Safe Exercises for Legg-Calvé-Perthes Disease
Children with Legg-Calvé-Perthes disease should perform daily stretching exercises for hip range of motion at all disease stages, with strengthening exercises added during the reossification stage, while avoiding high-impact activities like running, jumping, trampolining, and ball sports during the initial and fragmentation stages. 1, 2
Exercise Prescription by Disease Stage
All Disease Stages (Initial, Fragmentation, and Reossification)
Stretching exercises are universally recommended and should be performed daily:
- Hip flexion, extension, abduction, adduction, and rotation stretches maintain range of motion and prevent contractures 1, 2
- These exercises produce significant improvements in articular range of motion and reduce joint dysfunction 2
- Range of motion is the most important factor when prescribing physiotherapy, more so than age, sex, or pain level 1
Strengthening Exercises - Timing Matters
Strengthening exercises should be approached cautiously:
- There is controversy regarding strengthening during initial and fragmentation stages, with no clear consensus among pediatric orthopedic surgeons and physiotherapists 1
- Strengthening exercises are more uniformly recommended during the reossification stage 1
- When performed appropriately, strengthening improves hip flexor and other muscle groups significantly 2
Weight-Bearing Guidelines
Complete non-weight-bearing is not recommended at any disease stage:
- No pediatric orthopedic surgeons or physiotherapists recommend total non-weight-bearing for the affected hip 1
- Weight-bearing as tolerated is acceptable, though the specific limits depend on pain and range of motion 1
Safe Physical Activities by Stage
Allowed Activities (All Stages)
These low-impact activities can be performed without restrictions:
Restricted Activities (Initial and Fragmentation Stages)
High-impact activities must be avoided during active disease:
- Trampolining - restricted 1
- Running - restricted 1
- Ball sports (soccer, basketball, etc.) - restricted 1
- Gymnastics - restricted 1
Return to Full Activities
The timeline for resuming unrestricted activities lacks clear consensus:
- No standardized protocol exists for when to allow full return to high-impact sports 1
- Decisions should be based on disease stage progression, hip range of motion, and pain levels 1
Treatment Protocol for Optimal Outcomes
A structured approach combining range of motion exercises with containment strategies produces the best results:
- Daily hip range-of-motion exercises maintain and improve abduction, which is critical for femoral head containment 3
- Adductor tenotomy followed by abduction casting may be needed initially to restore hip abduction 3
- This regimen resulted in 93% congruent hips at maturity, with 78% of severe cases (lateral pillar B and C) achieving spherically congruent hips regardless of patient age 3
Key Clinical Considerations
Pain and disease stage should guide exercise intensity:
- Physiotherapists recognize pain and disease stage as important factors when prescribing exercises, while orthopedic surgeons focus primarily on range of motion 1
- Exercises should not exacerbate hip pain significantly 1
Radiographic changes lag behind clinical improvements:
- Physiotherapy produces significant improvements in range of motion, muscle strength, and joint function that are not evident on radiographs 2
- Clinical parameters (range of motion, strength, function) are better markers of treatment response than imaging 2
Common Pitfalls to Avoid
- Do not restrict all weight-bearing - this is not supported by current practice and may lead to muscle atrophy 1
- Do not delay stretching exercises - these should begin immediately and continue throughout all disease stages 1, 2
- Do not allow high-impact activities during fragmentation stage - this risks further femoral head damage 1
- Do not rely solely on radiographs to assess treatment response - clinical examination of range of motion and function is more sensitive 2