Perthes disease, known also as Legg-Calve-Perthes disease, affects children when, for unknown reasons, blood supply to the hip joint temporarily decreases. Lack of blood to the growing hip joint results in the death of bone cells at the top of the femur, or thigh bone, leading to inflammation and irritation in the hip area, and pain and weakness in the leg, hip or groin. Most common in boys between the ages of four and 10, Perthes disease often responds well to conservative treatment, especially with younger children, according to MayoClinic.com. Exercise is an important component of this treatment.
Purpose
The ultimate goals of exercise for Perthes disease are improving muscular strength and range of motion about the hips while keeping weight off the hip joints. Additionally, when femoral bone cells die due to a period of insufficient blood supply, your child's hip area may become deformed if his leg is not properly aligned with his hips when new bone cells eventually grow. Exercise helps keep his leg correctly aligned within the hip joint, minimizing the chances of disfigurement. While the disease usually affects only one hip, exercising both hips ensures even muscular development throughout treatment.
Beneficial Exercises
Beneficial exercises for Perthes disease focus on abduction, adduction, internal rotation, external rotation, flexion and extension of the hips. Abduction exercises move the leg away from the hip, while adduction moves it closer to the midline of your child's body. Internal, or medial, rotation turns his toes in toward the center of his body, and external, or lateral, rotation moves them outward. Flexion occurs when his knees bend toward his hips, while extension exercises straighten his legs. To keep weight off the hip joints, your child may perform these exercises lying on a bed or exercise mat. Alternatively, swimming both strengthens muscle and provides range-of-motion exercise while the water helps support your child's weight.
Exercises to Avoid
Any movements that place force or strain on your child's hips are contraindicated in Perthes disease. Contact sports and sports or activities that involve running or jumping may worsen the condition. Your child's doctor may also advise against bicycling because, although it strengthens the muscles of the lower body in a low-impact manner, it carries the risk of injury if your child falls off the bike.
Considerations
While some amount of rest is important during treatment for Perthes disease, many children can remain quite active. However, if your child complains of new or increased pain or stiffness in his knee, hip or groin area, or if he begins limping or otherwise moving in a compromised manner, decrease his activities and increase his rest. Consult your child's health care provider with any concerns.
Prognosis
The prognosis for Perthes disease is usually good, with most children returning to their regular activities within two years of treatment, reports the American Academy of Orthopaedic Surgeons. Physical therapy with exercises to strengthen hip and leg muscles and improve range of motion helps decrease your child's chances of any long-term negative effects.
