ROMMER
Condition

Metabolic Muscle and Skeletal Disorders

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What Are Metabolic Musculoskeletal Disorders in Children?

Metabolic musculoskeletal disorders in children encompass a range of conditions in which abnormal metabolic processes affect the development, strength, or integrity of bones, muscles, and connective tissue. These include rickets (vitamin D deficiency), osteogenesis imperfecta (brittle bone disease), juvenile osteoporosis, hypophosphataemia, and various inborn errors of metabolism that affect the musculoskeletal system. Children may present with bone pain, fractures, deformities, muscle weakness, and reduced exercise tolerance.

Common Conditions

  • Rickets: Softening and weakening of bones due to vitamin D, calcium, or phosphate deficiency. Causes bowing of legs, widening of wrists, and delayed walking.
  • Osteogenesis Imperfecta (OI): Genetic disorder causing fragile bones that fracture with minimal trauma. Ranges from mild (a few fractures in childhood) to severe (multiple fractures and significant deformity).
  • Juvenile Osteoporosis: Reduced bone density in children, often secondary to prolonged immobility, steroid use, or chronic illness. Increases fracture risk.
  • Metabolic Myopathies: Inherited enzyme deficiencies (e.g., glycogen storage diseases, mitochondrial myopathies) causing muscle weakness, exercise intolerance, and fatigue.

Rehabilitation at ROMMER

Rehabilitation in metabolic musculoskeletal conditions must be carefully calibrated to protect fragile tissues while still building strength and function:

  • Safe Exercise Programme: Low-impact, joint-protective exercises — aquatic therapy, gentle resistance training, and proprioceptive exercises — are prescribed to build bone density and muscle strength without fracture risk.
  • Posture and Alignment: Postural assessment and correction, orthotic support, and adaptive seating address spinal and lower limb deformities.
  • Fracture Rehabilitation: After fractures (particularly in OI), careful rehabilitation planning ensures recovery of function and prevention of further injury.
  • Mobility and Independence: Assistive devices, adapted sports, and activity modification support participation in daily life and school activities.
  • Nutritional Collaboration: Close collaboration with dietetics and endocrinology ensures that calcium, vitamin D, and other metabolic needs are optimised alongside physical rehabilitation.
  • Family Education: Safe handling techniques, fall prevention strategies, and activity guidelines are provided to families to manage risk at home and in community settings.

Interdisciplinary Management

Metabolic musculoskeletal disorders require coordination between paediatric rehabilitation, endocrinology, orthopaedics, dietetics, and genetics. At ROMMER, the rehabilitation programme is embedded within this wider care team to ensure that physical therapy supports and is supported by the medical management plan.

Frequently Asked Questions

Can children with osteogenesis imperfecta exercise safely?+
Yes, with appropriate precautions. Aquatic therapy is particularly valuable as water supports the body and reduces fracture risk while enabling meaningful exercise. Physiotherapists experienced in OI at ROMMER design programmes that build strength and bone density within safe parameters for each child's OI type.
How does rehabilitation help children with rickets?+
Once nutritional treatment begins, physiotherapy supports the recovery of bone strength and corrects gait abnormalities. Muscle strengthening and balance exercises help children regain full motor function. In severe bowing deformity, rehabilitation is also important before and after corrective surgery.
What is aquatic therapy and how often is it needed?+
Aquatic therapy uses the properties of water (buoyancy, resistance, warmth) to enable exercise that would be too painful or risky on land. For children with metabolic bone conditions, it is typically recommended 2–3 times per week in the initial phase, reducing as land-based exercise becomes feasible.
My child has a metabolic myopathy — how does rehabilitation help?+
Rehabilitation for metabolic myopathies focuses on maintaining functional capacity and preventing secondary complications (contractures, scoliosis, respiratory decline). Exercise must be carefully dosed — too much can worsen symptoms while appropriate activity helps maintain strength and cardiovascular health.

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