Physiotherapy without surgery
In almost all stages of Perthes disease, conservative forms of treatment can be used – for example, physiotherapy. In this clinical picture, the movement of the leg away from the body plumb line (abduction) and internal rotation in the hip joint are particularly restricted.In addition to training that concentrates on these movements, training of the gluteal muscles (gluteal muscles) can improve joint stabilization. Physiotherapy is intended to maintain the mobility in the joint without adding extra load.
Exercises
In Perthes disease, movement restrictions during internal rotation and abduction are the main symptoms. Abduction is the spreading of the leg – the movement of the leg from the body plumb line to the outside. Exercises that train this axis of movement can be performed either standing or sitting.
When standing, the leg can be moved back and forth between two fixed points. One point is just behind the opposite foot, so that the legs cross over each other during the movement. The other point is located on the side of the leg to be trained, approximately so far away that the leg is spread 45 degrees apart.
If you want to train abduction in a sitting position, the easiest way to do this is with an elastic band (Terra band). When the legs are bent, the band is placed around the knees. These must now be pressed outwards against the resistance.
Also the inner rotation in the hip joint can be practiced in standing as well as sitting position. The patient places the heel on the floor and swings the forefoot inwards and outwards to practice the rotation in standing position. When sitting, the elastic band (Terra-Band) is also used.
It is attached to a fixed point and a loop is placed around the foot. While the leg is stretched, the foot is turned inwards. To strengthen the gluteal muscles, simple stretching movements in the hip are sufficient, as when climbing stairs.
Relief of the hip
In addition to a surgical relief of the hip, a load reduction can also be achieved in a conservative way. The simplest remedy is bed rest, which can lead to social isolation for the affected children. A positioning in a baby carriage, if the child is not yet too old, or a mobilization with the help of a wheelchair are more acceptable possibilities. Other walking aids can also be used.
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