Physiotherapy is very important in the treatment of Perthes disease and should be performed regularly and often over a long period of time. Parents should also consistently continue a homework program with their child in the home environment that was developed in the physiotherapy program.
Applications/Contents
In the early stages, it is important to relieve the undersupplied, possibly inflamed femoral head. In physiotherapy, this can be achieved using traction techniques (e.g. on a sling table or manual therapy). The joint surfaces can thus be loosened and relieved by light traction from one to the other.
This technique also serves to reduce pain. The capsule-ligament apparatus is relaxed and relieved. Gentle movements with complete or partial reduction of the weight promote the blood circulation in the joint.
Cycling, swimming, etc. are beneficial, as the weight of the child is taken off the joint. Jumping and hopping should be avoided as a heavy load.
Mobilization of the hip joint can also be done passively by the physiotherapist using manual therapy techniques. This involves manual mobilization of the joint surfaces against each other or light traction (see above), which leads to improved joint function and trophics and thus promotes the regeneration of the femoral head. Supplementary therapy methods from physiotherapy can be soft tissue techniques, such as friction (local stretching tissue techniques) on irritated tendons and ligaments, massage grips on tense muscles or active or passive stretching techniques.
Physiotherapy for Perthes disease should be effective but also playful, since it may be necessary over a long period of time and the child should not lose the fun of physiotherapy. Variety in the exercise repertoire, but also playful breaks during long thearpies sequences can prevent the child from refusing the physiotherapy and thus promote the success of the therapy. After a possibly necessary longer-term immobilization or relief of the joint, physiotherapy can also be used to build up strength.
For this purpose, exercises can be performed on the Bobath roll, with the Pezzi ball or other aids. There are no limits to creativity. Also techniques from Vojta therapy (by stimulating certain zones, reactions can be called up via the nervous system, which, among other things, address the muscles and thus have a strengthening effect) can be considered.
The focus should be on training the muscles that stabilize the hip joint (extensors and abductors). The mobility of the hip should be trained in all directions in Perthes disease. Postures resulting from Perthes disease can be corrected during physiotherapy and any consequences on surrounding joints can also be treated.
The use of aids (orthoses, forearm supports) can also be worked out in physiotherapy. The close cooperation between child, parents and physiotherapist is important, since a complete and consistent therapy is important for the success of the treatment. During the entire therapy, the doctor’s instructions must be observed; in the case of acute inflammatory processes, a break in therapy should be taken or the level of stress should be greatly reduced! You will find exercises for the hip in the article Exercises from physiotherapy for the hip
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