Pediatrics and Manual Therapy Can Go Together

Pediatric physical therapists are skilled in treating a wide variety of patient diagnoses, ages, and functional levels. As PTs, we are experts on handling and facilitating gross motor development, but there are not a lot of opportunities to learn and apply manual therapy techniques if you aren’t working in an orthopedic setting. As well, once children move through the developmental spectrum and reach an adult body height/weight, it is harder to apply pediatric knowledge and parent education. The use of manual therapy techniques is a needed and useful tool in every pediatric therapist’s toolbox and can be incorporated into the way therapy is already done. Restrictions to movement, and subsequent pain, usually have more than one root cause. If a joint is stuck or rotated even slightly, the surrounding muscles either become overlengthed or shortened, resulting in myofascial restrictions leading to trigger points and pain. As opposed to stretching the surrounding muscles, fascial release and restoring normal joint mechanics will more quickly allow restoration of the normal muscle resting length and a decrease in pain.

A typical example of this in the pediatric population is when a child presents with elevated scapulae and tight anterior chest muscles due to primarily using a wheelchair for mobility with limited time in standing/supine/prone. This rounded shoulder posture often leads to pain in the upper trap region and neck due to impaired shoulder mechanics necessitating the overuse of the upper trapezius for shoulder elevation.

Manual techniques that could be employed here include:

• Myofascial release of the pectoralis major and pectoralis minor
• Anterior/posterior glides to the thoracic spinous processes for pain relief and increased extension
• Inferior and medial glide of the scapulothoracic joint
• Myofascial release of the upper trapezius
• Myofascial release of the anterior neck musculature
• Motor re-education of cervical retraction

Other commonly found impairments and functional limitations where manual interventions can help include:

• Toe walking
• Crouched gait
• Low back pain
• Asymmetrical stride length
• Unilateral trunk lean

There is emerging evidence that the use of manual therapy in pediatrics is desired amongst clinicians, but the opportunities to learn safe techniques and how to apply them are not widely available. Integrating manual therapy into pediatric practice will help patients reach goals faster and provide an avenue for caregiver education and useful techniques they can use to help their children at home.