Muscle, Bones and Joints

A soft tissue injury is damage of muscles, ligaments and/or tendons anywhere in the body. Soft tissue injuries usually occur from a sprain, strain, overuse or a direct blow. Soft tissue injuries are most common in the ankle and knee but they can happen anywhere in the body. People with soft tissue injuries will have pain and swelling.

Severe soft tissue injuries will cause your child or young person to stop their activity. It is important to start moving the affected area early on. Evidence shows this is the best treatment to prevent further problems.

The use of ice is still recommended if swelling is a major problem. Remember to never place ice directly on your skin. Use a barrier, like a towel, to protect your skin. How long you use ice as a treatment can depend on the area of injury. However, generally apply ice for up to 15 minutes at a time and leave a few hours before reapplying.

Moving the joint will also get rid of swelling. Try and encourage gentle movements of the affected area. If it is a leg injury you should try and encourage taking weight on it and walking normally. With arm injuries, try and encourage normal use. It may take your child or young person a few days to be able to do this but continue to encourage it.

If needed, your child or young person may take medicine to decrease any pain and inflammation. Use according to the package directions or as instructed by your doctor/pharmacist.

Your child or young person may need to take a break from sporting activities. This should only be for about 2 weeks until the pain and swelling have eased. More severe injuries may take as long as four to six weeks to heal.

Please contact your local paediatric physiotherapy advice line or your GP if your child or child or young person is not getting better.

The ankle joint connects the foot to the lower leg. It is surrounded by various muscles and ligaments, which give it stability.

Ankle problems are fairly common. They can also cause pain in the foot. Ankle problems often get better with time and do not usually cause any long term issues.

If your child rolls, twists or turns on their ankle in an awkward way this can lead to a soft tissue injury. It can stretch or tear the tough bands of tissue (ligaments) that help hold the ankle bones together.

Sever's is a common cause of heel pain in children and adolescents, between the ages of 8-14. It is most common in very active children/young people and/ or those who have had a recent growth spurt. Tight calf muscles or the Achilles tendon (the tendon which attaches the calf muscle to the heel bone) cause the pain. There is 'pulling' where it attaches to the heel. It can be painful to touch and sore on activity; such as running and jumping or with prolonged walking. Wearing flat shoes can also be a cause. Sometimes Sever's can cause limping, walking on toes, and or some swelling around the heel. It can occur in one or both heels. Sever's gets better with a period of rest and doing less high impact activities. Ice packs can be used for pain and swelling. Well-fitting footwear is important.

Stretching of the calf muscles if they are tight, and it is not sore to do so, can also help. Sever's can take a few weeks and up to a few months to settle. It does not cause any long term damage, but it can recur until growing stops.

For more information and advice look at:

• Sever's / Calcaneal Apophysitis leaflet from the Association of Paediatric Chartered Physiotherapists (APCP)
• Advice on physical activity and participation

When to seek help:

Please contact your local paediatric physiotherapy advice line or GP if you are worried about your child/young person and none of the above points are true.

The spine is made up of bones called vertebrae. They are connected by ligaments (strong soft tissue connections between the bones). Shock absorbing discs separate the vertebrae. The bones provide structure and support and they protect the spinal cord and nerves. Muscles attach to the spine and allow mobility.

Back pain in children and young people is common. But most cases are not caused by a serious problem. It usually gets better on its own within a few weeks. Encourage your child to stay active. Sitting around or lying in bed for more than a couple of days can make it harder to get moving again. Backs don’t generally like to be still. Try to gradually get back to normal activities and do some form of regular exercise. Try not to game, watch TV, read or study for too long in one position.

For more information and advice look at:

• Fit for the Future (Scotland) leaflet from the Chartered Society of Physiotherapy (CSP).
• Back problems from NHS Inform

When to seek help:

Please contact your local paediatric physiotherapy advice line or GP if you are worried about your child/young person and none of the above points are true.

The hip is a ball and socket joint that connects the thigh bone to the pelvis. The hip joint supports your body weight and allows you to move your upper leg. It also helps you to maintain your balance.

There are many reasons why children and young people can have hip pain. They use their hips every day for walking, crawling, sitting, standing and running. The pain may be in their hip, but they could also feel it in their knee or thigh.

You can find out more about hip conditions and managing hip problems on NHS Inform.

Snapping Hip is a condition that causes the feeling of catching or snapping when moving the hip. The feeling may come with noise and/or pain. Sometimes it may even be a sensation of the hip “giving way” or “coming out of the socket.” The snapping is the movement of a muscle or tendon over the bony structure of the hip. Usually, it is on the outside surface of the hip. It is not the hip coming in and out of the socket.

This is treated with stretches.

Hamstring Stretch 

• Sitting with your back against the wall/sofa
• Legs straight out in front with knees as straight as you can get them
• You should feel a stretch down the back of your leg
• Hold for 40 seconds
• Repeat 4 times
• Do 3 times a day

Hamstring Stretch 

• Sitting on a chair
• Have one leg straight out in front and one leg bent
• Rest your hands on your bent leg
• Gently lean forwards from the hip while keeping your knee straight on your straight leg
• You should feel a stretch down the back of your leg
• Hold for 40 seconds
• Repeat 4 times each leg
• Do 3 times a day

Hip Stretch 

• Sitting in a chair
• Place your ankle on your opposite thigh and gently place your hand on your knee and push down towards the floor
• You should feel a stretch around your hip and inner thigh
• Hold for 40 seconds
• Repeat 4 times each leg
• Do 3 times a day

ITB Stretch 

• Sitting on the floor
• Cross one leg over the other outstretched leg and place your foot on the floor
• Gently place your hand on your bent knee and pull it across your body
• You should feel a stretch in your hip and the outside of your thigh
• Hold for 40 seconds, repeat 4 times on each side
• Do 3 times a day

Quad Stretch 

• Lying on your tummy
• Bring one foot up at a time towards your bottom, making sure your hip isn’t going out to the side while doing this
• You should feel a stretch in your thigh
• Hold for 40 seconds, repeat 4 times on each side
• Do 3 times a day

When to seek help:

Please contact your local paediatric physiotherapy advice line or GP if you are worried about your child/young person and none of the above points are true.

The knee’s main job is to bend, straighten and take the weight of the body along with the ankles and hips. The knee is made up of bones, ligaments, tendons and cartilage. Knee pain is common in children and young people. It is usually due to growth and changes to their body as they mature.

Anterior Knee Pain is felt around and under the kneecap. It might be worse after long periods of sitting, going downstairs, squatting, running and walking. This could be due to muscle tightness and weakness due to growth. Using an ice pack can help (frozen peas/corn). Always wrap the ice pack in a damp towel before use. Use it for 10 minutes. Then allow 30 minutes for the area to warm up before moving again.

Osgood Schlatter’s Disease occurs in children and young people who are growing. It is more common in those that are active but can also occur in those who are not. Pain is usually just below the knee and it can be tender to touch and there can also be a lump. It can occur in one or both knees. It can come and go until the child or young person stops growing. You can find more information about Osgood Schlatters Parents Leaflet from the Association of Paediatric Chartered Physiotherapists (APCP). You can find this leaflet in some other languages.

Sinding Larsen Johansson Syndrome is felt at the bottom of the knee cap.  You might also see swelling and tenderness there. It occurs during growth spurts for children and young people. It is caused by repeated stress and overuse from activities that involve lots of running and jumping. The child or young person may need to reduce activity levels as pain will limit what they can do. In other words, be active as long as it does not increase the pain or cause limping. They may need 1-2 days rest between activities.

When to seek help:

Please contact your local paediatric physiotherapy advice line or GP if you are worried about your child/young person and none of the above points are true.

Bow Legs and Knock Knees

Bow legs and knock knees are part of the normal development of children’s legs and will change as they are growing. Vitamin D is essential for keeping bones healthy, find out more on our Vitamin D page.

For more information and advice look at:

• Bow legs and knock knees in children and young people from NHS Inform

When to seek help:

Flat Feet

Flat feet can often be seen in babies starting to stand or toddlers and young children. The arches of the foot may not develop until the child is 4-5 years of age. This is normal.

For more information and advice look at:

• Flat Feet leaflet from the Association of Paediatric Chartered Physiotherapists (APCP). You can find this leaflet in some other languages.
• Flat feet in children - information for parents and carers by Royal Hospital for Children Glasgow
• Flat feet in children and young people from NHS Inform

When to seek help:

Intoeing

It is normal for toddlers and young children to walk with their feet facing in the way. It is more common than out-toeing. Your child may appear to trip more often but this will get less in time.

Intoeing is more common in children who 'W' sit. Encourage your child to sit with their legs in a basket, out in front of them or tucked to the side. Intoeing tends to happen on both sides. It usually resolves by 8-10 years of age.

For more information and advice look at:

• Intoeing Gait leaflet from the Association of Paediatric Chartered Physiotherapists (APCP). You can find this leaflet in some other languages.
• Intoeing in children and young people from NHS Inform

When to seek help:

Toe Walking

Toe walking is walking on tip toes or when the heel doesn't touch the ground. It can happen some, most or all of the time. Toe walking is a normal part of development and lots of children grow out of this. In some cases toe walking can continue into adulthood. Toe walking can sometimes be due to other conditions like cerebral palsy, muscular dystrophy or neurodevelopmental differences like autism.

For more information and advice look at:

• Toe walking in children and young people from NHS Inform

When to seek help: