: 12-22 Richmond Road, Keswick