What should I expect from treatment?
Following surgery for Perthes disease, physiotherapy treatment at Peak Physical Therapy is very useful in returning your child to their pre-injury activity level as quickly as possible. Physiotherapy can also assist in avoiding other compensatory problems in the back or lower limb in the future as well as to restore and regain any strength and range of motion deficits that have developed as a result of the disease up to this point.
Rehabilitation at Peak Physical Therapy can begin as soon as your child’s surgeon recommends it. Each surgeon will set his or her own specific restrictions based on the child’s individual severity of injury, the surgical procedure used, personal experience, and whether the hip is healing as expected.
If your child is still suffering from any residual pain from the surgical procedure when they come to Peak Physical Therapy for their initial appointment, your physiotherapist may use modalities such as heat, ice, ultrasound, or electrical current to assist with decreasing the pain. If your child is walking with a walker/frame or crutches, your physiotherapist will ensure your child is using the crutches safely and appropriately and that they are abiding by any weight bearing restrictions set by their surgeon. Your physiotherapist will also ensure that your child can safely use the crutches on stairs.
We generally recommend that until it is possible to walk without a significant limp, either a walker or one or two crutches continue to be used. Improper gait can lead to a host of other pains in the knee, hip and back so it is prudent to continue on crutches until near normal walking can be achieved. Your physiotherapist will give advice regarding the appropriate time for your child to be walking without any support at all, although with young children, the ongoing use of a walking aid, even if recommended, can be difficult as they tend to discard them once they can get around without them. Once your child is no longer using any walking aid your physiotherapist will assist with normal gait re-education.
The next part of our treatment at Peak Physical Therapy will focus on normalizing any deficits that may have developed in the range of motion and strength of your child’s lower limbs. Your physiotherapist may assist in stretching your child’s limb or lower back while at the clinic and, if necessary, will ‘mobilize’ the joints of your child. This hands-on technique encourages the stiff joints to move gradually into their normal range of motion. In addition to the hands-on treatment in the clinic we will also prescribe a series of stretching exercises that we will encourage your child to do as part of a regular home exercise program. We will especially focus on maintaining or gaining range of motion in the surgical hip.
Similarly to the range of motion deficits, strength deficits will also be addressed. Strength building exercises particularly for the hip will be taught in the clinic and added to your child’s home program. For older children we may incorporate items such as Theraband or light weights into the exercises to provide additional resistance for the limb. If your child is still young your physiotherapist will explicitly explain how you can work with your child to complete the stretching and strengthening exercises. We will provide ideas for ways that you can incorporate the exercises into your child’s daily play routine.
The final part of our physiotherapy treatment at Peak Physical Therapy will be ensuring that your child’s coordination and balance have returned to normal after their surgery. Following even a short period of walking with crutches or a period where your child is walking abnormally due to pain, your child’s normal balance, coordination, and proprioception (the ability to know where your body is without looking at it) can decline in function. Exercises, which may include balancing on one foot, jumping, and quick agility movements will be encouraged at an appropriate time in line with the surgeon’s restrictions.
Fortunately, gaining lost range of motion, strength, and coordination after surgery for Perthes disease happens quickly. You will notice improvements in your child’s function and gait even after just a few treatments with your physiotherapist at Peak Physical Therapy. If, however, your child’s post-surgical therapy is not progressing as your physiotherapist would expect, we will ask you to follow-up with your surgeon to confirm that the hip is tolerating the rehabilitation well and ensure that there are no post-surgical complications that may be impeding your child’s recovery. Generally your child’s surgeon will follow-up quite regularly anyways to monitor symptoms, check on hip mobility, and to make sure that the condition is not deteriorating, so appropriate progression of rehabilitation is easily monitored as well. The surgeon will also take X-rays during their follow-up visits to determine the healing of the femoral head.
Despite optimal surgical and post-surgical care, patients with Perthes disease are always at higher risk of developing osteoarthritis of the hip. The end result is that most patients with Perthes disease will require an artificial hip at some point in the future. Most patients do not develop problems for 40 years or more. How soon patients have problems with their hip is directly related to how much deformity remains once the condition heals. In general, the more round the femoral hip is at that time of complete healing, the longer the hip will stay free of pain.
Portions of this document copyright MMG, LLC
Peak Physical Therapy provides services for physiotherapy in Lethbridge.