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.
