Therapy Spotlight: Paediatric Physio

 In Ehlers-Danlos Syndrome, Hypermobility Spectrum Disorders, Joint Hypermobility Syndrome, Loeys-Dietz Syndrome, Management Skills, Marfan Syndrome, Pain Management, POTS, Therapy Options

We are doing a series on different therapies over the next few months, and are interviewing some therapists who have experience working with hypermobility conditions.

To kick us off, we have Ashleigh Palombi, a Paediatric Physiotherapist on the Northern Beaches of Sydney!

What’s the best part of being a paediatric physio?

The best part is without a doubt seeing a kid’s smile at the start and end of each session. I love being able to help children and their families achieve goals that, at one stage seemed so far out of reach. I love working as a team with families, to help them feel empowered in their rehabilitation journey, may it be from a niggly injury, a trauma, persistent pain or a diagnosed condition.

I love the variety in my day and how every single child presents with something a little different. I love the creative approach we take to get children back to doing what they love most. I love sharing my passion for exercise and sport with my patients; when I was growing up, it was such a big part of my life so I want every single child to have the opportunity to experience the same, at whatever level that may be at, in whatever sport they may choose.

What’s the most challenging part of being a paediatric physio?

Sometimes the things we love are also often the most difficult! So as fun and enjoyable as being creative is, it can also be extremely challenging. Each child has different interests and motivators, so making sure that I am continually addressing these in my management techniques is imperative!

How is paediatric physiotherapy different from regular physiotherapy?

A quote that I preach is that “Children are not mini-adults” and therefore they cannot be treated that way.

Children and adolescents have unique bodies that go through many changes in just a short period of time. It is imperative that your Physiotherapist has a clear understanding of what changes are happening in your child’s body at each stage of their development and what this means for the musculoskeletal system. By having this knowledge, it means that treatment targets are appropriate, and treatment goals are realistic.

One of the aims of paediatric physio is to treat injuries and presentations that are commonly a result of skeletal immaturity (e.g. injuries where muscles attach onto bones), as well as those caused by a loss of neuromuscular control which can lead to ligament injuries and poor postural habits. The goal is to address these with targeted treatments before they become problems that could affect them into adulthood.

Can paediatric physiotherapy help children with hypermobility?

I believe that Physiotherapy should be a mainstay in the management of children who have hypermobility, particularly as an addition to all of the other great members of the multi-disciplinary team. Here at The Sports Academy in Narrabeen, we are fortunate to have Paediatric Rehabilitation Specialist Dr. Louise Tofts who is globally recognised for her work and research into hypermobility, and Mo Maarj, our Sports Podiatrist, as a part of our team and we all work closely together to set achievable goals for our patients.

There have been many recent studies and an abundance of anecdotal evidence that clearly outlines the importance of having a Physiotherapist with a sound working knowledge of hypermobility, as they are aware of the needs, the symptoms, the limitations and the associated conditions that an individual with hypermobility may experience. By having a Physiotherapist who understands all of this, it means therapy goals are likely to be more achievable, and a holistic approach can be applied to ensure that the child as a whole is treated, not just a particular injury.

But the question usually is – HOW does Physiotherapy help children with hypermobility? There are many answers to this as Physiotherapy can be helpful in pain management, cardiovascular fitness, injury prevention and postural control, but I believe that the foundation to all of this is muscle strength!

Muscle strength promotes mechanical stability at the joints; it stops them from resting in extreme positions and relying on the stretched structure for support. In addition to this, by improving muscle strength, we are also improving the sensory feedback mechanisms associated with the joints themselves known as proprioception. This word is often thrown around for children with hypermobility, as by improving their proprioception, they will have a better awareness of where the joint should be in space helping with things like running, jumping, hopping, catching and throwing. Here at The Sports Physio Clinic, we, therefore, use graded exercise rehabilitation (that is FUN) to help promote muscle strength and progressively build up a child’s tolerance and confidence for activities of daily living.

Of course, this isn’t all! The list of things that Physiotherapy can help with for a child with hypermobility goes on, but keeping your child’s body as strong as it possibly can be, under the guidance of your Physiotherapist is fundamental in the ongoing management of their musculoskeletal symptoms, their cardiovascular fitness, pain management and even their mood. The road is long, and setbacks will occur, but as long as the child and their family feel empowered and educated on how exercise can be such a valuable tool in their life, they will quickly reap the rewards from this!

What services do you offer?

At Narrabeen (Northern Beaches of Sydney), we are lucky to have access to some fantastic facilities, which means that we can offer a range of services to our children and adolescents.

Physiotherapy musculoskeletal examination and treatment plan:
• A thorough examination reviewing your child’s injury history, general health and well-being followed by a musculoskeletal assessment can be conducted to devise an appropriate management plan specific to your child and their presentation.

General Strength & Fitness Classes:
• A fun and interactive strengthening class tailored to children’s bodies and their growing needs. This strength and fitness class is for small groups with the content individualised and modified based on each participants ability and specific needs. It is a great socialising tool for children with similar goals, aiming to give each child confidence to carry out skills learnt in class into their school activities and club sport settings.

Injury Prevention Classes:
• A great class for our hypermobile kids, this exciting new concept is designed to allow each child to participate in the sport of their choice at the level of their choice. The content is sport-specific, breaking down movement patterns that are frequently used in their chosen sports, and ensuring that they have sufficient strength and control throughout to reduce their risk of injury. Injury prevention concepts are taken from the latest evidence-based protocols in the FIFA 11+ (Football) and the Netball Australia KNEE program, and we make it fun and engaging.

Hydrotherapy Classes:
• With a pool onsite, there are many options available here –

1:1 classes to allow for close supervision and feedback while the patient is learning new movements. The pool setting is excellent for those that fatigue easily or have persistent pain plaguing their ability to progress through activities of daily living and exercise.

Small (3-5 person) classes with a focus on strength, control and endurance. A great starting point for those looking to get into some gentle activity and to have a consistent form of exercise available to them that is not only achievable but also loads of fun! This = pool toys galore (ensuring their use is effective and outcome-focused without even knowing about it).

Motor Assessment Battery for Children (second edition):
• A new addition to the clinic, I am trained and qualified to carry out the globally standardised MABC2 test. The MABC2 is a great tool for those families wanting to establish a baseline for their child’s gross motor and fine motor skills prior to intervention and then to reassess post-intervention to determine efficacy and ensure that things remain goal-driven. Further to this, the MABC2 can be used to determine your child’s eligibility for schooling assistance and potential funding eligibility via referral from your paediatrician.

Alter-G Anti-Gravity Treadmill:
• One of very few in Sydney, the Alter-G is a fun and extremely effective tool for rehabilitation. Lots of my kids liken it to being in a spaceship, the Alter-G is a vacuum sealed treadmill which uses “unweighting” at anywhere between 20 to 100% of your bodyweight. An excellent tool for kids that have become deconditioned through illness or become fatigued very quickly, it reduces the load on the joints and the demand on the muscles empowering them to return to exercise in a graded fashion.

How do people find you? What are your practice details?

I’m based at The Sports Physio Clinic in Narrabeen located on the Wakehurst Parkway as a part of The Sports Academy. Please feel free to contact us at any time on (02) 9981 4099 or schedule an appointment through our website

Alternatively, you can contact me directly should you have any questions or wonder if I could be of assistance to you and your family.

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