The development of the musculoskeletal system in children is a complex process that requires a balance between movement, nutrition, genetic factors, and environmental conditions. In some cases, this balance is disrupted, which can lead to musculoskeletal disorders. These may range from mild and reversible deformities to chronic conditions requiring long-term treatments or complex interventions. Early medical evaluation and a personalized treatment plan can make a real difference in a child’s development.
Causes
Musculoskeletal disorders in children can have multiple, sometimes combined, causes. Identifying triggering factors is essential for diagnosis and choosing the appropriate treatment. Below are the main contributing causes:
Genetic Factors
Some conditions are inherited from parents or have a significant genetic component. For example, hip dysplasia or idiopathic scoliosis may occur more frequently in children who have relatives with the same issues.
Trauma and Accidents
Falls, impacts, and other injuries can lead to fractures, sprains, or conditions affecting muscles and joints. If not properly treated, these injuries can negatively influence skeletal development.
Incorrect Posture and Lack of Movement
Children who spend a lot of time in front of screens, sit improperly, or carry heavy backpacks are more prone to spinal deformities and walking disorders. Lack of physical activity affects muscle tone and joint health.
Nutritional Deficiencies (e.g. lack of vitamin D, calcium)
An unbalanced diet low in calcium, vitamin D, and other essential nutrients can lead to brittle bones and growth problems. Rickets is a classic example of a condition related to nutritional deficiencies.
Neurological or Developmental Issues
Neurological conditions such as cerebral palsy or coordination disorders can affect a child’s posture and gait, gradually leading to musculoskeletal deformities. In some cases, these issues appear in the first months of life and require specialized therapy.
The Most Common Musculoskeletal Disorders in Childhood
Musculoskeletal disorders in children vary in severity, from minor and reversible issues to conditions requiring long-term medical treatment or surgery. Early diagnosis and proper treatment are essential to ensure harmonious child development. Here are the most frequently encountered conditions in pediatric practice:
Scoliosis
A lateral deviation of the spine, commonly appearing during growth spurts (pre-adolescence). It can be mild or severe and, if untreated, may affect posture, breathing, and appearance. Treatment includes physiotherapy, braces, or, in severe cases, surgery.
Flatfoot (Pes Planus)
The absence of the foot arch, causing the arch to collapse. It’s common in children and often disappears as they grow. Persistent forms, however, may cause pain and fatigue while walking, requiring orthotics and corrective exercises.
Hip Dysplasia
An abnormal development of the hip joint, most often diagnosed in infancy via ultrasound. If left untreated, it can lead to abnormal walking and early-onset osteoarthritis. Treatment includes special braces and, in some cases, surgery.
Congenital Torticollis
Occurs when the sternocleidomastoid muscle is shortened on one side, causing the head to tilt and rotate in one direction. It becomes noticeable within the first few weeks of life. Treatment involves physiotherapy and, rarely, surgery.
Congenital Clubfoot
Also known as “talus valgus” or “talipes equinovarus,” it is a foot deformity visible at birth. Prompt treatment includes serial casting, physiotherapy, and sometimes surgery.
Kohler's Disease
A rare condition where small foot bones (usually the navicular) temporarily undergo necrosis. Typically affects children aged 3 to 7 and causes pain and difficulty walking. Treatment includes rest, orthotics, and physiotherapy.
Kyphosis
An exaggerated curvature of the spine in the posterior direction (hunchback). It may be caused by incorrect posture, spinal diseases, or genetic conditions. Treatment includes postural correction exercises and, in some cases, orthopedic braces.
Legg-Calvé-Perthes Disease
Occurs when blood supply to the femoral head is interrupted, causing necrosis. It usually affects children between ages 4 and 10. Symptoms include hip pain and limping. Treatment involves rest, orthotics, and physiokinetotherapy.
Sever's Disease
An inflammation of the growth plate in the heel (calcaneus), common in active children. It causes pain while walking or after physical activity. Treatment includes rest, local ice, orthotics, and stretching exercises.
Inflammatory Conditions (e.g. Juvenile Idiopathic Arthritis)
A group of autoimmune diseases causing chronic joint inflammation. They present with pain, swelling, and joint stiffness. Require specialized medical treatment and continuous physical rehabilitation.
Symptoms That Should Alert Parents
Certain signs and symptoms may indicate the presence of a musculoskeletal condition and should not be ignored. Parents should seek medical consultation if they observe:
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Abnormal or asymmetric positions of the child’s body (shoulders, spine, hips)
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Abnormal gait – limping, toe-walking, or walking on the inner/outer edge of the foot
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Persistent pain in the back, hips, knees, or feet
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Quick fatigue while walking or refusal to participate in physical activities
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Joint swelling or stiffness, especially in the morning
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Limb length discrepancies or spinal curvature
Early detection of these signs increases the chances of effective treatment and reduces the risk of long-term complications.
Modern Diagnostic Methods
Diagnosis of musculoskeletal conditions in children is based on thorough clinical evaluation and specialized investigations. Common modern methods include:
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Pediatric orthopedic consultation – clinical assessment of posture, gait, mobility, and body symmetry
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Musculoskeletal ultrasound – non-invasive method, ideal for diagnosing hip dysplasia and assessing joints
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X-ray – useful for detecting bone deformities and spinal alignment
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MRI (Magnetic Resonance Imaging) – for detailed detection of joint or muscular disorders
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Laboratory tests – used when inflammatory or autoimmune conditions are suspected
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Laser interstitial & intra-articular therapy – modern, minimally invasive methods used to treat musculoskeletal conditions in children, aiming to reduce inflammation and pain, and stimulate tissue regeneration
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Ozone & Hyperbaric Therapy – complementary therapies used in musculoskeletal conditions to reduce oxidative stress, improve tissue oxygenation, and accelerate healing and regeneration
An accurate diagnosis is essential for establishing a personalized treatment plan.
Treatment of Musculoskeletal Conditions
Treatment varies depending on the condition, severity, and child’s age. In our clinic, the approach is personalized and multidisciplinary, focusing on modern and non-invasive therapies:
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Kinesiotherapy – corrective exercise programs adapted to the child’s age and needs
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Physiotherapy – includes personalized exercises, TECAR therapy (stimulates circulation and tissue regeneration through deep heating), electrotherapy (uses electrical currents to reduce pain and relax muscles), and laser therapy (reduces inflammation and accelerates healing)
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TECAR Therapy – stimulates tissue regeneration and joint mobility
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Nutritional counseling – important for children with calcium or vitamin D deficiencies
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Psychological support – for children emotionally affected by limited physical activity
Prevention
Prevention of musculoskeletal conditions starts with healthy habits and careful attention to the child’s development. Key recommendations:
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Encourage daily physical activity (walking, swimming, outdoor games)
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Avoid excessive screen time and promote proper posture
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Choose a light backpack and wear it properly (on both shoulders)
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Balanced diet rich in calcium, vitamin D, and protein
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Monitor gait and motor development, especially during early childhood
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Regular visits to the pediatrician and orthopedic specialist
An active lifestyle and careful supervision of a child’s development are key to prevention.
Bibliography:
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Davis, P. J., & McDonagh, J. E. (2006). Principles of management of musculoskeletal conditions in children and young people. Best Practice & Research Clinical Rheumatology, 20(2), 263–278.
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LeBlanc, K. E., & LeBlanc, L. L. (2010). Musculoskeletal disorders. Primary Care: Clinics in Office Practice, 37(2), 389–406.
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Fernandes, G., Gonçalves, D. A., & Conti, P. (2018). Musculoskeletal disorders. Dental Clinics, 62(4), 553–564.
Frequently Asked Questions
What age is critical for proper bone development?
The critical age for proper bone development is in the early years of life, up to around 7 years old. During this period, bones are growing rapidly and are more flexible, making correction of deformities more effective. The puberty period (ages 10–14) is also crucial for bone strengthening and skeletal alignment.
Is it normal for a child to walk on their toes?
Up to around 2 years old, toe-walking may be a normal temporary behavior as children learn to walk and test their balance. If toe-walking persists after this age, it could signal issues such as increased muscle tone, deformities, or neurological disorders and should be medically evaluated.
How often should a child see an orthopedic specialist?
It is recommended that every child have an orthopedic check-up at least once a year, especially during critical growth periods (early childhood and puberty). If symptoms or diagnosed conditions are present, the frequency of visits may be higher as per the specialist’s advice.
When is wearing orthotics indicated?
Wearing orthotics is indicated when there are deformities in the feet, hips, or spine that can be corrected or stabilized with external support. Examples include severe flatfoot, hip dysplasia, scoliosis, or congenital torticollis. The decision is made only after medical evaluation to ensure effectiveness and comfort for the child.
