My experience with Paediatrician Rheumatologist Dr Hasson

Dr Nathan Hasson quote on osteopathy:

“Osteopathy is very important as many patients I see have musculoskeletal symptoms such as backache and neck pains with headaches and respond well to osteopathy. Osteopaths form an integral part of the multidisciplinary team that help treat my Rheumatology patients, and have skills other members of the team don’t have.”

Who is Dr Nathan Hasson?

Dr Hasson is a Consultant in General Paediatrics and Paediatric Rheumatology, with a special interest in hypermobility and juvenile idiopathic arthritis. He worked at Ealing Hospital before moving to Great Ormond Street Hospital in Paediatric Rheumatology.

Dr Hasson is a believer of multidisciplinary approach to patients using many different therapy referrals such as osteopathy, physiotherapy, podiatry, psychology etc.

Why did I want to sit with him for a day?

Rheumatology is a huge part of our work as osteopaths and Dr Hasson is an authority in his field. I find that observing consultants, and surgeons in practice gives me a better perspective and greater understanding of my patients, allowing me to perform at my best.

Children are mainly suffering from weakness and pore core due to lack of physical and outdoor activities. For those that are called ‘hypermobile’, ‘double jointed’or, ‘flexible’, this can become a problem as they lack  strength to protect their body and end up suffering from different aches, pains and joint inflammation.

Dr Hasson uses a physical muscle test of strength for different groups of muscles on both sides of the body:

  • Arms:
    . Shoulder muscles
    . Biceps,
    . Triceps
    . Forearm muscles
  • Pelvis:
    . Gluts
  • Legs
    . Quadriceps
    . Hamstrings
    . Calves
  • Core:
    . Abs
    . Chest
    . Trapezius
    . Latissimus Dorsi

He uses 11 different muscle power tests on both sides and has a final score out of 22.

His general findings in initial consultations are the following:

  • Children have a general score of 5 out of 22 of normal muscle strength: Right biceps, both hamstrings and calves
  • Children are weaker than their parents, even if they train at the gym or are rugby players (I witnessed a 16 years old boy, training at the gym every day, being weaker than his mother and the previous patient who was 8 years old)
  • Their shoulder on the non-dominant side is atrophied, shorter and higher, due to its lack of use.
  • The best management to hypermobile weak children is symmetrical activity, such as dancing, swimming, climbing etc. Physical activity and rehabilitation of muscle strength will decrease aches and pains and prevent injury.

According to recent researches here are some interesting – but worrying facts:

  • 1/3 of teenagers in UK suffer from knee pain due to chondromalacia patella caused by discrepancy in leg muscles (weak underdeveloped quadriceps, chronically tight hamstrings and calves)
  • An Australian study found that modern children perform less well when running compared to their parents at the same age.
  • Hypermobility is not a disease, it is a just a genetic version of tissue elasticity, children suffer from being weak, not hypermobile
  • Anxiety is coded by the same gene, hence the hypermobile child tends to be prone to anxiety
  • Hypermobile children can also suffer from tiredness (lack of stamina), poor balance and coordination, easy bruising, abdominal pains, headaches, dizziness and, poor concentration

So what can we do about it?

There is no medication for hypermobility, and the best treatment for weakness is… EXERCISE! And this would be for their life-time.
Children would have to do exercises daily, designed to improve the strength and fitness of each muscle group specifically. The key point is to carry out significant number of repetition and low weights. There is no point in being able to do a few repetitions with heavy weights, this will not help build up stamina, although the muscle would appear bigger. Stamina or endurance is known to decrease anxiety, depression, chronic pain, fatigue, etc. With more stamina, children would also perform better at school, sleep better, and be able to focus more.

Supports such as pen grip or insoles may be useful according to the child’s needs, but it would be in combination with their exercise programme.
Occupational therapy and osteopathy are found to be useful too.

My intake on my day with Dr Hasson:

I had such an enlightening time. Dr Hasson is brilliant with his patients and on the top of his field. His way of explaining and talking to his patients and their parents is admirable, and I could observe how much trust he inspires in all his patients.
I learned so much from Dr Hasson in such a short time and I know that has already made me a better practitioner. I am very thankful to have had this amazing opportunity.

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