My name is Shaun and I am a pediatric physical therapist. I help children work toward their physical fitness related goals through activity modification and individualized exercises. To an outsider watching some of my physical therapy sessions, the enthusiastic man running around the gym and diving into crash pads with his client could very well be a youth personal trainer. Physical therapists and personal trainers both collaborate with their clients to meet their fitness and gross motor function related goals. They account for and modify risk factors to improve their health and prevent disease. However, behind the games and exercises lie a number of considerations that reflect the rigorous training physical therapists receive to treat each person as a whole. How a child moves and performs is not simply a function of their muscle and bones: a physical therapist has extensive training on how all organ systems affect one’s movement, diseases and conditions that affect gross motor performance, and an eye for detailed movement analysis.
Physical therapists recognize that the body’s systems are interconnected and that dysfunction in one area can lead to difficulties in another. A common example I encounter are inefficient breathing patterns that, in turn, hamper a child’s ability to participate in games with their peers due to low endurance. Teaching a child to “fix their breathing” can be tricky and unintuitive, but our extensive training in cardiopulmonary rehabilitation allows this impairment to be easily identified and addressed. Other systems that pediatric physical therapists most commonly consider include the nervous (e.g. unintegrated neonatal reflexes), integumentary (e.g. orthotic wear and therapeutic taping), digestive (e.g. core strength and G.I. motility) systems.
A hallmark of the physical therapist’s profession in the public eye is identifying and addressing musculoskeletal injury. The lives of children are appropriately filled with activities like jumping from play structures and running on asphalt with 20 peers, chasing after a ball. These activities, while developmentally appropriate and should continue to be encouraged, come with risk of injury. Compounded with inefficient or maladaptive movement patterns and habits, the risk for injury increases. As pediatric physical therapists, we identify these risk factors, whether they are postural impairments, muscle weakness, or coordination deficits, and provide exercises to strengthen or retrain the child’s movements in the form of fun and engaging games.
On the other hand, not all injuries are preventable and a physical therapist must be able to identify, treat, or refer to a more appropriate provider. For example, one of my clients complained of knee pain, but upon testing, it became apparent that the source of pain was actually his hip. I advised his family to seek medical attention to rule out a SCFE (slipped capital femoral epiphysis), a hip fracture that can present as “referred” groin or knee pain (think of arm pain when one is having a heart attack), and would require surgery to fix if confirmed. Through detailed movement analysis and an intimate knowledge of musculoskeletal injuries, physical therapists are best suited to help their clients function optimally and address existing injury.
My clients and I play soccer while crab walking. We race down hallways on scooter boards. We play dodgeball while flying on swings in our large multi-sensory gym. The kids have fun, and at the same time, they get a great workout – usually without their knowledge. And yes, the session may look like a personal training session. The key difference is that throughout each session, I keep in mind all of each child’s medical histories and risk for injury and how to best address it in a creative game or activity.