W4:

MUSCULOSKELETAL
DEVELOPMENT & ADAPTATION
AHPT 3334
8.30 – 12.30 p.m.
20.03.2024
ELIN ELISA
LEARNING OUTCOMES
• To understand the development of musculoskeletal system
• To understand how bone and muscle adaptation take place
following post-traumatic injuries
• To understand the effect of intervention on musculoskeletal
system
• To understand the long-term effect of atypical muscle
development
UNDERSTANDING MUSCULOSKELETAL
DEVELOPMENT
• During fetal development, bone is
created through:
• Intramembranous ossification
• Endochondral ossification
• Intramembranous ossification
• Directly convert mesenchymal tissue to bone &
form the flat bone of the skull & clavicle
• Endochondral ossification
• Mesenchymal tissue is transformed into
cartilage intermediate
• Later formed axial skeleton & long bone
• Development & maintenance of bone
extended postnatally

(Breeland et al., 2023)

Cont.

Muscle percussor Migration to cite Differentiation & Formation of

cell activation of muscle fusion to yield mature muscle
production postmitotic fibre
multinucleated
myotube

• During fetal development, muscle is

created through myogenesis
• Skeletal muscle originate from paraxial
mesoderm
• Development & maintenance of muscle
extended postnatally

(Stewart & Jones, 2012)

POST-TRAUMATIC INJURIES: BONE &
MUSCLE ADAPTATION
• Bone healing is a proliferative physiological process whereby, the body
facilitate bone repairing process
• # → conservative treatment (# reduction, screw, k-wire) →
immobilisation (cast) → bone healing take place
• UL # are more common compared to LL # in children (0-12 y/o) & UL #
also heal at faster rate compared to LL # (Lau et al., 2022)
• Healing duration of # may vary depending on type & severity of #
• UL# : 4-8 weeks
• LL# : 6-12 weeks
• Children generally able to heal more rapidly compared to adult as their
periosteum thicker with open growth plate & their bone is highly
vascularised
Cont.
• Soft tissue injuries in children heal with min-mod immobilisation
& treated following RICE protocols (less severe)
• In case of more severe cases, may impact children ability to
develop strength efficiently. Weakness d/t immobility may limit
their engagement in physical activities
• Muscles or soft tissue injuries heal at faster rate compared to
adult
• Rigorous physical activities should be avoided for 3 weeks
EFFECT OF INTERVENTION ON
MUSCULOSKELETAL SYSTEM
Milestone act as a marker of child’s development from infancy to
childhood. Through appropriate physiotherapy approach, the
children hopefully able to achieved age-appropriate milestones
(Dosman et al., 2012)

Stretching remain widely prescribed intervention. Stretch help to

improve joint ROM & prevent the worsening of muscle
contracture even it did not promote muscle growth or improve
function (Kalkman et al., 2020)

Weight bearing exercises which is proven to stimulate anti-gravity

muscle strength, improve bone mineral density, improve bowel
movement, assist feeding & reduce spasticity (Pin, 2007)

Following strengthening exercise, children may gain strength d/t

improved in neuromuscular control (increase motor unit
activation / coordination) instead of hypertrophy (Tecklin, 2015)
LONG TERM EFFECT OF ATYPICAL MUSCLE
DEVELOPMENT
• Children may experience delayed milestones, motor skill deficits &
musculoskeletal dysfunction, which can affect their physical development
and functional abilities
• Atypical muscle development may increase the risk of secondary conditions
or comorbidities, such as joint instability, postural abnormalities & long-
term musculoskeletal problem if left untreated
• Children may experience frustration, embarrassment, or social isolation
due to their physical limitations, which can impact their overall quality of
life and mental health
• Atypical muscle development in childhood can persist into adulthood,
potentially leading to ongoing musculoskeletal issues, functional
limitations, and reduced quality of life.
REFERENCES
Breeland, G., Sinkler M. A. & Menezes. R., G. Embryology, Bone Ossification. [Updated 2023 May 1]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK539718/
Dosman, C. F., Andrews, D. & Goulden, K.J. (2012) Evidence-based milestone ages as a framework for
developmental surveillance. Paediatr Child Health, 17(10), 561-8. doi:
https://doi.org10.1093/pch/17.10.561
Huurman, W. W., & Ginsburg, G. M. (1997). Musculoskeletal injury in children. Pediatrics in Review, 18,
429-441.
Kalkman, B. M., Bar-On, L. & O’Brien, T. D. (2020). Stretching intervention in children with cerebral palsy:
Why are they ineffective in improving muscle function and how can we better their outcome? Frontier
in Physiology, 11. doi: https://doi.org/10.3389/fphys.2020.00131
Lau, C. F., Malek, S., Gunalan, R., Chee, W. H., Saw, A. & Aziz, F. (2022) Paediatric upper limb fracture
healing time prediction using a machine learning approach. All Life, 15(1), 490-499, doi:
10.1080/26895293.2022.2064923
Pin, T. W. (2007). Effectiveness of static weight-bearing exercises in children with cerebral Palsy. Pediatric
Physical Therapy, 19(1), p 62-73. doi: 10.1097/PEP.0b013e3180302111
Stewart, C.E., Jones, D.A. (2012). Myogenesis. In: Mooren, F.C. (eds) Encyclopedia of Exercise Medicine in
Health and Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-29807-6_144
 THANK YOU!

Resilience is very different than being dumb.

Resilience means
you experience, you fail, you hurt, you fall but
YOU MUST KEEP GOING

-YasminMogahed-