Therapy Options
At your appointments, your specialist will check your child's ROM (range of movement). This will include the following:~ lying on their back with legs straight, moving legs apart (external rotation), moving feet/toes together (internal rotation); whether the child can pull their knees up to their chest (hip flexion); lying on their stomach with legs straight, lifting the legs up straight (hip extension); lying on the stomach with knees bent to 90 degrees with legs splayed/apart (internal rotation), crossing legs/feet (external rotation).
He/She will then possibly recommend exercising to maintain ROM and your options are:~
Physiotherapy will involve exercises specifically for maintaining ROM. You will need to do these exercises at home between appointments too for maximum benefit - the exercises recommended by Sinai Hospital, Baltimore, USA are listed in the column to the left. More images can be found here Swimming is the very best exercise for a Perthes child. There is no weightbearing and allows the child to move their legs freely. It's a skill that we need here in New Zealand with so much coastline and lakes and it's fun! More images can be found here Bike riding is another great exercise for these kids, however there is the risk of them falling off their bikes and getting hurt, or needing to put their foot down suddenly and 'jarring' the hip (which can add to the pain). Hydrotherapy can be hard to find, but is well worth it. This is usually a one-on-one or small class-size session, where specific exercises are done in the water. The added bonuses are that there is no weight-bearing and exercises are more fun done in the water than on land. Further images can be found here Therapeutic Horse Riding at Riding for the Disabled is another option that might be available to you. A letter signed by your specialist is required and a thorough assessment of your childs abilities will be carried out before a horse and programme is chosen for your child. Riding a horse is the closest thing to walking, as horses backs move back and forwards, side to side as well as up and down. The horse will also be chosen based on the width of their back, how flat their back is and a number of other factors that are relevant to your child and their well-being. They may decide that other than riding in the 'normal' manner or upright, facing forward would be beneficial, so your child may end up facing backwards, lying down (as shown in the photo), sitting sideways, lying across the horses back and many, many other variations. More images can be found here 20 minutes horse riding is equivalent to 2 hours of physiotherapy. For further information either follow the link in the column on the left or do a Google search on 'Hippotherapy' - the correct term for horse riding therapy.
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