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Description
Prognosis
Etiology
Relative Anatomy
Signs/Symptoms
Treatments & PT
Legg-Calve-Perthes Disease (LCPD) is an osteonecrosis disease where the blood supply is cut off to
the femoral head of the femur and leads to the
death, fracturing, and remodeling of the femoral
head and acetabulum. LCPD affects children between 3 and 12 years old. The disease progresses
through four stages
Stage 1: Blood flow to the capital epiphysis of the
femoral head ceases. Due to the ischemia,
the bone stops growing, becomes denser,
develops cysts, and begins fracturing. Waldentroms sign, a fracture in the subchondral area of the femoral head, can be seen on
x-rays during this stage. Stage 1 may last
approximately 6 months.
Stage 2: The femoral head fragments into sections: medial, central, and lateral portions.
Under stress, the acetabulum reshapes irregularly. Reabsorption begins in the subchondral area of the femoral head at the end of
stage 2.which lasts approximately 8 months.
Stage 3: The femoral head begins to heal. Generally, the healing begins at the interior of the
head and moves outward. Once healing is
complete, the femoral
head remodels into trabecular bone. Stage 3
occurs over approximately 54 months (4.5
years).
Home Program
Legg-Calve-Perthes
Rebecca Stevens
PTA 103: Hip Disorders
Home
Program
References
4-6
Etiology
LCPD is a rare disease primarily affecting children between 3 and 12 years old. It is most
common in boys between 5 and 7 years old.
Bilateral LCPD is present in 5%-20% of all cases.
Children affected tend to be small for their age
and most likely are first-born children.
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Legg-Calve-Perthes Disease
Relative Anatomy
Several areas of the hip are affected by
LCPD.
Fracturing may proceed from the femoral head into the anatomical neck and surgical neck of the
femur. The articular cartilage surround the femoroacetabular
Muscle weakness is common on the affected leg, with particular weakness in the Gluteus medius. This weakness may lead to
a combination antalgic and Trendelenburg type gait pattern.
Without treatment, this gait pattern may in turn affect other
hip and leg muscles, bone and joint development, and the
childs psyche.
Prognosis
Prognosis is determined based upon disease onset, extent of
femoral head involvement, and hip deformation. Prognosis
may range from poor to favorable.
Although treatments will not cure LCPD, they may increase
the chance of a good prognosis, especially for older children
or those with sever femoral head involvement or severe hip
deformation. Because LCPD generally runs its course until
the growth plates close, the use of physical therapy and modalities will allow for good pain managements and correct
exercise stress application
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Legg-Calve-Perthes Disease
Home Program
Warm Up
It is important to follow the Home Program as prescribed. Several exercises can be done by your child by themselves. Many are
designed to incorporate a parent, adult, or therapist to keep the
exercises fun yet therapeutic. The following is an example of
some exercises which may be part of your home program.
It is worth breaking up the home program into several sessions
throughout the day. Your child will tire both physically and
mentally if you try to do 45 minutes of exercises all at once. 10-15
minute sessions 3 times a day may be more manageable for both
you and your child.
The following is a list of suggested equipment to have ready at the
start of the exercise program. Ask you Physical Therapist where
you can purchase these items or if there is a suitable substitution.
Your insurance company MAY cover
certain items, so it is worthwhile to
call for a listing of what items and
brands they will cover.
It is important to
start your routine
with a good warm
up. A good warm
up should be about
5-10 minutes and
should increase the
heart rate. If you
cant get outside or
on a treadmill, all
of these can be
done in place.
Walking
Skipping
Jumping Rope
Jogging
Jumping Jacks
Dancing
Swiss Ball
Theraband
Bath Towel
Bicycle
Ankle Weights
Basketball
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Legg-Calve-Perthes Disease
Example Home Program
Legg-Calve-Perthes Disease
Page 5
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Legg-Calve-Perthes Disease
Example Home Program
Bridging
PURPOSE:
Bridging is used to work on both Gluteal contractions and the muscles in your back, abdominals, and legs.
WHAT TO DO:
Lay on the floor and bend your knees. Squeeze your behind muscles together and lift your hips up. At the top position, only your head, shoulders, and feet will be on the floor. Hold the position for 20 seconds then slowly lower
yourself back to the floor
TO INCREASE THE CHALLENGE
Intermediate: Place a ball or towel between your knees. Once you are in the bridge position, squeeze your knees
together while holding.
Advanced: Once you are in the bridge position, straighten out one leg and return it to the floor then lift the other
leg and return it to the floor. Then lower yourself slowly to
the floor.
Do 10 bridges (repetitions) 3 times.
Do 2 times a day
The Clam
PURPOSE:
The clam is an exercise for your hip abductors (gluteus medius). This
exercise is a good way to strengthen the muscles to prevent limping and
outer thigh pain.
WHAT TO DO:
Lay on your right side and bend your knees a little bit (30). Place you
left hand on the outside of your hip (gluteus medius). Keeping your feet
together, lift your top knee up in the air about 12 inches. After completing the exercise on the right, flip over so you are laying on your left
side and repeat.
TO INCREASE THE CHALLENGE
Tie a Theraband or place an ankle weight at the knees.
Do 12 clams (repetitions) 3 times on each leg.
Do 2 times a day
Legg-Calve-Perthes Disease
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Wobbly Ball
PURPOSE:
The Wobbly Ball exercise is a fun and challenging way to increase good
balance and isometrically strengthen the leg and back muscles.
WHAT TO DO:
Stand with both feet on the wobble board or bosu ball.
Beginners: Hold on to your parent or a chair to help you balance
Intermediate: Try balancing without using a chair
Advanced: Play catch with your parent!
Hold for 60 seconds, repeat 3 times
Do 2 times a day
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Legg-Calve-Perthes Disease
Example Home Program
Monster Walk
PURPOSE:
The monster walk is a fun way to strengthen all the muscles of the hip. It can easily be made more challenging by adding weights or therabands.
WHAT TO DO:
Stand with your feet wider than shoulder width apart and in a slightly squat position. When you take a step, keep your feet very wide. Walk approximately 20 feet.
TO INCREASE THE CHALLENGE
Beginner: Once you reach the end of your 20 feet, try going back to the starting
pointbackwards! Have your parent guide you in a straight line!
Intermediate: Tie a Theraband around the ankles, increasing the force needed to
open the legs. Go forward and backwards.
Advanced: Continue using the Theraband, but move it to the knees or add ankle weights to increase the challenge. Go forward and backwards.
Walk 20 feet repeat 3 times
Do 2 times a day
References
Colby, L., and Kinsner, C. Therapeutic Exercise: Foundations and Techniques. 6th Ed. F.A. Davis Company, Philadelphia, PA. pages 709-763.
Evelyne, B. and Gonzalez,P. Physiopedia: Legg-Calve-Perthes Disease, http://physio-pedia.com/Legg-CalcePerthes_Disease.com. (accessed: 3/25/13)
Lee J, Allen M, Hugentobler K, Kovacs C, Monfreda J, Nolte B, Woeste E; Cincinnati Children's Hospital Medical
Center:Evidence-based clinical care guideline for Conservative Management of Legg-Calve-Perthes Disease,
Occupational Therapy and Physical Therapy Evidence-Based Care Guidelines, Cincinnati Children's Hospital
Medical Center , Guideline 39, pages 1-17, August 1, 2011.
Kembitz, C., Jenkins, G., and Tortora, G. Anatomy and Physiology: From Science to Life. 2nd Ed. John Wiley &
Sonds, Inc. USA. 2010.
Terjesen T, Wiig O, Svenningsen S. The natural history of Perthes' disease. Acta Orthopaedica [serial online]. December 2010;81(6):708-714. Available from: CINAHL with Full Text, Ipswich, MA. Accessed March 27, 2013.