Sunday, 5 March 2017

Modern day myopathy - children are weak today

When I learnt, 30 years ago at the Hammersmith Hospital, to examine muscle strength and stamina in children, all typical children were found to be of normal strength in all muscle groups, and therefore we could distinguish them from those with muscular dystrophy or other neuromuscular disorders.  The method for determining strength was resistance of the muscles to pressure, for example holding the arms out sideways from the body, while the assessor tried to push them down. Normal strength was scored as 5/5 on the Oxford manual muscle testing scale.

More recent experience with hundreds of children has demonstrated that typical children are now weak. When I now examine children who come to see me with aches and pains, particularly those who are hypermobile, I have found a set pattern of weakness related to modern day living. Only 5 of the 22 muscle groups are shown to be grade 5 strength.

Hypermobility syndrome was described in 1967 by Kirk, Ansell and Bywater as “Musculo-skeletal symptoms in the presence of generalised joint laxity in otherwise normal subjects”.  More recently, people have realised that hypermobility is generally an advantageous thing to have. People with hypermobility and good strength are actually natural sportsmen. For example, many of the men’s top world tennis players, Djokovic, Nadal, Murray and Federer are all hypermobile and the Olympic swimmer Michael Phelps has been described in newspapers as hypermobile. Numerous professional football players, including David Beckham, are hypermobile and studies have concluded that the vast majority of gymnasts and dancers are hypermobile, as were musicians such as Rachmaninoff and Paganini. So how can a condition that seems to confer talent to some, cause symptoms in others? The reason is that, in contrast to the population studied in Kirk’s paper, these are not normal subjects. They are weak.

We have realised that muscle weakness and lack of exercise are behind the increasing incidence of aches, pains and cramps, which used to be termed “growing pains”, as well as obesity. One issue is that when children complain of aches and pains, a significant proportion of them are stopped from taking part in physical education and sports in order to try and rest the affected limbs. This rest further exacerbates the weakness.  With the growth of television, computers, mobile phones and social networking, there is very little encouragement for children to do physical activity which is ultimately the cause of the modern day myopathy. Unfortunately schools today are only really incentivised by attendance and academic results and are encouraged to make children spend ever longer periods learning at desks. One way to potentially reverse this would be to also judge schools on the number of children with a BMI of 25+ and to test muscle strength and stamina in schools and report back on how fit and strong pupils are.

A further problem is the growing level of obesity with the major contributing factor not being intake of calories but rather a lack of exercise.  Recent government-led initiatives, mainly aimed at obesity,  have said that children over the age of two should not be pushed around in pushchairs and that children under the age of five should be doing at least three hours of physical activity a day.  The minimum exercise guidelines from the American Academy of Paediatrics now call for sixty minutes per day of moderate to vigorous exercise. This does not include activities such as walking which does not build up muscle strength and stamina.  The school in Sterling Scotland who have introduced the ‘daily mile’ have already seen improvements in overweight levels in their 5 year olds, where none of the 57 children in the 5 year old class are overweight.

We need to push forward with initiatives on exercise and muscle strengthening for all our children.  This is an issue for the future as people with hypermobility who have poor proprioception and weakness will suffer more from osteoarthritis and osteoporosis in later life. Vitamin D levels have declined as children appear to be spending too much time indoors with little exposure to sunshine (even when there is such a thing).  As a nation, we need to take note, and utilise schools, clubs and access to sports in order to reverse current trends. We are wasting our talent, ending up with weak, hypermobile people instead of fulfilling our sporting potential.