What exercises are recommended for an adult with mild hip arthritis due to Legg-Calve-Perthes disease?

Exercise Recommendations for Adults with Mild Hip Arthritis from Legg-Calvé-Perthes Disease

Adults with mild hip arthritis secondary to Legg-Calvé-Perthes disease should perform a daily individualized exercise program consisting of strengthening exercises for both legs (especially quadriceps and hip girdle muscles), low-impact aerobic activities, and range of motion/stretching exercises, while avoiding high-impact activities that rapidly load the joint. 1

Core Exercise Components

Strengthening Exercises

• Perform sustained isometric exercises for both legs, targeting quadriceps and proximal hip girdle muscles regardless of which hip is affected 1
• Include gluteal strengthening exercises (gluteal squeezes held for 6-7 seconds, repeated 5-7 times, 3-5 times daily) 1
• Quadriceps exercises should include quad sets and short-arc quad sets performed in lying or sitting positions 1
• Start at manageable levels within your capability and gradually increase intensity over several months 1

Aerobic Activity

• Choose low-impact aerobic exercises such as swimming, cycling, walking, aquatic exercise, or Tai Chi 1
• Aquatic exercise in warm water (86°F) is particularly beneficial as buoyancy reduces joint loading while providing resistance for strengthening 1
• Moderate-intensity training (70% of maximal heart rate) for 45 minutes per day, 3 days per week is effective 1
• Avoid high-impact activities like running, trampolining, ball sports, and gymnastics as rapid joint loading may accelerate damage 1, 2

Range of Motion and Stretching

• Perform daily stretching exercises to maintain hip mobility 1
• Range of motion exercises are critical given that Legg-Calvé-Perthes disease commonly results in restricted hip motion 3
• These exercises should be adjunctive to strengthening and aerobic components 1

Exercise Implementation Principles

Pacing and Integration

• Follow a "small amounts often" approach rather than prolonged single sessions 1
• Link exercises to daily activities (before morning shower, before meals, before bed) so they become habitual rather than additional burdens 1
• Perform strengthening exercises 5-7 repetitions, 3-5 times daily at key transition points 1

Supervision and Delivery

• Supervised exercise programs are more effective than unsupervised home programs, often delivered by physical therapists or in group settings 1
• The mode of delivery (individual sessions, group classes, pool facilities) should match your preferences and local availability 1
• Initial professional instruction is essential, but the goal is independent performance in your own environment 1

Joint Protection Strategies

Mechanical Considerations

• Use appropriate comfortable footwear with shock-absorbing properties to minimize joint stress 1
• Consider a walking cane on the contralateral (opposite) side to reduce hip joint loading 1
• Implement home modifications: raised chairs/beds/toilet seats, hand-rails for stairs, walk-in shower instead of bath 1

Activity Modification

• Avoid excessive loading of the affected hip which may accelerate arthritis progression 4
• Swimming, short walks, cycling, and horseback riding can typically be performed without restrictions 2
• Utilitarian activities like walking the dog, mowing the lawn, or playing golf count as beneficial aerobic exercise 1

Weight Management

• If overweight, implement weight loss strategies including increased physical activity, structured meal planning starting with breakfast, and regular self-monitoring 1
• Reduce saturated fat and sugar intake, limit salt, increase fruit and vegetables (at least 5 portions daily), and control portion sizes 1

Critical Caveats

Disease-Specific Considerations

• Adults with Legg-Calvé-Perthes disease frequently develop femoroacetabular impingement, which is associated with pain and poorer functional outcomes 5
• Pain and radiographic arthritis are common long-term sequelae, with 44% showing moderate-to-severe osteoarthritis at 20-year follow-up 5
• The Stulberg classification (hip shape after healing) significantly predicts outcomes, with types III-V having worse prognosis 5

Exercise Tolerance

• While pain should not automatically preclude exercise, use shared decision-making about when to initiate or modify programs 1
• Clinical trials demonstrate that patients with OA pain and functional limitations still achieve improvements with exercise 1
• Never hold your breath during exercises 1

Long-term Monitoring

• Re-evaluate at 4 weeks for pain reduction and improved function 1
• Continue monitoring at 4-6 month intervals 1
• Regular follow-up allows adjustment of the exercise program based on response 1

Vocational Considerations

• If experiencing work-related difficulties, seek vocational rehabilitation counseling about modifying work tasks, hours, or workplace environment 1