Core strengthening exercises for 10 year old

[allison9127]

I have a patient who is a 10 yo boy. He complains of increasing hip and lateral thigh pain with hips feeling loose and increased clumbsyness. Referral has come from a podiatrist and he now has orthotics fitted. Gait is with a pronounced external rotation of the feet and circumduction of the hips.
On examination the hips are not too bad to mobilise (some pain). Most significant finding is tightness ++ of gluts, piriformis and ITB. He is also very weak in the core muscles and hip F/Abd/ER/IR. X-ray is NAD.
I am treating him with massage and strengthening exercises (theraband and also on a fitball).
I am wondering in particular if anybody knows of any good exercises to keep the exercise program fun for kids.

[msk101]

Hi Allison,

Have you checked the lumbar spine? I notice you didn't mention if he's c/o LBP which i then presume he's not but increasing clumsiness, lateral thigh pain (as opposed to groin-hip pain) and anything bilaterally is NOT good in kids. Check him out to clear a spondylolysthesis and get Lx Xrays (i assume the Xrays you have are hips) if needed (plain view AND in flexion/extension). Also have you done a neurological examination of the LL's (reflexes, sensation, strength) as he's got bilateral Sx, it's really important to clear any other really nasty red flags (like a serious neuro issues like muscular dystrophy etc). Make sure there's no scary stuff going on...

So basically I'd suggest get the all clear on the lumbar spine and neuro things first and then continue with the core strength. Fitballs are great as is sport-specific training if he's up to that level and/or interested in a particular sport.

Cheers,
Let us know how you go.

msk101

[allison9127]

Thanks for your reply - sorry it has taken me so long to reply.

In response to your queries;

He has no back pain and active range of movement is full (although flexion is limited by hamstrings tightness) and without pain. Extension and hyperextension are not painful.

I ordered a L/S X-ray to rule out spondylolisthesis. Unfortunately the radiologist did not do flexion extension and I believe oblique views due to concern of exposure (he has only had the one hip/pelvis X-ray before!). X-ray was however normal.

Neuro exam is normal.

On review his pain is now resolved. His primary complaint is now one of fatigue with exercises.

He has terrible core strength and hip strength. Squats are limited to about 1/2 way without support with internal rotation of the hips so that the knees are pointing in at one another.

Unfortunately he has lost motivation for most of the exercises and is not concentraing on the core group. I was more recently wondering of the wii fit game (he is quite into video games) and whether it is actually beneficial in building core and hip strength??

Thanks again, Allison.

[physiotrav]

Have you tested general co-ordination via cerebellar co-ordination tests? Or co-ordination with throwing/catching ect. Possibility of developmental co-ordination disorder