In the last two decades, physicians have seen children increasingly struggle with the basic aspects of movement: coordination, balance and agility. It stems from a loss in neuromuscular control, the communication loop between the brain and muscles.
Two different factors contribute. First, children spend more time sitting, usually at screens. Second, some kids are overly active in a single sport at a younger age.
To find out more about how a loss in neuromuscular control affects children, we spoke with UCLA Health’s Calvin Duffaut, MD, an associate clinical professor in the department of family medicine and orthopedics at the David Geffen School of Medicine at UCLA.
Dr. Duffaut practices pediatric sports medicine at the Luskin Orthopaedic Institute for Children, treating young patients ages 8 to 18.
Additionally, he is a team physician for UCLA Athletics, the Los Angeles Chargers and the Los Angeles Lakers, and head primary care team physician for the Los Angeles Sparks and the South Bay Lakers.
Let’s start with a basic definition of neuromuscular control. What does the term mean?
Dr. Duffaut: It’s the two-way communication between the brain and the muscles to move the body. The muscles tell the brain where the body is, in time and space. The brain tells certain muscles to activate – when to contract and with how much force.
Neuromuscular control is not just about being strong. It's having proprioception: knowing where the body is in relation to the ground and the air.
Why is that important for children?
Dr. Duffaut: It's how they develop coordination and keep their balance. When they’re babies, it's how they learn to roll over and crawl. And when they’re a little older, it’s how they do more explosive things, like walk, run, balance on one leg, climb on rocks or up a tree. Neuromuscular control makes the body move smoothly, what some people call athletically.
Ages 6 to 10 is when a lot of these pathways form and you start seeing more coordination during sports. During growth spurts in the pre-teen and teenage years, those pathways can be disrupted because the bones are growing and the muscles are stretching out. Teenagers can be a little uncoordinated because they've lost some of that neuromuscular control – the body's not able to keep up with how fast it's changing. There’s a certain degree of re-learning those pathways.
How can parents tell if their children are losing neuromuscular control?
Dr. Duffaut: By looking at how they move. You may see them being a little clumsier than usual – stumbling over things, falling over, having difficulty with their balance.
A common one we see is when kids jump and land: Their knees should be straight over their toes. Losing that control means the knees bow in a little bit, which can lead to a risk of injuries. For a good measure of balance, parents can challenge their kid to stand on each foot for 15 seconds.
There's even neuromuscular control of posture. Unfortunately, everything we do is in front of us, with our phones and our computers. Kids are hunched over because they've lost some of that control to put their bodies in a proper position.
Screen time, whether phones or video games, may also mean that kids are less active. How does that contribute to a loss in neuromuscular control?
Dr. Duffaut: The less active you are, the less neuromuscular control you're developing.
I think we've lost a lot of play time – being outside and playing with friends, without structure, like going to the park, jumping on and off things, climbing rocks and climbing trees. Those activities teach your body to balance, to use certain muscles.
Another thing is that we have made parks and playgrounds super safe. Things are flat and smooth. No uneven surfaces mean kids miss out on some of that development of neuromuscular control.
Instead of unstructured play, many kids are on their phones and other screens. If they’re not playing sports, they're maybe getting physical education once a week at school. Some kids don't even go out and play at recess.
Spending more hours on screens, with hunched posture, means losing some of their ability to move. Their muscles are not working because they're in a seated position for a long period of time.
How is neuromuscular control affected for children who are very active, especially if they’re playing sports?
Dr. Duffaut: When kids focus on just one sport and no other activities, that can lead to problems, especially during ages 6 to 10 when development of neuromuscular control is key. A variety of sports means a variety of motions. Neuromuscular control plays a role because you train the body to do different things.
I used to play two sports, basketball and soccer. Basketball is a very explosive sport, mostly sprints and jumps and quick change of direction. Soccer was more of an endurance sport.
Playing a variety of sports helps you become very well coordinated and a better athlete overall. For example, 91% of last year’s NFL draft picks were multi-sport athletes in high school. And UCLA research found that 70% of NCAA Division I athletes studied did not specialize in one sport until after age 12.
How does losing neuromuscular control contribute to injuries in children?
Dr. Duffaut: I see a lot of kids who are injured during sports. If kids play a lot of one sport, it puts a lot of stress on certain parts of the body, and they can get overuse injuries. That’s very common.
I also see kids who are hurt because they lack neuromuscular control. They get hurt doing things that some of us take for granted. For example, they roll their ankle just running down a flat surface. They don't have that proprioception where their brain is telling their muscle, “My foot's landing, keep it straight, don't let it twist in, use strength from the hip to control it.”
So, you have the injury of the high-level athlete, and you have the injury of the person who's just trying to participate in P.E. But neuromuscular control can be part of both.
If a child loses some neuromuscular control, can they get it back?
Dr. Duffaut: It's harder to do, but they can definitely get it back.
Sometimes they need to rest from the sport or activity or decrease the frequency. We then incorporate physical therapy to help with the strengthening and improve that neuromuscular connection.
For kids who are in sports, I also advise parents to give them a physical and mental break. Most governing bodies, like the American Academy of Pediatrics, recommend nine months out of the year for a sport. A three-month break -- a couple weeks here, a month there -- allows the body and mind to recover, and the child can experience other things.
I also tell parents that, in general, the age of a child is the number of hours per week they should be playing a sport. A 10-year-old child shouldn't be doing more than 10 hours of soccer or basketball. That can lead to overuse injuries.
And finally, just get them outside to play. That is part of the joy of being a kid. Going outside and playing with your friends and siblings. That’s key.
